The benefits of circumcision outweigh the risks, but parents should still make the final decision about whether it's right for their child, a task force on circumcision said.
The procedure has been shown to prevent urinary infections and sexually transmitted infections, but parents must "weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices," according to a statement from the American Academy of Pediatrics (AAP) published in Pediatrics.
"Although the health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it, and to warrant third-party payment for circumcision of male newborns," the AAP declared.
The latest policy statement updates guidelines drafted in 1999. In 2007, the AAP formed a task force to evaluate more recent evidence on male circumcision and create an update.
The group found the procedure offers several benefits, including the prevention of urinary tract infection, penile cancer, and the transmission of some sexually transmitted infections, particularly HIV.
Risk of urinary tract infection is most reduced in the first year of life, they reported.
Circumcision is well tolerated when performed by trained professionals under sterile conditions with appropriate pain management, they found.
The true incidence of complications after newborn circumcision isn't known, they wrote, but significant acute complications are rare.
For instance, about 1 in 500 newborn male circumcisions involve minor complications such as bleeding, infection, or an imperfect amount of tissue removed.
Late complications could include adhesions, skin bridges, and meatal stenosis, but rates are unclear and it's unknown how often these require surgical repair, the authors reported.
It doesn't appear that circumcision adversely affects penile sexual function or satisfaction, they added, and complication rates are always lower when performed in newborns than when performed at a later age.
The procedure is contraindicated in significantly premature infants, as well as in those with blood dyscrasias, with a family history of bleeding disorders, and with congenital abnormalities such as hypospadias, congenital chordee, or deficient shaft skin such as penoscrotal confusion or congenital buried penis.
Analgesia for circumcision, which involves sterile techniques and effective pain management, is safe and effective, according to the task force's review of the literature.
Nonpharmacologic techniques alone - positioning, sucrose pacifiers - aren't sufficient to prevent procedural and post-procedural pain, they added, and aren't recommended as the sole method of analgesia.
They also warned that topical creams may cause a higher incidence of skin irritation in low birth weight infants. Clinicians should use the penile nerve block technique in these cases instead, they reported.
The AAP policy statement was also endorsed by the American College of Obstetricians and Gynecologists.
Primary source: Pediatrics
Source reference: "Technical Report: Male Circumcision" Pediatrics 2012; DOI: 10.1542/peds2012-1990.
Additional source: Pediatrics
Source reference: "Circumcision Policy Statement" Pediatrics 2012; DOI: 10.1542/peds.2012-1989.