February 18, 2013
THE AAP REVISITS THE CIRCUMCISION DEBATE
One of the most frequent question asked by new parents during a prenatal visit or at the first hospital newborn visit just happens to be about a subject that involves only half of babies being born. That would, of course, be circumcision. While many families have their decision made early during the pregnancy, the issue continues to weigh on others right up to the time when they are changing the first diapers. And anywhere along the way pediatricians are frequently consulted (unless religious reasons obviate the whole question).
As in many areas, individual physicians use policy recommendations of the AAP for at least some guidance. And last autumn, the Academy updated its approach after an extended study by a task force assembled in 2007 to review evidence covering myriad aspects of the procedure (the previous formal policy statement had been expressed in 1999 and reaffirmed in 2005. The key findings (and recommendations) included,among other things that (quoted sections all from the AAP Policy Statement):
- “Preventative health benefits of elective circumcision of male newborns outweigh the risks of the procedure” (with a list of some of these benefits)
- “The procedure is well tolerated when performed by trained professionals under sterile conditions with appropriate pain managment”
- “Complications are infrequent,” mostly mild and rarely severe, and that newborn circumcision has a much lower complication rate that of the procedure later in life
- These health benefits do not comprise enough reason to recommend routine circumcision for all new little boys, but that they do justify insurance coverage
- “Physicians should routinely inform parents of the benefits and risks…in an unbiased and accurate manner”
The concluding paragraph stated the highly reasonable and fairly predictable: that after evaluating well presented medical information, parents should integrate this with “their own religious, ethical, and cultural beliefs and practices, and make their own personal decision as to whether “circumsion is within the best interests of their male child.”
Moving from the policy statement to a more personal observation, it was interesting to read the cluster of online and media, print and interview comments protesting the Academy’s position. Well, maybe not that interesting. Most were from Europeans, non-physicians, and representatives of anti-circumcision organizations. A spectrum of claims regarding negative aspects of circumcision has long existed, many of them having nothing to do with infant health and lacking credible medical evidence. But view it in this perspective: if there can still be opposition to rountine vaccinations given the enormous benefit and low risks that these provide, how can there be any surprise that there will be continue to be an anti-circumcision movement despite any recommendations of the AAP?
The bottom line is that parents’ feelings about circumcision will remain largely personal and cultural. Those who choose the procedure for religious reasons will generally continue to do what they have done for centuries (or millenia). Others will make their decisions for various personal preference one way or the other. And for those who seek for an medical evidence-based basis for this decision, the recent AAP research and resulting policy position provide the general guidelines that the benefits outweigh the risks–but avoid making a clear endorsement of routine circumcision on all male newborns. It should and will remain a decision left up to parents, hopefully a well-informed decision, and the AAP task force findings are helpful to both parents and the physicians advising them.
The AAP Policy Statment can be found at: http://pediatrics.aappublications.org/content/130/3/585.full?sid=0fd76a3f-2ca9-4069-9960-8c889def313a
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