Last week, the American Academy of Pediatrics (AAP) issued an update to their circumcision policy statement that attracted significant attention. In it, the task force clarified the previous neutral policy for boys’ circumcision. The AAP stated that research has advanced since it’s most recent report in 2005 to conclude the health benefits of circumcision outweigh the procedure risks. Like any medical test or procedure, circumcision carries both benefit and risk. With global data expanding about benefits of circumcision and protection against sexually transmitted diseases, the AAP changed its stance. Risks from circumcision are reported to be very unlikely and happen less than 1% of the time. Most common side effects can be a small chance of bleeding or a need for antibiotic ointment. The most frequently reported adverse event from parents is a concern not enough foreskin was removed. Fortunately, circumcision revisions are very rare.
The statement doesn’t go so far as to recommend that boys undergo circumcision, rather the task force stated that the procedure should be done under sterile technique by a trained, experienced clinician. Importantly, they stated for the first time that it should be covered by Medicaid and insurance. This with the hope that every family ought to have the right to make a choice for or against circumcision, not just those with private insurance.
Clearly, the decision to circumcise a newborn baby boy isn’t made simply in the content of medical data. Families weigh religious traditions, cultural practices, family history, and medical information when choosing to circumcise or not. The AAP statement maintains and honors this belief. Ultimately, the decision is a private one for families to make. A pediatrician, family doctor, or ARNP should help you go over medical benefits/risks as needed. As a parent, you go over the rest.
My advice is to talk about this decision far before the birth of a new baby so you have a plan in place. Some families want to wait until their child is 18 years old to transfer decision-making and autonomy. The only challenge is that it’s difficult to predict which boy will protect themselves well during teenage and young adult years and much of the benefit of circumcision comes during childhood. Further, newborn circumcision carries less risk than circumcision later in life.
And what about the neighbors’ kids? Although hospital circumcision rates have fallen in the last few decades (only about 55% of baby boys are circumcised when they leave the hospital in the US), it varies by region. The true numbers are difficult to assemble as many babies are circumcised in the clinic setting and are not accounted for in the numbers. But know that where you live may predict patterns. In the Midwest for example, the majority of babies are circumcised (75%) when they go home from the hospital, while in the West, the minority are (25%). However, many of my patients are circumcised after leaving the hospital so in practice, it feels like my patients hit the national numbers: about half of the boys are uncircumcised.
Research backed medical benefits of neonatal circumcision:
- Lower risk of acquiring HIV, syphilis, human papillomavirus, and genital herpes
- Lower risk of cervical cancer in sexual partners
- Lower risk of penile cancer over a lifetime
- Lower risk of urinary tract infection in the first year of life
Resources For Parents Of Circumcised & Uncircumcised Boys:
- What Is A Circumcision? AAP information on circumcision including risks, benefits, and decision-making.
- What Is A Foreskin? –my short video, blog, & drawings on how to care for a foreskin (in uncircumcised boys).
- Data on number of hospital circumcisions preformed by year and region in the United States.
- Dr Doug Diekema explains the task force decision to pediatricians and parents.