In March 1999 the Task Force on Circumcision of the
American Academy of Pediatrics (AAP) issued
new guidelines.
The conclusions of the report stated that
[1]:
"Existing scientific evidence demonstrates potential medical benefits of
newborn male circumcision; however, these data are not sufficient to
recommend routine neonatal circumcision. In the case of circumcision, in
which there are potential benefits and risks, yet the procedure is not
essential to the child's current well-being, parents should determine what
is in the best interest of the child. To make an informed choice, parents of
all male infants should be given accurate and unbiased information and be
provided the opportunity to discuss this decision. It is legitimate for
parents to take into account cultural, religious, and ethnic traditions, in
addition to the medical factors, when making this decision. Analgesia is
safe and effective in reducing the procedural pain associated with
circumcision; therefore, if a decision for circumcision is made, procedural
analgesia should be provided. If circumcision is performed in the newborn
period, it should only be done on infants who are stable and healthy."
(to read the full report, see Ref. [1] )
Comments on the 1999 Statement:
General Comments
When the Report of the AAP Task Force was issued in March 1999, it was widely reported in the media that the conclusions supported the anti-circumcisionist view that neonatal circumcision has no health value, and that it was even potentially harmful. This impression was underlined by quoting the responses of anti-circumcision activists.
However, the AAP report did not recommend that all infants should either be circumcised or not. Rather the AAP encouraged parents to consider the circumcision decision by carefully weighing the medical benefits and risks of the procedure as presented to them through unbiased informed consent counseling. In addition to the medical information on circumcision, the AAP further recognized that parents' decisions about circumcision would likely take into consideration their social, cultural, family and religious convictions.
Since the AAP report neither encouraged nor discouraged parents from making the choice to circumcise their sons it was not substantially different from the 1989 statement. What really differentiated the 1999 AAP statement from the previous statement was that it was more heavily weighted in terms of formulating an official policy on "routine" circumcision. In addition to this, the AAP, for the first time, recommended that effective pain relief should be used if parents decide to circumcise their sons.
Another important conclusion of the report was the dismissal of the claim that circumcision causes long term psychological trauma (what the opponents of circumcision like to call "neonatal circumcision shock"). They also did not find supportive evidence for the claim that circumcision causes sexual dysfunction.
Comments and criticisms of the 1999 Policy Statement by several noted medical researchers have been published in the March 2000 issue of Pediatrics.
1989 Statement:
In the policy statement issued in the August 1989 issue of
the Journal Pediatrics [2] ,
the Task Force on Circumcision reversed their
earlier policies issued in 1971 and 1975 which had said
that "there are no valid medical indications for circumcision
in the neonatal period" [3]
to the statement that
"Since the 1975
report, new evidence has suggested possible medical benefits from newborn
circumcision. Preliminary data suggest the incidence of urinary tract infection
in male infants may be reduced when this procedure is performed during the
newborn period. There is also additional published information concerning the
relationship of circumcision to sexually transmitted diseases and, in turn, the
relationship of viral sexually transmitted diseases to cancer of the penis and
cervix" [2].
Properly performed newborn circumcision prevents phimosis,
paraphimosis,
and balanoposthitis and has been shown to decrease the incidence of cancer of
the penis among US men. It may result in a decreased incidence of urinary
tract infection. However, in the absence of well-designed prospective studies,
conclusions regarding the relationship of urinary tract infection to
circumcision are tentative. An increased incidence of cancer of the cervix has
been found in sexual partners of uncircumcised men infected with human
papillomavirus. Evidence concerning the association of sexually transmitted
diseases and circumcision is conflicting.
Newborn circumcision is a rapid and generally safe procedure
when performed
by an experienced operator. It is an elective procedure to be performed only
if an infant is stable and healthy. Infants respond to the procedure with
transient behavioral and physiologic changes.
Local anesthesia (dorsal penile nerve block) may reduce
the observed
physiologic response to newborn circumcision. It also has its own inherent
risks. However, reports of extensive experience or follow-up with the
technique in newborns are lacking.
This change in policy towards circumcision represented a definite
shift towards a more pro-circumcision viewpoint.
The Canadian Pediatric Society made the following
statement after their latest study (1996):
"The overall evidence of the benefits and harms of circumcision is
so evenly balanced that it does not support recommending circumcision
as a routine procedure for newborns."
1. C.M. Lannon et al.,
Circumcision Policy Statement of the AAP Task Force on Circumcision (March 1999)
Pediatrics 1999; 103(3):686-693. 2. E.J. Schoen et al.,
1989 Report of the Task Force on Circumcision
Pediatrics 1989; 84:388-391
3.
1975 Report of the Task Force on Circumcision,
Pediatrics 1975; 56:610-611
4.
Canadian Medical Association Journal; March 1996: 154 (6)
http://www.cps.ca/english/statements/FN/fn96-01.htm
Statement from the Canadian Pediatric Society (CPS)
"When parents are making a decision about circumcision, they should
be advised of the present state of medical knowledge about its
benefits and harms. Their decision may ultimately be based on
personal, religious or cultural factors".
Recommendation: Circumcision of newborns should not be routinely
performed
[4] .
(to access an on-site copy of the article,
see here )
References
