Little Evidence of Circumcision's Benefit, Says Pediatric Group

Last Editorial Review: 1/30/2005

Little Evidence

WebMD Feature

The United States' largest group of pediatricians is calling for an end to the routine circumcision of newborn boys, saying the procedure offers minimal medical benefits.

The American Academy of Pediatricians' announcement reverses a nearly century-old practice. For decades, American physicians have claimed removing the foreskin from the head of the penis reduced the risk of infections.

More recent research, however, has questioned the benefit of the procedure. Uncircumcised boys, the research shows, have only a slightly higher rate of infection and disease than circumcised boys. Now the AAP has declared in its March issue of the journal Pediatrics, "What medical benefits [circumcision] does have do not warrant the AAP to recommend routine newborn circumcision."

"It appears most people can lead a healthy life without having to have it done," Dr. Jack Swanson, a member of the AAP's Task Force on Circumcision, tells WebMD. "All the studies did show a benefit to having circumcision, but the benefits were not great."

According to the AAP, circumcision has been around since the Egyptian dynasties as a method to maintain penile hygiene. In the United States, about 1.2 million newborn boys are circumcised each year. In analyzing numerous studies from around the world, the AAP found that even though circumcision has been touted to lower the risk of urinary tract infections, the chances of an uncircumcised boy developing such an infection was low.

The AAP found only one in 100 uncircumcised boys was likely to develop a urinary tract infection compared with one in 1,000 circumcised boys. In a study appearing in the Dec. 5 issue of The Lancet, a team of Canadian researchers found after analyzing about 30,000 boys, uncircumcised boys were only 3.7 times more likely to develop a urinary tract infection. Earlier research suggested that boys were 39 times more likely to get such an infection.

Uncircumcised males also were three times more likely to develop cancer in the penis compared with a circumcised man, but fewer than 10 men in 1 million develop this extremely rare cancer, the AAP says. Circumcision did not appear to influence the risk of developing sexually transmitted diseases. The AAP says sexual behavior is more likely to determine if a man contracts a STD than circumcision status.

"The medical debate is over; there are no medical reasons to justify it," says Dr. George Denniston, president of the international organization Doctors Opposing Circumcision and a professor at the University of Washington in Seattle. Dr. Denniston says removing the foreskin to prevent infection is like "cutting off the ear to reduce ear infections. It's just absurd."

Should parents decide to have their son undergo circumcision, the AAP says that the child should receive topical painkillers. The pediatric group's analysis found newborns circumcised without anesthesia experience pain and stress during the procedure. This was determined by measuring their heart rate, blood pressure and increased oxygen intake.

Parents also are being advised to consider cultural, religious and ethnic traditions when deciding whether or not to circumcise. Dr. Swanson says parents should "know all the facts about possible medical reasons and risks, and try to make a decisions based on all the facts."

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