The benefits of circumcising baby boys outweigh the small risks, the largest group of U.S. children's doctors says. The American Academy of Pediatrics (AAP) published the new policy statement in its journal, Pediatrics. The statement does not urge circumcision for all newborn boys. It says the decision is up to parents and doctors. The old statement said risks and benefits were equal. The new one cites recent evidence that circumcision reduces the risk of sexually transmitted diseases, including HIV. It also reduces the risk of urinary tract infections in babies. Risks include bleeding and infection, but these are rare. Circumcision does cause pain. The AAP says baby boys should get medicine for pain before the procedure. The AAP report comes amid efforts to ban infant circumcision in some places. Opponents say it violates a boy's rights because he is unable to consent. In Germany, a judge recently banned infant circumcision. The ruling stirred protest by Jewish and Muslim groups. Both religions practice ritual circumcision. Last year, a judge threw out an effort to get a public vote on infant circumcision in San Francisco. The Associated Press wrote about the AAP report August 27.

By Claire McCarthy, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

If you have or are expecting a son, you should strongly consider having him circumcised.

That's the message of the latest policy statement from the American Academy of Pediatrics (AAP). The position has changed over the years. At first, the AAP was in favor of infant circumcision. Then, the policy statement that preceded this one said that the risks and benefits were essentially equal. That statement said parents should make the decision based on their own preferences and beliefs.

Now, after looking more closely at all the medical evidence, the AAP has concluded that the benefits outweigh the risks.

The benefits include:

• A lower risk of urinary tract infection in the first year of life.
• A lifelong lowered risk of sexually transmitted infections, including HIV. The thin inner surface of the foreskin is easily scratched or torn, allowing germs to enter. The foreskin can trap germs underneath it. And some cells in the foreskin are particular targets for HIV.
• A lifelong lowered chance of passing those sexually transmitted infections to sexual partners. Not transmitting human papilloma virus, the main cause of cervical cancer, can prevent this cancer in women. Prevention of HIV in women also protects the children they bear.
• A lower risk of penile cancer, although this is a very rare cancer.
• Prevention of problems with the foreskin itself, such as phimosis (when the foreskin gets inflamed and won't go back).

There are risks to any procedure, and circumcision is no exception. Bleeding and removing too much or too little of the foreskin are the most common risks. However, they are rare in experienced hands.

The biggest objection to infant circumcision has generally been that it is painful. The AAP acknowledges this. But there are many ways to use medicines to lessen the pain. They are listed in the technical report that was published with the AAP policy statement. Every boy who has a circumcision should have medicine for pain.

The policy statement stops short of saying that every baby boy should be circumcised. The decision needs to be made by families and their doctors, the AAP says. But as they decide, they should know that circumcision has very real health benefits.

What Changes Can I Make Now?

If you are making the circumcision decision, talk to your doctor about both the health benefits and the risks. It's very important that you understand both, and that you have all of your questions answered.

If you decide to have your son circumcised, make sure someone who is skilled and experienced performs the procedure. It's also crucial that it be done in a "sterile" way. This means that every precaution is taken against infection, and that pain is controlled, preferably with medicines.

This has been a bone of contention in lots of situations involving ritual circumcision, which is part of the Jewish and Muslim faiths. If you are planning this kind of circumcision, talk to the person who will be doing it, and to your doctor. Make sure that what is planned is completely safe and that something will be done for the pain.

What Can I Expect Looking to the Future?

It's hard to imagine that the controversy surrounding circumcision will disappear. This debate has gone on for more than 2,000 years. It's a complicated decision, involving not just medical facts but personal beliefs and traditions.

The AAP has given parents, doctors and everyone else more information to use as they decide about circumcision. In the future, we will likely learn more about circumcision and about pain control. I hope that we'll be able to help people even more in this ultimately very personal decision.