The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Canadian Journal Reviews Studies on Circumcision

Canadian Medical Association Journal
Copyright 1996 Canadian Medical Association.
Volume 154(6), March 15, 1996, pp 769-780

Neonatal circumcision revisited
Clinical Practice Guidelines]
Fetus and Newborn Committee, Canadian Paediatric Society
Reprint requests to: Fetus and Newborn Committee, Canadian
Paediatric Society, 401 Smyth Rd., Ottawa ON K1H 8L1

Objective: To assist physicians in providing guidance to parents regarding neonatal circumcision.

Options: Whether to recommend the routine circumcision of newborn male infants.

Outcomes: Costs and complications of neonatal circumcision, the incidence of urinary tract infections, sexually transmitted diseases and cancer of the penis in circumcised and uncircumcised males, and of cervical cancer in their partners, and the costs of treating these diseases.

Evidence: The literature on circumcision was reviewed by the Fetus and Newborn Committee of the Canadian Paediatric Society. During extensive discussion at meetings of the committee over a 24-month period, the strength of the evidence was carefully weighed and the perspective of the committee developed.

Values: The literature was assessed to determine whether neonatal circumcision improves the health of boys and men and is a cost-effective approach to preventing penile problems and associated urinary tract conditions. Religious and personal values were not included in the assessment.

Benefits, harms and costs: The effect of neonatal circumcision on the incidence of urinary tract infection, sexually transmitted diseases, cancer of the penis, cervical cancer and penile problems; the complications of circumcision; and estimates of the costs of neonatal circumcision and of the treatment of later penile conditions, urinary tract infections and complications of circumcision.

Recommendation: Circumcision of newborns should not be routinely performed.

Validation: This recommendation is in keeping with previous statements on neonatal circumcision by the Canadian Paediatric Society and the American Academy of Pediatrics. The statement was reviewed by the Infectious Disease Committee of the Canadian Paediatric Society. The Board of Directors of the Canadian Paediatric Society has reviewed its content and approved it for publication.

Sponsor: This is an official statement of the Canadian Paediatric Society. No external financial support has been received by the Canadian Paediatric Society, or its members, for any portion of the statement's preparation.

Conclusions

• There is evidence that circumcision results in an approximately 12-fold reduction in the incidence of UTI during infancy. The overall incidence of UTI in male infants appears to be 1 percent to 2 percent.
• The incidence rate of the complications of circumcision reported in published articles varies, but it is generally in the order of 0.2 percent to 2 percent. Most complications are minor, but occasionally serious complications occur. There is a need for good epidemiological data on the incidence of the surgical complications of circumcision, of the later complications of circumcision and of problems associated with lack of circumcision.
• Evaluation of alternative methods of preventing UTI in infancy is required.
• More information on the effect of simple hygienic interventions is needed.
• Information is required on the incidence of circumcision that is truly needed in later childhood.
• There is evidence that circumcision results in a reduction in the incidence of penile cancer and of HIV transmission. However, there is inadequate information to recommend circumcision as a public health measure to prevent these diseases.
• When circumcision is performed, appropriate attention needs to be paid to pain relief.
• 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. There is therefore no indication that the position taken by the CPS in 1982 should be changed.
• 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.