To Circ or Not to Circ

Michael C. Carr, MD, PhD


June 10, 2013

Editorial Collaboration

Medscape &

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I'm Michael Carr, Associate Director of Pediatric Neurology at Children's Hospital of Philadelphia. Today I wanted to talk about circumcisions and the recent American Academy of Pediatrics (AAP) Guidelines that came out in the fall of 2012 about this issue. As we know, circumcisions have been performed since biblical times. In fact, there has been a lot of controversy about circumcisions.

In the early 1970s, the AAP published guidelines about circumcisions. Basically, they stated that there was no health benefit to performing circumcisions. As a result of this recommendation, there was a decrease in the number of circumcisions performed in newborns. In the 1980s, AAP looked at the question a second time and again concluded that there were no indications from a medical standpoint to perform a circumcision.

More recently, though, a number of articles have come out indicating that there may be benefits to performing a newborn circumcision. In fact, for a long time we had known that the incidence of urinary tract infection in uncircumcised males is somewhere between 8- and 20-fold greater than in those infants who have undergone a circumcision. More recently, more work has been done looking at the incidence of sexually transmitted diseases. Predominantly in the African population, it has been found that the incidence of HIV and sexually transmitted diseases was much less in circumcised men.

As a result of this, the task force of the AAP convened again and looked very carefully at the data. What they found is that, in fact, there do seem to be health benefits to performing a newborn circumcision. As a result of this review, their most recent policy statement stated that there may be benefits to the individual to undergoing a circumcision. For this reason, it really becomes important that this statement was made, because insurance should cover that newborn circumcision.

One thing that, as a pediatric urologist, I think is very important is ultimately who is performing the circumcision. Many years ago, we had discussions about this issue. I think pediatricians would certainly be the best to perform circumcisions, rather than obstetricians. After all, it is your patients that are undergoing the circumcisions.