Last week, the American Academy of Pediatrics (AAP) issued an update to their circumcision policy statement that attracted significant attention. In it, the task force clarified the previous neutral policy for boys’ circumcision. The AAP stated that research has advanced since it’s most recent report in 2005 to conclude the health benefits of circumcision outweigh the procedure risks. Like any medical test or procedure, circumcision carries both benefit and risk. With global data expanding about benefits of circumcision and protection against sexually transmitted diseases, the AAP changed its stance. Risks from circumcision are reported to be very unlikely and happen less than 1% of the time. Most common side effects can be a small chance of bleeding or a need for antibiotic ointment. The most frequently reported adverse event from parents is a concern not enough foreskin was removed. Fortunately, circumcision revisions are very rare.
The statement doesn’t go so far as to recommend that boys undergo circumcision, rather the task force stated that the procedure should be done under sterile technique by a trained, experienced clinician. Importantly, they stated for the first time that it should be covered by Medicaid and insurance. This with the hope that every family ought to have the right to make a choice for or against circumcision, not just those with private insurance.
Clearly, the decision to circumcise a newborn baby boy isn’t made simply in the content of medical data. Families weigh religious traditions, cultural practices, family history, and medical information when choosing to circumcise or not. The AAP statement maintains and honors this belief. Ultimately, the decision is a private one for families to make. A pediatrician, family doctor, or ARNP should help you go over medical benefits/risks as needed. As a parent, you go over the rest.
My advice is to talk about this decision far before the birth of a new baby so you have a plan in place. Some families want to wait until their child is 18 years old to transfer decision-making and autonomy. The only challenge is that it’s difficult to predict which boy will protect themselves well during teenage and young adult years and much of the benefit of circumcision comes during childhood. Further, newborn circumcision carries less risk than circumcision later in life.
And what about the neighbors’ kids? Although hospital circumcision rates have fallen in the last few decades (only about 55% of baby boys are circumcised when they leave the hospital in the US), it varies by region. The true numbers are difficult to assemble as many babies are circumcised in the clinic setting and are not accounted for in the numbers. But know that where you live may predict patterns. In the Midwest for example, the majority of babies are circumcised (75%) when they go home from the hospital, while in the West, the minority are (25%). However, many of my patients are circumcised after leaving the hospital so in practice, it feels like my patients hit the national numbers: about half of the boys are uncircumcised.
Research backed medical benefits of neonatal circumcision:
- Lower risk of acquiring HIV, syphilis, human papillomavirus, and genital herpes
- Lower risk of cervical cancer in sexual partners
- Lower risk of penile cancer over a lifetime
- Lower risk of urinary tract infection in the first year of life
Resources For Parents Of Circumcised & Uncircumcised Boys:
- What Is A Circumcision? AAP information on circumcision including risks, benefits, and decision-making.
- What Is A Foreskin? –my short video, blog, & drawings on how to care for a foreskin (in uncircumcised boys).
- Data on number of hospital circumcisions preformed by year and region in the United States.
- Dr Doug Diekema explains the task force decision to pediatricians and parents.
Julie says
I am planning on asking my own ped about this but useful to get your take for sure. When does it become riskier to do later? When my son was born five years ago our ped recommended waiting a year and then having a urologist perform the procedure because my son was so small upon birth. A year went by and it just wasn’t top of our list to think about so still have not done it and unless we have a really good reason to do so (which from the way it sounds I think we still have more pressing things to worry about) I still am not sure I would do it because while we aren’t religious I can’t see putting him through a procedure where the medical advantages at this point might not really be worth it esp. if we did it at age five or six. Just how much of a decrease in risk of disease do we see and did this study establish cause or just correlation? It does seem that there could be some socioeconomic factors at play here contributing to the decrease in disease or is it some purely biological function? Or in comparing rates in places like Africa and the US did they control for some social & economic factors like access to resources like condoms and circumsion and education?
June Park says
Honestly, there is info showing that circumcised men actually raise the chance of hiv/aids and help spread it bc they have such a loss of sensation they do not want to use condoms plus they have no langerhans cells to help fight of the HIV/AIDS among other things. y cut hubby has infections a lot from yeast to utis yet my intact son does not. I would leave him alone and be wary of any doctor who tells you otherwise. They do charge for the circumcision then sell the foreskin to companies that turn it to face cream among other things. Your son will see zero of those profits.:/ I do think the aap is giving poor intact care info in order to cause boys harm. Please do not retract and please know that the glans is supposed to be wet.
https://hivinkenya.blogspot.com/2012/05/appropriate-penile-hygiene-not.html
https://www.drmomma.org/2009/10/dr-edell-discusses-africa-aids.html
whatUneverknew says
You’re on the right track. “benefits” are about probabilities. Any body part has a probability to have an issue, and cutting them off would certainly prevent it. But is that good medicine? Something pretty valid that is emerging too is how men feel when their right to refuse amputation of their healthy genital tissue is denied them. What’s happening now is that men are starting to speak, and starting to be heard, finally, that they don’t appreciate it. How can we know what our son’s opinion of all these “benefits” and risks will be when he’s a capable adult? And of course, even though the AAP is failing miserably to mention it, he still just might hear, like other men are, about the value of the foreskin and all it’s functions. It’s getting harder and harder to look at this solely in the light of ‘potential medical benefit’. There’s a human attached to that debated piece of skin, and he has rights and feelings. \ /,,
Erica Wijenayaka says
Oh, please don’t believe this article! Remember that the AAP is representing physicians interests (read: profit), not those of children. As someone who got HPV from a CIRCUMCISED man, it makes me absolutely livid that doctors and advocating circumcision as a way to prevent cervical cancer, etc. YOUR SON IS INTACT, PLEASE LEAVE HIM THAT WAY. The foreskin is AMAZING (just google “foreskin anatomy and function”, and in their report, the AAP makes NO MENTION of this. PLEASE RESEARCH this, do not follow advice like this blindly.
Mary Wells says
Please do not have it done! At 5 years old it would be extremely traumatic! There’s really no benefit and the foreskin contains so many nerve endings……it’s said that sex is better for uncircumcised men(not really sure how they figured that out). Keeping clean is no big deal, either. And you shouldn’t retract OR let the pediatrician do it. Your son will do it on his own eventually!
sam jones says
Please women,
As a circumcised male I can tell you it is just fine. It is much easier to keep clean when circumcised. Smegma is a problem in the uncircumcised. Look it up if don’t know what it means. The woman that tried to say disease is more prevalent in circumcised is WRONG. The reliable studies show otherwise. Also the foreskin will harbor various germs. In spite of your insistence of easy to clean, modern society has become lazier, more unclean and most of all modern soaps are NOT working very well to clean anything. If you have compassion for your male children, please do it when they are an infant. You have no recollection of it when you grow old enough to remember so there is no pain. It is painful if done as an adult.
Hugh Intactive says
The policy is seriously flawed.
It fails to consider the structure or functions of the foreskin, a normal healthy body part, only the cutting of it off. The erogenous value of the foreskin has been known for millennia, even to its enemies. (Shakespeare called it “my sweet ounce of man’s flesh.” Recent denial of that value is confined to those who have no experience of it.
It claims benefits of circumcising outweigh the risks without ever numerically comparing them.
It exaggerates benefits and minimizes risks and harm.
It ignores major complications and death from circumcision.
It discusses the Mogen circumcision clamp without mentioning that the clamp has caused too much of several boys’ penises to be cut off; lawsuits have driven the company out of business.
It repeats the common claim that it is safer to circumcise babies than adults, but offers no evidence for that claim.
Its discussion of ethics assigns no value to his autonomy or his human right to bodily integrity.
Its ethical consultant (Dr Diekema of Seattle) has said that circumcision is not necessary and has a risk of harm, and (quoting the AAP’s Bioethics Committee) that a parental wish is not sufficient to justify doing any surgery, and it ignores that.
These flaws are documented at tinyurl.com/aapanno
The AAP should withdraw its circumcision policy the way it withdrew its female genital cutting policy after a storm of outrage two years ago, when it recommended a token ritual nick to baby girls, much LESS extensive than neonatal male genital cutting. (Dr Diekema chaired that committee and has never backed down from the policy.) If that was unacceptable, how can this be acceptable?
Bottom line: HIS body, HIS choice, when he is old enough to make one. The AAP admits that he will almost always choose to keep it all.
David Hoffman DO says
You’re right that the statistics vary by region. I work in suburban Indianapolis and I am sure that 95% or more of my male patients are circumcised, and I draw from at least 6 different hospitals.
Julia Ziobro says
What a tragedy!
If circumcision prevents HIV transmission, why do we have the highest rate in the world?
If my sons choose to amputate their foreskins when they are adults of suitable age, I will support them. However, even as children, they clearly enjoy having it, and I doubt they will be willing to give them up!
Mom to three children, two sons and a daughter, each intact
Craig Garrett says
The foreskin is an important part of male anatomy, and it is an erogenous zone. A study in 2007 by Sorrells, et al., measured the fine-touch sensitivity of 17 different places on the male genitalia, both circumcised and intact. This study concluded that “circumcision ablates the most sensitive parts of [male anatomy].”
https://www.doctorsopposingcircumcision.org/pdf/sorrells_2007.pdf
Someone was nice enough to create color-coded diagrams using the data from this study to visually show the areas of sensitivity:
https://www.circumstitions.com/Sexuality.html#sorrells
Google functions of the foreskin for more information.
Intact America has just published an excellent response in which they explain the flaws and bias in this new AAP statement.
https://www.intactamerica.org/aap2012_response
This is a listing of other nations’ medical statements on circumcision which show they do not agree with the AAP:
https://www.cirp.org/library/statements/
For example, in 2010, the Royal Dutch Medical Association said, “there is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene” and “non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity.”
Finally, this video is an excellent educational resource. It is narrated by Dean Edell, MD:
https://www.youtube.com/watch?v=h_bEBAdhjGg
Anti Mutilation says
“The only challenge is that it’s difficult to predict which boy will protect themselves well during teenage and young adult years and much of the benefit of circumcision comes during childhood.”
Then only listing the “research backed” benefits, but not the risks…
Pushing genital mutilation on helpless children. You are as repulsive as Sandusky. Ugh
Jere DeBacker says
Wendy Sue Swanson doesn’t have a clue! Look around. Every mammal in the world is born with a foreskin that fits their life and sexual practice, including baby men. Even women are born with a foreskin – but we don’t cut that off at birth. Decreases risk of HIV and other STD’s? Amazing that anyone with a brain can still quote this. We have the highest percentage of cut men in the world and the highest percentage of HIV and STD’s. Penile Cancer – really??? Only one in 100,000 men might ever get penile cancer. A quick search reveals that the AAP Statement on Circumcision is a blatant advertisement. It is a classic case of the fox guarding the chicken coop. Have you researched the makeup of the AAP committee? Quick research reveals that the “studies” these people quote are bought and paid for by pro-circumcisers, religious zealots and circumfetishists. The African HIV, UTI, and cancer “studies” were all bought and paid for with the intention of one “result”. They are scorned by responsible medical organizations, around the world. The AAP fails to mention that circumcision started during the Victorian era as a method to desensitize the penis and to prevent masturbation, and has claimed to cure well over 100 ailments and diseases as its justification. The foreskin is not a birth defect. It serves it’s owner with many functions, including pleasure! Mother Nature does not make mistakes – the AAP does! Try asking an intact man if he wants his foreskin cut off and see what answer you get. Wake up, people! It’s the best part.
Kathy in WA says
I would like to point out that WSS was simply communicating the new AAP statement — as she often does when the AAP updates their statements. She clearly stated this was a personal choice. No need to attack the messenger.
As the mom of an INTACT son, I have often wondered why the CDC and others draw such long conclusions from the AIDS/HIV work in Africa. Perhaps I’m not familiar enough with the research, but last I checked, most countries in Africa have VERY DIFFERENT cultural practices, health economies, diseases, and medical systems than the US. How can they conclude that because circumcision helps reduce HIV transmission in this very high risk population, that this should be the policy in the US?
Our son (almost 8) has never had any issues or problems and we certainly don’t regret our decision or consider having him cut later in life, unless he chooses to this himself. As others have posted, why cut off a perfectly functioning piece of a child’s body (some might even say “as God designed them”) — I have no clue why people make that choice.
And as far as I know, Medicaid and most insurance plans already do cover circumcision, for better or worse.
Lastly, WSS being based in Seattle, is probably already aware that there is a higher-than-average amount of parents choosing to leave their sons intact. I would guess the pacific northwest is a bit of askew in the circumcision data, as is the Midwest for the opposite direction. The PNW has higher rates of not circumcising, not vaccinating, and longer-term breastfeeding. Very different populations exist even just here in the US.
Thinking mother says
When I was pregnant with a boy, I thought long and hard about this issue, and after reading a bunch of studies and other stuff including the AAP position at the time, I decided that I would not remove a part of my child’s body unless I knew that the procedure had clear and significant benefits. In the end, I was simply not convinced that the benefits described were significant enough for me to do this to a newborn.
So I am supposed to be on the same side with Jere DeBacker on this issue, but when s/he writes “We have the highest percentage of cut men in the world and the highest percentage of HIV and STD’s” I shudder. Where is the source for this assertion? Knowing that almost all Muslim and Jewish boys would be circumcised in traditional societies, I’d expect that most Muslim countries and even possibly Israel would have a higher percentage of “cut men”. Also the second part is most likely not accurate either, because the HIV rate in this country is really not that high, especially in comparison to some unlucky African nations.
And please stop calling them “cut men”. It sounds awfully like you have an agenda to promote. (Reminds me of other phrases like “pro-life” that zealots use to undermine critical thinking and open debate).
Well, I guess WSS knew that she was opening a can of worms when she decided to mention this topic; the internet is full of wildly emotional (and oftentimes irrational) discussions on this topic…
Julie says
@Kathy – my understanding is the opposite – medicaid currently does not cover this procedure but the AAP is recommending that if it is something parents want to choose to do it should be covered.
James Mac says
Why not just let all children keep all the body parts they’re born with, including letting boys keep and enjoy a complete set of sexual organs?
Fact is, the foreskin is the best part of the penis. It is protective, highly mobile, highly erogenous and facilitates intercourse for both partners. And it’s a perfectly normal and healthy part of *someone else’s* body.
As a father and grandfather, if there was one thing I could change in my life, above all else, it would be that someone was there to protect me from having part of my penis cut away by some emotionally detached doctor when I was too young to defend myself. I say to all parents; be the protector your perfect son needs you to be. And research circumcision; everything you think you know is probably wrong.
Jai Mason says
“My advice is to talk about this decision far before the birth of a new baby so you have a plan in place. Some families want to wait until their child is 18 years old to transfer decision-making and autonomy. The only challenge is that it’s difficult to predict which boy will protect themselves well during teenage and young adult years and much of the benefit of circumcision comes during childhood. Further, newborn circumcision carries less risk than circumcision later in life.”
This paragraph is seriously flawed.
1) “Protect themselves.” Protect themselves from what? I assume you mean STDs? Which are infections, viruses, and diseases transmitted by bodily fluids. Not foreskin.
2) “Newborn circumcision carries less risk.” This is an outright lie. Circumcision of infants is far more dangerous and severe than circumcision of adults. Infants will not receive adequate pain management during or after the surgery and will be awake. An adult will be asleep, receive anesthesia, and receive prescription pain relief for the time following the surgery. At birth, the foreskin is fused to the head of the penis, meaning the foreskin must first be sliced from the glans penis before it can be clamped off and removed. As a result, the glans penis is left a raw and open wound after an infant circumcision and the frenulum is often removed by accident. In an adult, the foreskin can be retracted, meaning the glans penis and frenulum will be left unharmed. Also, an infant needs only to lose 2.3 ounces of blood before they exsanguinate and their circumcision wound will be exposed to feces and urine in their diaper.
June Park says
Sadly the AAP is not being truthful here. They give improper intact care info. They do not address the legal issues surrounding male circumcision. They also do not discuss the fact that langerhans cells, found on intact penises in the mucosa, KILLS HIV/AIDS. They do, however, make it clear in the statement that they are in this to try to get the insurers will pay for circumcisions again. “Neonatal circumcision is not good health policy, and support for it as a medical procedure cannot be justified financially or medically.”
https://mdm.sagepub.com/content/24/6/584.abstract
https://www.washingtonpost.com/wp-dyn/content/article/2007/03/05/AR2007030500357_pf.html
https://www.norm.org/lost.html
https://www.prweb.com/releases/2002/06/prweb41148.htm
Tim King says
All of the monotheistic religions are represented in the anti-circ fight with Jewish voices calling out and sending news more often than the others. We must band together and brothers and sisters for the future of children, end genital mutilation!
Mark Lyndon says
It’s really easy to find circumcised doctors who are against circumcision, but surprisingly difficult to find male doctors in favor who weren’t circumcised themselves as children.
The AAP are way out of line with other national medical organizations, and it’s very disappointing that they say this:
“Parents are entitled to factually correct, nonbiased information about circumcision”
but they provide information that is both biased and highly selective. They simply don’t seem to consider that the foreskin might actually be valuable.
How strange that all the health benefits the AAP claim don’t seem to exist in Europe, where almost no-one circumcises unless they’re Jewish or Muslim.
I suppose it’s a good thing they didn’t look at operating on girls to prevent breast cancer. 11% of women get breast cancer, and 3% die of it, so the health benefits to the girls would massively outweigh the risks.
Meanwhile, other national health organizations including the Canadian Paediatric Society and the Dutch Medical Association continue to recommend *against* circumcising newborns.
It’s not like it can’t wait. There are just two countries in the world where more than 50% of baby boys are circumcised – the USA and Israel. Other countries circumcise, but it’s usually anywhere from the age of seven to puberty or adolescence.
Juan Alzate says
“Most common side effects can be a small chance of bleeding or a need for antibiotic ointment.”… Except that bleeding in a baby can become fatal. 2.4 ounces of blood loss can kill a baby, as it has happened after circumcisions. Infections can also threaten the life of a baby: he can develop sepsis and die. Some methods of circumcision (Plastibell) have caused deaths simply by causing urine retention.
The policy dismissed the most severe complications because they didn’t know how frequent they were, just read the Technical Report and you will see that. They also acknowledged not knowing the cost and family distress over corrective surgeries in the case of botched circumcision, those where due to surgical mishap or improper cleaning can result in partial or full amputation of the glans, developing of adhesion, skin bridges, concealed penis and even pain during erections as adult due to removal of too much skin. Yes, parents may complain when they remove too little skin, but when they remove too much skin it’s the adult who will suffer, most times in silence and shame.
And why would the AAP honor cultural and religious beliefs? Are they a religious institution or a medical institution? We surely don’t honor the cultural and religious beliefs of those who think they need to subject their daughters to “sunat” or other forms of female genital cutting.
Also, why did the AAP ignored the fact that many adult men are unhappy and angry about being circumcised at birth? Circumcision is the product that they are selling, shouldn’t they check with the clients’ satisfaction? After all, it’s an irreversible procedure.
The AAP ignored the voice of the victims: The dead babies, the babies who grew up with a deformed or amputated penis, the adults that couldn’t live a normal sexual life due to botched circumcision, shame, pain, lack of sensibility. They are not for the protection of the children, they are just pushing what they can sell to naive and uninformed parents, putting a price tag on every foreskin. They should retract that policy immediately.
Meagan says
In terms of HiV transition, my understanding has always been this: in unprotected sex with an infected partner, the risk is greatest for a man engaging in sex with another man, followed by a woman having sex with a man, followed by a man having sex with a woman, and lowest for a woman having sex with another woman.
My question: is an uncircumcised man at greater risk for contracting HIV in a heterosexual encounter than a woman? In other words, how big a difference is this degree of risk?
On a population level, where HIV is out of control, routine circumcision makes a lot of sense, but as a parent, having my son circumcised wouldn’t give me a whole lot of comfort if I worried that he was engaging in unprotected sex.
BTW, for the commenters saying that Dr. Wendy doesn’t have a clue… You DO realize she’s only explaining the official comments of the AAP, right?
Pam Gereau says
Not really, Meagan. If Dr Wendy was in disagreement with the policy she could have said so. There’s nothing stopping her from speaking her mind. There are countless physicians who have done so. But by writing what she wrote, this is an indication she subscribed to the policy, clear and simple.
The speaking out by physicians against circumcision of newborn males could help to save the bodily integrity of countless men in our society. Something these men deserve to make their own decisions about.
What other body part do we surgically remove from humans? To do something this violent and offensive (and if you think I’m exaggerating, go check out some youtube videos) to another human being, especially one so vulnerable, there better be a darn good reason for it.
So riddle me this: IF if was so wonderfully protective, shouldn’t the AAP have recommended it be done to boys? Seeing how it didn’t, does that tell you anything?
James Loewen says
Cutting normal, healthy, erogenous tissue from a child’s genital organ is abuse. This is a severe trauma for some (perhaps all) children when subjected to it, or when later discovering what was done to them.
The Global Survey of Circumcision Harm documents the physical and emotional harm caused by this forced surgery without consent.
Forced circumcision of children whether for specious medical “benefits” or dogmatic religious excuses is abuse.
James Loewen says
The crafty title of this article is misleading and disturbing.
“Circumcision For Newborn Boys” suggests doing something of benefit for a baby.
It should read “Circumcision Of Newborn Boys” or if totally honest, “Foreskin Amputation of Newborn Boys”
Bud Yanker says
At the end of the day, only two types of people push circumcision. One, the ignorant, because they are scientifically and morally illiterate. This is about 50% of the American popopulation, which accounts for the 50% rate. Second, the pushers, who both enjoy performing the act on helpless children and also make some money doing it. Think about the Ultra Orthodox mohels or the village circumciser in Turkey. Think about doctors like Diekma and Schoen who made millions from this 20 minute procedure at 350 a shot. They love their jobs. And you thought Sandusky was a sick person.
LAMR says
If religion is not a good enough reason to circumcize girls then it certainly it’s a good reason to do the same to boys. Every child deserves their WHOLE body. Worried about STD’s? Teach your sons and daughters about condoms, don’t remove up to 50% of their genital skin.
Worried about how it will look to others well that is just creepy. You shouldn’t be thinking about that. Your child’s sexual function/appeal of the member is none of your bees wax.
Crystal says
“Research backed medical benefits of neonatal circumcision:
1-Lower risk of acquiring HIV, syphilis, human papillomavirus, and genital herpes
2-Lower risk of cervical cancer in sexual partners
3-Lower risk of penile cancer over a lifetime
4-Lower risk of urinary tract infection in the first year of life”
1- condoms and responsible sexual behavior are more effective than circumcision
2- related to hpv possibly? There is safer sex and now an immunization against hpv.
3- already a very rare cancer. Makes are more likely to get breast cancer than penile cancer.
4- females get more uti’s than males, circumcised or not. It is simply treated with antibiotics and life goes on. No amputation necessary.
Pam Gereau says
If you really believe that circumcision provides a benefit to reckless teens in preventing STD’s, please explain this:
1) This article from 2010 states STD rates were reaching epidemic rates in Wisconsin. (Note that nowhere in the article does it mention circumcision:
https://host.madison.com/ct/news/local/health_med_fit/article_96d0ee57-e3dc-59d7-a5ec-e5cbc5b71ffc.html
2) The rates of circumcision in Wisconsin have been monitored since 2001 and are shown to be between 82 and 84% starting and since then:
https://www.cirp.org/library/statistics/USA/state-by-state/
3) Assuming all of the above to be true, one would think that today’s teens would be part of the 82-84% crowd (or greater allowing for higher rates in earlier years prior to more information available online and more circumcisions to be done outside the hospital). That being said, how has circumcision protected these teens??
The USA has some of the highest STD/HIV rates in the world with a majority adult male circumcised population. Why don’t men in Europe with foreskins intact have STD’s proliferating the population? These supposedly protected circumcised penises don’t really seem to have the protection the AAP is claiming, which means they consider the rest of us dolts or “dumb sheep” who will follow whatever they tell us.
I find you and your like very offensive and I believe the day will come when men will rise up and take action against those medical organizations who flat out lied about the value of the foreskin they would have cherished.
Mona says
Dr. Swanson always presents as a clear headed, thoughtful professional. She is presenting information, and clearly supports a parent’s right to consider this issue for themselves. We do what we think is best for our children when decisions are required.
As a mother of two sons, I find the comments comparing this discussion to anything having to do with the disgusting crimes of Jerry Sandusky completely VILE and way off the mark.
Danielle says
ONLY in the USA, does hygiene seem to be an issue with the male penis. This article is a whopping load of BS.
If it really prevented the spread of disease, the USA wouldn’t have the highest rate of HIV in the developed world and the highest rates of circumcision!
No one else in the world routinely hacks off a functioning organ from their baby boys.
Take your WHOLE baby home and spare him the pain of these useless procedure. Teach him 10 seconds in the shower when he’s older and actually retracts to clean, and teach him of safe sex, condoms prevent HIV, circumcision does not.
And DON’T RETRACT HIM as a newborn, it’s cleaned like a finger, much easier than an open wound in a dirty diaper.
Laura C says
Please please please don’t force circumcision on a baby. It should be his choice when he is older. There are so many benefits to leaving him intact. I could never cut off a healthy body part from my son. All I ask is you find a video on drmomma.org, savingsons.org or something like that and watch a full circumcision. It is not something any child should go through.
Kelly says
You know what else is difficult, or rather, impossible for any parent to predict? Whether or not HE will be happy with the choice that someone else made for him about cutting off the MOST sensitive part of HIS PENIS. If men were meant to have foreskin, they’d be born with it.
Jenn says
The AAP technical report is replete with problems. I kind of wonder if you even read it, Dr. Swanson. There is absolutely no mention of the functions of the foreskin and the benefits of keeping a boy intact. Doctors have a professional obligation to inform parents of the risks of circumcision, which includes death, among many other horrible complications that are more likely than death. Doctors also have a professional obligation to present the benefits of doing nothing. The benefits of keeping all of his parts. If they don’t acknowledge in the technical report what the function of the foreskin is, does that discount the surgeon’s responsibility in providing this information? NO, it does not. There will be many, many lawsuits stemming from this documented ignorance of human rights (which also was a topic conveniently ignored in the technical report – proxy consent only applies to therapeutic surgery, something Dr. Diekema knows full well as a bioethicist.) Surgeons, pediatricians and interns now might want to consider this before cutting off another piece of flesh from another voiceless and defenseless boy. He needs it, and he will figure that out before the statue of limitations runs out. Boys are smart enough to clean their penises, and boys will be smart enough to figure out the truth and hold those responsible for the injustice that is non-therapeutic infant circumcision.
Wendy Sue Swanson, MD, MBE says
Jenn,
I did read the technical report.
Here’s the link if others would like to as well.
https://pediatrics.aappublications.org/content/130/3/e756
Julie says
Thank you for the link! I am just trying to understand the section Male Circumcision and Diseases, Morbidities, and Sexual Function/Satisfaction. I think the answers to my original questions are in there but I am getting a headache trying to understand it on my own! One of the reasons I appreciate going to real doctors to sort out what these findings say (and what they don’t say) is that they have seen studies and recommendations like these come and go so can be very helpful in helping you make a choice that is best for your child by taking all factors of your lives into account. So ask your ped! I did talk to my ped and for now I can feel good about leaving my son intact. I know well enough to not count on a teenage boy to exercise good judgment so will have to be vigilent and open about safe sex practices & why abstinence is best at that age anyway but I understand they won’t always do what is best. Which is why he’ll get his HPV vax when he is old enough too (and whatever other vax comes out in the future maybe one for HSV?) but at this point until we have more conclusive studies that tell me the risk reduction is substantial we’ll let him make the call when he is 18. However as his mother I reserve the right to change my mind if more studies come out suggesting it is for the best, which would in turn cause the AAP to come out with a much more strongly worded statement too I would imagine.
Charlie Weder says
Odd that you say it’s difficult to predict who will protect themselves during teen and adult years. In fact, the CDC has detailed data showing that only 42% of males have sex as teens, and of those who do, 85% use condoms. So It’s very likely that he will be protected during his teen years, and adults can choose circumcision if they’re one of the ~0.35% that choose it. https://www.nytimes.com/2011/11/15/health/teenagers-having-sex-are-now-a-minority.html?_r=2
Even then, the (questionable) data on HIV shows only a reduction in females infecting males; no one else. Only 0.02% of overall males in the US are infected with HIV through heterosexual sex, so that’s not an argument for forcing circumcision on the other 99.98%. In fact, that’s more than a 99.98% chance that he will not benefit!
Alan Greene says
In areas of strong disagreement in kids’ health, vigorous conversation is healthy – each side listening to the other, digesting, bringing new things to consider. Passionate advocacy is also healthy, championing a perspective other’s haven’t reached. Personal attacks, though, are unhealthy and diminish progress. All sides are here because we believe we want what’s best for kids, so we achieve the most by focusing on that. Thanks, WSS, for getting this important conversation rolling.
ellen mary says
Clearly this article presents 2 options: cutting an Infant or feeding an 18 year old contested, controversial info & cutting him then. My sons are intact, they are not uncircumcised. This article is biased, not unbalanced.
June Park says
Langerhans cells are only present in intact penises and kill HIV/AIDS. https://www.norm.org/lost.html
https://www.washingtonpost.com/wp-dyn/content/article/2007/03/05/AR2007030500357_pf.html
June Park says
“Dear American Academy of Pediatrics,
We know the truth. We know that you benefit from not only the payment for circumcisions, but also by selling the foreskins to cosmetic and research companies. We know you rarely use pain medication and that you routinely consider sugar pacifiers and lollipops to be “enough” pain medicine for an infant. We know there are no health benefits to circumcision, but there are downfalls. A child may die from shock or from bleeding out. A child may have psychological issues such as PTSD or other psychological and social problems. We know circumcision affects breastfeeding and often ceases the nursling/mother relationship. A child may also have physical injuries beyond the amputation of the foreskin and it’s immunological protections. He will not be as protected as his intact peers from disease and infection. He will not be able to perform properly during intimate acts with his partner due to the keratinization of his glans among other issues. We know circumcision is illegal under child abuse laws in each state which say you cannot leave a mark on a child. Circumcision is illegal under the 14th Amendment which guarantees equal rights to all regardless of religion or age. Yes, children do have religious freedom as well as the freedom to not be harmed by others. Courts have repeatedly ruled that parents cannot martyr their children which makes religious freedom and parents’ rights arguments invalid. Muslim parents are not supposed to circumcise and a growing number of Jewish families keep their children intact because they know it is harmful to circumcise. Yes, we know the truth. We know that mandated reporters are the perpetrators of many of these child abuses you so lightly call circumcisions. No matter what your policy states when it comes out in September, we will continue to share the true facts instead of bow to those who are in it for the money and the power. We hold you accountable to “do no harm”. ” All information is cited in the blog.https://happymommy1.blogspot.com/2012/08/dear-aap-we-know-truth.html
ellen mary says
I do not ever resort to personal attacks but we are increasingly frustrated with medical & public health professionals who do not know enough about foreskin sparing care, who practice & promote forcible premature retraction, who endorse agenda’ed flawed science & who refer to our sons in terms of an operation we do not want them to have as if said operation is inevitable.
Do you think people lie about behavior that is illegal? Men in Africa face stiff penalties up to & including death for homosexuality. The flawed research around HIV was funded by Bloomberg with a predetermined result. Actually research has just revealed that HIV is transmitted medically in 1 in 5 cases in Africa but I don’t suppose injections will be slowed. . . . Infant Circ in Africa will either not involve a dorsal block OR will expose infants to HIV, so flawed research begets flawed policy.
Judith says
“The only challenge is that it’s difficult to predict which boy will protect themselves well during teenage and young adult years and much of the benefit of circumcision comes during childhood.”
Umm, where do you get that idea from? Even your alleged benefits supposedly backed by research mostly relate to problems only old men encounter. Even UTIs are rare for both sexes and are only marginally less for circumcised boys. Even that would be nonexistent if doctors would stop telling new parents to retract their boys foreskins, something that should only be done by the boy himself when it has detached from the glans. It’s really scary that a doctor would post this kind of nonsense for the world to see.
And by the way, even the American Cancer Society no longer claims that circumcision prevents penile cancer. I think you need to update your own research. Just sayin’.
cosmopolite says
“Some families want to wait until their child is 18 years old to transfer decision-making and autonomy.”
ME. Many do.
The only challenge is that it’s difficult to predict which boy will protect themselves well during teenage and young adult years…”
ME. This sentence embodies a grimly patronising point of view about young men and women. We chop off all foreskins because some high school and college boys are incorrigible horndogs? Why not teach our daughters to say “no condom; no sex”?!?
“…and much of the benefit of circumcision comes during childhood.”
ME. This is simply wrong. Most of the claimed benefits pertain to STIs and cancer, conditions which do not strike in infancy. As for childhood UTIs, there is no data from Europe and Japan showing that UTIs in boys are a serious problem. UTIs are common in girls, and the treatment is sulfa/antibiotics.
“Further, newborn circumcision carries less risk than circumcision later in life.”
ME. This is completely unproven. There is ample anecdotal evidence of botched infant circumcisions. There is little talk of adult circumcision going awry. Unlike the case with a baby, the foreskin has detached from the glans, and the patient can fully cooperate with his recuperation.
Dan Bollinger says
Actually, parents don’t HAVE to make the “circumcision-decision.” For millions of parents around the world it doesn’t even cross their minds.
Parents who are considering circumcision should check out Circumcision Decision-Maker.
https://circumcisiondecisionmaker.com/
Stan Brown says
“Families weigh religious traditions, cultural practices, family history, and medical information when choosing to circumcise or not. The AAP statement maintains and honors this belief.”
When are American doctors going to start respecting and honoring the right to genital autonomy of boys and the men they become?
I was circumcised when I was a baby. A normal, healthy part of my penis was cut off without a valid medical indication and without my consent. The small potential medical benefits cited by the AAP do not come close to making up for the harm caused by cutting off a part of my penis that would have given me sexual sensation during my lifetime nor making up for the violation of my right to bodily autonomy.
Stan Brown says
“And what about the neighbors’ kids?”
Does that same logic also apply to teen smoking and underage drinking? How can parents claim the high moral ground when their teenage son tells them all his friends are smoking or drinking or getting tattoos if they allow a doctor to cut off a normal part of his penis because they want him to look like all the other kids in the neighborhood?
John Dalton says
The sleight of the AAP is to tacitly acknowledge that men won’t get circumcised if they let them grow up to have the choice, so they therefore want to get it done before the child is old enough to have a say.
This of course completely negates the point about consent (ie to sense with)which is to safeguard the patient’s right to autonomy.
No doubt there would be “medical benefits” to cutting off any part of a child’s body that you care to name, but that is more than parents have a right to authorise.
And by the way, America, most of the world gets along just fine without circumcision. On the whole we have better health than you do and more affordable healthcare.
Roland Day says
This new AAP statement is simply promotional material for doctors who profit by performing circumcision. It should not be taken seriously by parents. It primarily is based on some African studies that were published in 2005 and 2007, which already have been debunked, although the AAp did not acknowledge this.
More recently a new large-scale study from Puerto Rico found higher rates of STDs and HIV infection in circumcised men, so it appears that the AAP statement is totally wrong. Intact boys are safer and enjoy better health and well-being.
Although the incidence of circumcision in the United States was recently reported to be 54 percent, that is not uniform. The actual rate various by state. In the state of Washington, the rate is one of the lowest at 14 percent. Genital integrity is the choice of most Washington families.
Jane Lupton says
This is ridiculous. To be fair I read a similar thing after I visited https://mumandbabyonline.blogspot.co.uk/ to get an update on this nonsense. Just truly wrong if you ask me.
Maria B says
We should be very skeptical and very aware of the implications of a group of people in authority telling us to remove body parts because we won’t be able to use them responsibly. This idea that behaviour of boys is so radical and uncontrollable, we must take knives to their penises is victorian-era logic.
I intend to raise a son who respects his own body, respects the bodies of others and understands the meaning of consent. One cannot simultaneously teach a boy to respect other people and the meaning of consent as it comes to sexual relationships, while making his first experience in life a violent violation of HIS body, HIS rights, HIS sexuality, and HIS consent. I trust our sons who will grow up to be men the same as I trust our daughters who grow into women. We are all capable of making decisions regarding our OWN sexual health, that isn’t a parenting choice, it’s a PERSONAL one. We do not own our children, their bodies, or their sexuality.
Humans are capable of making responsible choices regarding their sexuality, and as adults we teach our children responsible behaviour, we don’t cut their bodies. In fact, this same line of thinking presented here and by the AAP can be and is used by culture who cut girls. Girls cannot be trusted, circumcision keeps them chaste.
You should know that studies not included in the AAP’s body of literature showed an increased risk for women who had circumcised partners. Circumcision ONLY protects men, and according to actual risk, to a tune of 1.3% protection, not 60% – that stat is relative risk. Further, there is a highly effective HPV vaccine offered to girls as young as 12.
Regardless of circumcision status, one must still use condoms. The bald penis is not a silver bullet. We should be giving our sons the respect to make their own choices concerning their sexuality, and arming them with all the information so that he and his partners are healthy.
Sean B says
I think it’s important to talk about the health benefits of circumcision, but why are they always stated in a qualitative way? How does that help people make a realistic informed decision when weighing the benefits and risks? Are there any good resources that quantify they health benefits and risks, so that expecting parents can make a more detailed and analytically based informed decision?
Susan T says
The doctor is right: Should I circumcise is a question that expectant parents should think about, research and answer long before their child is born. After researching the issue for over three years, however, I learned that it is far more complicated than simply weighing the medical considerations of foreskins versus circumcisions. There are so many other issues, including religious, cultural, looking like Dad, sex, and who has the right to make the decision. Read the book I wrote with my longtime editor if you want to look at these issues in depth — and want a chapter, the final chapter, that helps you sort through the ones to consider and the ones that ought to be overlooked. The Circumcision Decision: An Unbiased Guide for Parents.
Steve P says
Well, I’m an American living in Australia and when my son was born a few years ago we didn’t have to worry about it. Circumcision is banned in Australian public hospitals (and most private ones too). No stress, no doctors trying to sell useless extra surgery. Looking back I can’t imagine how on top of evrything else, like getting immunisations, establishing breast feeding, learning to change nappies (diapers) we could have dealt with the stress of caring for a painful open wound on a newborn. Sick!
And guess what? STDs, urinary tract infections ect are lower here than in the US. Same in England and mainland Europe.
But the AAP didn’t mention this. They focused on a few studies in Africa.
The real question that any responsible doctor should be asking is “why is the AAP so out of line with every other first world nation when it comes to circumcision?” How is it that billions of men in Europe, Asia etc are doing just fine when according to the AAP they should be suffering higher rates of disease? Seems to me that the AAP should be investigated.
pediatric oncall says
Yeah it’s good article and thanks for sharing information. I had one child that got have circumcision in newborn age but what i should i do my understand and some i give the issue the problem and while searching information i got one site that one good information…
https://www.pediatriconcall.com/fordoctor/diseasesandcondition/article.aspx?artid=9
Tuba says
Infant circumcision is sexual assault. If it were invented today we would be appalled at the idea. It is a hold-over of religious barbarism and any doctor who performs said should be prosecuted. Women have spent several decades driving home the idea that it is their body, their sexuality, and they will made what decisions need to be made about their body. To deny males that is sexism. No child ever died of a foreskin before the are of personal consent, 18. Of all the things a medical professional can do circumcision is the least justified. It’s also a billion dollar business, blood money is the most foul manner.