Neonatal Circumcision

There are potential health benefits from neonatal circumcision. The evidence is strongest for the prevention of UTI in newborn males. The number needed to treat to prevent one UTI is about 140 and to prevent one hospitalization for UTI is 195. Circumcision also prevents penile cancer, but this is a rare disease (0.6/100,000), and the number needed to treat to prevent one case is approximately 300,000. In addition, about 1/3 of penile cancers are caused by human papilloma virus and may be prevented by HPV vaccine. There is also evidence that circumcision can prevent some other STDs, including the acquisition of HIV, but the evidence for this comes from studies of adult circumcision in Africa and may not be generalizable to neonatal circumcision in the U.S.

Circumcision can also result in complications. Acute complications can include bleeding (0.8-1.8/1,000), infection (6/10,000), and injury to the penis (4/10,000). Late complications can include incomplete circumcision, excessive skin removal, adhesions, meatal stenosis, phimosis, inclusion cysts. The rate at which these late complications occur is not well defined.

The potential health benefits from circumcision justify it being a covered medical service by third-party payers, and it should be an available service for those who desire it.

The decision whether to circumcise a newborn male is affected by parents’ values and beliefs and should be made by parents after a discussion of the benefits and harms. Family physicians should provide this information in an unbiased manner, and the parents’ decision should be respected.

Circumcision is preferably performed in the newborn period. When circumcision is performed, topical or local anesthesia techniques should be used to minimize newborn discomfort.  (2013 COD)