Newborn Circumcision Techniques

 

Am Fam Physician. 2020 Jun 1;101(11):680-685.

  Patient information: A handout on this topic is available at https://familydoctor.org/circumcision.

Author disclosure: No relevant financial affiliations.

Newborn male circumcision is a common elective surgical procedure for the removal of foreskin covering the glans penis. The American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians recognize that there are health benefits of newborn male circumcision but do not universally recommend the procedure. Performing male circumcision during the neonatal period has several advantages, including a lower risk of complications, faster healing, and lower cost. The three most common techniques for newborn male circumcision utilize the Mogen clamp, the Gomco clamp, or the Plastibell device. Complications are uncommon and can include bleeding, injury to the penis, adhesions, excessive skin removal, phimosis, and meatal stenosis. Anatomic and medical contraindications may require that the procedure be deferred beyond the neonatal period. Infants with anatomic abnormalities should be referred to a pediatric urologist. Physicians should present information about potential benefits and risks rather than withholding or recommending circumcision. Parents should weigh the health benefits and risks and consider their own religious, cultural, and personal preferences when making the decision.

Newborn male circumcision is a common elective surgical procedure for the removal of foreskin covering the glans penis. It is most often performed in the first days of life.1 According to the World Health Organization, there are several advantages of circumcising males at a younger age, including a lower risk of complications, faster healing, and lower cost.2,3 The frequency of adverse events is four per 1,000 procedures for early infant circumcision, but this number increases 10- to 20-fold in older boys.4 Physicians should present information about potential benefits and risks rather than withholding or recommending circumcision, and parents should consider their own religious, cultural, and personal preferences when making the decision.3,5

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Parents should be offered newborn circumcision in a nonbiased conversation regarding potential benefits and harms.3,6,7

C

Expert opinion and consensus guidelines

The Mogen clamp, the Gomco clamp, and the Plastibell device can be used effectively for newborn circumcision.19

C

Usual practice and expert opinion in the absence of clinical trials

Local anesthesia should be used during newborn circumcision.2630

B

Randomized controlled trials and meta-analyses showing benefit

Infants with abnormal penile anatomy should be referred to a pediatric urologist for circumcision.1,20,22

C

Usual practice and expert opinion in the absence of clinical trials


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Parents should be offered newborn circumcision in a nonbiased conversation regarding potential benefits and harms.3,6,7

C

Expert opinion and consensus guidelines

The Mogen clamp, the Gomco clamp, and the Plastibell device can be used effectively for newborn circumcision.19

C

Usual practice and expert opinion in the absence of clinical trials

Local anesthesia should be used during newborn circumcision.2630

B

Randomized controlled trials and meta-analyses showing benefit

Infants with abnormal penile anatomy should be referred to a pediatric urologist for circumcision.1,20,22

C

Usual practice and expert opinion in the absence of clinical trials


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

The American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists, the Centers for Disease Control and Prevention (CDC), and the American Academy of Family Physicians (AAFP) recognize the potential health benefits of newborn male circumcision, but they do not universally recommend the procedure.3,6,7 The AAFP recommends that circumcision be available and covered by health insurance for those who desire it.7

Established health benefits of circumcision include a reduced lifetime incidence of urinary tract infections, penile cancer, phimosis, HIV, and several other sexually transmitted infections.3,6,810 A 2017 systematic review concluded that the health benefits of newborn circumcision are greater than the risks associated with the procedure.

The Authors

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FOLASHADE OMOLE, MBChB, FAAFP, is the Sarah and William Hambrecht Chair and Professor of the Department of Family Medicine at Morehouse School of Medicine, Atlanta, Ga....

WALKITRIA SMITH, MD, is the associate program director for the Family Medicine Residency Program, medical director of telemedicine, and assistant professor in the Department of Family Medicine at Morehouse School of Medicine.

KITTY CARTER-WICKER, MD, is the medical director of the Clinical Skills Center and an associate professor in the Department of Family Medicine at Morehouse School of Medicine.

Address correspondence to Folashade Omole, MB, ChB, FAAFP, Morehouse School of Medicine, Department of Family Medicine, 720 Westview Dr. SW, Atlanta, GA 30301 (email: fomole@msm.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

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3. American Academy of Pediatrics Task Force on Circumcision. Circumcision policy statement. Pediatrics. 2012;130(3):585–586.

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31. Heras A, Vallejo V, Pineda MI, et al. Immediate complications of elective newborn circumcision. Hosp Pediatr. 2018;8(10):615–619.

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