The American Urological Association, Inc.® (AUA) believes that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks. Neonatal circumcision is generally a safe procedure when performed by an experienced operator. There are immediate risks to circumcision such as bleeding, infection and penile injury, as well as complications recognized later that may include buried penis, meatal stenosis, skin bridges, chordee and poor cosmetic appearance. Some of these complications may require surgical correction. Nevertheless, when performed on healthy newborn infants as an elective procedure, the incidence of serious complications is extremely low. The minor complications are reported to be three percent.
Properly performed neonatal circumcision prevents phimosis, paraphimosis and balanoposthitis, and is associated with a markedly decreased incidence of cancer of the penis among U.S. males. In addition, there is a connection between the foreskin and urinary tract infections in the neonate. For the first three to six months of life, the incidence of urinary tract infections is at least ten times higher in uncircumcised than circumcised boys. Evidence associating neonatal circumcision with reduced incidence of sexually transmitted diseases is conflicting depending on the disease. While there is no effect on the rates of syphilis or gonorrhea, studies performed in African nations provide convincing evidence that circumcision reduces, by 50-60 percent, the risk of transmitting the Human Immunodeficiency Virus (HIV) to HIV negative men through sexual contact with HIV positive females. There are also reports that circumcision may reduce the risk of Human Papilloma Virus (HPV) infection. While the results of studies in other cultures may not necessarily be extrapolated to men in the United States at risk for HIV infection, the AUA recommends that circumcision should be presented as an option for health benefits. Circumcision should not be offered as the only strategy for HIV and/or HPV risk reduction. Other methods of HIV and/or HPV risk reduction, including safe sexual practices, should be emphasized. Circumcision may be required in a small number of uncircumcised boys when phimosis, paraphimosis or recurrent balanoposthitis occur and may be requested for ethnic and cultural reasons after the newborn period. Circumcision in these children usually requires general anesthesia.
The risks and disadvantages of circumcision are encountered early whereas the advantages and benefits are prospective. When circumcision is being discussed with parents and informed consent obtained, medical benefits and risks, and ethnic, cultural, religious and individual preferences should be considered.
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