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Circumcision: Neonatal Circumcision
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Neonatal male circumcision is the most common paediatric operation carried out in the U.S. and in Australia today, though only on a minority of newborn males. The United Kingdom ... practices circumcision on a minority of males. The practice is almost unknown in the rest of Europe and all of Asia, except as a religious ritual. The only country that still routinely circumcises a majority of male infants is Israel. Today, most paediatric surgeons will discourage this common practice.
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The increasing doubts about Jewish circumcision are based on the understanding that it causes harm. Anatomical, neurochemical, physiological, and behavioral studies confirm what mothers already know: infants feel pain. Drs. Anand and Hickey, in a comprehensive review of recent medical literature on newborn pain, conclude that newborn responses to pain are "similar to but greater than those in adult subjects."11 This study is accepted by virtually all medical authorities and is often cited in the literature whenever there is a discussion of infant pain. As a surgical procedure, circumcision has been described as "among the most painful performed in neonatal medicine."12 Studies of infant responses show that the pain of circumcision is not like that of a mere pin prick. It is severe and overwhelming.
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Penile cancer is claimed by some to be an indication for circumcision in the adult, but its prevalence is low. Recurrent balanitis is an indication, particularly in men with diabetes mellitus. A frequent indication is phimosis, which cannot be diagnosed in the newborn because the cleavage plane between the glans and the deep preputial layer of the penis in not developed at birth; often the foreskin is not retractable until 3 years of age. An estimated 10% of men will develop phimosis. (28,29) Although neonatal circumcision has fewer complications than adult circumcision, evidence to support routine neonatal circumcision in order to prevent the need for adult circumcision is not available.
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The Fetus and Newborn Committee of the Canadian Paediatric Society posted "Circumcision: Information for Parents" in November 2004,[55] and "Neonatal circumcision revisited" in 1996. The 1996 position statement says that "circumcision of newborns should not be routinely performed," (a statement with which the Royal Australasian College of Physicians concurs,) and the 2004 advice to parents says it "does not recommend circumcision for newborn boys. Many paediatricians no longer perform circumcisions."[41]
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Groups that oppose neonatal circumcision contend that the foreskin has specialized nerve endings that enhance sexual pleasure and important functions, including natural protection of the glans penis. They argue that permanent externalization of the glans penis results in desensitization due to keratinization of the glans that buries nerve endings deep into this structure. However, no solid scientific evidence supports this assumption. Although many families choose to have their male infants circumcised for cultural, religious, or hygienic reasons, only a few accepted medical indications are recognized: phimosis, paraphimosis, balanitis and posthitis. Circumcision is ... recommended in male infants and toddlers who develop UTIs and children who require clean, intermittent catheterization to facilitate this procedure.
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Neonatal circumcision is generally a rapid and safe procedure when performed by an experienced physician. 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 might 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.
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Neonatal Circumcision