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Circumcision. Yes or no? In a recent review by the fetus and newborn committee of the Canadian Pediatric Society (CPS), regarding circumcision, several recommendations were made. The committee reviewed the relevant literature and concluded there is evidence that circumcision results in an approximately 12-fold reduction in the incidence of urinary tract infection (UTI) during infancy. The overall incidence of UTI in male infants was between 1% and 2%. They felt that further evaluation of alternative methods of preventing UTI in infancy was required, such as the effects of simple hygienic interventions. They also found that there is evidence that circumcision results in a reduction in the incidence of penile cancer and of HIV transmission. However, the committee felt that there was inadequate information to recommend circumcision as a public health measure to prevent these diseases. The incidence rate of the complications of circumcision reported in published articles varied, but was generally in the order of 0.2% to 2%. Most complications were minor, but occasionally serious complications did occur. When circumcision is performed, the CPS committee recommended that appropriate attention needs to be paid to adequate pain relief. While the committee felt that the overall evidence of the benefits and harms of circumcision were so evenly balanced that it did not support recommending circumcision as a routine procedure for newborns, they indicated that the ultimate responsibility of deciding to do a circumcision or not, rests with the parents. The role of the physician is to advise and inform the parents of the present state of medical knowledge about its benefits and harms. The parents' decision may ultimately be based on personal, religious or cultural factors. Reference:Canadian Medical Association Journal 1996; 154(6): 769-780
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