Infant Male Circumcision

The matter of routine infant male circumcision was a subject of discussion at a recent meeting of the College Council. The College has received repeated requests from special interest groups and individuals to ban this procedure. Their objections to routine infant male circumcision are based on a variety of factors including the lack of medical indications, the right of the newborn to make its own long term decisions, immediate risks, long term effects, ethical issues, and so on.

The College's position on routine infant male circumcision is that it is a matter of patients' (or parental) choice, which may be based on traditional, religious, cultural or personal preference. The issue of perceived medical necessity is, in the opinion of most experts, no longer pertinent. Though some studies suggest slightly lower frequencies of urinary tract infection and decreases in HIV transmission in circumcised males, most physicians agree that the procedure should be regarded as a cosmetic procedure and in North America should be approached as such. Younger physicians (coming out of training programs) often do not have skill or experience in performing circumcisions and also may have little interest in acquiring such skills or being involved in the procedure.

College Council did not identify any necessity to place restrictions on the availability of routine infant male circumcision, except to remind physicians that when performed routinely, this is a cosmetic surgical procedure which should only be considered after detailed discussion with the parents. This allows parental request and consent to be based on accurate and comprehensive information. Such discussions should include the fact that infant circumcision is not a medical necessity, that many experts including  national pediatric associations do not recommend it, that there are risks such as bleeding and infection which can be significant in rare instances, and that currently the majority of male infants are not circumcised. Also, physicians should be aware that they are not required to accept the parents' request for routine circumcision if they are personally unable or unwilling to perform the procedure. Such requests should be referred to others in those situations.

It is Council's opinion that the requests for this procedure will decrease through the natural evolution of public and medical opinion. As a uniquely North American cultural trend in the absence of medical indications, (except for requests based upon religious beliefs) routine infant circumcision will likely become an uncommon procedure.

This bulletin is forwarded to every practitioner registered with the College. Decisions of the College on matters of standards, policies and guidelines are published in this bulletin. The College therefore assumes that each practitioner is aware of these matters.

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