Newborn male circumcision

Question 1

What is the prevalence of circumcision in Canada?

Answer 1

32%

Question 2

What are the potential risks of neonatal circumcision?

Answer 2

1. Minor bleeding (1.5%)
2. Local infection (minor) (NNH 67)
3. Severe infection (extremely rare)
4. Death from unrecognized bleeding (extremely rare)
5. Unsatisfactory cosmetic results
6. Meatal stenosis (NNH 10-50, <1% when petroleum jelly used)

Question 3

What are the potential benefits of neonatal circumcision?

Answer 3

1. Prevention of phimosis (NNT 67)
2. Decrease in early UTI (NNT 111-125)
3. Decrease in UTI in males with risk factors i.e. anomaly or recurrent infection (NNT 4-6)
4. Decreased acquisition of HIV (NNT 298, 65-1231 depending on population)
5. Decreased acquisition of HSV (NNT 16)
6. Decreased acquisition of HPV (NNT 5)
7. Decreased penile risk (NNT 900- 322 000)
8. Decreased cervical cancer risk in female partners (NNT 90-140)

Question 4

What are the CPS recommendations?

Answer 4

1. The CPS does not recommend the routine circumcision of every newborn male.
2. Physicians and other health care professionals caring for newborns must stay informed about circumcision and assist parents in understanding potential risks and benefits of the procedure.
3. The parents of male newborns must receive the most up-to-date, unbiased and personalized medical information available about neonatal circumcision, so that they can weigh specific risks and benefits of circumcision in the context of their own familial, religious and cultural beliefs.
4. Parents who choose to have their sons circumcised should be referred to a practitioner who is trained in the procedure.
5. Neonatal male circumcisions must be performed by trained practitioners whose skills are up-to-date and strictly adhere to hygienic and analgesic best practices.
6. Close follow-up in the early postcircumcision time period is critical. The parents of circumcised boys must be thoroughly and accurately informed about postprocedural care and possible complications.
7. At the time of hospital discharge, health professionals should ensure that the parents of uncircumcised newborn boys know how to appropriately care for their son’s penis and are aware that the normal foreskin can remain nonretractile until puberty.
8. Quality Canadian data are required to understand the clinical and economic issues involved with neonatal male circumcision, including its potential risks, benefits and costs, in the Canadian context.