AAP and Circumcision: What’s a Parent to Think?


The American Academy of Pediatrics (AAP) issued a new policy statement on the medical circumcision of infants today. A multi-disciplinary work group was created in 2007 to update the AAP’s recommendation and their statement has long been anticipated.


The new policy claims that the benefits of infant circumcision outweigh the risks, but falls just short of recommending the procedure. Instead, the AAP leaves the decision up the parents, as it has done since 1989. A survey of AAP members found that parents do not seek their pediatrician’s recommendation about the procedure, but instead are more influenced by family and sociocultural influences.




One of the sociocultural influences the AAP may be referring to is the overall declining rate of circumcision worldwide. In Europe, for example, only about 10% of men are circumcised, and those mostly for religious reasons.


The social acceptance of circumcision is less in Europe than in the US. In a recent German case, for example, the court ruled that circumcision constituted an act of inflicting bodily harm, comparing it to female genital mutilation, widely banned in Europe. Several regions of Switzerland and Austria have made it illegal to perform circumcisions, and Scandinavian countries are considering doing the same.


Circumcision is on the decline in the US as well. According to the National Inpatient Sample (NIS), 57% of male newborns born in hospitals were circumcised from 1998 to 2005. In the Western states, the rate has dropped to 30%. Along with this decline, has come a parallel decline in insurance coverage for the procedure; increasingly, circumcision is looked upon as elective.




2011 study found that insurance coverage for circumcision varies. Private insurance provides far broader coverage than do Medicaid programs. In fact, Medicaid programs in 17 states do not cover circumcision at all and circumcision rates fall when a procedure is not covered by Medicaid


Sixty-one percent of circumcisions are paid for by private insurance; 36% are paid for by Medicaid, and 3% are paid for by parents—at a cost of between $250 and $500. As a result of the cost, parents covered by private insurance are 2.5 times more likely to choose circumcision than parents who pay for it themselves.


Insurance coverage for circumcision is a significant cornerstone of the new AAP circumcision policy, and one of the few substantive changes from past policies: “The preventive and public health benefits associated with newborn male circumcision warrant third-party reimbursement of the procedure.”


According to the new AAP statement, the “preventive and public health benefits” “…include significant reductions in the risk of urinary tract infection in the first year of life and, subsequently, in the risk of heterosexual acquisition of HIV and the transmission of other sexually transmitted infections.”




A 2005 meta-analysis estimated the risks of circumcision to include haemorrhage and infection and to occur at a rate of about 2% of circumcisions. According to the analysis, urinary tract infections occur in “normal boys” at a rate of about 1%, but at a much higher rate among high risk boys. The analysis concludes, “Assuming equal utility of benefits and harms, net clinical benefit is likely only in boys at high risk of UTI.”




In 2012, there were 1,570 new cases of penile (and other genital) cancer in the US. Like UTIs, the risk of penile cancer in the US is 1%, or 1 in 100,000. According to the National Cancer Institute, some, but not all, observational studies suggest that newborn male circumcision is associated with a decreased risk of penile cancer. However, when diagnosed early, penile cancer is highly curable.




A new study, conveniently released the week before the publication of the new AAP circumcision statement, claims huge increases in future health care costs from the treatment of STDs if the rate of US circumcision falls to the European level. However, the study assumes that newborn circumcision prevents STDs and this has not been proven.


The studies that support a correlation between circumcision and a reduction in STDs, have been done among adult African men. It is unclear if the benefits of circumcision would be the same in newborn babies as they are in adult men. In addition, the African studies only show efficacy for penile-vaginal sex, not the primary mode of HIV sexual transmission in the US.


The CDC is more cautious than the AAP in response to these African HIV studies and suggests the possible benefit of circumcision for men in similar settings, not babies: “Accordingly, male circumcision, together with other prevention interventions, could play an important role in HIV prevention in settings similar to those of the clinical trials.”




2000 study examined the records of 354,297 boys born in Washington state hospitals from 1987 to 1996 and found that there was a complication in one of every 476 circumcisions, the most common being intraoperative bleeding and damage to the penis. According to the study’s author, Dr. Dimitri Christakis, ”Now, I can tell parents that one in 500 circumcised children may suffer a complication, and one in 100 children may derive a benefit. But people will weigh that differently. However, the vast majority of children will gain no medical benefit nor suffer any complication as a result of circumcision.”


In addition to the risks of bleeding, infection and disfigurement. is the risk of loss of penile sensation. According to pediatrician Paul Fleiss, MD, “Circumcision desensitizes the penis radically.”




While the new AAP policy on circumcision addresses anaesthesia, informed consent, and ethics in new ways, its primary purpose appears to be to ensure continued insurance reimbursement for circumcision, for without it circumcision in the US will continue to plummet as it did in England when coverage was withdrawn. Circumcision is the most common childhood surgery in the US and revenues from the procedure are in the hundreds of millions of dollars. In addition to revenue from the procedure itself, private hospitals sell infant foreskins for use in bio-tech research and cosmetic preparations.


It’s important to remember that nothing has really changed. The AAP still does not recommend circumcision and it never has. The AAP recommends breastfeeding, Vitamin D for babies, and no TV for toddlers, but not circumcision. Apparently, though the benefits of circumcision might outweigh the risks, the benefits are not compelling enough to actually recommend the procedure, only its reimbursement.


As parents we have to ask ourselves hard ethical questions about circumcision. If we are looking at the question from a religious perspective, our introspection will be personal and private. If we are looking at it from a medical perspective, we will have to weigh possible future benefits for our son—providing he is heterosexual, at high-risk for UTIs, and slow to seek medical care—against certain present risk.


Think it over. Regardless of your decision, someday you will have to explain it to your son.


Peggy O’Mara  (101 Posts)Peggy O’Mara founded Mothering.com in 1995 and is currently its editor-in chief. She was the editor and publisher of Mothering Magazine from 1980 to 2011. The author of Having a Baby Naturally; Natural Family Living; The Way Back Home; and A Quiet Place, Peggy has lectured and conducted workshops at Omega Institute, Esalen, La Leche League International, and Bioneers. She is the mother of four.


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53 thoughts on “AAP and Circumcision: What’s a Parent to Think?”

  1. Just a quick request (as I agree with Peggy on the content of the blog post)…would you mind changing the photo or at least warning people that when they click through that there will be a photo of a baby being circumcised? My imagination is more than good enough–I don’t need a relatively traumatic visual to go with the article.

  2. ‘wishin’&hopin’, I witnessed my both of my son’s circs in person. The pic you find distressing is barely showing anything – no blood, just a crying baby and tools. Nothing compared to what I saw done to my second son. He was given anaesthesia, which must not have worked, the cutting went around and around while he screamed himself hoarse and then threw up violently afterwards, and then could not be calmed enough to nurse. (The first son had a simple snip which he slept through!)

    I will live with my regret over both of their circs till my dying day, and my sons will have to live with their surgically altered bodies till their dying day. My husband wanted them to ‘look like everyone else, look like daddy’. Now I realize how stupid and superficial that idea was.

    I do NOT look forward to the day I have to talk to my sons about what we (all) decided to do to them when they were defenseless infants.

  3. I appreciate this article in its impartiality (for the most part). Thank you for commenting on the facts and not attempting to illicit an emotional response to convince parents one way or the other. It is distressing to see that in most cases, when researching this topic, too many people are so far convinced one way or the other, that the information is not presented in a objective manner. This is extremely distressing to me as I prefer sound, solid arguments when I research topics such as this.

  4. I agree. My stomach is upset. I realize that the photo is probably placed for shock value. However, I think anyone reading Mothering magazine is probably reading with an open-mind. Although there is an emotional piece wrapped up in circumcision, it is not relevant to the facts of the article. Thank you.

  5. My older son is intact. He now has a stepbrother the same age. When my husband and I were having a heated discussion about whether or not to circumsize our baby when he was born, the older boys started asking questions. We were very open with them.

    The concensus of the boys was that we should not alter their baby brother, and that doing so to “look his dad” would be “stupid.” Neither boy remembers ever seeing their dad’s penis, and probably would have simply thought it look different by virtue of being a grown man’s, and hairy. The conversation ended with my preteen stepson asking his dad why he was “mean enough” to have the procedure done to him. “Why couldn’t you have left mine alone too?”

    In the end we chose to circumsize our newborn, as my husband researched it and felt very strongly. I think parents need to be informed and thoughtful.

  6. I cannot help but wonder when reading about circumcision why it is no one talks about some of the negative effects of circumcision? What about the loss of sensitivity for the man during sex? What about the callous that has to develop over the glans to protect the very sensitive membrane covering the head of the penis? What about the job of the foreskin to maintain lubrication of the glans and allow free movement of the penile shaft during sexual intercourse? What about skin bridges and/or scarring that causes the penis to bend during erection to the right or to the left? Why does no one ever talk about that?…

  7. I agree completely! While researching circumcision I found the same to be true. Most websites and/or documents were either for or against it and presented info as such.

  8. I am aware that this picture is “tame” (I’ve attended a bris and seen a variety of surgical procedures), but do feel that folks should be aware when they “click” that they will be seeing a photo of a screaming baby experiencing a circ…in the forums most folk are kind enough to alert others that what they are writing may be “triggering”, I wish this blog post had the same warning.

  9. Agreed. …and how about the affect this has on a circumscribed man’s partner and their sexual relationship? Yes, these facts are important too.

  10. We have two boys, both of whom are circumcised. My husband and I talked about it very earnestly when we were pregnant with our first, read all the research, and made our decision based on what we consider to be an educated and thoughtful study of the matter.

    Because the research is so benign on both sides every one needs to remember that is is a personal decision made by the parents and should be respected as such. I don’t judge my friends who don’t circumcise their children but because it’s so trendy right now not to do it I have had quite a few associates accuse me of things like “genital mutilation”, “child abuse” and other extremely offensive things. I don’t know any grown circumcised men who hold long lasting resentful towards their parents for snipping the tip. I doubt my boys will ever really think about it. In my book it’s on par with something like ear piercing. I probably wouldn’t pierce my infant daughter’s ears but I don’t care if other people want to do it to theirs.

  11. A story about babies being circumcised should be illustrated with a picture of a baby being circumcised – close up and in detail would be even better. Enough of these bananas, Egyptian papyri, babies’ feet, and kitchen utensils! If they could be illustrated with videos of babies being circumcised – there are plenty on YouTube – the rate of circumcision would plummet.

  12. That’s the annual risk. The lifetime risk is well under 1 in 1000 or 0.1%, meaning even if it was 100% protective – and it isn’t – that’s 999 circumcisions, with all their risks and harm, wasted.

  13. To this day bonafide peer-reviewed medical research has not clearly proved that routine circumcision of newborns signifcantly prevents disease ( definitely not enough to actually recommend this surgery on a routine basis; the AAP still does not recommend it).

    If there are diseases there are doctors who observe that these can in many cases be treated equally well by antibiotics. Eye infection, nose bleed and hangnail can readily be prevented by removing those body parts but why would someone do that?

    Some very renowned doctors have argued effectively that the human foreskin may serve healthy immunological and sexual functions to the male and that cutting it off is counterproductive in the maintenance of health. Bottom line is that most of the world’s boys are left intact with no detriment to health because of it.

    In the view of some, this is a cultural issue and not a health one. Personal decision means the baby and he does not want it done for obvious reasons; there are no really sound reasons on why it should be done on a routine basis without clear medical indication.

    It is difficult for many people around the world to understand why it should be done on a routine basis given the pain and trauma involved to the neonate apparent in the photo. It is puzzling for many people to contemplate and seems counterintuitive.

  14. I have to say, I have heard the “ear piercing” argument a few times before– and,while I too would never pierce someone’s ears (ie a child) until they were ready to make their own decision about it, ear piercing is NOT to be compared to cutting off a piece of your child’s anatomy without their consent. I myself didn’t get my ears pierced until I was in my 20’s and remember a slight prick, not a gut-wrenching pain that may have caused me to not be able to eat, throw up, etc. I also stopped wearing earings and my holes closed up, as though it had never happened! Cutting a newborn and piercing one’s ears like comparing is apples and oranges.

    I also would like to say that as a parent educator/teacher of young children, circumcsion is often discussed and I have had conversations with men who ARE upset with their parents for “snipping the tip” (or cutting part of their body off, as I see it) There have been very difficult conversation about this. If you do the research, you will actually find many support groups out there.

  15. Then allow me to introduce myself, Robynn. I’m a grown man who STRONGLY resents his parents for having circumcised him. There are many of us out there, who feel sexually violated because of this. Most of us speak out anonymously online because we’re afraid of being shamed in public. The “snip” you talk about ends up being 6 square inches of erogenous, specialized tissue, nearly 50% of the skin on the human penis. People who cut their sons should be aware they made a terrible, terrible mistake. It needs to stop. Now.

  16. Robynn most men will not talk about what has happened to us. I for one, am beyond mad at being cut and have been since I found out I was cut! Imagine, being a boy and finding out that someone cut your penis! As a father, I could never do something so drastic to my son (and he is intact)

  17. Robynn most men will not talk about what has happened to us. I for one, am beyond mad at being cut and have been since I found out I was cut! Imagine, being a boy and finding out that someone cut your penis! As a father, I could never do something so drastic to my son (and he is intact). What gives a parent the right to surgically remove a body part for no medical reason? I don’t understand the thinking in this country that it’s a parents right! It makes me want to throw up! And yes, I have suffered greatly from my botch circumcision. How would you feel if you tore and bleed when sexual aroused?

  18. Peggy, You and I were among the very first people to work at getting this concern out in the open with Mothering Magazine back in the ’80’s. You published articles written by me and so many others and put me in touch with countless people to help start this grassroots movement. None of this would have ever gotten off the ground without your help. The avalanche of voices coming through in protest is absolutely amazing. Most are people that I’ve never met or heard from. Many were probably not even born yet when we began our activism. You and I can see it from a “Grandmothering” position now. Ironically, the AAP’s highly biased statement just might be the best thing that has happened to the intactivist movement. It is causing countless people to coalesce and work harder to reach the hearts and minds of so many. Keep up the good work. All 6 of my kids are grown now and I am a grandmother (all granddaughters so far!), but I haven’t forgotten you or our work together. Love, Rosemary

  19. Mothering has been a pioneer indeed on bring this issue to the awareness of people. There is still so much education to do. So very few people in America understand the function and anatomy of the foreskin. Doctors and nurses don’t learn it in medical school. Kids don’t learn it in health and sex ed or from their parents, magazines, books, porn or other kids. If you don’t understand it’s function, you can’t know it’s value. Here is something I wrote about this after a decade of activism, much of http://www.drmomma.org/2012/08/the-aap-2012-circumcision-policy.htmlit face to face with the general public.

  20. Oops, any way you can fix the formatting of the link? I didn’t mean for it to be in the middle of my last sentence. Thanks.

  21. Peggy and all of us would MUCH rather not have the pic, but I see it far from shock value as reality check. Time and again religious circumcisers and doctors and religious midwives have told me and radio audiences that baby feels NO pain and is happy and sucking his soother after mere seconds.

    Most importantly this picture shows how babies speak (ie with their little voices and their little faces) and the time for their silence is over!

  22. Wow guys…

    When my husband and I make decisions for our children we go off of what science and facts tell us. We don’t consider any soft science, opinion, popular trends, scare tactics, or alarmism. We go off science. And in this case the data are completely split. Again…the data is split right down the middle. As this AAP study shows there are scientifically proven benefits in favor of circumcisions. I’m sure parent’s who choose not to circumcise have found just as many compelling reasons not to have it done. The science on this one goes both ways. You can link to a hundred reasons not to do it and I can link to a hundred reasons to do it.

    As parents we are called upon daily to make split second decisions in behalf of our children. Last night my 3 year old woke up with a 102 fever and was vomiting and shaking. I had to decide on the spot what medications he needed, whether or not he needed to go to the hospital, if he needed to be chilled or warmed, etc. All of these decisions have a lasting affect on his overall well being and as responsible parents we have to make these types of educated choices every day.

    Keep emotion and rhetoric out of this discussion. Base your opinions on science, love, and reason. Respect other’s decisions. I can tell this website, however, is not particularly interested in facts, rather spreading a one-sided opinion that is based on SOME facts, but not all of them.

  23. Nowhere in the AAP’s statement do they even address the impact circumcision has on sexual function. A very convenient oversight when weighing the “risks vs benefits,” don’t you think?

  24. Viewing a photos of root canal or appendix surgery wouldn’t be pleasant either. But I doubt those procedures would plummet as a result of viewing them.

  25. If you cut off your sons hands and/or lips and tongue, then he might not have acquired the infection that gave him a fever and vomiting, since most viruses are transmitted through hand-to-mouth contact. What were you thinking to have overlooked this important preventative health measure? Oh wait, this sounds stupid. Just as you waited until he was actually ill to administer treatment, we do not remove healthy, normal, functional body parts to prevent infections that may never be an issue for our children. Any medical issue that circumcision can supposedly prevent or treat can already be prevented or treated in much more effective and less invasive ways- condoms and proper care of the intact penis.

  26. Comparing a foreskin to a root canal or an inflamed appendix is hardly fair… there is nothing inherently sickly or diseased with a foreskin, or an appendix for that matter… but we don’t go around doing major surgery to remove an appendix unless it’s causing problems.

  27. Oh C, your story is so disturbing to me on so many levels, reading it has bothered me all day today. You already had an intact boy and were having a “heated discussion” with your husband, so it seems you didn’t want to circumcise your baby. I’m sorry that you couldn’t protect him. Both of your older sons didn’t want their new brother “altered”, and yet in the end their voices didn’t matter. How awful that his older son’s feelings were disregarded. So in the end your husband chose to circumcise your newborn so he wouldn’t have to admit that maybe it shouldn’t have been done to him…or to his older son. How very very sad.

  28. I am sorry but imo the photo should stay. If you cannot look at that, then you should rethink circ’ing your son (not you, a general you).

    Too many women are handing their children over and ignoring what is actually happening. This picture is what happens, it should stay.

  29. The research is not benign in the countries that do not advocate RIC.

    As an English native I am horrified that RIC happens here. The rest of the world does not circ because there are no health benefits proved to recommend to do so. Look outside of the USA.

  30. The data is not split – look at the European men. They are perfectly healthy. The hard science is there, if you really want to look.

  31. When I was expecting my son, his father’s family (especially his dad & brothers) tried to bully me into having him circumcised so he would “look like everyone else.” I’m so happy I told them I wouldn’t pay ANYONE to cut on my son’s body. When he is older, if he decides he wants it, good for him, but for now, I am glad he is intact.

  32. Why is the foreskin there? what is its purpose? These facts are left out of the American decision because most people in America have never seen a normal penis and think it is normal to circumcise children. This is exactly what happens in cultures which circumcise females. It is not emotive to say tat cutting the end of a childs penis off is child abuse is a fact.

  33. You’re absolutely right, they wouldn’t – because unlike circumcision, they are necessary. Does the American Academy of Denistry set up a Task Force on Root Canal Surgery to set forth a policy that the benefits outweigh the risks but in the end it’s a patient’s (or parents’) choice? No, they only do root canal when they absolutely HAVE to do root canal.

    Thank you for underlining my point so well.

  34. Let’s remember that the AAP is the same organisation that endorsed a mild form of female circumcision for girls a couple years ago. (see for example http://www.nytimes.com/2010/05/07/health/policy/07cuts.html or just Google. The AAP is not high on my list of trustworthy organisations anymore.

    It’s not just intactivists who are against circ. Every industrialised country other than the US has done proper scientific studies and rejected both male and female circumcision. Male circumcision is now banned in Australian public hospitals and never caught on in the first place in Europe.

    If there were any truth to what the AAP is saying you would expect to see higher rates of HIV, other STDs, cancer etc etc in Europe,Scandinavia England, Australia etc where circumcision is below 10% and often below 1%. But we don’t. US STD, cancer rates etc are slightly higher than in other industrialised countries. In short there is no benefit to circumcision but there are a lot of risks and disadvantages. For a response to the AAP’s nonsense see: http://www.beyondthebris.com/2012/08/circumcision-resource-center-responds.html

    http://www.beyondthebris.com/2012/08/circumcision-resource-center-responds.html which by the way is run by an intelligent and attractive female Jewish lawyer who supports the Bris Shalom (an alternative Jewish ceremony where the boy is welcomed into the Jewish community, receives his name but keeps his foreskin.)

  35. C, The mind boggles at your logic and inhumanity. You had a family discussion whereby your kids told you the circumcision is stupid and your son openly questioned why you cut part of his penis off, and you went ahead and ignored your gut, your kids and common sense and went ahead and paid a stranger to cut off part of your baby’s penis. SMH I hope people like you stop breeding, its making the rest of us look bad.

  36. Not to mention with a root canal, no one has yet suggested doing them on newborn infants “just in case”. (which would be REALLY odd seeing as they haven’t had even one tooth yet)

    A better example would be the appendix or tonsils. Medical science has discovered that until a problem arises with either of these areas that medication or early intervention can’t cure or treat, they should be left alone.

  37. Circumcision to lower the risk of HIV/STDs? Babies aren’t having sex. When your son decides to become sexually active, he can exercise good judgement and use a condom. Even circumcision campaigns in Africa state that circumcised men must still wear condoms.

    Circumcision to prevent penile cancer? Babies don’t get penile cancer. It rarely affects men younger than 50. In fact, most men don’t. 50% of penile cancer cases are caused by HPV, an STD that can be prevented by safe sex practices. A man is more likely to develop breast cancer than penile cancer.

    Circumcision to look like dad? What about tattoos? Piercings? Scars? Hair color? Eye color? Skin color? Should a white man never have a child with a black woman because his son won’t be the same color as him?

    This is no reason in circumcising a healthy infant. Foreskin is not a birth defect. It is totally unethical to remove healthy tissue from a child at parental request.

  38. Having recieved 2 phone calls this week from clients trying to make informed decisions, I welcomed Peggy’s article. In light of the changes in Germany and other countries, it’s very hard to justify the AAP’s position.

  39. Pilar i had the same thought initially, 1% is one in 100 not 1 in 100,000. I think they mean 1% of the population, but not knowing the current population statistics I can’t do the math on that, but that seems to be the logical interpretation.

  40. Forced circumcision of children is most certainly NOT on par with ear piercing. You might be a bit closer if you wish to compare ear piercing with genital piercing or circumcision with cutting the earlobes off, but circumcision has NOTHING to do with ear piercing. But just a bit closer, earlobe piercing is far less painful than genital piercing.

    Robynn you also said, “I don

  41. Cutting normal, healthy, erogenous, genital tissue from infants and children who cannot understand or consent is most certainly NOT “based on science” it is based on a total ignorance of the anatomy and neural function of normal, healthy genitals. Forced genital cutting of children is also done with flagrant disregard for a child’s most basic human rights.

    If anyone is to blame it is the so called “doctor” making false health claims about prevention of urinary tract infections, penile cancer or AIDS. That is called medical fraud and as others have pointed out is entirely false. One only has to look at the male humans of other countries to see that the human penis is NOT defective, is NOT in need of immediate surgical correction at birth.

    The AAP is a business organization protecting its members’ interests, and infant circumcision (as forced genital cutting is euphemistically called) is in the USA a big business.

  42. Nor did the AAP’s statement address partial or total penile destruction, or death of infants from circumcision. Seems to me those “oversights” would pretty much cancel out all the professed “benefits.”

  43. As first time parents, my husband and I I researched this issue a great deal, but at the end of the day what it came down to was my gut feeling to protect my newborn son from any hurt. We chose to keep him intact, despite being the first in our families to do so. I have never regretted my decision.

  44. Everytime I open an intactivst page on the Internet, I make sure that my 4 year old son is not standing behind me. These pictures are aweful and mostly preaching to the choir. While I think that many parents need to see this to understand, a warning should be posted. My facebook feed also shows photos like this, and it is hard for me, it makes me immeditaly want to bust into tears, and makes me sick to my stomach.

  45. In response to Robynn, I would have to sadly say, that there is increasing evidence and recognition, that a LOT of what we call modern science and research is “SOFT”. It appears most studies results can not be replicated, calling into question their validity. Trying to make a decision for one’s child based on current science alone sounds noble, but it is a tragically weak base. Just remember all the studies and research used to support procedures and treatments that turned out to be harmful. History is full of examples, even recent history, as we see the controversy over angioplasty and bypasses. Culture science and medicine are closely intertwined.

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