Current Circumcision Trends and Guidelines

Abstract

Most consensus statements are made after clear consideration of the evidence at hand tempered by local politics. Routine circumcision was the norm in Great Britain, Canada, and the USA until after the Second World War. The early promoters of routine circumcision reflected the state of medicine in the late nineteenth century and were primarily influenced by anecdotal case reports, often of dubious nature. The reports of neonatal deaths from circumcision and the advent of the National Health Service before the end of the 1940s led Great Britain to abandon coverage for routine circumcision. It was more than 20 years later that Canada and Australia followed suit. The United States, for various reasons, took a different path, and following the First World War promoted routine circumcision, with an even stronger position following the Second World War. In 1999, to address the growing question as to the validity of routine circumcision, the AAP issued a policy statement that took the middle of the road, rather than polarized for or against. This policy has been revisited and revised based on new data as it accrues and last reaffirmed in 2005. That is, circumcision confers some medical benefit but not enough to call for its routine application.