CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants

Circumcision is the oldest planned operative procedure in the history of the human civilization, but there continues to be a lack of consensus and strong opposing views on whether universal neonatal circumcision should be adopted as a public health measure. The recent American Academy of Pediatrics (AAP) guideline on male circumcision (MC) reversed its prior stand, stating that the “health benefits of newborn male circumcision outweigh the risks,” and justify access to the procedure if the parents so choose.1 This recommendation was primarily based on the impressive results from African trials demonstrating the protective effect of MC against human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). A review of the literature on MC shows evidence of a vehement debate, often clouded by strong personal biases and lack of high-quality evidence. Creation of a guideline specific to the need of Canadian infant males is, therefore, difficult given the level of evidence provided for each potential benefit, the lack of data directly applicable to the Canadian population, the inability to quantify the true complication rate of routine circumcisions accurately, uncertainty about the health benefits of a circumcision compared with other health interventions, the ethical issues and acceptability of a surgical procedure done by parental consent for future benefits, and the costs of training and implementation of any universal neonatal circumcision policy in Canada.