links to products available in the Campaign for Genital Integrity .
1999 American Academy of
Pediatrics Task Force Committee Statement on Circumcision
Suggested Guidelines for
Evaluation and Critical Reporting
NOTE: Links with a right-facing blue arrow will take you off this site.
The 1999 American Academy of Pediatrics Task Force Statement on Circumcision is
noteworthy for what it does say, but also for what it does not
say. Here are some critical questions to verify, as well as potential biases to look for in the statement. Links
access relevant support documentation.
View 1999 American Academy of
Pediatrics (AAP) Circumcision Policy.
View NOHARMM's official response.
Read NOHARMM's Critical
Analysis of the 1999 AAP Statement
the 1999 AAP statement acknowledge...?
- existence of non-surgical prophylaxis/treatment alternatives for the
problems that circumcision is alleged to address?
Development and Care:
- the concerns of prominent medical ethicists who consider
non-therapeutic circumcision of healthy children for reasons of social custom a violation of modern medical
ethics, and perhaps the law?
- equal application of ethical standards to both genders? (Example: Removing the
female foreskin/clitoral hood can improve hygiene by reducing smegma buildup, but is
termed "mutilation," while removing the male foreskin is termed a "hygienic
- that circumcision in the U.S. began as a form of
physician-assisted sexual oppression of children; that the social demand for
circumcision was created by the medical profession; and that today's medical community
bears an ethical responsibility to actively discourage the practice?
- the ethical dilemma of physicians performing non-therapeutic surgery, thereby acting as
the agents of social custom?
- the full range and severity of potential outcomes (reduction of penile sensory ability,
gangrene, death, surgical accidents, gender reassignment, etc.), or does it dismiss these
from inclusion in the informed consent process?
- the inherent conflict of interest physicians face when attempting to discourage parents
who demand a non-therapeutic, yet financially profitable, intervention on a vulnerable
- the ethical question of normal tissue (the foreskin) being removed from infants
and either sold or donated to biotissue corporations, which convert the foreskin into
profitable artificial skin products? Foreskins for Sale
- that there is reliable scientific evidence demonstrating that the risk of urinary tract
infection is not caused by the foreskin but by underlying congenital urinary tract
anomalies, a risk that can be effectively reduced by breastfeeding?
- that penile and cervical cancer, as well as sexually transmitted diseases (including
HIV/AIDS), are behavior-based diseases that are more effectively addressed by sexual
health education programs, proper hygiene and condom usage, than by circumcision?
- the advice of the American Cancer
Society, which discouraged the AAP from promoting circumcision as prevention for
- the need for continuing education programs for practicing physicians to update
themselves about the development of the foreskin, so that they discontinue the obsolete
advice to retract a child's foreskin (which can damage the penis and require
- the need for improved education of medical students concerning the unique anatomy,
specialized functions, normal development and proper care of the intact penis, as well as
the ethics of non-therapeutic surgery on unconsenting children?
Human Rights and Legal
- the existence of human rights concerns, as non-therapeutic circumcision of a healthy
child violates basic human rights to physical integrity and self-determination? See
articles on this site by Baer, Chessler and Svoboda.
- that recent legislation protecting the genital integrity of
female minors leaves male children unprotected from violations of their genital integrity
and is being challenged? Details: Zenas Baer,
Attorney (Tel. 218-483-3372)
- that physicians should be advised of the current legal challenges
to male newborn circumcision under International Law and Constitutional principles of
equal rights and non-discrimination?
- the inherent conflict in the AAP's claim to be a child advocacy organization when
its statement asserts an alleged "parental right" to amputate and destroy a
functional part of a child's body?
- that the alleged "parental right" to choose circumcision of a healthy child,
as well as parental "informed consent," are either non-existent or
invalid? (Parents cannot give proxy consent for non-therapeutic surgery on a healthy
Opposing Opinions &
- the circumcision
position statements of Australia, Britain and Canada, all of which advise against
- the existence of, reasons for, and need for support of doctors
and nurses who
conscientiously oppose participation in non-therapeutic circumcisions?
- the objections to circumcision by genital integrity and children's rights advocates as
being based on the fundamental human right to bodily integrity, or does it mischaracterize
the objections as being based only on pain?
- that on those occasions when pain relief is used on infants undergoing circumcision: 1)
EMLA topical anesthetic is contraindicated for
newborns and on genital tissue, and 2) Dorsal Penile Nerve Block uses needles to inject
narcotics into the penis, and the potential for nerve damage manifesting in adolescence or
adulthood has not been adequately assessed on a prospective basis?
- that there is no pain-relief system that totally eliminates the pain of infant
circumcision and that circumcised boys will still suffer pain during and after the
- that the least expensive, most ethical, and only effective way to eliminate infant
circumcision pain is to refuse parental requests/demands for non-therapeutic circumcision?
for hidden bias, undisclosed information, or disinformation (20 questions)
The AAP's candor about the injury that circumcision inflicts will likely be
limited by its need to protect from legal liability its members who still perform
circumcisions or who have performed them in the past.
Does the statement...?
- express concern that imposing a non-therapeutic genital alteration on a child exploits
the child's vulnerability?
- provide a valid explanation for why circumcision cannot be delayed until the child is of
an age to determine for himself whether or not to be circumcised?
- expand upon which parts of a normal, healthy infant's anatomy can be removed with
parental consent? (Example: If parents are counseled about the risks and benefits, can
healthy tonsils be removed with parental consent? Can healthy breast tissue be removed
from male infants, since twice as many U.S. men die from breast cancer (400 annually) as
from penile cancer (220 annually?)
- recognize that the primary motivation for infant circumcision in the U.S. is not
medical, but social and cultural, and if so, does the AAP propose a public education
program to acquaint parents and others with the value of intact genitals and the rights of
the child? Why or why not?
- explain how hospital solicitation for elective, non-therapeutic infant circumcision is
permissible, when solicitation for other elective, non-therapeutic surgeries violates
medical ethics and may constitute medical fraud/malpractice?
- minimize the dangers of circumcision by terming it a "simple" or "the
most common" procedure?
- obscure the prognosis that the overwhelming majority of intact babies will become, as
they do in the rest of the world, happy functional intact men?
- dismiss as "anecdotal," information that could only be obtained anecdotally,
such as male dissatisfaction with an incomplete penis?
- suggest negative psychological ramifications of remaining intact, without recognizing
similar psychological consequences from amputating part of the primary male sexual organ?
- adequately warn doctors and parents of the significant
resentment rate among non-intact (circumcised) males?
- ignore the loss of functional erogenous tissue, which would otherwise be unacceptable in
a female, and presume that damage from male circumcision must be extreme before
recognizing it as "harmful"?
- demonstrate "selective quantification," using unbalanced statistical arguments
for circumcision? (Example: Is a ten-fold increase in urinary tract infections [UTI]
alleged among intact male newborns, without clarifying that less than 1% of intact male
newborns will ever get a UTI, and that infection rates are higher in female newborns?).
Tract Infection and Circumcision. Excellent analysis by a doctor, with easy-to-read
- urge application of equal standards for medical care? (Example: Female children, who get
urinary tract infections at a higher rate than males, receive no preventive intervention,
while males are subjected to surgery. When females get a UTI, they are treated with
antibiotics, to which circumcised and intact males would respond equally well, but more
often than not, intact males are treated surgically with circumcision.)
- evidence gender and cultural bias by discounting comparisons with female circumcision?
(Example: Primitive forms of female circumcision are contrasted with "modern"
forms of male circumcision, without recognizing that the vast majority of male
circumcisions in the world occur under the same rudimentary and unsanitary conditions as
female circumcision, while in some parts of the world less severe forms of female
circumcision are medicalized alongside male circumcision.)
- make vague recommendations ( e.g., that parents should be counseled, without defining
what parents should be told)?
- use only the biased term "uncircumcised," instead of positive terminology such
as normal, natural, whole, complete, or intact? (Example: Do we call someone
"untonsillectomized" or women "unmastecomized?")
- use the euphemism "circumcision," instead of clearer and more accurate terms
such as "amputation of the foreskin," "penile surgery,"
"wound," "scar," etc.
- employ misleading terms such as "prevent" disease, when circumcision cannot
"prevent" any disease? Does it use trivializing terms such as
"discomfort" to describe "excruciating pain."
- employ "apples and oranges" comparisons, such as comparing inherent
short-term risks to potential long-term benefits, while omitting inherent
- discuss only the statistical risks and benefits of circumcision, or does it include the
guaranteed disadvantages, such as: financial cost, permanent disfigurement, keratinization
(leading to sensitivity loss), as well as the loss of erogenous tissue, natural
lubrication, penile bulk, and protection from injury?
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Last updated: 22 February, 2008
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