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Critical Analysis of the
1999 American Academy of Pediatrics
Policy Statement on Infant Circumcision

NOTE: Links with a right-facing blue arrow will take you off this site.

View Blue_ArrowD096.gif (140 bytes)1999 American Academy of Pediatrics (AAP) Circumcision Policy.

Positive Points:



Embryologic and Anatomic Considerations

The AAP Task Force on Circumcision did not discuss the functions of the foreskin. How can a parent make an informed decision about circumcision if they do not know these functions?


It appears that the AAP attempts to inflate circumcision rates. It used a 1970 reference to report a Canadian newborn circumcision rate of 48%. Health & Welfare Canada statistics report that the national Blue_ArrowD096.gif (140 bytes)newborn circumcision rate in Canada today is less than approximately 25%.

The AAP also reported the national newborn circumcision rate in the U.S. to be 64.1%, based on National Center for Health Statistics (NCHS) data from 1995, rather than reporting the lower Blue_ArrowD096.gif (140 bytes)1996 figure of 60.2%, which was readily available at the time that the Task Force met. The AAP faults the NCHS data  as being "based on voluntary collection of data from participating hospitals", which provide "an inadequate sample." The NCHS states that its sample is larger than that mentioned by the AAP and the data are collected from a national probability sample with a 95% participation rate. Also, hospitals often increase their income by billing insurers for circumcisions that were not performed. This too creates the impression that circumcisions are more common than they actually are.

Sexual Practice, Sensation and Circumcision Status

The adverse physical, sexual and psychological effects of infant circumcision on men's health and well-being are dismissed as "anecdotal." This, despite the fact that over 300 men wrote to the AAP in 1997 to describe the harm they've suffered from this surgery they did not choose, as well as the harm findings from over 500 respondents to NOHARMM's survey, which were published in the January 1999 British Journal of Urology.

The AAP cites a seriously flawed 1966 survey by Masters & Johnson to defend the notion that there is no difference in sensation or sexual satisfaction between the circumcised and intact penis.

Urinary Tract Infections

The AAP did not mention an 8-year prospective study by Blue_ArrowD096.gif (140 bytes)Mueller that found little difference in UTI among between circumcised and intact boys and that the common cause in both was abnormalities in the genitourinary tract, not the presence or absence of a foreskin. See also Blue_ArrowD096.gif (140 bytes)Urinary Tract Infection and Circumcision. Excellent analysis by a doctor, with easy-to-read graphs.

Ethical Issues

The 1999 AAP Task Force on Circumcision does not recommend circumcision on medical grounds yet appears to condone doctors acting on parental requests for circumcision for non-medical reasons (i.e., culture, religion, ethnicity). This completely contradicts a key passage of the Blue_ArrowD096.gif (140 bytes)1995 Committee on Bioethics report which states: "(P)roviders have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses."

The AAP indicates that the process of informed consent obligates the physician to "enumerate the risks, benefits and alternatives " for the patient to make an informed choice. Most physicians are not aware of the Blue_ArrowD096.gif (140 bytes)nonsurgical alternatives to circumcision. How can they explain these to parents?

The AAP failed to answer the question of whether it is ethical for physicians to act as the agents of social custom by performing non-therapeutic, culturally-motivated surgeries on unconsenting children.

The AAP failed to indicate that the current U.S. custom of male circumcision was started by the medical community (see: A Short History of Circumcision in the Physicians' Own Words) and therefore the medical community bears a responsibility to actively work for the elimination of physician involvement in non-therapeutic circumcision.


In both 1989 and 1999 the AAP admitted that the exact incidence of complications was unknown. The AAP, like the rest of the medical community, bears a responsibility to parents to investigate what the exact incidence of complications is. An intolerable situation exists where hospitals and doctors do not adequately record these incidents (or they record the cause as something other than circumcision). How can parents be fully informed of these risks if even the AAP does not know and makes no attempt to know?

The AAP seriously underestimates the complication rate at 1%. A more realistic figure estimated by Blue_ArrowD096.gif (140 bytes)Williams and Kapila is 2%-10%, an important study that was never cited by the 1999 AAP Task Force on Circumcision.

The AAP failed to offer guidance on how much of the penis is to be removed during neonatal circumcision:

[Questions originated by Dr. Christopher Cold   Tel: 715-387-9806    E-mail: ]

In general, the AAP has not shown any leadership on this issue for the past 25 years. It has failed to make continuing education programs mandatory for pediatricians on the development, functions and care of the foreskin. The AAP calls for parents to be fully informed, yet fails to sponsor any coherent, consistent, or widespread educational programs for parents to insure that they are fully informed before making this decision.

Blue_ArrowD096.gif (140 bytes)Circumcision Resource Center analysis of the AAP Policy Statement

Blue_ArrowD096.gif (140 bytes)1999 AAP Policy Statement on Circumcision

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Last updated: 22 November, 2013
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