Notat om omskæring af drenge - Sundhedsstyrelsen

FIGURE 2Prevalence of male circumcision, according to self-report; United States, 1999–2004. 5having a medical professional performthis procedure in a clinical settingversus having it performed bya traditional/religious provider ina nonmedical environment.Parents may wish to consider whetherthe benefits of the procedure can beattained in equal measure if the procedureis delayed until the child is ofsufficient age to provide his own informedconsent. These interests includethe medical benefits; the culturaland religious implications of beingcircumcised; and the fact that theprocedure has the least surgical riskand the greatest accumulated healthbenefits if performed during the newbornperiod. Newborn males who arenot circumcised at birth are much lesslikely to elect circumcision in adolescenceor early adulthood. Parents whoare considering deferring circumcisionshould be explicitly informed that circumcisionperformed later in life hasincreased risks and costs. Furthermore,deferral of the procedure alsorequires longer healing time than ifperformed during the newborn periodand requires sexual abstinence duringhealing. Those who are already sexuallyactivebythetimetheyhavetheprocedurelose some opportunities forthe protective benefit against sexuallytransmitted infection (STI) acquisition,including HIV; moreover, there is therisk of acquiring an STI if the individualis sexually active during thehealing process. (See the section entitledSexually Transmitted Diseases,Including HIV.)Finally, there is a moral obligation totake reasonable steps to reduce therisk of harm associated with theperformance of any surgical intervention.These include ensuring thatthe providers who perform circumcisionhave adequate training anddemonstrate competence in performingthe procedure; the provision ofadequate procedural analgesia andpostprocedural pain control; and thatthe risks of infection are minimizedthrough appropriate infection controlmeasures, such as a sterile environmentand sterilized instruments. 14 TheTask Force advises against the practiceof mouth-to-penis contact duringcircumcision, which is part of somereligious practices, because it posesserious infectious risk to the child.TASK FORCE ON MALECIRCUMCISIONCommittee Membership andResearch QuestionsIn December 2007, the AAP formeda multidisciplinary workgroup of AAPmembers and other stakeholders toevaluate the evidence on male circumcisionand update the AAP’s recommendationsin this area. The Task Forceincluded AAP representatives from specialtyareas, including anesthesiology/pain management, bioethics, child healthcare financing, epidemiology, fetusand newborn medicine, infectiousdiseases (including pediatric AIDS),and urology. The Task Force also includedmembers of the AAP Board ofDirectors and liaisons representingthe American Academy of FamilyPhysicians (AAFP), the American Collegeof Obstetricians and Gynecologists(ACOG), and the CDC. The Task Force’sevidence review was supplemented byan independent, AAP-contracted, physicianand doctoral-level epidemiologistwho was also part of the entire evidencereview process.Literature Search OverviewThe Task Force members identifiedthe following topics and questions asrelevant to male circumcision and tobe addressed through a critical reviewof the peer-reviewed literature: What is the current epidemiologyof male circumcision in the UnitedStates? What are the most common proceduresand techniques for newbornmale circumcision? What best supports the parentaldecision-making process regardingcircumcision? What is the association betweenmale circumcision and both morbidityand sexual function/satisfaction? What is the impact of anesthesiaand analgesia? What are the common complicationsand the complication rates associatedwith male circumcision? What workforce issues affect newbornmale circumcision?e760FROM THE AMERICAN ACADEMY OF PEDIATRICSDownloaded from pediatrics.aappublications.org by guest on June 19, 2013