There is no evidence to justify routine circumcision of babies, an influential group of US paediatricians has said in the most detailed study of its kind.

Although circumcision can have some benefits, these are not significant enough to recommend it as a standard procedure for newborns, says the American Academy of Paediatrics.

It also says for the first time that pain relief should be given to children undergoing the operation.

However, it does not advise against the procedure, and says parents should be talked through the pros and cons of circumcision before making a decision.

Resistance

Circumcision is popular for health reasons in the US and Canada, although it is used less in Europe, Asia and South and Central America.

However, there has been growing resistance to increased use of the procedure in recent years.

Opponents say it leaves long-term psychological scars and can reduce sexual pleasure.

Supporters say it cuts the risk of urinary tract infections and penile cancer.

Exact figures are difficult to obtain, but estimates suggest that use of the operation has fallen from 85% of all boys born in the US in the late 1960s to around 60% at the moment.

Review body

The academy, which represents 55,000 doctors in the US and Canada, outlined a policy statement in its journal Paediatrics.

A seven-strong team reviewed medical studies performed since 1989 and produced the statement.

Dr Carole Lannon, a doctor at the University of North Carolina, chaired the team.

She said: "I believe we have gone farther than in the past on two fronts. With the benefit of additional medical research we agree there are potential medical benefits but they are not compelling.

"The academy does not recommend a policy of routine newborn circumcision. We encourage parents to discuss the subject with their paediatrician and make an informed choice."

The second breakthrough was in the recommendation to provide pain relief.

The policy statement mentions research showing that infants suffer pain when the foreskin is removed.

It has been done in the past with little or no anaesthesia.

'It is now an ethical issue'

Ronald Goldman is director of the Circumcision Resource Centre, an anti-circumcision organisation based in Boston.

He said: "I think what that means is the medical debate is over. I think circumcision is now an ethical issue. It challenges us to empathise with newborn infants."

He added that studies "on infants' response to pain clearly demonstrate that it's traumatic and there is evidence that behavioural changes result that are not just temporary".

One such study found that circumcised infants had a much greater response to pain when they were vaccinated at a later date.

He said this was a sign of "post-traumatic stress".

Benefits remain

However, the academy did find there were some benefits linked to circumcision.

For example, uncircumcised males are more likely to develop a urinary tract infection during the first year of life.

And penile cancer rates are three times higher in uncircumcised men.

It added that, as the disease is rare - affecting at most 10 men in a million annually worldwide, any added risk is insignificant.