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CommonHealth: A New Policy Cites Benefits Of Infant Circumcision

In this photo provided by the University of Colorado Hospital, Katie Medley holds her newborn son Hugo Jackson Medley at the hospital in Aurora, Colo. in July. (AP/University of Colorado Hospital)

In this photo provided by the University of Colorado Hospital, Katie Medley holds her newborn son Hugo Jackson Medley at the hospital in Aurora, Colo. in July. (AP/University of Colorado Hospital)

In their updated policy statement released on Monday, the American Academy of Pediatrics stated that the health benefits of circumcision outweigh the risks of the procedure.

The AAP press release outlined the known benefits of infant circumcision:

According to a systematic and critical review of the scientific literature, the health benefits of circumcision include lower risks of acquiring HIV, genital herpes, human papilloma virus and syphilis. Circumcision also lowers the risk of penile cancer over a lifetime; reduces the risk of cervical cancer in sexual partners, and lowers the risk of urinary tract infections in the first year of life.

Despite their new statement, the AAP acknowledged that parents’ decision to circumcise isn’t so cut and dry:

Parents ultimately should decide whether circumcision is in the best interests of their male child. They will need to weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices. The medical benefits alone may not outweigh these other considerations for individual families.

The AAP’s revised stance on circumcision touched off a new round of debate around the procedure, leaving parents possibly more confused about what’s best for their boys.

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Rachel Zimmerman explained the nuanced shift in the American Academy of Pediatrics’ stance on circumcision:

Back in 1999, the AAP had issued their earlier recommendations on circumcision – basically it was neutral. So what they did on Monday was come back to this issue and basically say the health benefits outweigh the risks. They say that the health benefits, for instance, decreased number of urinary tract infections, penile cancer, lower rates of transmission of some sexually transmitted infections (notably HIV) justify circumcision, but they can’t recommend that for all babies. The bottom line is that parents should decide for themselves what’s best for their children.

Zimmerman also noted the AAP’s stance could affect whether insurance covers circumcision:

They say the health benefits are enough to warrant insurance coverage for the procedure, which they had not stated in the earlier recommendations, so that’s a big difference. Government insurance, Medicaid, had also used the lack of AAP backing for this procedure as a justification for not covering the procedure in certain states.

About half of infant boys in the United States are circumcised, but that percentage was much higher a generation ago. Dr. Wang gave a few reasons for that decline:

That estimate comes from the Centers for Disease Control and Prevention, which is based primarily on hospital circumcisions done, so it possibly underestimates the total number of circumcisions done in the United States. But certainly that is a steady decline and a much smaller percentage compared to 40 years ago — and even 50 years ago — when the circumcision rate was probably up to about almost 100%. A lot of that downward shift has to do with some interesting cultural and historical changes over the time. But it also has a lot to do with research that’s been coming in over the course of the last 20 or 30 years or so that casts doubt on the significant health benefits of circumcision. They basically have shown — on the whole — boys who are circumcised really aren’t that much healthier than boys who are uncircumcised.

There have been some studies examining circumcision and HIV, and these have played a key role in informing policy recommendations, Dr. Wang explained:

The game changer happened about five or six years ago with clinical trials done in sub-Saharan Africa where they took uncircumcised adult men and gave them the opportunity to have the circumcision. When they followed those men through time, they found that those particular men had a 50% reduction in acquiring HIV compared to men who were uncircumcised. Those things have sort of tilted the balance towards being able to say there is a more significant health benefit that parents should be aware of.

The studies conducted were in an entirely different context compared to the United States. Are the results therefore applicable to the American context?

That is why you’ve seen such a delay from that onset of those studies to this current set of recommendations from the AAP. How do you justify adult men in a third world country where HIV is that much more prevalent versus newborns in developed countries where HIV is not so prevalent? I think that’s the difficulty in being able to make a full recommendation saying that circumcision could potentially prevent HIV. I think people are afraid to make that connection because we haven’t really done those studies yet — in looking at newborns in particular.

Zimmerman points out the nature of the circumcision controversy:

Let’s not forget what this is about: This is involving pain and a newborn and cutting the foreskin of the penis – it’s a serious choice you have to make as a parent.

Dr. Wang reflected on how the new AAP policy statement will modify his approach to talking with patients:

Up until yesterday, I had the same mantra that I go through with parents. And now, today, I have to sort of finagle that and add the caveat, “Well, you know what, there is a little bit more health benefit, so we are kind of encouraging it — but the decision is still yours. And I still want you to think more about family health, social and religious reasons to balance all of that together for your decision for wanting or not wanting it.”

At the end of the day, Dr. Wang reminded us that it’s all about making an informed decision, weighing the benefits and the risks:

Let’s not forget this is a surgery. This is not a procedure without risk. So all the things we associate with surgery — things like bleeding and infection and, in this particular case, damage to the area you’re cutting into, damage to the penis — are always going to be possible. And that’s what I impart to the parents…“Yeah, there could be benefits to circumcision. Let’s also remember there are risks involved, too.”

 


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  • Tobias

    The new policy does not recommend circumcision, please change the headline.  The new policy from the AAP, which is highly flawed and minimizes the short term and long term risks while exaggerating the benefits , states that, in their opinion the risks outweigh the benefits.  Please change your headline, it is misleading and inaccurate.

    • Ksundt

      I hope you find the new headline more clear, Tobias.

      -Kassandra, WBUR Web Producer

      • http://twitter.com/NORM_UK NORM-UK

        It is better, but while there may be “benefits” that is not the same as improving health.

        Health is about wholeness, enjoying normal functions and wellbeing.

        Children may have “benefits” from circumcision, but it doesn’t improve their health.

  • David in Lowell

    I find it odd no one talks about letting the male determine for himself whether he wants a piece of his reproductory organs chopped off for these “health benefits.”  If there were research showing the same reduced risks listed above for the surgical removal of female labia, would doctors recommend it?  Why not recommended standard infant appendectomies?  For an issue as intimate as this, shouldn’t the male make this decision himself?

  • J__o__h__n

    This should be up to the male at age 18. 

    • Call_Me_Missouri

      Men wait until they are 18 to have sex?

      The decision should be made BEFORE the first time they have sex, not after when they might already be contaminated by the diseases the surgery is intended to reduce the risk of.

      • J__o__h__n

        Fine, let them chose at 14 or 16.  Condoms are more effective than circumcision. 

      • http://twitter.com/NORM_UK NORM-UK

        Nobody should be circumcised unless they freely want to at an age when they can understand what they are doing and be free of coercion.  If they want to be circumcised before they have sex, they can be circumcised  after they are 18.

  • J__o__h__n

    Lower risk of acquiring HIV – condomsLower risk of acquiring genital herpes – condomsLower risk of acquiring human pilloma virus – vaccineLower risk of acquiring syphilis – condomsLowers risk of penile cancer over a lifetime – rare cancerReduces the risk of cervical cancer in sexual partners – vaccine & someone shouldn’t be surgically altered for someone else’s benefitLowers the risk of urinary tract infections in the first year of life. – temporary v. permanent mutilation

    • Call_Me_Missouri

      Men are surgically altered for someone else’s benefit all the time…  They call the procedure a Vasectomy.

      • J__o__h__n

        And they choose it themselves and get a benefit.

      • http://twitter.com/NORM_UK NORM-UK

        Done with personal consent.  To perform a vasectomy on a child would be unethical.  To perform a circumcision on a child is unethical too.

  • Mr. Johnson

    Um….did you really have to interview a “Dr. Wang” for this story?  

  • dd

    I’m a 43 year old male. I believe a majority of males in the US are circumcised? I could be wrong? The bottom line is that if you you asked any guy what they would want their penis to look like they would probably say that they want it to look like a circumcised penis. That’s it! Women shouldn’t have an opinion on this. They are not the ones who are going to be made fun of in the high school showers over what their penis looks like. You are not addressing what should be a very important part of the conversation. What do guys want their penis to look like!

    • J__o__h__n

      Not everyone values being a sheep. 

    • http://twitter.com/NORM_UK NORM-UK

      Lots of men resent circumcision forced on them in childhood.  Many don’t and no doubt many more haven’t event thought about it.

      We don’t know what percentage of men recent it, but everyone should have the opportunity to decide for themselves, not have it forced on them when they are too young to say no and too small to fight back.

  • TLCTugger

    Hundreds of thousands of men are enduring a tedious multi-year process of non-surgical foreskin restoration to undo just some of the sexual damage of circumcision.  

    Foreskin feels REALLY good.  HIS body, HIS decision.  

    If parents are as the story says “bewildered” about what to do, it would certainly be prudent to NOT perform an irreversible amputation which could just as easily wait until the boy can make a rational informed choice.  

  • http://www.facebook.com/richard.scalper Richard Scalper

    They brand men like a herd of cows. American men are such wimps to let their sons be subjected to this absurd surgery. If it were women tied down & cut, the Feminists would be howling all over the world. The male genitals are a cheap commodity. There is no argument too absurd for the circumcisers. They insult the appearance of the intact penis, claim that circumcision heals everything from body warts to HIV, and draw an illogical distinction between female & male genitals. Circumcision is the mark of a slave, my friends.
    Top Ten Tortures Less Painful Than Circumcision 10. Get knocked out by Mohammed Ali. 9. Pull out your fingernails. 8. Eat a pile of steaming bear crap. 7. Skin yourself alive. 6. Fall into a vat of molten iron. 5. Get run over by a train. 4. Go through a sausage grinder. 3. Saw off your legs. 2. Poke out your eyes. 1. Go To Hell
    ~Dick-Scalper

  • TLCTugger

    The AAP completely ignored the functions and benefits of HAVING a whole normal penis like most of the world (who incidentally DO NOT suffer the ills the AAP is hawking) in their unethical calculus.  

    I’d bet $100 there was not a foreskin in the room among the policy writers.  They are simply blind to the possibility that foreskin feels REALLY good.  

  • http://twitter.com/NORM_UK NORM-UK

    The AAP report completely misrepresented their own policy on informed consent (ref 9 to the policy).  That policy does not support a broad lattitude of parents to decide what happens to their children, rather states that “proxy consent is problematic” and children should receive “competent medical care based on what the child needs, not what someone else expresses”.

    Children are human beings with rights.   That includes a right to autonomy and that right is denied by circumcision without therapeutic need or personal consent.

    Even if AAP is right about the miriads of benefits which exceeds the risks, it remains unethical to remove a normal body part.  Unless it can be justified that removing normal body parts from healthy children is acceptable, then any discussion of benefits and risks is irrelevant.  AAP have not made that case.

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