Circumcision benefits outweigh risks, say U.S. pediatricians
Published Monday, August 27, 2012 7:07AM EDT
Last Updated Monday, August 27, 2012 7:16PM EDT
The health benefits of circumcision in newborn boys outweigh the risks, says the American Academy of Pediatrics in its strongest statement yet in favour of the procedure.
In guidelines issued Monday, the influential physicians’ group says the latest scientific evidence shows that circumcision can reduce the risk of urinary tract infections in infants and cut the risk of sexually transmitted diseases, including HIV, syphilis, and human papillomavirus or HPV, which causes cervical cancer in females as well as some oral cancers. As well, the procedure can also reduce the risk of penile cancer, the group said.
Until now, the AAP’s stance on circumcision has been fairly neutral. The American Medical Association also has a neutral policy on circumcision.
This new statement, published in the journal Pediatrics, comes down firmly in favour of the procedure, saying circumcision’s health benefits "justify access to this procedure for families who choose it."
At the same time though, the group doesn’t universally recommend circumcision for all newborn boys, saying the benefits are not great enough, and that parents should make the final call.
“Ultimately, this is a decision that parents will have to make,” Dr. Susan Blank, chair of the task force that authored the AAP policy statement, said in a statement.
“Parents are entitled to medically accurate and non-biased information about circumcision, and they should weigh this medical information in the context of their own religious, ethical and cultural beliefs.”
Circumcision involves removing foreskin at the tip of the penis. The area under the foreskin is thought to sometimes harbour the viruses and bacteria that can cause sexually transmitted diseases as well as the germs that lead to urinary infections.
The doctors’ group says circumcision is safest and offers the most health benefits if performed during the newborn period.
The AAP policy strongly recommends circumcision be performed by trained and competent providers, using sterile techniques and effective pain management.
Since the AAP last issued a policy on circumcision back in 1999, the group has reviewed more than 1,000 scientific articles on the procedure.
It concludes that while the circumcision carries some risks of bleeding and infection, those complications are rare. As well, the procedure does not appear to adversely affect penile sexual function, sensitivity of the penis or sexual satisfaction later in life, the group concludes.
The AAP also said in a policy statement that insurance companies should pay for the procedure, which typically costs around US$250 to $300. Coverage varies among U.S. insurers and several states have stopped Medicaid funding for circumcisions.
In Canada, circumcisions for non-medical reasons are not covered by all provincial and territorial health plans.
According to the World Health Organization, about 30 per cent of the world’s male population, aged 15 and older, are circumcised. Most have had the procedure for religious reasons: 69 per cent of the world’s circumcised men are Muslim, while one per cent belong to the Jewish faith.
Circumcision is a ritual obligation for infant Jewish boys, and a common rite among Muslims.
In the U.S., about half of baby boys undergo circumcision; the rates are thought to be somewhat lower in Canada, though it appears no national agencies track the rates.
The Canadian Paediatric Society has not issued a position statement on newborn circumcision since 1996. At that time, its position was that circumcision of newborns should not be routinely performed.
The AAP’s new guidelines come amid an ongoing debate over whether circumcision is an effective public health measure to prevent sexually transmitted diseases or whether it constitutes genital mutilation.
In Germany, a regional court ruling in June said newborn circumcision amounts to “bodily harm,” though it said older consenting males should have the right to choose the procedure.
That ruling sparked a huge outcry from Jewish and Muslim leaders who said it amounted to religious persecution. The country's parliament later upheld the right to religious circumcision.