The health benefits of circumcision outweigh the procedure's risks, and
the operation should be covered by insurance, according to new recommendations
from an influential group of doctors.
The recommendations, released today (Aug. 27) by the American Academy of
Pediatrics (AAP), say the procedure's benefits include reducing the risks of
HIV infection, urinary tract infection and penile cancer. But the AAP also says
the benefits of circumcision are not weighty enough to broadly recommend
circumcision for all male infants.
Instead, "parents ultimately should decide whether circumcision is
in the best interests of their male child," the AAP says. "They will
need to weigh medical information in the context of their own religious,
ethical, and cultural beliefs and practices." The new advice is a shift
from the Academy's previous policy on circumcision, released in 1999. Those
recommendations acknowledged the potential health benefits of circumcision, but
did not did make clear whether the benefits outweighed the risks, and made no
mention of insurance.
The previous policy may have influenced the percentage of infants
circumcised in the United States — in recent years, it has declined — as well
as insurance reimbursement for the procedure, according to the Centers for
Disease Control and Prevention. Although nearly 80 percent of U.S. boys born in
the 1970s and 1980s were circumcised, that number decreased to 62.5 percent in
1999, and 54.7 percent in 2010, according to a recent study. And in recent
years, Medicaid policies in 18 states have stopped covering routine infant
circumcision.
The new statement "demonstrates a consensus that there are clear
medical benefits to circumcision," said Dr. Marty Ellington, Jr., chairman
of the Department of Pediatrics at Lenox Hill Hospital in New York City, who
was not involved in writing the policy.
"Hopefully the trend towards state Medicaid programs not covering
circumcision will be reversed," Ellington said.
Health benefits
For the new policy statement, the AAP reviewed studies on circumcision
conducted between 1995 and 2010. Studies from Africa showed that circumcision
reduces the risk of acquiring HIV by 40 to 60 percent in men, the AAP says.
There is also good evidence to suggest circumcision lowers the risk of human
papillomavirus (HPV) infection, and infection with some strains of genital
herpes.
Circumcision may prevent transmission of some sexually transmitted diseases
because the region beneath the foreskin is "thought to 'trap' pathogens
and bodily secretions, and favor their survival," the AAP says. In
addition, the foreskin itself contains a higher proportion of a type of skin
cell that is thought to ease the entry of HIV into the body. Circumcision has
also been linked with a threefold to 10-fold reduction in the risk of urinary
tract infection in boys age 2 or younger. However, the risk of urinary tract
infection in young boys is less than 1 percent; studies show about 100 boys
would need to be circumcised to prevent one case of urinary tract infection.
Considerations
Acute complications of circumcision, including infection and bleeding,
are rare, and occur in about 1 in every 500 circumcisions, the AAP says.
Circumcision does not appear to affect male sexual function or sexual
sensitivity, the AAP says.
"It is important that clinicians routinely inform parents of the
health benefits and risks of male newborn circumcision in an unbiased and
accurate manner," the policy statement says. Circumcision should only be
performed on healthy infants by trained practitioners, and using effective pain
management, the AAP says.
A study published earlier this week suggested a significant decline in
male circumcision rates could lead to millions of extra dollars yearly in
health care costs, mainly due to increased infections.
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