Circumcision pluses outweigh risks: Pediatricians

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(AP) CHICAGO — The nation's most influential pediatricians group says the health benefits of circumcision in newborn boys outweigh any risks and insurance companies should pay for it.

In its latest policy statement on circumcision, a procedure that has been declining nationwide, the American Academy of Pediatrics moves closer to an endorsement but says the decision should be up to parents.

"It's not a verdict from on high," said policy co-author Dr. Andrew Freedman. "There's not a one-size-fits-all-answer." But from a medical standpoint, circumcision's benefits in reducing risk of disease outweigh its small risks, said Freedman, a pediatric urologist in Los Angeles.

Recent research bolstering evidence that circumcision reduces chances of infection with HIV and other sexually spread diseases, urinary tract infections and penis cancer influenced the academy to update its 13-year-old policy.

The group's old stance said potential medical benefits were not sufficient to warrant recommending routinely circumcising newborn boys. The new one says, "The benefits of newborn male circumcision justify access to this procedure for those families who choose it." The academy also says pain relief stronger than a sugar-coated pacifier is essential, usually an injection to numb the area.

The federal Centers for Disease Control and Prevention has estimated circumcision costs range from about $200 to $600 nationwide. Coverage varies among insurers, and several states have stopped Medicaid funding for circumcisions.

The new policy was published online Monday in the journal Pediatrics. It comes amid ongoing debate over whether circumcision is medically necessary or a cosmetic procedure that critics say amounts to genital mutilation. Activists favoring a circumcision ban made headway in putting it to a vote last year in San Francisco but a judge later knocked the measure off the city ballot, ruling that regulating medical procedures is up to the state, not city officials.

In Germany, Jewish and Muslim leaders have protested a regional court ruling in June that said circumcision amounts to bodily harm.

Meantime, a recent study projected that declining U.S. circumcision rates could add more than $4 billion in health care costs in coming years because of increased illness and infections.

Circumcision involves removing foreskin at the tip of the penis. The procedure can reduce germs that can grow underneath the foreskin, and complications, including bleeding and infection, are rare, the academy says.

Despite the U.S. decline, about half of baby boys nationwide still undergo circumcision, or roughly 1 million each year. The country's overall rate is much higher than in other developed nations, but U.S. rates vary by region and are higher in areas where it is a cultural or religious tradition, including among Jews and Muslims.

Psychologist Ronald Goldman, director of an anti-circumcision group, the Circumcision Resource Center, said studies show circumcision causes loss of sexual satisfaction — a claim the academy said is not supported by the research it reviewed — and can be psychologically harming. Goldman contends medical studies showing benefits are flawed and that the academy's new position is "out of step" with medical groups in other developed countries.

The American Congress of Obstetricians and Gynecologists took part in the research review that led to the new policy and has endorsed it. Circumcisions in hospitals are typically performed by obstetricians or pediatricians.

The CDC also participated in the review, and will consider the academy's updated policy in preparing its own recommendations, a CDC spokesman said. The agency has a fact sheet summarizing circumcision's potential health benefits and risks but no formal guidelines.

The American Medical Association and American Academy of Family Physicians have neutral policies similar to the pediatrics academy's previous position.

Philadelphia social worker Shannon Coyne examined medical research on circumcision before her son was born last September and had a tough time making a decision. She learned that a relative's boy needed reconstructive surgery after a botched circumcision, and that another's son who wasn't circumcised developed urinary infections.

Coyne said she and her husband ultimately decided against circumcision, because she didn't want her baby to have what she considers cosmetic surgery without being able to consent.

Her advice to other parents is "just make an informed decision. Do your research, be open-minded."

Some 18 states have eliminated Medicaid coverage for circumcision, a trend that could contribute to rising health care costs to treat infections if circumcision rates continue to decline, according to a study published Aug. 20 in Archives of Pediatrics & Adolescent Medicine.

Dr. Aaron Tobian, a Johns Hopkins University assistant professor who co-authored the study, said the academy's updated policy "is a very good step."

[JT770]

I believe circumcision should be done if required by faith and not some stupid excuses. For heaven's sake, use anesthetics and do it when the boy is older, as practised by the Muslim. I have a friend who circumcized his boy. We are Orientals and it is not customary for us to circumcize. When I asked the mother why they circumcized their boy, she said that they (the parents) did not want the boy to feel strange or to be made fun of in the boys' shower room in school. We were so shocked and flabbergasted when we heard the excuse. The mother even described their baby boy trembling after the procedure. Duh! How about asking his daddy to cut off his foreskin without anesthetics. The parents are highly educated with masters and PhD. It is just baffling how with such education, they still came up with such silly excuse to circumcize their poor little baby. I am not convinced that circumcision has anything to do with sexually transmitted diseases. I believe it is the lifestyle that is the main cause. If circumcision is really helpful, how is that countries in the Far East have less incidence of AIDS/HIV? See the CIA report: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html

[tom1027]

voxpopulus, hundreds upon hundreds of studies have confirmed the benefits of this procedure... I'm pretty sure most of those who conduct these studies do not actually perform the procedures or have any vested interest in the procedure... Please tell me, what does the CDC or the WHO gain from supporting this procedure?
Please find some other argument to support your biased opinion than "they just want to make more money"

[TomFTobin]

A billion dollars a year, is the estimated spending of Americans on circumcision.
The WHO gains a lot of grant money, and a lot of psychological power.
Sick stuff, cutting healthy babies, no matter what the gender.

[tvwatcher5345]

i'm circumcised, i don't have any sons, but i wish i was the way God originally made me, i think when guys get older they can decide for themselves whether they want something like this done or not...i don't think there'll be a long line of guys once they turn 18 waiting to have this done, which basically proves the point it is a waste of time and money and it is a form of mutilation, but some people still get tatoos and body piercings but they have to be 18

[tom1027]

God didn't "make" you, your parents did. It was their decision to have you, along with countless other decisions they made for themselves and you. Did your mother smoke or drink or take any other drugs or medications? That was her decision. Did you receive any vaccinations? Breast or formula fed? That was their decision. The fact that you even mention God is probably because they decided to raise you religiously. That was their decision. What if you were born with a heart condition that lowered your chance of survival, but could be fixed through surgery? Would you still wish that your parents left you "the way God originally made you"? Would you consider that to be a "form of mutilation"?

The fact that fewer grown ups would choose this once they turn 18 proves nothing.. I'm not really sure how you think that proves circumcision is a waste of time and money and a form of mutilation.. I guess that is your personal belief so you just pick some random assumption and call that proof of your belief? Countless studies PROVE that circumcision is not a waste of money, but actually saves money in the long run. As for the idea that it is "mutilation"? That is a personal opinion. Nothing you or anyone else says or thinks is "proof" that this medical procedure is mutilation.

I don't know you at all, but I really find it hard to believe that you were circumcised. I have never heard of anyone who was circumcised who considers themselves "mutilated" or even wishes that they were not circumcised.

[StevenC87]

I'm also circumcised and wish I wasn't.

[jimpast60]

My only concern in this is the possibility that those whose religions require male circumcision be allowed to practice it. The impact on the baby boy appears to be a non-event, barring that one in ten million chance that something goes wrong (see the comment that a baby boy in the Bronx died last year - that was about 2 million circumcisions ago).

[tlctugger]

One in 10,000 US circumcisions kills an otherwise healthy infant.

Foreskin feels REALLY good. HIS body, HIS decision

[TomFTobin]

You must have missed the LA Times article, entitled Injuries Linked to Circumcision Clamp. The kid's head was removed.
The CDC doesn't keep track of deaths, or injuries. What does that tell you, besides they don't want to know?

[rwsmith29456]

Looks like the stats show that there is more to circumcision than just a religious mutilation rite.

[voxpopulus]

Not that US pediatricians have any vested interests here. Oh no.

[TomFTobin]

Gee, why do Europeans have their foreskins, and seriously lower rates of disease, than Americans?
I guess there isn't much more to it, than a lust for money.

[pbaird2]

Circumcision is logically more healthful than allowing the foreskin to remain; only when the individual is capable of maintaining strict hygiene would the foreskin not be an issue. As for sensitiviy, how can this be evaluated? If you have foreskin how do you know the sensitivity would be lessened? If you have never had foreskin how do you know you have less sensitivity? I am grateful my parents had the progressive foresight to prevent me from a potential problem by having me circumcised; and, as far as I can tell I retained plenty of sensitivity. With all the other health issues to deal with at least this is not one of them.

[JackieNO]

As to the theory that ***** parts should be cut off in order to facilitate hygiene, consider the following comments of a pediatrician. This is certainly a different (and more logical) view of Hygiene:

"My experience as a pediatrician has convinced me that circumcision makes the ***** dirtier, a fact that was confirmed by a study recently published in the British Journal of Urology.1 For at least a week after circumcision, the baby is left with a large open wound that is in almost constant contact with urine and feces--hardly a hygienic advantage. Additionally, throughout life the circumcised ***** is open and exposed to dirt and contaminants of all kinds. The wrinkles and folds that often form around the circumcision scar frequently harbor dirt and germs.

Thanks to the foreskin, the intact ***** is protected from dirt and contamination. While this important protective function is extremely useful while the baby is in diapers, the foreskin provides protection to the glans and urinary opening for a lifetime. At all ages, the foreskin keeps the glans safe, soft, and clean.

Throughout childhood, there is no need to wash underneath the foreskin. Mothers used to be advised to retract the foreskin and wash beneath it every day. This was very bad advice indeed. When the foreskin becomes fully retractable, usually by the end of puberty, your son can retract it and rinse his glans with warm water while he is in the shower."

No one that is at all credible claims there are no functions to the ***** parts cut off. However, the sexual function and pleasure are ignored or downplayed by the ***** parts removal pushers. The long term harm is huge with nerve damage and harm to the sensory system. A whole range of sensation and sexual and protective function are lost. The lips, nipples and fingertips have similar touch sense. To take this away from another person without their consent is heinous.

[tom1027]

JackieNO, well you certainly convinced me.... You were able to fund ONE unnamed pediatrician (assuming you didn't make this all up) who opposes circumcision. Surely, this one unnamed pediatrician you cite knows much more than thousands upon thousands of doctors and medical experts, and surely the ONE study you cite is proof that the hundreds upon hundreds of studies confirming the benefits of circumcision are all wrong...
I'm being sarcastic of course. The truth is, you can find one or two medical hacks that will support any claim you want. But the established medical community accepts that the benefits of circumcision outweigh the risks. Are there risks? Sure there are. But the BENEFITS OUTWEIGH THE RISKS. If you think you (or ONE pediatrician) know better than thousands of doctors and experts and studies, then you are delusional.

[CraigGarrett1]

The AAP is now a disgrace. They are going to be the laughing stock among the international community; this new statement is way out of line with statements from other modern nations with advanced medical systems. The AAP should withdraw this statement immediately.

The foreskin is an important part of male anatomy, and circumcision has serious negative consequences for not only the man, but his female partner as well. Men who were circumcised at birth have never known what a foreskin is like and don't know what they are missing.

The foreskin is erogenous tissue, containing thousands of erogenous fine-touch nerve endings. The most sensitive and pleasurable parts of the ***** are removed by circumcision. These are color-coded diagrams showing the areas of sensitivity for both circumcised and intact anatomy:
http://www.circumstitions.com/Sexuality.html#sorrells

The boy is the one who should be able to choose what happens to his body once he is an adult. Bodily integrity is a fundamental human right. Clearly the AAP doesn't understand that.

This is an excellent video narrated by Dr. Dean Edell, a pediatrician:
http://www.youtube.com/watch?v=h_bEBAdhjGg

[Robegera]

Its a human rights violation. We have the right to to body we are born with. The motivation here is money, shameful. Where was this study conducted? In a fishbowl. Countries without circumcision have lower rates of Prostate cancer than the U.S.
Outweigh the risks? Didn't a baby die in the Bronx last year from a circumcision? I guess what they really mean is that this source of income outweighs the risk of being sued from a wrongful death lawsuit. Get the insurance companies to cover it. That's the pot of gold at the end of the rainbow.
An infant who was just circumcised is not going to sleep for a couple of days, only pass out from the pain. How does that effect his psychological development. The frenelum is very important. What effect does partially or completely destroying it do to a man. Has there ever been a study comparing sexual crimes in countries that circumcise men in comparison to those that don't?
Any complications in childhood is because people are retracting the foreskin when they are not supposed to. It retracts naturally just before puberty. How many doctors involved in this study actually had foreskins?
If an adult chooses to engage in irresponsible sexual behavior with multiple partners then let that adult make the decision to mutilate his ***** or only choose partners with mutilated *******.

It my body, Its my decision.

[totalcrap]

A major point that is being missed about the AAP's updated policy statement is that they are still NOT recommending routine circumcision. All they've said in this update is that the procedure should be covered by insurance if parents choose it for their sons.

If the data their reviewed by taskforce was so overwhelmingly strong in favor of routine circumcision, they would have stated that. But, obviously, the data does not support routine circumcision, which is why the AAP policy, on this important point, has not changed since 1999.

[totalcrap]

Wow...so much unnecessary emotion and vitriol, from BOTH sides.

Here are a few questions I would ask before allowing a guy with a knife (even a trained surgeon) within 10 feet of my child's genitalia:

1. IN THE UNITED STATES (and not Africa), what is the absolute risk (meaning raw numbers like 1 in 200,000) of contracting an STD being 'cut' vs. 'uncut'? (Ditto for UTI's or other infections)

2. IN THE UNITED STATES, what is the absolute risk of injury or complication from a circumcision?

3. How much of the increased STD/UTI risk for being 'uncut' can be eliminated with condoms/proper hygiene?

4. If circumcisions were optional, but considered part of the labor and delivery procedure (meaning, the OB/GYN gets paid the same, circumcision or not) would the existing data lead you to routinely circumcise or not?

When the AAP and the ACOG provide data on these questions, I think many more people will feel comfortable trusting their policy statements.