Circumcision is a centuries old procedure that has been the subject of intense and passionate debate. The controversy has even divided scientific researchers and doctors alike. Recently, researchers studying newborn male circumcision have uncovered new scientific evidence indicating that the benefits of the procedure appears to outweigh the risks. These findings along with AAP’s (American Academy of Pediatrics) recommendation that the procedure be covered by the insurance industry could have impact profound on our quality of life. Nevertheless, not all physicians or organizations agree with these new conclusions further making the circumcision debate increasingly controversial.
The policy statement and accompanying technical report from the AAP will be published in the September 2012 issue of Pediatrics (published online Monday, Aug. 27). The documents update the previous policy that the AAP published in 1999 and reaffirmed in 2005.
Since the last policy was published, scientific research shows clearer health benefits to the procedure than had previously been demonstrated. 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.
The AAP believes the health benefits are great enough that infant male circumcision should be covered by insurance, which would increase access to the procedure for families who choose it.
“Ultimately, this is a decision that parents will have to make,” said Susan Blank, MD, FAAP, chair of the task force that authored the AAP policy statement and technical report. “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.”
The medical benefits alone may not outweigh other considerations for individual families. The medical data show that the procedure is safest and offers the most health benefits if performed during the newborn period. The AAP policy recommends infant circumcision should be performed by trained and competent providers, using sterile techniques and effective pain management.
The policy has been endorsed by the American College of Obstetricians and Gynecologists (the College). “This information will be helpful for obstetricians who are often the medical providers who counsel parents about circumcision,” said Sabrina Craigo, MD, the College’s liaison to the AAP task force on circumcision. “We support the idea that parents choosing circumcision should have access to the procedure.”
Parents who are considering newborn circumcision should speak with their child’s doctor about the benefits and risks of the procedure, and discuss who will perform the circumcision. “It’s a good idea to have this conversation during pregnancy, and to learn whether your insurance will cover the procedure, so you have time to make the decision,” said Dr. Blank.
Dr. George Denniston, President of the international group, Doctors Opposing Circumcision, questions these new findings. Denniston claims: “This is yet another blatant attempt at ‘medical marketing and upcoding. The AAP is the same organization that tried to introduce genital cutting for Muslim girls in both 1996 and 2010, and was shouted down both times. Those were also lucrative business opportunities.”
“Doctors are finding their livelihoods squeezed by HMO’s and Medicaid restrictions, and are trying to find new sources of income and maintain old ones — this time by scaring young parents –again.”
Says Denniston, “A urinary tract infection bothers only one in 100 infant boys and is easily cured with antibiotics. Even if circumcision helped, statistically it would require 111 circumcisions to prevent one easily treated UTI. Some of those 111 boys would suffer circumcision complications much more serious than a simple UTI.”
Denniston adds, “Penile cancer is the rarest of all male cancers, affecting only one in 100,000 very old men, and circumcision does not fully prevent it. Circumcision of 100,000 males to prevent — maybe — a single case of penile cancer would cost $75-100 million. This is money better spent treating the cancer victim himself. Among the 100,000 circumcisions would be thousands of unavoidable complications further draining medical resources.”
“The only new reason for circumcision the AAP offers is HIV. The seriously flawed HIV ‘studies’ they cite are of adult men in areas of high HIV prevalence in Africa. No one can legitimately claim that circumcision has a protective effect with respect to sexually transmitted infections, including HIV, in the developed world,” says Denniston.
Concludes Denniston, “European medical associations avoid genital tampering and over-treatment, and provide full access to actual medical care for their healthy, natural infants. They would not dare issue a word of this latest AAP policy, which is driven by American physicians’ monetary insecurities, a sense of compulsion, and is only supported by old myths.”
According to Associated Press, Psychologist Ronald Goldman, director of an anti-circumcision group, points out that 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 says medical studies showing benefits are flawed and that the academy’s new position is “out of step” with international opinion on male circumcision.
Controversy over circumcision has ramped up in recent years, highlighted in the U.S. last year when a male circumcision ban almost made the November ballot in San Francisco. A judge eventually ruled such a decision should be a state matter, rather than decided by a city election.
In Cologne, Germany, a court ruled this July that circumcision went against the “fundamental right of the child to bodily integrity,” and should be decided by the child himself once he gets older. The German government is currently working with the German Medical Association to clarify the ruling to ensure religious freedoms.
Clearly, the circumcise debate is far from a consensus, and judging from the passion the subject seems to engender a general agreement is perhaps beyond practicality. There is however, one position that all parties might eventually agree upon; that is, to leave the decision to the parents. Not all dissenters agreed to parental authority in this matter; but chances of achieving any other unity within the circumcision debate have little chance if any.
Contributor D. Chandler