New Policy Supports Choice for Male Circumcision

Doctors Say New Studies Show Benefits of the Procedure Outweigh Risks

By Brenda Goodman, MA
WebMD Health News

Reviewed by Hansa D. Bhargava, MD

Aug. 27, 2012 -- The nation's pediatricians are changing their stance on male circumcision, again.

This time, the American Academy of Pediatrics (AAP) says they want parents to know that the benefits of the procedure outweigh its small risks. But they stop short of recommending the surgery, which removes the foreskin of the penis, for every newborn boy.

Instead, the updated policy statement advises parents to weigh the medical information along with ethical, cultural, and religious beliefs when making the decision. The statement is published in the journal Pediatrics.

"I think it's a step in the right direction," says Arleen A. Leibowitz, PhD, a research associate at the University of California, Los Angeles, who studies the public health impacts of circumcision. She was not involved in drafting the new policy.

"This is obviously a personal decision that families make. This is an important step that the academy clarifies where the scientific evidence is and that they do evaluate that the benefits are much stronger than we had previously realized," Leibowitz says.

The American College of Obstetricians and Gynecologists, made up of the doctors most likely to discuss the option of circumcision with parents, are also endorsing this policy.

New Science Supports Shift to Older Position

The new guidelines are something of a course correction for the AAP. Their previous policy, published in 1999, questioned the medical necessity of male circumcision.

"The guidelines at that time suggested that there were few, if any, health benefits associated with circumcision," says Michael Brady, MD, chairman of the department of pediatrics at Nationwide Children's Hospital in Columbus, Ohio.

States looking to slash their Medicaid spending used that policy to deny coverage for the procedure. The result was a steady drop in circumcisions in the U.S. According to the CDC, 63% of newborn boys were circumcised in 1999 compared to 55% in 2010.

"This is a shift in position," says Brady, who was on the task force that updated the guidelines.

The new policy sounds a lot like the AAP's 1989 statement, which for the first time found that male circumcision offered some advantages, particularly protection against urinary tract infections.

"Since that time, there have been some significant additions to the information related to the health benefits of circumcision," Brady says.

Circumcision Cuts Infections, STDs

Studies from Africa and Europe show that circumcision cuts the rate of transmission of sexually transmitted diseases, including HIV, herpes simplex, and human papillomavirus (HPV). Evidence also shows that circumcision reduces the rate of urinary tract infections, especially in the first year of life; reduces the risk of penile cancer; and reduces the risk of cervical cancer in sexual partners.

What's more, a study published last week in the Archives of Pediatrics & Adolescent Medicine estimated that if circumcisions continue to decline to levels seen in Europe, the U.S. could see:

  • A 12% increase in men infected with HIV
  • A 29% increase in men infected with HPV
  • A 19% increase in men infected with herpes simplex
  • A 211% increase in urinary tract infections in infants

The new policy statement also says the benefits of circumcision warrant coverage by third-party payers like Medicaid and insurance companies.

"This is very good news," says Aaron Tobian, MD, PhD, an assistant professor of medicine, pathology, and epidemiology at the Johns Hopkins School of Public Health in Baltimore, Md. Tobian is one of the researchers who estimated the economic consequences of continuing declines in circumcision. He was not involved in drafting the new policy.

"It is important that we remove all barriers to the procedure. This will allow parents to discuss the risks and benefits of the procedure with their physician, and make an informed decision," Tobian says in an email to WebMD.

The risks of circumcision include bleeding and infection. "There are potential health benefits," Brady says. "In situations where parents believe it's in the best interests of their child to be circumcised, we would hope that they aren't denied that opportunity because they can't afford it."

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SOURCES: Circumcision Policy Statement, Pediatrics, Aug. 27, 2012. Arleen A. Leibowitz, PhD, professor emeritus, School of Public Policy, University of California at Los Angeles, Los Angeles. Michael Brady, MD, chairman, department of pediatrics, Nationwide Children's Hospital, Columbus, Ohio. Aaron Tobian, MD, PhD, assistant professor, departments of medicine, pathology, and epidemiology, Johns Hopkins School of Public Health, Baltimore, Md.

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