Family Matters

Circumcision: Pediatricians Say Benefits Trump Risks

After years of remaining neutral, the American Academy of Pediatrics has revised its policy statement, saying that the risks of newborn circumcision are outweighed by the health benefits

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The newborn penis has been the subject of more than a little ink lately. San Francisco tried in vain to curtail circumcision. Germany recently ruled that the procedure constitutes “bodily harm.” “Intactivists” rail against circumcision even as most baby boys born in the U.S still get circumcised.

Until now, the American Academy of Pediatrics (AAP) has remained fairly neutral on the subject. But on Monday, the influential pediatricians’ group updated its policy statement from 1999, stating that the “preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure.” The organization stopped short of routinely recommending the procedure for all baby boys, noting that the decision of whether circumcision “is in the best interests of their male child” should be left up to individual families. But they added that those families that choose circumcision — and most U.S. families still do, although the practice has been on the decline — should be reimbursed by insurance.

“There has been a change in tone,” says Dr. Doug Diekema, a member of the AAP task force on circumcision and a pediatrician at Seattle Children’s Hospital. “We are saying that based on our review, male circumcision does have significant health benefits that outweigh the risks of the procedure.”

(MORE: Uncircumcised Boys Have a Higher Risk of UTI)

From 1999 to 2010, the CDC found that between 56% to 59% of newborn boys were circumcised. Circumcision has been on the decline in the U.S., from 63.5% in 1999 to 56.3% in 2008, according to the Agency for Healthcare Research and Quality’s National Inpatient Sample, which is commonly used to track hospital procedures and outcomes.

A recent study in the Archives of Pediatrics & Adolescent Medicine projected a health-care doomsday marked by a steep rise in infections and medical-related spending if circumcision rates continue to fall. Already, Medicaid in 18 states doesn’t cover circumcision, and the study’s author, Dr. Aaron Tobian of Johns Hopkins University, worries that private insurance companies will be quick to follow suit. “[W]ith private insurance carriers following the government’s rules, we are implying there are no medical benefits to this procedure,” he told Healthland earlier this month.

In its updated policy, the AAP makes it clear there are medical upsides to choosing circumcision. Since 1999 when the original policy was written, nearly 1,000 new journal articles on circumcision have been published. More evidence was suggesting that circumcision has a protective effect against human papilloma virus (which, in turn, may lead to fewer HPV infections in women), HIV, genital herpes and even syphilis. It’s also associated with a decrease in urinary tract infections in babies and boys, as well as a reduced risk of penile and prostate cancers.

The risks are mostly limited to bleeding or mild infection; there is no clear evidence that either sexual function or sexual performance are affected.

(MORE: If Circumcision Rates Keep Falling, Health Costs and Infections Will Spike)

The American College of Obstetricians and Gynecologists has endorsed the AAP’s “technical report,” a more in-depth explanation of how the agency reached its decision. That’s significant because obstetricians perform many in-hospital circumcisions. Many Jewish and Muslim baby boys are circumcised in ceremonies outside the hospital.

In June, a court in Cologne, Germany banned religious circumcision of young boys after a Muslim boy’s circumcision went awry because “the fundamental right of the child to bodily integrity outweighs the fundamental rights of the parents.” Last year, a bid to ban circumcision in San Francisco was ultimately taken off the ballot.

At Tablet Magazine, which refracts news through a Jewish lens, Yair Rosenberg acclaimed the AAP’s updated policy statement:

The statement solidifies the scientific consensus behind the advisability of infant male circumcision…and places the traditional practice squarely within the realm of sound medical science…Thanks to the AAP, we can now state that all circumcisions are medically beneficial. If German courts continue to prosecute Jews and Muslims for practicing circumcision, then we will know that this animus is rooted not in science or fact, but in ignorance and prejudice.

(MORE: San Francisco’s Circumcision Ban: An Attack on Religious Freedom?)

Meanwhile, Intact America, which is advocating for the prohibition of circumcision, posted last month on its blog:

There is no question that, but for the “freedom of religion” claim, holding down a baby boy and cutting off part of his penis constitutes a forcible physical and sexual assault, with visible and permanent consequences.

Diekema, who is also a bioethicist, says the committee understands that circumcision can be a highly emotional issue for many families. “The tone of this policy statement is that there shouldn’t be a recommendation one way or another that they circumcise, but rather we should tell them it’s an option they have and educate them what the benefits might be for their child.”

MORE: What’s a Bris? L.A. Hospital Launches Workshop for Jewish Parents-to-Be