Rethinking Circumcision

In the US, circumcision on infant boys is more the norm than the exception. But should it be?


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For decades, circumcising infant boys has been relatively common practice in the US, with the procedure performed on 58.3 percent of newborn baby boys as of 2010, according to the Center for Disease Control (CDC). Though the percentage of infants circumcised is actually higher than what the CDC reports—those figures do not take into account the many circumcised after leaving the hospital, for religious or other reasons—it has still declined over the past several years, as Millennial parents seem to be steering away from the procedure. One reason could be that many believe that the procedure is medically unnecessary. After all, fewer than 20 percent of European men are circumcised.

In 2012, the AAP issued a policy statement maintaining that the health benefits of newborn male circumcision outweigh the risks and that its benefits justify access to the procedure for parents who choose it. Specific benefits, according to the AAP, include “prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV.” The American College of Obstetricians and Gynecologists has endorsed this statement.

In January, the American Academy of Pediatrics (AAP) published research concluding that “repeated exposure to pain early in life can create changes in brain development and the body's stress-response systems that can last into childhood.” Consequently, a new AAP policy statement, issued in February, recommends that all health facilities caring for newborns “should use strategies to minimize the number of painful procedures performed, and routinely monitor and treat pain with greater emphasis on proven non-drug interventions.”

Georganne Chapin, former president and CEO of Hudson Health Plan and executive director of Tarrytown-based Intact America, the largest national advocacy group working to end what it calls “involuntary circumcision,” says the organization is “baffled” by the AAP’s recommendation.

Though many in the medical community—as well as numerous studies—maintain that circumcision has been shown to be protective against the heterosexual transmission of HIV, and though it is widely believed that personal hygiene is easier and more thorough without having to contend with a foreskin, Chapin contends that “the intact penis is easily cleaned throughout a boy’s and man’s lifetime” and that “circumcision does not prevent STDs, including HIV.”

But a study published in mBio, the Journal of the American Academy of Microbiology, in 2013 showed that circumcision reduced the incidence of heterosexually transmitted HIV, and controlled trials showed that circumcision reduces the risk of HIV infection in men by 50 to 60 percent. (The World Health Organization contends that the reduction is about 60 percent.) 

What about the pain? There is no doubt that, like any surgical procedure, circumcision, without the use of anesthetics or analgesia, causes pain. But there are anesthetic creams and nerve blocks, as well as non-phramacological methods of pain relief, that doctors, hospitals, and mohels use to provide pain relief to infants.

Still, Chapin feels strongly that “there is no justification to perform invasive, medically unnecessary surgery that removes a natural and valuable part of a boy’s sexual anatomy—the foreskin.”

The bottom line for parents? Do your research, ask lots of questions, get more than one medical opinion, and weigh the pros and cons before making a decision.

For more information on Intact America, visit www.intactamerica.org.

 

 

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