AAP says infant circumcision benefit outweighs risk, but doesn't recommend for all
The health benefits of circumcision include lower risks of acquiring HIV, genital herpes, human papilloma virus and syphilis.
The American Academy of Pediatrics (AAP) this week announced that a comprehensive review of medical evidence has shown that circumcision of newborn boys confers more advantages -- including reduced risk of HIV and other sexually transmitted diseases -- than drawbacks. However, the organization did not recommend that all baby boys should undergo the procedure, but rather that the decision should be made by parents.
Infant circumcision remains a controversial issue. Though widely practiced among the general population in the U.S. and by some religious and ethnic groups worldwide, it is uncommon in many countries.
Randomized trials have convincingly shown that adult male circumcision can reduce the rate of HIV incidence by more than 50% in high-prevalence settings in sub-Saharan Africa, and scale-up of circumcision is now considered part of a comprehensive prevention approach. But other studies have not seen a difference in HIV rates between circumcised and uncircumcised men in lower prevalence settings in the U.S. and Europe.
Below is an edited excerpt from AAP's press release describing the new findings and updated policy statement.
The full AAP statement is available at http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-1989, with an accompanying technical report at http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-1990.
New Evidence Points to Greater Benefits of Infant Circumcision, But Final Say is Still Up to Parents, Says AAP
August 27, 2012 -- New scientific evidence shows the health benefits of newborn male circumcision outweigh the risks of the procedure, but the benefits are not great enough to recommend routine circumcision for all newborn boys, according to an updated policy statement published by the American Academy of Pediatrics (AAP). The revised policy, like the previous one from the AAP, says the decision whether or not to circumcise should be left to the parents in consultation with their child’s doctor.
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.
American Academy of Pediatrics. Circumcision Policy Statement. Pediatrics. August 27, 2012 (Epub ahead of print).
American Academy of Pediatrics. New Evidence Points to Greater Benefits of Infant Circumcision, But Final Say is Still Up to Parents, Says AAP. Press release. August 27, 2012.