Circumcision: American Association of Pediatrics Revises Policy and Guidelines

Circumcision has declined in the U.S., but proof emerges now for more health benefits than risks.

By Judy Felfdman on August 27, 2012 3:02 PM EDT

Baby
Circumcision: American Academy Revises Policy and Guidelines with Evidence that Health Benefits Outweigh Risks (Photo: Wiki Commons)

The prestigious and well-respected American Academy of Pediatrics has revised its previous policy and opinions about male circumcision for the first time since 1999. Not quite endorsing the practice, they have said the health benefits do outweigh the risks involved, and that they do believe it should be covered by insurance.

"In 1999, there was some data suggesting that there were some small medical benefits to circumcision but, at the time, there was not a compelling medical reason to recommend circumcision. So the previous policy didn't argue for or against circumcision," Dr. Douglas S. Diekema, a member of the circumcision task force behind the new statement, told the Associated Press. "However, now there is much stronger evidence about protective medical benefits associated with circumcision, so the tone of this policy statement has changed."

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But researchers have been studying this since 2007, reviewing 1,000 studies that took place between 1995 and 2010, and have found that the procedure does have proven preventive health. These include a reduction for male urinary tract infections - especially during the first year of life, a lower risk of cancer, and heterosexual acquisition of HIV and other sexually transmitted diseases and infections (STIs), including heterosexually acquired HIV, syphilis, herpes and human papillomavirus (HPV). Specifically, risk for herpes was 28 to 34 percent lower for circumcised men and the risk to contract HPV was lowered by as much as 40 percent.

The new policy is published in the Aug. 27 issue of the academy's journal, Pediatrics, and is also endorsed by The American College of Obstetricians and Gynecologists.

Long controversial subject for several reasons, the debate heated up last year when a ban almost reached the voting box in San Francisco.  The judge ruled that the decision should be a state issue, rather than decided by a city election. (To see more on that story, you can read here.)

 Proponents for circumcision believe that the medical procedure helps prevent the spread of disease. Circumcision is also an important religious practice.

But there are certainly those against the practice.

"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." Psychologist Ronald Goldman, director of an anti-circumcision group, the Circumcision Resource Center, told the Associated Press.

The  Centers for Disease Control and Prevention has estimated circumcision procedures cost about $200 to $600 nationwide, Coverage also varies among insurers, and several states have stopped Medicaid funding for circumcisions.

Several surveys have shown that the number of newborn males being circumcised decreased from about 63% in 1999 (when the Academy released its earlier policy) to about 57% in 2008. And insurance coverage has also decreased. As of 2009, 15 states had eliminated coverage by Medicaid. Currently as reported by CBS, 18 states do not provide Medicaid payment for circumcision.

As reported by CBS, "Despite the U.S. decline, about half of baby boys nationwide still undergo circumcision, or roughly 1 million each year. The country's overall rate is much higher than in other developed nations, but U.S. rates vary by region and are higher in areas where cultural and religious traditions support it, for example, among Jews and Muslims."

A CDC spokesperson told CBS that they have yet to publish new guidelines based on the new studies. Currently, The American Medical Association and American Academy of Family Physicians have neutral policies.

"It's not a verdict from on high," policy co-author Dr. Andrew Freedman told the Associated Press. "There's not a one-size-fits-all-answer." But from a medical standpoint, circumcision's benefits in reducing risk of disease outweigh its small risks, said Freedman, a pediatric urologist in Los Angeles.

Bottom line:  The new studies suggest that for families who choose to have the procedure, insurance should cover the costs, and that health benefits do outweigh the risks. As of now, is considered a health precaution most important for the first year of life.  It is considered a personal family decision for each family to make. 

See more recent statements from the American Acadeny of Pediatrics, see here

© 2012 iScience Times All rights reserved. Do not reproduce without permission.

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