Nation’s Leading Pediatric Group Gives Circumcision Benefits a Thumbs Up

The circumcision of baby boys has more health benefits than risks and should be covered by insurers, says a new policy statement from the American Academy of Pediatrics.

The statement replaces a more neutral stance held by the doctors' group since 1999. But it stops short of recommending infant circumcision as a routine procedure. Instead, it says the final decision rests with parents -- who, increasingly, are leaving U.S. hospitals with uncircumcised sons. The infant circumcision rate was about 56% in 2008, says the federal Centers for Disease Control and Prevention. Rates peaked at about 80% in the 1970s and 1980s, said a report last week from researchers at Johns Hopkins University. That report said falling circumcision rates could ultimately cost billions of U.S. health care dollars. It also said 18 states Medicaid programs have stopped covering the procedure.

Male circumcision involves removing the foreskin from the penis. For some families, it's a religious or cultural tradition. But groups that oppose it see it as an unneeded surgery and a violation of a baby boy's rights. A recent effort to ban circumcision in San Francisco failed. But one German court has banned the procedure in a part of that country, outraging Muslim and Jewish groups.

"With circumcision, there clearly are very strong traditions and cultural values that come into play," says Douglas Diekema, a pediatrician and bioethicist at Seattle Children's Hospital. He was on the committee that wrote the new statement.

But the committee also had to consider growing evidence that the foreskin can be a hiding place for viruses and bacteria and that circumcision can help prevent some infections -- including urinary tract infections in babies and HIV infection in sexually active teens and men. Even penile cancer, though it it is rare disease, is less common in circumcised men, Diekema says.

"There's potential for significant medical benefits," he says, along with some risks, including bleeding and pain. In a detailed report accompanying the policy statement, the committee says all babies being circumcised should get medicine to prevent pain and that the procedure should only be done by "trained and competent practitioners" using sterile techniques.

The statement also says "complications are infrequent; most are minor, and severe complications are rare." Recovery takes longer and complications are more common when the procedure is done in grown men, it adds -- addressing the common suggestion that parents should let boys grow up to make their own choices on the matter.

The bottom line, according to the pediatricians: "Parents ultimately should decide whether circumcision is in the best interests of their male child. They will need to weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices. The medical benefits alone may not outweigh these other considerations for individual families."


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