September 3, 2012
Will male circumcision guidance reverse trends in the procedure?One prominent organization's change in position is designed to encourage doctors and families to discuss the risks and benefits.
By Christine S. Moyer
The American Academy of Pediatrics, by adopting a more positive position on infant male circumcision, is aiming to remove health and cost barriers to the procedure.
The guidance, which was posted online Aug. 27 in Pediatrics, says the health benefits of infant male circumcision outweigh the potential risks and recommends that physicians give expectant parents factual, nonbiased information ...
“For health care professionals who are going to be responsible for educating patients, [the updated report] provides them with a lot of rich information with which to do that,” said Andrew L. Freedman, MD, a member of the AAP’s task force on circumcision who helped write the guidance. [Here is an annotated version of the policy.]
However, the current guidance stops short of suggesting routine circumcision for all infant boys, partly because evidence of its health benefits is not strong enough to warrant it being a medical necessity, Dr. Freedman said. AAP changed its position, though, because of growing evidence that infant male circumcision could have positive health effects.
Let parents decide
The AAP encourages physicians to ensure that families understand that infant male circumcision is an elective procedure. The updated statement also accounts for the fact that male circumcision is not purely a medical decision, but includes aesthetic, cultural and religious factors as well, Dr. Freedman said.
“We recognize our ethical obligation is in the best interest of the child, and we don’t have the ability to judge the best interest of the child across all those paradigms,” said Dr. Freedman, a pediatric urologist at Cedars-Sinai Medical Center in Los Angeles. “If [families] want the procedure, they can justify getting it. If they don’t want it, they don’t have to have it.”
55% of males born in the U.S. each year are circumcised, compared with only 10% in Europe. [Actually much less - virtually no non-religious infant circumcision happens in Europe.]
The American Medical Association says the decision for neonatal circumcision should be determined by parents in circumstances in which the procedure is not essential to the child’s well-being.
The AAP was spurred to re-examine the issue in 2007 as mounting evidence linked higher prevalence of male circumcision to lower rates of herpes simplex virus type 2, HIV, human papillomavirus, penile cancer and urinary tract infections. [Yet the policy finds evidence for protection of each of those is slim.] The organization formed an eight-person multidisciplinary task force to examine the recent evidence on male circumcision.
However, some opponents of circumcision question the accuracy and validity of the data on which the AAP based its updated statement and report.
Intact America, a New York nonprofit against infant circumcision, is demanding that the AAP retract its report “on the basis that it is inaccurate, biased and misleading,” among other charges.
Dr. Freedman said such backlash was expected. He said the AAP task force went out of its way in the technical report “to be inclusive, comprehensive and transparent as to the quality of the evidence.”
“As a practicing pediatric urologist, 20% of the patients I will see today are here because of something related to their circumcision,” Dr. Freedman said. “The procedure has some modest benefits and some modest risks.”
Families shouldn’t “feel like they’re harming their child no matter what they decide to do.”