A federal proposal to encourage discussions about
circumcision for baby boys and at-risk men of all ages has drawn nearly
2,000 mostly negative comments and a planned protest in front of a
federal agency this month.
The proposal from the Centers
for Disease Control and Prevention (CDC)
doesn’t explicitly recommend circumcision, but it urges health care
providers to proactively discuss the benefits and risks of circumcision
with parents of baby boys and “uncircumcised at-risk heterosexual
males” to allow people to make well-informed decisions about the
procedure.
A public comment period on the proposal in the Federal
Register ends Friday.
Circumcision, which cuts away a section of the tissue
covering the head of the penis, is associated with a lower risk for
acquiring HIV, genital herpes and human papillomavirus, as well as
penile cancer and infant urinary tract infections in male infants, the CDC
said in its draft recommendations.
The overall risk of adverse events is “low,” with minor
bleeding and inflammation cited as the most common complications, the
agency said.
“The scientific evidence is clear that the benefits
outweigh the risks,” Dr. Jonathan Mermin, director of the CDC’s
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention,
told The Associated Press when the proposal was unveiled in November.
But the vast majority of the 1,978 public comments on
the CDC
proposal opposed it — often furiously.
“Stop mutilating helpless babies,” wrote one commenter
named Lucy Brenton. “There is no reason to cut healthy tissue of a
normally functioning organ, especially without the permission of the
owner,” she wrote.
Others decried the physical harm and deaths that have
occurred with circumcision, as well as lifelong trauma associated with
the loss. An online organization called foreskin-restoration.net said
it had more than 5,000 members, some of whom “are so bothered by the
imposed loss of their foreskin that they endure a tedious process of
nonsurgical foreskin restoration to undo some of the sexual damage.”
Other critics noted that circumcision is unlikely to
dent HIV transmission in the U.S. since most HIV cases are among men
who have sex with men. The CDC
proposal recognized this, saying that the studies showing circumcision
as an effective HIV-prevention strategy only involved men who had sex
with women.
U.S. health care providers “should inform men who
exclusively have sex with men that male circumcision has not been
proven to reduce the risk of HIV or [sexually transmitted infections]
during anal sex,” the CDC
said, adding that circumcision is still advised for bisexual men as
well as men who have sex with HIV-infected women, commercial sex
workers, injection-drug users and women who live in areas with a high
HIV prevalence in the population.
“Please don’t listen to the hysterical nay-sayers. Look
at the evidence,” wrote one medical doctor, while a man writing as
“Anonymous” said his bouts with balanitis, a swelling condition of the
penis in uncircumcised men, “could have been prevented if I had been
circumcised as an infant.”
Another circumcision supporter, Dr. Jeffrey Klausner,
urged the CDC
to recommend that the U.S. Preventive Services Task Force review the
issue of newborn circumcision. If that task force would endorse newborn
circumcision with “an A or B recommendation,” he wrote, it would
require Medicaid and Medicare to pay for the procedures as a preventive
intervention.
A peer review panel will also be assembled to examine
the evidence for the proposal and offer expert opinion on whether the CDC
recommendations are justified and appropriate for the intended
audience. Final recommendations are likely to be published later this
year in the Morbidity and Mortality Weekend Report, the CDC
said.
The agency did not directly respond to a question about
whether its expert-review panel would include anyone who is critical of
circumcision. [Will even one of them have a
foreskin?] But it said its peer
reviewers would be selected because of their expertise in such matters
as urology, pediatrics, public health, infant circumcision and
prevention of sexually transmitted diseases such as HIV/AIDS. [Foreskin
anatomy and function, sexology, ethics?]
Anti-circumcision advocates in Atlanta said on their
Facebook page that they are planning a rally Jan. 22 outside the CDC
offices to protest the proposal.
“We all know that there are no benefits to the
amputation of healthy body parts,” said organizers, including members
of Bloodstained Men & Their Friends, who protest while wearing
white pants with bright red circles at the crotch.
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