August 27, 2012 | 26
Evidence for the long-term health benefits of circumcision for newborn boys has been mounting for years. Today the influential group the American Academy of Pediatrics (AAP) declared that the procedure is, indeed, beneficial—and that it should be covered by public and private health insurance plans. The recommendation was published online August 27 in Pediatrics.
Previously the group was less committal on the subject of circumcision, their last guidelines noting that it was not “a medical necessity for the well-being of the child.” But “since that time, substantial contributions have been made to the peer-reviewed literature,” The AAP noted.
The new statement comes after five years of work by the group’s Task Force on Circumcision and an analysis of 15 years of the medical literature on circumcision. The new recommendations are also backed by the American College of Obstetricians and Gynecologists.
With the removal of part or all of the penis’s foreskin, a male child’s risk of urinary tract infections, sexually transmitted infections including the human papillomavirus (HPV) and penile cancer are reduced, the organization noted. Removing the skin reduces the areas that infectious bugs can linger. A study published earlier this year in Cancer linked circumcision to a 15 percent lower risk of getting prostate cancer. Circumcision has also been shown to drastically reduce the spread of HIV, and the World Health Organization now recommends it as a preventive strategy. A 2011 study found that circumcision, including that of adults and adolescents, in many African countries could prevent millions of new HIV infections—in both men and women—on that continent over the next decade, saving lives and billions of dollars in future health care costs.
With all of this evidence, “the procedure’s benefits justify access to this procedure for families who choose it,” the task force concluded. The group recommends that circumcision should be performed by trained medical workers, using sterilized equipment and adequate pain management. It acknowledges that the procedure does carry risks, but most of them are minor—such as local infection—and more major complications are rare. And circumcising a newborn appears to carry the lowest risk of complications compared to other age groups.
The rate of male newborn circumcisions has been declining in the U.S. since the late 1990s, from roughly 62 percent in 1999 to 57 percent in 2008, according to the National Hospital Discharge Survey. Without insurance coverage, newborn male circumcision can cost upward of $600, and public and private health plans do not always cover the procedure.
The group does not go so far as to insist every male baby be circumcised, despite the medical evidence for its benefits. “Parents should weigh the health benefits and risks in light of their own religious, cultural and personal preferences,” the task force noted in their more detailed technical report, also published online August 27 in Pediatrics. It also might not be appropriate for infants who have other medical complications, or it might be delayed for health or cultural traditions.
“Ultimately, this is a decision that parents will have to make,” Susan Blank a pediatrician affiliated with the New York City Department of Health and Mental Hygiene and who chaired the task force, said in a prepared statement. But “parents are entitled to medically accurate and non-biased information about circumcision,” and should talk with their doctors early in pregnancy to ensure adequate decision making time—and to establish whether they can get insurance coverage for the procedure, she noted.
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