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A few months ago, I wrote a blog about circumcision. In it, I said that the American Academy of Pediatrics (AAP) was "firmly on the fence" when it came to the procedure, saying that the risks and benefits were about equal.
That just changed.
It's really a change back, because when I started practicing as a pediatrician, the AAP was in favor of circumcision because it decreased the risk of urinary tract infection and penile cancer. Then in 1999 they changed their stance to a more neutral one, and said that families should make their own decision based on their personal and religious beliefs.
Since then, it's become really clear that circumcision makes a difference when it comes to preventing sexually transmitted infections. The thin inner surface of the foreskin is easily injured, allowing germs in, and the foreskin itself may "trap" germs underneath. Not only that, there are cells in the foreskin that are targets for HIV infection. HIV rates are definitely lower in circumcised men--as are rates of genital herpes and Human Papilloma Virus (HPV) infection, which is the main cause of cervical cancer.
That's what's a bit different for me about this new policy statement: they aren't just talking about the health of men. They are talking about the health of women, and how if more men were circumcised, there would be less HIV, genital herpes, HPV (and subsequent cervical cancer) and other sexually transmitted infections for them, too.
There are still the same benefits in terms of lessening the risk of urinary tract infection (mainly in infants), penile cancer (although that risk is small), and problems with the foreskin itself such as infections or getting stuck (obviously if you don't have a foreskin you're not going to have problems with it). And after looking at lots of studies, the AAP said that there is no good evidence that circumcision interferes with sexual pleasure or function.
The biggest objection to circumcision is generally that it is painful--and this is an important concern, especially since it's usually done on newborns (there are fewer complications if you do it then than if you wait). The technical report that went along with the policy statement statement took this very seriously, saying that pain should absolutely be prevented using medication (sugar water isn't enough). The report also stressed that it's important that the procedure be done carefully and by someone who is skilled and experienced at doing them.
The AAP stopped short of recommending circumcision, though. While the benefits are greater than the risks, they say that the "health benefits are not great enough to recommend routine circumcision of all male newborns". As I wrote in my previous blog, circumcision is yet another example of how often medicine offers information, not answers. What the AAP did this week is give a bunch more information. What parents do with that information is, as it's always been, up to them.
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