Circumcising baby boys has clear health benefits and parents should feel free to have it done, but they shouldn’t feel pressured to do so, the top U.S. pediatricians group said on Monday.

Circumcision lowers the risk of a range of diseases, from AIDS to herpes, and doesn’t hurt sexual performance or pleasure in adulthood, the American Academy of Pediatrics said. While the Academy doesn’t go so far as to recommend circumcision as routine, it’s the group’s strongest endorsement yet of the sometimes controversial procedure.

“Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks,” the AAP says in its latest update of its circumcision policy, released in the journal Pediatrics.

Noah Berger / AP

Benjamin Abecassis rests on a pillow surrounded by family members immediately following his bris, a Jewish circumcision ceremony in San Francisco. The nation's top pediatrician's group said the health benefits of procedure outweigh the risks, but stopped short of recommending it.

“Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns.” In other words: Health insurance should pay for it.

The decision is certain to anger anti-circumcision activists, who call the practice genital mutilation. Doctors who support circumcision say the Academy’s on-the-fence stance up to now has encouraged such groups.

“In the policy itself, the changes are actually fairly small,” Dr. Doug Diekema of the University of Washington, a member of the AAP’s task force, said in a telephone interview.

“What has changed mostly is the tone. The statement from 1999 said that there were some benefits of circumcision, there were some risks, and essentially it was a pretty close call. This time around the policy says, based on the evidence, it appears there are still some benefits of circumcision and those benefits outweigh the risks.”

Circumcision is becoming less and less common in the United States. It’s routinely done for religious and cultural reasons among groups such as Jews and Muslims, and U.S. hospitals once circumcised newborn boys routinely.

But the numbers dropped -- from around 79 percent of newborn boys in 1980 to around 55 percent to 58 percent in 2010, according to the U.S. Centers for Disease Control and Prevention. This is mostly because public insurance programs such as Medicaid often don’t pay for it any more. Eighteen states have stopped paying for circumcision under Medicaid, the state-federal health insurance plan for the poor.

News that the decision was coming started to leak out last week and groups opposed to circumcision -- there are more than a dozen -- have already prepared their responses.

“It is clear that the AAP is blind to the mounting worldwide movement against the genital cutting of boys,” Georganne Chapin, Executive Director of Intact America, said in a statement posted on the group’s website. “This American physician organization is disregarding the risks and harms of the procedure. It also is ignoring the fact that circumcision is rare in Europe, with no negative health consequences, and that European politicians and physician groups -- in increasing numbers -- are calling for doctors to refuse to perform the procedure,” she added.

Diekema said the Academy is familiar with the arguments. “I think every member of the task force has gotten thousands of emails, most of them copycat emails,” he said.

“Our task was not to base our decisions on which people yelled the loudest about the issue. Our task was to look at the evidence,” he said. 

The evidence shows circumcision rarely causes complications and can also reduce medical costs.

Earlier this month, a team at Johns Hopkins University projected that U.S. medical costs will go up as circumcision rates fall. They used data showing that urinary tract infections would triple and HIV rates would go up 12 percent if circumcision rates fell to 10 percent. The bill for all these extra infections? Half a billion dollars a year, they wrote in the Archives of Pediatrics and Adolescent Medicine. Already, the decline in circumcision rates has cost $2 billion, they calculated.

How does circumcision prevent infections? The foreskin of the penis, which is removed during the procedure, is loaded with immune system cells that are easily infected by viruses such as HIV and herpes. Bacteria can collect under the foreskin, causing infections in both males and their sex partners.

A circumcised penis develops thicker, strong skin that can more easily withstand little tears and cuts that admit germs, as well, infectious disease experts say.

A German court banned circumcision in June, saying the procedure was inflicting bodily harm on babies who could not consent. The ruling dismayed and angered Jews and Muslims.  There is a similar battle in Austria. 

In July 2011, a judge prevented activists from putting a circumcision ban on the ballot for November in San Francisco but groups say they’ll keep trying.

The AAP says that in the United States, the decision should be between the parents and doctors or certified professionals who perform circumcision. Pain relief is important for the baby and it’s important for doctors to be neutral in discussing the pros and cons of circumcision.

“I would like to see parents making this decision thoughtfully,” Diekema said.

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By MyHealthNewsDaily Staff

An ultra-Orthodox Jewish circumcision practice in which the circumciser places his mouth on a newborn's newly circumcised penis and sucks blood away from the wound carries a risk of transmitting the herpes virus to the baby, sometimes fatally, according to a new report from the Centers for Disease Control and Prevention.

The report is based on researchers' investigation into the cases of 11 infants in New York City who were infected with the herpes virus after this procedure, known as metzitzah b’peh ("direct orogenital suction"), between November 2000 and December 2011. Ten of these infants were hospitalized, and two died.

Some of the infants’ parents were not aware this technique would be a part of their child’s circumcision, the researchers found. Parents should be aware of the risk of herpes in metzitzah b’peh, and should inquire in advance whether direct orogenital suction will be performed so the practice can be avoided, the CDC researchers said.

"Oral contact with a newborn’s open wound risks transmission of [ herpes simplex virus ] and other pathogens," the researches wrote in their report. "Circumcision is a surgical procedure that should be performed under sterile conditions."

The virus that was found in most of the infants, called herpes simplex virus type 1 (HSV-1) — which is typically associated with cold sores, but does not always cause any symptoms — is highly prevalent in the general adult population, the report said. A 2004 study showed that 73 percent of adults ages 20 and older in New York City carried the virus.

At least three of the infants, including one who died, were circumcised by the same person, the report said. The New York City Commissioner of Health has issued a directive ordering that person to stop performing direct orogenital suction during circumcisions.

At least three mohliem (circumcisers) performed the circumcisions of the 11 infected infants, and there may have been as many as eight mohliem, the CDC said. In some cases, parents refused to identify their child's circumciser to CDC officials.

The rate of newborn boys who undergo direct orogenital suction and contract herpes infections is 24.4 per 100,000, the report said. That's 3.4 times higher than the rate of herpes infections seen in the general newborn male population, which is 8 per 100,000. Other cases of herpes are typically transmitted from mother to infant during delivery.

Neonatal herpes infections is a potentially disabling, life-threatening infection, the report said.  

Physicians should counsel parents considering out-of-hospital circumcisions about the risks of direct orogenital suction, and should consider herpes infection when evaluating a newborn male infant with a fever following Jewish ritual circumcision, and inquire about direct orogenital suction, the CDC said.

Mohelim should inform parents about whether they perform direct orogenital suction, and explain the risk of virus transmission, so that parents can choose not to have their newborns exposed, the report said.

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By Joseph Brownstein
MyHealthNewsDaily

Men who are circumcised may have a lower risk of developing prostate cancer, a new study finds.

Researchers at the University of Washington surveyed 1,754 men with prostate cancer, and 1,645 similar men who did not have the disease.

They found that those who had been circumcised before they first had sexual intercourse were 15 percent less likely to have prostate cancer.

"These data suggest a biologically plausible mechanism through which circumcision may decrease the risk of prostate cancer," said study researcher Dr. Jonathan Wright, an assistant professor of urology at the University of Washington School of Medicine. He noted that the study was observational; it did not show a cause-and-effect link.

Still, the reason for the findings might be that men who are uncircumcised are more likely to contract sexually transmitted infections. The inflammation caused by those infections may in turn be involved in the development of prostate cancer, the researchers said.

The study appears today (March 12) in the journal Cancer.

Circumcision & cancer

Because the results were based on men with prostate cancer at a single point in time, and not the result of following patients forward in time, from circumcision through developing prostate cancer, other experts expressed concerns the results might be skewed for unknown reasons.

"It certainly is an interesting and thought-provoking report," said Dr. Durado Brooks, director of prostate and colorectal cancers for the American Cancer Society, which publishes the journal.

But the findings would need to be replicated in other groups of people, Brooks said.

"I don't believe it's anything that will alter clinical practice, either for adults or children," Brooks said.

For parents wanting to know the benefits from circumcision, the possibility of lowering the risk of infections "would be a more convincing and better documented concern…than the possibility of prostate cancer 50 years down the line," he told MyHealthNewsDaily.

Medical organizations have noted small benefits potentially arising from circumcision, but have not advocated for circumcision as a matter of routine, largely because the procedure can have complications.

"At the end of the day, we feel there's risks and benefits, and it's up to the parents to decide what is in the best interests of their child," said Dr. Andrew Freedman, a pediatric urologist and a member of the circumcision task force at the American Academy of Pediatrics.

The AAP is now revisiting its position on circumcision, which was last reaffirmed in 2005. A new statement is due to be released this year.

Circumcision in adulthood

One concern Freedman expressed about the new study was that the highest rates of prostate cancer were found in men who were circumcised as adults.

While this was the smallest group of men in the study, and therefore most likely to have the results skewed by chance, he said that the inclusion of these men with others who were not circumcised may have made the benefit of circumcision seem larger than it actually is.

Men getting circumcised later in life might be doing so because of increased infections, Freedman said.

"Circumcision after sexual debut means the male may have already acquired a STI, and might already have inflammatory damage to the penis," said Brian Morris, a professor at the University of Sydney.

Morris said he is more in favor of circumcision than most in the mainstream medical community, having published research that indicates cost savings from circumcision in infancy, in the form of reduced infections later in life.

Noting a higher rate of urinary tract infections among uncircumcised men, Morris said, "I'd like to see more research done to see whether there is a connection between these and prostate cancer."

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