Health benefits of circumcision outweigh risks
The health benefits of circumcision in male newborns outweigh the risks, but parents should be free to choose what they believe is in the best interest of their child.
This statement, which was issued by the American Academy of Pediatrics this week, represents a change from the previous policy in which they neither advocated for or against neonatal male circumcision. The policy shift comes after a task force of medical professionals reviewed 1,000 studies on infant circumcision that took place between 1995 and 2010.
What are the health benefits of circumcision?The number of males in the U.S. who are circumcised at birth has steadily declined in recent years. However, evaluation of recent scientific data on the topic has produced more compelling evidence of the positive outcomes associated with circumcision:
Less risk of urinary tract infections in infancy
Urinary tract infections in males are most common within the first year of life. When they occur in infants, these infections usually require a doctor’s visit and sometimes painful procedures or hospitalization. Circumcision reduces the risk of urinary tract infection, but this may be more important for those who are already at greater risk of infection. (These problems are relatively uncommon in the general population.)
Less risk of sexually transmitted infections in adulthood
For heterosexual males living in areas with high rates of HIV, a man’s likelihood of contracting HIV is reduced 40-60% when he is circumcised.
Men who are circumcised also have less incidence of human papilloma virus (HPV), some types of which when transmitted to a female partner are known to cause cervical cancer
The risk of acquiring herpes simplex virus-2 is reduced, and circumcision may also play a protective role in the transmission of syphilis. It does not, however, appear to protect against chlamydia or gonorrhea.
Less risk of penile cancer in adulthood
Studies have shown some association between circumcision and protection against invasive penile cancer. However, penile cancer is rare.
What are the risks?Complications associated with the procedure are uncommon, affecting approximately one of every 500 patients. The most common issue is bleeding, followed by infection; penile injury may occur in approximately one in 2,500 patients.
Complications may also occur after the procedure- excessive skin removal, incomplete circumcision, adhesions, cysts and others.
Other key considerationsMore risk and less benefit if done later in life
When performed within the newborn period, the procedure utilizes local anesthesia. However, if conducted later in life, the procedure is more complicated, takes longer, and often results in more bleeding. This makes it necessary for patients to undergo general anesthesia, which brings more possibility for complications.
Those who elect to undergo the procedure later in life may also miss some of the protective effects if exposed to sexually transmitted infections prior to the procedure.
Cost to the healthcare system
A study published last week in the Archives of Pediatrics and Adolescent Medicine calculated that the decline of male circumcision over the last two decades has cost the U.S. healthcare system approximately $2 billion. Treatment for urinary tract infections and sexually transmitted infections such as HIV, HPV and herpes are costly to the system, not to mention the personal toll it takes on patients.
Although it has been suggested that circumcision results in decreased penile sensitivity and lower sexual satisfaction, there is significant evidence to show that there is no difference in sexual functioning between circumcised and uncircumcised men.
The decision to circumcise is often a highly sensitive and personal one, based heavily on cultural and religious beliefs. The AAP advocates that parents should be given accurate, unbiased information from their healthcare providers regarding the benefits and the risks of the procedure. Parents can then weigh the health information combined with their personal beliefs to decide what is in the best interest of their child.