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Circumcision Benefits Are Significant, Pediatricians Say

By Randy Dotinga
HealthDay Reporter

MONDAY, Aug. 27 (HealthDay News) -- A leading organization of pediatricians says the medical benefits of male circumcision outweigh the risks, but they're not enough to recommend the controversial procedure be performed on all baby boys.

"There are modest benefits and modest risks," said Dr. Andrew Freedman, a member of the American Academy of Pediatrics task force that issued the new guidelines. "We recognize that the topic cuts across many paradigms in your life -- cultural, religious, ethnic, family tradition, aesthetic. We're not in a position to make recommendations on those paradigms."

Circumcision decisions should be left to parents after weighing up-to-date advice from their doctor and their own preferences and beliefs, the task force concluded.

Circumcision -- the surgical removal of foreskin from a penis -- is an intensely controversial issue. Rates have fallen from almost 80 percent of infant boys in the 1970s and 1980s to about 55 percent in 2010, according to a recent study that warned lower rates could lead to higher sexually transmitted disease rates.

Over 10 years, those infections could add billions of dollars to U.S. health care costs, that study found.

Opponents of circumcision say it's an unnecessary and mutilating procedure that robs males of sexual sensation.

The procedure costs about $150 to $300 in the Los Angeles area, said Freedman, director of pediatric urology at Cedars-Sinai Medical Center there. Cost is an issue for some people, since 18 states refuse to cover the procedure under their Medicaid programs for the poor.

The academy last issued guidelines about circumcision in 1999 and reaffirmed them in 2005.

The new guidelines, published online Aug. 27 and in the September print issue of the journal Pediatrics, offer stronger evidence about the benefits of circumcision, especially in terms of preventing the transmission of HIV, the virus that causes AIDS, Freedman said.

The guidelines also say that circumcision lowers the risk of urinary tract infections in infants, genital herpes, human papilloma virus, cervical cancer in women and penile cancer.

Still, "the degree of benefit is modest enough that you don't have to say everyone has to do it," Freedman said. "It's not like wearing a seatbelt vs. not wearing a seat belt."

Risks include significant bleeding, which occurs in about one in 500 boys, he said. As for loss of sexual sensation during adulthood because of the loss of nerve endings on the foreskin, Freedman said it's a poorly studied issue.

"There are lots of people who are unhappy" about a lack of sexual sensation, he said, but "millions of men are perfectly happy. From a scientific standpoint, we really don't have a good handle on it."

Will the guidelines from the association matter? Freedman said parents often turn to pediatricians and obstetricians for guidance, and they in turn read the guidelines.

Arleen Leibowitz, a specialist in health policy and a research professor at the University of California, Los Angeles Luskin School of Public Affairs, praised the guidelines. They "recognize that information on the benefits has been increasing," she said.

"It's very much a personal decision, and they're striking the right tone," Leibowitz added.

Her own research has suggested that thousands of poor people don't have their infants circumcised because their states don't cover the procedure through Medicaid.

More information

For more about circumcision, see the U.S. National Library of Medicine.

SOURCES: Andrew Freedman, M.D., director, pediatric urology, Cedars-Sinai Medical Center, Los Angeles; Arleen Leibowitz, Ph.D., research professor, University of California, Los Angeles Luskin School of Public Affairs; September 2012 Pediatrics

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