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Posted at 07:00 AM ET, 10/06/2011

The case for male circumcision

As many critics have come to question the wisdom of circumcising newborn boys or even regard the practice as barbaric, a commentary in the Journal of the American Medical Association makes a case in favor of male circumcision.

In their commentary published Wednesday, Aaron Tobian and Ronald Gray of Johns Hopkins University spell out the scientific research supporting circumcision.

Studies based in Africa show adult male circumcision reduces HIV infection among men engaging in heterosexual sex (though the effect on men who have sex with men was unclear). It reduces acquisition and transmission of the HPV virus, which causes genital warts in men and cervical cancer in women, and cuts a man’s risk of other infections such as genital herpes.

The commentary further cites research showing that circumcision doesn’t reduce men’s pleasure during sexual intercourse and may actually enhance pleasure for both men and women.

The commentary notes that 18 states have opted to deny Medicaid coverage for infant circumcisions. It also notes efforts to establish local bans on infant circumcision, most recently in San Francisco. Proponents of such bans argue that the decision to be circumcised should be left to the man when he becomes an adult and that allowing parents to make the decision to circumcise violates the child’s right to informed consent.

(Read more about the debate here.)

But the commentary notes that whereas circumcising a newborn poses relatively little risk of medical complications, the procedure becomes riskier when performed on adults.

It also makes the point that parents make health-care decisions with long-term implications for their children all the time, including when they choose to have them immunized against communicable diseases such as Hepatitis B.

Health concerns aside, the authors point out that banning or refusing to provide insurance coverage for circumcision denies religious freedoms to people of Jewish and Muslim faiths, which call for baby boys to be circumcised.

Data published by the CDC in September show a decline in newborn male circumcisions over the last decade, with just over half of newborn boys undergoing the procedure in hospitals in recent years.

The authors press the American Academy of Pediatrics to update its policy statement regarding circumcision. Issued in 1999 and reaffirmed 2005, that document takes a medically neutral stance toward the procedure. The commentary suggests it should be revised to take into account the latest science, which they say favors circumcision of infants. (The AAP press office says a revision is underway with an eye toward publication at the beginning of 2012 but that no details about its content are yet available.)

“If a vaccine were available that reduced HIV risk by 60 percent, genital herpes risk by 30 percent, and HR-HPV [high-risk human papillomavirus] risk by 35 percent” the authors observe, “the medical community would rally behind the immunization and it would be promoted as a game-changing public health intervention.”

Dare I ask where you stand on this matter?

By  |  07:00 AM ET, 10/06/2011

 
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