Circumcision, long in decline in the U.S., may get a boost from a doctors’ group

According to its 2005 position statement, which reaffirmed its 1999 stance, “existing scientific evidence demonstrates potential medical benefits” of newborn circumcision but not enough to “recommend routine neonatal circumcision.”

That position is poised to change, though, as the AAP is expected to release an updated statement and report reflecting recent research later this month.

While details are not yet available, the new position concludes that the health benefits of circumcision outweigh the risks, said Michael Brady, a pediatric expert at Nationwide Children’s Hospital in Columbus, Ohio, and a member of the AAP’s task force on circumcision.

Three large-scale trials in Africa within the past decade found that circumcised heterosexual men were up to 60 percent less likely to become infected with HIV than uncircumcised men. The men were also less likely to contract herpes and human papillomavirus, which, if spread to female partners, can lead to cervical cancer.

Ronald H. Gray, a professor of reproductive epidemiology at Johns Hopkins University, who led two of the recent studies, attributed the results to the fact that the cells of the foreskin and the low-oxygen, moist environment it creates are more receptive to viruses.

Responding to these studies, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (better known as UNAIDS) in 2007 recommended more voluntary circumcisions in 14 African countries where HIV is epidemic and circumcision is uncommon.

The AAP’s new position falls short of a routine recommendation, Brady said, adding that parents should continue to take into account their own cultural, religious or social views. “But from a public health perspective, I think it’s a good decision and a lot of children will benefit.”

‘A human right’

Many people, however, question the safety and ethics of using surgery to prevent disease. Some opponents liken it to using mastectomy to prevent, rather than treat, breast cancer.

At last month’s AIDS conference in Washington, protesters displayed signs outside the Walter E. Washington Convention Center that read “Circumcision is torture” and “Intact genitals are a human right.”

Activists traveled from Norfolk, Boston and New York to hand out condoms as a safer way to contain the virus. They challenge the relevance of the African studies in the United States. And they argue that men, not their parents, should be able to choose what to do with their genitals.

Recently, they have scored some victories. The German Medical Association this summer advised doctors to stop performing elective circumcisions after a regional court in Cologne ruled that the rights of “bodily integrity” outweighed the rights of parents or religious freedom in a case involving a Muslim boy who suffered medical complications after his circumcision.

In San Francisco, activists gathered 12,000 signatures last year, enough to put a measure on the ballot to criminalize the circumcision of anyone under 18. The measure was withdrawn before election day following intense protest from the Jewish community and a court ruling that such medical regulations could be enacted only by the state.