Debate on circumcision heightened as CDC evaluates surgery

By Rob Stein
Washington Post Staff Writer
Tuesday, January 19, 2010

Circumcision, long one of the most emotionally charged surgical procedures performed in the United States, has become the focus of yet another intense debate as leading health authorities are about to issue major new evaluations of the potential health benefits of the operation.

The war of words over the procedure has been sparked by a decision by the federal Centers for Disease Control and Prevention to issue recommendations for the first time about whether newborn boys and possibly even adult men should undergo the common surgical procedure, just as the American Academy of Pediatrics is poised to revise its position of not recommending the operation.

The two evaluations, which are nearing completion, come in the wake of new research indicating that the procedure has more health benefits than previously thought, including reducing the risk for getting the AIDS virus and contracting other sexually transmitted diseases.

The rate at which U.S. male newborns are undergoing the procedure has dropped to about 56 percent since peaking at about 80 percent in the 1960s.

The new data on its health benefits have prompted supporters of circumcision to call for greater efforts to encourage the surgery, but opponents liken the operation to genital mutilation and have launched a lobbying campaign to preempt any possible endorsements.

"Circumcision is not an ethical medical procedure," said Georganne Chapin, executive director of Intact America, a Tarrytown, N.Y., advocacy group. "You are removing a perfectly normal body part. We don't allow people to do that to their daughters. We should not let them do it to their sons."

Circumcision, which has been practiced for centuries, involves removing an infant's foreskin. Although long motivated primarily by cultural and religious practices, evidence has been accumulating that it also has health benefits.

In addition to reducing the risk for urinary tract infections among infants, studies indicate that circumcision cuts the chances of adult men's getting penile cancer and becoming infected with a variety of sexually transmitted diseases, including syphilis, AIDS, herpes and the human papillomavirus (HPV), which causes genital warts in men and women and cervical cancer in women.

In 2005, the American Academy of Pediatrics reaffirmed a policy adopted in 1999 that backed away from routinely recommending circumcision, saying the evidence of benefits was insufficient to endorse the routine use of the procedure.

But evidence continued to mount about the possible benefits, most notably three large studies conducted in South Africa, Kenya and Uganda that concluded that circumcised heterosexual men were about half as likely to become infected with HIV as uncircumcised men.

"The evidence has gotten much stronger with the results of these trials of the potential benefits of circumcision," said Ronald H. Gray, a professor of reproductive epidemiology at Johns Hopkins University, who led two of the recent studies.

In addition to reducing the risk for HIV, research indicates circumcision cuts the risk of getting HPV and herpes by about a third, according to a review Gray published last week in the Archives of Pediatric & Adolescent Medicine. Although the procedure does not reduce the risk of HIV infection in the men's female partners, women who had sex with circumcised men were less likely to get HPV and bacterial infections.

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