To Circ or Not to Circ… That is the Question

The world’s oldest planned surgical procedure has come under fire in recent years by concerned parents who question its value. And given the outcry from a growing “save the foreskin” movement and the recent attempt to criminalize the act of circumcision by the city of San Francisco, it’s no wonder new moms and dads are worried.

Back in the 1970’s and 80’s, nearly 80% of baby boys born in the USA underwent circumcision. Today, that number has dropped to 55%, and the decline is more dramatic in Europe, where doctors remove a mere 10% of foreskins.

So what’s the big deal? Circumcision is an archaic procedure that began with a man named Abraham and the marking of a people, right? It isn’t relevant today.

Well, not so fast. Researchers at Johns Hopkins University claim the reduction in U.S. circumcisions has led to a 2 billion dollar rise in health care costs, and the American Academy of Pediatrics (AAP) released a new position statement this year with strong language in support of the procedure.

According to the AAP, a systematic evaluation of the medical literature shows the benefit of circumcision clearly outweighs the risk.

So what’s the benefit?

Circumcision reduces human suffering and prevents premature death by decreasing the incidence of HIV, syphilis, genital herpes, genital warts, and human papillomavirus infections. It decreases the incidence of penile and prostrate cancers and prevents kidney-threatening urinary tract infections in young boys. Circumcision also reduces human papillomavirus transmission to female sexual partners, which decreases the incidence of cervical cancer in these women.

The Johns Hopkins researchers say if U.S. circumcision rates decline to the numbers seen in Europe, Americans can expect 12% more men infected with HIV, 29% more with human papillomavirus, 19% more with herpes simplex virus, and 211% more young boys suffering from urinary tract infections.

Women would see a 50% increase in bacterial vaginosis and an 18% increase in human papillomavirus infections, with a corresponding increase in cervical cancer.

Suffering aside, what’s the cost to treat all these folks? Billions and billions of dollars!

But what about the risk?

Circumcision can result in pain, bleeding, infection, and an imperfect amount of foreskin removed. But in the hands of trained professionals, using sterile technique and proper pain management, these complications only occur in 0.2% of cases.

So what’s a parent to do?

That depends. If you only consider the medical facts, benefit appears to outweigh risk. That’s the word from the AAP, and I agree.

Of course, medical facts aren’t the only consideration. Parents have to weigh these in the context of their religious, ethnic, and cultural beliefs.

They should, however, ignore the cries from the “save the foreskin” set, whose fear-provoking rants are not based on scientific evidence.

And what about that proposed ban of circumcisions in San Francisco? Fortunately, a level-headed Superior Court judge struck the issue from the ballot, citing California law, which affords the state (not city) government with the responsibility of regulating medical procedures.

So parents, choose. But please… choose wisely.

 


for Nationwide Children’s Hospital. Each week, Dr. Mike presents news parents can use, answers listener questions, and interviews pediatric experts onPediaCast: a pediatric podcast
for parents.

 

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