Share |

Circumcision Task Force Member Tips Hand On What AAP Plans For Baby Boys

Citing new evidence to support routine infant circumcision, the AAP Task Force on Circumcision is working on a new position statement and guidelines for parents and doctors.

The American Academy of Pediatrics is set to issue a revised policy statement and guidelines on infant circumcision that could come out as early as this spring. The current policy guideline on infant circumcision does not recommend routine infant circumcision, and lays claim to the “potential health benefits” of the procedure. The new wording is expected to be more supportive of the benefits of the procedure, according one doctor who sits on the AAP’s Task Force on Circumcision.

Douglas S. Diekema, M.D., M.P.H. made his remarks to the Broward County New Times Broward-Palm Beach, which interviewed him for a recent feature article about anti-circumcision activism. “It’s fair to say that there are much more clear medical benefits than there were at the time of the last report,” he said. Diekema is an emergency room doctor at Seattle Children’s Hospital and a pediatric bioethicist.

The AAP’s current position statement on circumcision was first issued in the spring of 1999 and was affirmed in 2005. Diekema told the New Times Broward-Palm Beach that, “one of the changes you may see this time around is that there is sufficient data to suggest a substantial public health benefit—that it’s the sort of thing that insurance should be paying for.”

The data Diekema refers to comes out of several studies undertaken in sub-Saharan Africa, which indicate that circumcising adult males offers a degree of protection against acquiring and transmitting HIV and HPV.

Circumcision critics point to methodological, ethical and legal flaws in these studies. The Australian Journal of Law and Medicine has recently published a critique of three clinical trials from Africa that purport to show that male circumcision reduces female-to-male sexual transmission of HIV by 60 percent. The critique finds that circumcision only prevents HIV transmission by 1.3 percent (not the claimed 60 percent) which is not considered to be clinically significant. Further studies have found a 61 percent relative increase in male-to-female HIV transmission when the male partner is circumcised.

Critics also point to further flaws in these studies. All three of the HIV studies were terminated early, before the incidence of HIV infection in the circumcised group had time to catch up with the men who hadn’t been circumcised. Had the studies been continued for the scheduled time, critics say it’s probable there would have been little statistical significance between the groups. Since the circumcised group would not have engaged in intercourse for a period of time following the surgery, they would have been less likely to contract HIV in the short term.

Those who favor leaving newborn boys intact say U.S. pediatricians should not recommend, or in any way endorse, routinely dispensing with the foreskin—even if amputating it confers some health benefits. They say more solid and comprehensive research needs to be undertaken because there’s still much the medical world doesn’t understand about the protective role of the foreskin in neonates and the role it plays in natural sexual functioning during adulthood. For example, clinical reports suggest that foreskin removal might lead to decreased sexual sensitivity and impotence, especially in older men. This has not been explored in the medical literature. Nor has the possibility that the foreskin may play a role in disease prevention.

With the AAP edging toward a new and stronger endorsement of newborn circumcision, the stage is set once again for a national debate on circumcision, as well as for the education of the public on this issue. The most influential material will likely be offered by physicians, medical ethicists, and others in the medical and scientific community who can share their thinking and research.


Comments

Given what the press has quoted Diekema as saying in recent years, I am disturbed that he is a professional bioethicist. His treatment of intactivism is arrogant and patronising. This amounts to a deficient "bedside manner."

"...that it’s the sort of thing that insurance should be paying for..." There, the cat is out of the bag. The point is not truly the "promotion" of circumcision, but depriving insurers of grounds for refusing to cover it. I am strongly suspect that American pediatricians and obgyns appreciate -- but may refuse to admit -- a raw fact: RIC is going out of fashion among the educated middle class. Doctors know deep down that RIC is primarily about the appearance of the male sexual organs, and as such appreciate that those organs are subject to the vagueries of fashion. But I sense that doctors are angry that financial considerations are speeding this process along, namely because in recent years, a growing fraction of families are out of pocket if they choose to circumcise their newborn sons. In other countries, RIC has faded away when the govt. refuses to pay for it.

Thank you for drawing attention to Boyle and Hill (2011). You should also have mentioned Robert Van Howe. I warmly agree that the recent literature claiming public health benefits from routine infant circumcision is a deeply flawed literature.

I was elated to read you pick up on a favourite theme of mine, namely that the American medical and sexual literatures are silent or incompetent about the possibility that circumcision:
* May result in a penis whose capacity to perform and enjoy normal adult sexual activity is materially impaired;
* Removes tissues that could be a major player in adult sexual satisfaction, even if the penis is not impaired;
* May exacerbate premature ejaculation and lower the average age of onset of erectile dysfunction.

The way American medicine has been silent about the possible downside of routine circumcision, a downside amply attested to by a lot of anecdotal evidence, is absolutely unconscionable.