Health benefits linked to newborn circumcision

Systematic approach

In 2007, the Academy formed the Task Force on Circumcision to review data and update the policy statement. The task force consists of experts in the fields of primary care and subspecialty pediatrics, including neonatology, general pediatrics, infectious diseases, anesthesiology, urology, bioethics, epidemiology and child health care financing, as well as representatives from obstetrics and gynecology, and family practice.

According to task force Chair Susan Blank, M.D., M.P.H., FAAP, the group defined the subject areas to be addressed in the policy statement, developed criteria for searching the literature and reviewed the yield in order to include only scientific studies. Each task force member was charged with reviewing some of the 1,000 studies published between 1995 and 2010 that eventually were used to develop the policy statement and accompanying Technical Report: Male Circumcision (Pediatrics. 2012;130:e756-785; http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2012-1990).

What the data revealed

Some of the most significant findings were discovered in studies devoted to the link between circumcision and HIV prevention. According to research, the protective effects of circumcision reduced the incidence of heterosexually transmitted HIV by 40% to 60% in Africa where this type of HIV is prevalent.

Among the other protective benefits discovered in the research:

• Cases of herpes simplex virus type 2 were 28% to 34% lower in circumcised men.

• There was a 30% to 40% reduction in risk of HPV infection.

• Circumcised males had a much lower risk of UTIs in the first year of life.

Although significant data point toward the protective health benefits of circumcision, experts were unable to find any evidence indicating that circumcision negatively affects sexual function or sensitivity as many circumcision critics claim. In fact, several studies with men circumcised as adults suggest the opposite, with many study participants indicating either greater or the same sexual satisfaction and sensation.

Access, coverage, other concerns

Surveys show that circumcision rates range from 42% to 80% nationwide, depending on the population. In addition, several surveys report that the number of newborn males being circumcised decreased from about 63% in 1999 (when the Academy released its earlier policy) to about 57% in 2008.

Dr. Diekema said insurance coverage for circumcision also decreased after the Academy’s 1999 policy statement was released. As of 2009, 15 states did not provide Medicaid payment for circumcision, and two other states had variable coverage, according to the technical report.

“The new policy highlights the strength of the data showing that the benefits of newborn male circumcision warrant access and, thus, coverage for families choosing newborn male circumcision,” said Dr. Blank.

Parents whose children were not circumcised as newborns may question pediatricians about the new information.

“It is possible that some parents will look at the new information and feel they didn’t have adequate information when they made their decision, but I don’t think there will be a significant increase in older children getting circumcised,” said Michael T. Brady, M.D., FAAP, task force member and chair of the AAP Committee on Infectious Diseases.

One of the major reasons circumcision is performed during the newborn period is that it provides protection against UTIs, which are most likely to occur during the first year of life, according to the technical report. In addition, the likelihood of circumcision complications rises as children get older, from less than 1% during the newborn period to 1.1% to 9% in non-newborns. The most common risks for both newborns and non-newborns are bleeding and infection.

The technical report also includes information about the care of the circumcised vs. uncircumcised penis, analgesia and anesthesia methods, and areas for future research.

“The onus is going to be placed on providers to be more proactive about explaining the benefits and risks of circumcision,” said Dr. Brady, “because to not provide that information would not be good practice.”