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Circumcision Guidelines By The AAP Have Been Revised For The First Time Since 1999

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For the first time in more than a decade, the American Academy of Pediatrics has revised its policy on male circumcision showing more support for the procedure, yet stopping short of recommending routine circumcision.

The academy, the leading U.S. pediatric group, now says the health benefits of circumcision outweigh the risks and that families who choose to circumcise their baby boys should be able to.

"The tone of the policy certainly shifts somewhat in favor of circumcision in that it recognizes that there are clear medical benefits that outweigh the risks of the procedure, and that those benefits are sufficient to justify coverage by insurance," said Dr. Douglas Diekema, a member of the academy's circumcision task force.

"What remains unchanged is that the AAP still holds that the health benefits are not great enough to recommend routine circumcision for all newborn males," he said.

The academy's previous policy statement on circumcision was released in 1999. It concluded that there were "potential" medical benefits to newborn male circumcision, but not enough to recommend it routinely.

The new policy says that the health benefits of circumcision are not great enough to endorse it for all newborn boys, but "are sufficient to justify access to this procedure for families choosing it."

However, opponents to circumcision remain unswayed by such health claims.

Georganne Chapin, founding executive director of the anti-circumcision advocacy group Intact America, said last week that she looked forward to calling out academy leadership for "scientific blindness."

"They have done nothing to address the real risks and harms of circumcision," Chapin told The Huffington Post. "They also appear to be totally ignoring the fact that their European colleagues are not only unimpressed by the supposed 'benefits' of cutting up baby boys' penises, but are actually considering whether child circumcision should be banned on the basis that it violates children's rights. Talk about being out of step."

A 23-page technical report, which accompanied the policy, summarized studies between 1995 and 2010 used to draft the guidelines. According to that report, potential health benefits include the prevention of urinary tract infections, HIV and penile cancer. Some studies found that circumcision can prevent the transmission of certain sexually transmitted infections, including the human papillomavirus and genital herpes.

Major complications from circumcision, including death, were "so infrequent" that the academy excluded them from the review. However, the technical report described possible risks of infant circumcision, relying heavily on two hospital-based studies in the U.S. Those studies found that the most common risks from circumcision were bleeding, infection and penile injury. Procedures performed on infants had lower complication rates than those performed later in life, the report stated, concluding that the procedure is generally "well tolerated" when performed by trained professions in a sterile environment.

The academy's new policy comes as circumcision is a topic of increasing debate in the U.S., both at the research and policy levels: Medicaid programs in 18 states have stopped covering circumcision, and local governments in California have attempted to ban the procedure.

But Dr. Marvin Wang, director of newborn nurseries at MassGeneral Hospital for Children and an assistant professor at Harvard Medical School, said that the contents of the new statement and the academy's shift toward circumcision are not surprising.

"This new policy still puts the decision-making in parents' hands," Wang said. "But what the AAP says now is, 'We have enough to say that you can make the decision based on religion, cultural and family issues. But guess what? You can now throw health in as a reason for doing it if you want to.'"

It's unclear the impact the statement will have on circumcision rates in the U.S., which have declined from a peak of around 80 percent of baby boys in the 1970s and 1980s, to 55 percent in 2010. In 2010, Wang published a study that found parents' attitudes about circumcision remained largely unchanged after they read the earlier AAP statement.

"Nothing was going to change their mind," Wang said. "What they come into it with is what they go out of it with."

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