Circumcision: Clear Benefits, Some Risks

In a major policy shift, the nation’s largest pediatricians’ group has abandoned its long-held position that there are “no valid medical indications” for circumcising male infants, in favor of a finding that circumcision has clear medical advantages, balanced by some risks.

Announcement of the new position by the American Academy of Pediatrics is scheduled for today. The statement concludes that “newborn circumcision has potential medical benefits and advantages, as well as disadvantages and risks.”

It counsels pediatricians to explain benefits and risks fully to the parents of newborn boys, taking into account the medical implications of circumcision as well as issues of “aesthetics, religion, cultural attitudes, social pressures and tradition.” Since the medical perception of circumcision is scientifically neutral, the pediatrics academy concludes, parents should be encouraged to make their own personal decisions on a case-by-case basis.

Circumcision, the cutting away of the foreskin of the penis, is usually performed within a few weeks of birth, when complications are rare and deaths almost never occur. Circumcision of adult men is a far more serious surgery.

The statement is the final report of a task force created by the academy in January of last year to reexamine the procedure in view of recent studies that have attributed significant health benefits to circumcision, which has been in declining use since the mid-1960s.

The advantages of circumcision in newborns, the new report found, include prevention of urinary tract infections in infancy, cancer of the penis in adult men and inhibition of a variety of sexually transmitted diseases. The academy concluded that circumcision may also influence the rate of cervical cancer in women, which was found to be lower in the sexual partners of circumcised men.

AIDS Connection Denied

But the pediatrics academy dismissed as unconvincing other studies that have linked circumcision to preventing spread of the AIDS virus.

Marilyn Milos, executive director of the National Organization of Circumcision Information Resource Centers (NOCIRC), called the new position “disappointing.” Even though the academy’s position paper pointedly ignored the AIDS issue, Milos contended that “our fear is that, as has happened at other times with the AIDS scare, and the concern over urinary tract infections, the media will blow out of proportion what the academy is saying.”

Dr. Paul Fleiss, a Los Angeles pediatrician who is on NOCIRC’s professional advisory board, said the new statement is a significant departure from the pediatrics academy’s previous position, which has been in force since 1971.

“This new statement sort of vacillates,” he said, “characterizing it as “an unfortunate decision because (the policy) should remain that there are no medical indications for circumcision.”

Dr. James Strain, the Pediatrics Academy’s executive director, said the new neutral position may only be temporary. He said that if future studies--which, he said, have not yet been organized--confirm that circumcision prevents large numbers of urinary tract infections in newborns, the academy will probably change the policy to one of unequivocal endorsement.

Strain said he expected circumcision opponents to criticize the report, which has been awaited for months and has been the object of intense speculation among physicians. “I think we will be criticized by organizations that are opposed to circumcision and see no value in it and talk about it in terms of mutilation of the foreskin,” he said. “We try to deal with it in a purely scientific way.”

In Washington, the American College of Obstetricians and Gynecologists said it was reviewing its own position on circumcision and may officially endorse the new statement by the pediatricians.

The United States has a higher rate of newborn circumcision than any other Western country, according to anti-circumcision groups. But in recent years, even the American rate has fallen dramatically.

NOCIRC claims that, in 1987, 58.6% of American newborn baby boys were circumcised. The rate in the mid-1960s was as high as 85%, said the group.

Strain predicted that the new statement will either bring a halt to the slow reduction in the nation’s circumcision rate or cause a slight increase. “I think there are going to be parents who continue to be very concerned about it,” Strain said, noting that many families express concerns about pain inflicted by newborn circumcision. The new policy statement urges physicians to use carefully determined anesthetic doses to minimize babies’ discomfort.

The academy noted that, although anti-circumcision groups have contended that complication and death rates are unacceptably high and outweigh any benefits of circumcision, documentation for that could not be found. The few data that do exist, the statement said, could identify not a single death in two series of 675,000 cases reviewed. Other records, the academy said, found only three U.S. deaths from circumcision in the last 25 years.

Strain said that, in view of the new data and the Academy’s position, “I would say I probably would have my own child circumcised.”