In defense of circumcision

Circumcision has been under attack. So-called “intactivists” who believe that males – from infants to adults – have a human right to retain their foreskin have been campaigning against the procedure. They supported an initiative in San Francisco that would have banned circumcision in that city, though a judge tossed it off the ballot before election day. They have also helped persuade 18 states to stop paying for circumcisions under their Medicaid health insurance programs.

Under these conditions, who will stand up and defend the once-routine procedure? Two physicians from the Bloomberg School of Public Health at Johns Hopkins University, that’s who.

“If a vaccine were available that reduced HIV risk by 60%, genital herpes risk by 30%, and HR-HPV [high-risk human papillomavirus] by 35%, the medical community would rally behind the immunization and it would be promoted as a game-changing public health intervention,” Drs. Aaron Tobian and Ronald Gray write in Wednesday’s edition of the Journal of the American Medical Assn. Those are just some of the proven benefits of circumcision, and if parents would like their sons to have them, “it would be ethically questionable to deprive them of this choice,” they write.

In their commentary, Tobian and Gray recount the evidence in favor of male circumcision, much of it gathered in the last five years:

• A trio of randomized trials in Africa have shown that men who are circumcised reduce their risk of acquiring HIV by 51% to 60% compared with men who are not.
• Two other trials have shown that the risk of acquiring genital herpes is 28% to 34% lower in men who are circumcised.
• Trials have found that male circumcision reduces the risk of genital ulceration by 47%.
• Men who are circumcised are 32% to 35% less likely to contract the HPV virus, which causes cancer.

The doctors also point out that women benefit when their partners are circumcised. Studies have found that the risk of HPV is 28% lower, the risk of bacterial vaginosis is 40% lower, and the risk of trichomoniasis is 48% lower for women whose sexual partners lack foreskin.

These are all good reasons for males to be circumcised – and the earlier they have the procedure, the better, Tobian and Gray write.

If circumcision could be performed only once boys became consenting adults at the age of 18, they would miss out on several years of protection against sexually transmitted diseases. (Tobian and Gray say that half of American high schoolers start having sex before they turn 18.)

In addition, the procedure is much safer for infants than for adults. Tobian and Gray write that the complication rate for newborns is in the range of 0.2% to 0.6%, but in clinical trials, the complication rate for men was in the 1.5%-to-3.8% range.

Parents routinely make health decisions on behalf of their children and give consent for measures that will protect their health, the doctors write. They decide to have their children vaccinated, and if they become sick and need surgery they give the OK for that too. Circumcision, they say, should be no different.

The commentary is available online here.