August 22, 2012 | 11:21 AM |

Cost Study Adds To Growing Research On Benefits Of Circumcision

FILED UNDER: Medicine/Science, circumcision, men's health
Preparing for a ritual circumcision

Preparing for a ritual circumcision (Cheskel Dovid/Wikimedia Commons)

“You realize, of course, this is a purely cosmetic procedure.”

That snarky-toned remark by a neonatologist is imprinted in my memory forever, tinged by the extra distress it caused me. I’d just been through a scary pre-term birth and the anxiety of more than a month of hospital care for my baby son. Now he was finally almost ready to go home, still weighing only a little over five pounds, and the last thing I wanted for him was another procedure.

But the research I’d done persuaded me that circumcision was not just a venerable tradition; it had real health benefits, both shorter-term and when he reached maturity. I knew about the growing movement among men who denounce it. I’d also heard an earful from our babysitter about the penile problems of boys in Europe, where circumcision is rare.

We chose circumcision, but apparently more and more American parents are tipping the other way — and the health results could prove expensive. NPR’s Scott Hensley has just posted an excellent “Shots” piece on the potential tab for the decline in circumcision and its background. Right now, about 55 percent of American boys are circumcised, he notes, down from a peak of 79 percent. But a growing body of research — including this Johns Hopkins study last fall — finds that circumcision has significant health benefits, preventing sexual diseases and urinary infections.

Scott writes about the latest study, on costs:

Johns Hopkins researchers analyzed how declines in circumcision would affect future health care costs, including what would happen if the rate fell to 10 percent, which is the average in Europe. The change — up or down — in HIV infections is the biggest factor. So what’s the tab? If the circumcision rate fell to 10 percent, the annual net increase in health care costs would be about a half-billion dollars a year. The findings appear in the latest issue of Archives of Pediatrics and Adolescent Medicine.

Johns Hopkins pathologist Aaron Tobian, senior author on the paper, tells Shots an increase in health costs tied to less frequent circumcision is already happening. He lays some of the blame on the American Academy of Pediatrics, whose 1999 policy statement says the “data are not sufficient to recommend routine neonatal circumcision.”

Tobian says that data gathered since then show that position is wrong. “The trials were amazingly consistent,” he says.

The American Academy of Pediatrics declined to comment. But we won’t have to wait too long for more from the group. Next Monday, a long-awaited update to the group’s circumcision policy is set to be published.

We’ll be watching for their decision. Putting money aside, the health consequences themselves could be major. Futurity.org also reports on the study, writing:

According to the analysis, if circumcision among men born in the same year dropped to European rates, there would be an expected 12 percent increase in men infected with HIV, 29 percent more men infected with human papillomavirus, a 19 percent increase in men infected with herpes simplex virus, and a 211 percent jump in the number of infant male urinary tract infections.

Among their female sex partners, there would be 50 percent more cases each of bacterial vaginosis and trichomoniasis. The number of new infections with the high-risk form of human papillomavirus, which is closely linked to cervical cancer in women, would increase by 18 percent.

Readers? Have you faced this decision, and what was your thinking? By the way, we went the hospital route, not the ritual route in the photo above, and all went well.

  • dave

    As a male who was circumcised at twenty years of age, out of necessity in my rare case, I assure you there is a significant decrease in enjoyment physically after the procedure. You always kind of feel it, like any scar or injury. I think people who claim there is no physically sensational diminishment are just good at fooling themselves. I can’t imagine their anatomy being so much different than mine.
    The tip of the foreskin is the most sensitive area and then when it’s gone, it just really sucks. Sex is still better than everything else, and the mental desire is the same, but the physical part of it is just never ever the same.

  • Ruddeger Frutz

    “My Body, My Choice.” — This was denied me. It will never be denied my sons.

  • mike the rookie

    i stand by circumcision

  • J__o__h__n

    Cutting the entire organ off would also reduce STD rates.

  • rfra20

    Well someone has finally explained why Greece is in such a deep financial crisis! The cost of all those uncircumcised males is obviously destroying their economy! Maybe the Merkel bailout plan can impose mandatory circumcisions to make sure Greek finances can be stabilized for the next generation.

  • info

    This is bad math. Circumcision and dealing with its complications costs $2 billion a year. There is no cost savings from circumcising more boys, only more boys with complications. http://www.icgi.org/information/cost-of-circumcisions/

  • http://www.facebook.com/jack.page.526 Jack Page

    The emotional impact of discovering that you have HIV / AIDS can outweigh the physical health issues one has to deal with. Go to HIVMatching,com to
    find support and other people with HIV / AIDS in your area!

  • http://www.facebook.com/jack.page.526 Jack Page

    I don’t think circumcision is useful as I can see more and more new members
    at HIVMatching, a support community for people with HIV.

  • Don’t Circ Babies

    Men, test out what you are missing for yourself:
    Wear a condom on your penis night and day for a week (taking it off for usage, and using fresh condoms as needed). Then try having sex with your partner. Compare the sensations before and after that week of coverage. Now imagine what you would feel if the nerves weren’t cut off.

  • J__o__h__n

    Parents shouldn’t have to struggle with this decision as it shouldn’t be theirs. Men should decide at 18 if they want this irreversible medical procedure.

    • Ruddeger Frutz

      The only person who should decide is the owner of the penis.

  • a wound with no benefit

    There are no real world studies that show cutting off penis parts helps prevent HIV, HPV and other sexually transmitted infections in men! In the US no lowering of HIV risk has been noted, and the US has a high circumcised adult population with a high HIV rate and Europe and Japan have a very low number of adults that are circumcised and have a very low HIV rate. In the US only the number of sexual partners and NOT circumcision status is linked to HPV. There is clear evidence that baby boy penis parts removal does not shield the man the baby becomes from STDs in developed nations.

    Evidence of this comes from the Laumann study (USA, 1997), based on over 30,000 American men, which showed no advantage to the circumcised group. The most recent comparative study from Dunedin, New Zealand (cohort of about 500 men) backs this up, concluding: “Circumcision does not appear to shield men from most types of STDs in developed nations”. SOURCE: Journal of Pediatrics, MARCH 2008.In the US cut and natural men have HIV and HPV in the same % and example of this comes from the US Navy: Although known HIV risk factors were found to be associated with HIV in this military population, there was no significant association with male circumcision.

    Some studies show that circumcised men pass HIV to partners at a higher rate and aquire STDs at a higher rate. In other words natural will save STD costs:

    from Puerto Rico

    “Circumcised men have accumulated larger numbers of STI in their lifetime, have higher rates of previous diagnosis of warts, and were more likely to have HIV infection.”

    In fact real world data shows a natural penis is not at higher risk for HIV, HPV and all other STDS. Also consider some interesting Africa data:

    The US sponsored DHS Comparative Reports No. 22 showed that in Africa there appears no clear pattern of association between male circumcision and HIV prevalence. In 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries HIV prevalence is higher among circumcised men.

    In 2010 the same Kisumu team (Bailey) that did one of the flawed Africa studies reported the cut Kenyan men were no less likely to have HIV after all.

    The recent CDC Zambia study did find that men with herpes were more likely to be HIV-positive, but also found that lack of circumcision did not increase the risk of HIV infection.

    In 2009 the same Rakai team (Wawer/Gra-y) reported that the Ugandan men they cut were 50% MORE likely to infect their female partners.

    “The HIV prevalence rate among circumcised males between the ages of 15 and 49 in Zimbabwe is higher than that of the uncircumcised male” after a Bill Gates funded circumcision drive. Loss of pleasure and just a wound with no health advantage.

  • robger65

    It is simply a violation of a man’s most basic human rights, to have the body he was born with. Let an adult make the choice to mutilate his own penis, for whatever reason. Penile problems in intact boys, and later in men, occur most often when someone retracts the foreskin, and damages it, when they are not supposed to. It starts to retract fully and naturally just before puberty. Somebody should investigate that baby sitter. Intact men say the frenelum is the best part of the penis and could not imagine not having it. Circumcised men don’t have all of it, if they have any at all. Does that cause a subconscious feeling that something is missing, looking to fetishes to fill that desire? Does it cause an anger towards women? Where is that study? Religious circumcision has always been an attempt to stop masturbation, plain and simple. In desert societies, with the lack of water, there is only one way to properly clean your penis, spit on your hand and get to it. There was also a lack of food in desert societies so men could not afford to lose all that nutrition every time they had to clean themselves and be strong enough to fight invading armies. As the old saying goes, “In war the victor is not always who is right, but who is left.”

  • vorpaladin

    Do not mutilate your baby boy’s genitals! If he wants the extra skin removed, let him make that decision when he is an adult and in full possession of the facts. The penis evolved into the shape it has for a reason — just because we don’t fully understand that reason yet is no reason to go slicing off your baby’s body parts.

  • Don Williams

    To see how ridiculous Tobian’s study is , ask yourself
    what are going to be the medical costs of people who get HIV because they think their magic circumcision means that they don’t need to use condoms. Oh — and include in that the medical costs for all their subsequent female partners who also get HIV.
    And why does Tobian casually assume that American sex habits and frequency are identical to European sex habits? (Else his whole argument falls apart.) Is adultery as accepted in America as in France? Look behind the curtains and all those pot-bellied
    middledage married American men are really Dominique Strauss-Kahns?

  • eAbyss

    If all that’s true then insurance companies should charge uncircumcised men more. Simple as that.

  • Robert

    Yup, 65 million years of God’s evolution and it turn out she got it wrong.

  • George

    Yes, all mutilations, piercings, tattoos, tongue-splitting, circumcision, & the like ought be a free choice made by the adult receiving them. At least, I think, in an “advanced” civilization……………..

  • Don Williams

    But , hey, if the concern is that our billionaires might have to pay a few million in taxes because the poor are too irresponsible to use condoms or wash their penises, then why not just cut off the entire penis of any male child born to a family with an annual income less than $30,000? That would definitely work. Why use a half measure that will be only marginally effective?

  • Hans

    Makes you wonder about the pervert(s) that started circumcision – I doubt they saw it as a “health” benefit in those early days. We were created with foreskin for a physical benefit unless we’re stupid enough to have sex with anyone and risk catching a disease.

  • Kenny

    Circumcision is assault on helpless humans and is the domain of barbarians. Pretty simple really.

  • Don Williams

    I do not think it is in the best interest of the American Jewish community for a few jews in the news media to be strongly promoting this barbaric procedure in what I consider to be an intellectually dishonest fashion. Especially when the only explanation I can think of for this dishonesty is religious fanaticism.
    The argument for circumcision works only if you discard far better solutions to low probability threats and assume that men never wash their penis or use condoms.
    The “framing” in Tobian’s study is laughable.
    If you think circumcision is so great, trying offering the alternatives to a 12 year old boy and ask him which he chooses — don’t inflicit pain on him without his consent.

  • Tickbunny

    We circumcised our son who was born in 1998 with a barely functioning kidney. After surgery to remove the kidney at 6 months he developed reflux of the ureter which persisted until he was two. During the first two years of his life he had a much increased chance of developing an uti, which could have serious with the kidney which was functioning at 7 percent. He has gone on to living a very healthy urinary life and the circumcision played and plays a part in that.

    • WTF

      I think we would all agree that that was a good decision. But in the case of a healthy baby boy there is no reason for circumcision!

    • vorpaladin

      A circumcision done to resolve a serious medical issue is completely different from simply cutting off part of a healthy boy’s penis. That’s like saying baby girls should have their breasts cut off because they might develop cancer some day and need them cut off anyway.

  • John Hix

    Circumcision is preventative care the same as removing the appendix when another invasive surgery is required and removing the tonsils of children. Too not have a circumcision done for a child is about the same as not having them vaccinated due to the myths of mercury poisoning. A person who relies on himself as a doctor has a fool for a patient.

    • WTF

      you don’t remove the appendix till there is a problem!!

    • Don Williams

      I would argue that people who accept doctors as demigods and accept their doctor’s opinion without question are even bigger fools. After all, that is why we pay twice as much for healthcare as people in the EU and get worse results. Why Medicare’s trustees say it’s shortfall in funding is $32 TRILLION.

    • eAbyss

      All your doing is removing a piece of skin that has no purpose other than spreading disease. Just like the appendix it can be removed before it becomes a problem if an opportunity arises that can avoid pain and discomfort from it’s removal later.

      It’s simple preventive health care people.

      • Jackno

        Yikes the ignorance of otherwise seemingly intelligent people is staggering.
        It is not just skin, it is the most innervated part of the penis (possibly the most innervated part of the human)!

        No one that is at all credible claims there are no functions to the penis parts cut off. However, the sexual function and pleasure are ignored or downplayed by the penis parts removal pushers. The long term harm is huge with nerve damage and harm to the sensory system. A whole range of sensation and sexual and protective function are lost. The lips, nipples and fingertips have similar touch sense. To take this away from another person without their consent is heinous.

    • vorpaladin

      Assuming a body part has no function because you don’t know its function is absurd. The tonsils are an important part of the lymphatic system and play a role in disease immunity. They should never be removed unless they have been destroyed by disease. My tonsils are alive and well at age 46 thank you very much. No one has (or EVER had) the right to cut them out without my consent.

  • wrong

    leave the boy alone knows crap. Jews have been performing this for more than a thousand years before the middle ages. And…the whole muslim world does it too.

    • the reasons keep changing

      Why not join the Muslims and circumcise girls as well I am sure we can manufacture some health reasons there as well!

    • CountWestwest

      Most of mankind, the Chinese, the Europeans, the Japanese have not circumcised their children in 10,000 years, and in this day and age they have less STD’s than Americans and are healthier in general. One area where the US and Israel lead the world, though, is erectile dysfunction.

  • snipsnipsnip

    Good to know. We’ve an appointment tomorrow to have our 2-week old clipped and this only further confirms we’ve made a good decision.

    • Cosmetic Surgery on Babies

      Let the boy choose for himself when he is old enough!!

    • vorpaladin

      You have made a terrible decision. Don’t let yourself be so easily persuaded by propaganda!

  • Christine

    You guys sure post a lot about the benefits of circumcision. It’s starting to feel like you have an agenda.

    • careyg

      Hey, Christine! I tried to be transparent about my own agenda: I made a health decision for my child that was hard for me, and I do tend toward news that reinforces it. But the level of coverage is for the same reason as breastfeeding: it’s a hugely widespread issue and the guidance leaves room for a lot more discussion — or do you have something more sinister in mind? Carey

      • Christine

        I’m confused by your comment. Are you trying to suggest that posting only pro circumcision stories because you’re biased towards them is a public service because deciding whether or not to circ is hard for people? To me it’s always irresponsible to exclude context and access to opposing views because you want to prop up your own beliefs. Whether or not to circ is not a ‘hugely widespread issue,’ it’s a minor, elective medical procedure that can be done easily at any point (but of course can’t be undone). I’m not sure how you’re comparing that to breastfeeding. Because they’re both controversial and likely to garner page views?

        • careyg

          It’s a hugely widespread issue in that all parents of boys — and 2 million boys a year are born in this country — face the decision, and many, like me, find it a difficult one. FYI, from the NPR story just posted about Israeli circumcisions: “The Washington Post reports that the pediatric association still won’t recommend routine circumcisions, but it will say circumcision can prevent some diseases and is beneficial to public health.”

      • Don Williams

        You mean that this is not part of a premptive political campaign designed to head off court rulings/laws like the recent ban on circumcision in Germany?
        http://www.economist.com/node/21558299
        Because otherwise I can not understand how Tobian’s hilarious hogwash got such wide circulation. If a woman’s partner does not use a condom then she is risking HIV regardless of whether he is circumcised or not. And if he is using a condom then there is no need to circumcise him.

  • WTF

    New study shows: People without noses get less sinus infections…I say we cut off babies noses!!

  • Dave

    My wife and I agonized over this decision and finally decided against circumcision. I couldn’t find any unbiased research on either side, so we decided against it for purely pain-avoidance reasons. I would NEVER criticize other parents for making a different choice, but the justification just wasn’t good enough for me to submit my son for more pain (we had a pretty rough start, too) at the hands of doctors.

    • careyg

      I totally understand, Dave, and feel the same about respecting other parents’ decisions, as I respect yours…Here’s hoping the AAP offers better guidance to parents next week…

    • Ruddeger Frutz

      Dave: I found it a very easy choice, because it isn’t mine. It is his. The only person who should decide is the owner of the penis. :)

  • uncircumcised

    Seriously, don’t mutilate your child’s genitals.

  • MD

    You can find “medical support” for pretty much any stance you want to take (see Akin’s comments about a doctor who spouts the idea that in “legitimate rape,” women’s bodies will prevent pregnancy). Using the above argument is specious – if we did mastectomies on all baby girls, we would eliminate breast cancer in women; if we did colectomies on everyone, no one would get colon cancer. It just doesn’t hold up.

  • Leave the boy alone

    This article is a bunch of crap. There is NO health benefit to being circumcised. People who suggest a health benefit are religiously opposed to the use of condoms which have been shown to prevent AIDS and HPV in men.

    The reason circumcision is done is because people in the middle ages thought it would keep boys from masturbating Didn’t work, did it.

    A few facts: circumcision is the NUMBER ONE performed surgery in the US. With the exceptions of the USA and Israel, almost NOBODY in the world circumcises their male children. There are THOUSANDS of nerve endings in that part of the body and the surgery is ALWAYS done without even a LOCAL anesthetic. The procedure is barbaric and it needs to end. DO NOT CIRCUMCISE YOUR CHILD. IF THEY WANT IT DONE, LET THEM DO IT WHEN THEY ARE AN ADULT.