circumcision

RECENT POSTS

Circumcision Boost: Study Cites Benefits, Notes Foreskin-Related Health Problems

New findings may offer a boost to proponents of newborn male circumcision: Researchers in the U.S. and Australia report that the health benefits of undergoing the procedure “exceed the risks by over 100 to 1,” and note that “over their lifetime, half of uncircumcised males will contract an adverse medical condition caused by their foreskin.”

The review, published online in the Mayo Clinic Proceedings, bolsters the position of mainstream physician groups, such as the American Academy of Pediatrics, which supports insurance coverage of the practice and full access for families who choose circumcision for their infants. But the new report is unlikely to silence critics of the practice, who have called it “insane” and a “disservice to American parents and children.”

Here’s some context, from the study, which shows a slight increase in circumcision among older men, but a decline among newborns:

Preparing for a circumcision

Preparing for a circumcision (Cheskel Dovid/Wikimedia Commons)

“The latest data on male circumcision in the United States show a 2.5% overall increase in prevalence in males aged 14 to 59 years between 2000 and 2010. In contrast, there has been a downward trend in neonatal circumcisions, with the present analyses finding that the true extent of this decline is 6 percentage points.”

And here’s more from the news release:

Whereas circumcision rates have risen in white men to 91%, in black men to 76%, and in Hispanic men to 44%, the study authors found an alarming decrease in infants. To get the true figures they had to correct hospital discharge data for underreporting. This showed that circumcision had declined from a high of 83% in the 1960s to 77% today.

There seemed to be two major reasons for the fall.

One is a result of demographic changes, with the rise in the Hispanic population. Hispanic families tend to be less familiar with the custom, making them less likely to circumcise their baby boys.

The other is the current absence of Medicaid coverage for the poor in 18 US states. In those states circumcision is 24% lower. Continue reading

In Defense Of Female Circumcision? Panel Presents Seven Facts

female circumcision

A roadside sign in Uganda (Amnon Shavit/Wikimedia Commons)

What? How can there be counter-arguments? Isn’t the genital cutting performed on girls in Africa the very definition of barbaric?

Not according to a provocative set of articles just out from The Hastings Center, the bio-ethics think tank. They argue that Western media have mis-portrayed genital surgery as worse than it is in a variety of ways. From the press release:

Despite widespread condemnation of female genital surgeries as a form of mutilation and a violation of human rights, an international advisory group argues that the practice is poorly understood and unfairly characterized. In a public policy statement in the Hastings Center Report, the Public Policy Advisory Network on Female Genital Surgeries in Africa, a group that includes doctors, anthropologists, legal scholars, and feminists, argues that media coverage of the practice is hyperbolic and one sided, “painting the now familiar portrait of African female genital surgeries as savage, horrifying, harmful, misogynist, abusive, and socially unjust.”

The advisory network’s statement takes no position on whether the practice should continue. It aims to “move the coverage of the topic from an over-heated, ideologically charged, and one-sided story about ‘mutilation,’ morbidity, and patriarchal oppression to a real, evidence-based policy debate governed by the standards of critical reason and fact checking.”

…Female genital surgery – a neutral term used by the advisory network instead of other terms, such as female genital cutting and female circumcision – has been condemned as a violation of the human rights of girls and women by a wide range of experts and organizations, including the World Health Organization and the United Nations. In several African countries, including Egypt, Guinea, Sierra Leone, and Somalia, more than 90 percent of women ages 15 to 49 have undergone such surgeries.

In its statement, the advisory network focuses mainly on two types of female genital surgery, which they state comprise 90 percent of procedures in Africa. These practices involve reducing the clitoral hood and tissue and reducing or eliminating the labia and the clitoris. A third type, referred to as infibulation or sealing, involves narrowing the vaginal opening with stitches or some other sealing method.

The authors put forth seven facts that they hope will change the scope of media coverage and lead to a better understanding of the cultural complexities underlying female genital cutting:

♠ Medical research has found that a high percentage of women who have had genital surgery “have rich sexual lives, including desire, arousal, orgasm, and satisfaction, and their frequency of sexual activity is not reduced.”
♠ Reproductive health and medical complications linked to female genital surgery happen infrequently.
♠ Those who value female genital surgery view it as aesthetic enhancement, not mutilation.
♠ In almost all societies where female genital surgery is performed, male genital surgery also takes place. Broadly speaking, then, such societies “are not singling out females as targets of punishment, sexual deprivation, or humiliation.”
♠ The link between patriarchy and female genital surgery is unfounded. Almost no patriarchal societies adhere to the practice and, at the same time, the practice is not customary in the world’s most sexually restrictive societies. Continue reading

Pulling Back The Curtain On The AAP’s New Pro-Circumcision Stance

For some excellent context and more backstory on the American Academy of Pediatrics’ new recommendations on circumcision, listen to Radio Boston today featuring the very knowledgeable Marvin Wang, co-director of the newborn nurseries at MassGeneral Hospital for Children. (As for his credentials, when asked how many circumcisions he’s done, Dr. Wang said he stopped counting after the first thousand.)

The AAP on Monday updated its 1999 circumcision policy statement (which said the data weren’t sufficient to recommend routine neonatal circumcision) and now asserts that the health benefits of newborn male circumcision outweigh the risks and insurers should cover the procedure. However, the influential pediatrician’s group stopped short of recommending universal circumcision for all baby boys and said the ultimate decision should be left to parents.

Wang says that much of the push for the new AAP recommendations came from clinical studies in sub-Saharan Africa that showed male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. Wang also put circumcision in a global context, noting that while the rate of hospital circumcision in the U.S. has dropped from about 79 percent two decades ago to about 55 percent today, in the U.K only about 9 percent of men are circumcised. Continue reading

Influential AAP Says Health Benefits Of Circumcision Trump Risk

(afagen/flickr)

The American Academy of Pediatrics new policy statement today asserting that the health benefits of male circumcision outweigh the risks will inevitably set off a firestorm of reaction. Even while the pediatrics group continued to reiterate in their paper that circumcision is a personal family decision best left up to “parents in consultation with their child’s doctor” folks who oppose the procedure and equate it with genital mutilation will certainly not be pleased.

Carey’s earlier post on the increased health costs associated with declining circumcision rates triggered scary and intense online outrage.

All I can say is I’m glad I have daughters.

Here’s the abstract from the AAP paper today:

Male circumcision is a common procedure, generally performed during the newborn period in the United States. In 2007, the American Academy of Pediatrics (AAP) formed a multidisciplinary task force of AAP members and other stakeholders to evaluate the recent evidence on male circumcision and update the Academy’s 1999 recommendations in this area. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. Continue reading

Cost Study Adds To Growing Research On Benefits Of Circumcision

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. Continue reading

Highlighting The Health Benefits Of Circumcision

The Circumcision by Tintoretto

A team of infectious disease experts wander into delicate political and parenting territory in the current Journal of the American Medical Association in their defense of male circumcision.

The three Johns Hopkins doctors argue that circumcising newborns and young boys offers clear medical benefits, and that political attempts to cut off public funding for the procedure are potentially dangerous, particularly to minorities and the poor.

Here’s much of the press release from Johns Hopkins:

Critics of infant or childhood circumcision claim, among other things, that the procedure should not be considered until males can give legal informed consent at age 18.

In an editorial to be published in the Journal of the American Medical Association online Oct. 5, Johns Hopkins health epidemiologist and pathologist Aaron Tobian, M.D., Ph.D., and health epidemiologist Ronald Gray, M.D., highlight the most recent medical research showing the considerable life-long health benefits of circumcision performed during infancy and the potential disadvantages associated with waiting until adulthood before undergoing the procedure. The experts point out that there are medical benefits during childhood, as many young men are already sexually active before age 18, and at greater risk of infection from sexually transmitted infections. Circumcision at older ages is also associated with more complications and cost than having the minimal surgery in infancy.

“Our goal is to encourage all parents to make fully informed decisions on whether to circumcise their infant boys based on medical evidence and not conjecture or misinformation put out by anti-circumcision advocates,” says Tobian, an assistant professor at the Johns Hopkins University School of Medicine. Continue reading

The Saga Of The $23,000 Circumcision

The high cost of circumcision

*3:15 Update: See Below

On Wednesday, Stephanie Bottner of Somerville, Mass. posted a story on the new HealthCare Savvy website about trying to get a circumcision for her son.

The post begins this way: “I have recently had an interesting experience which left me completely shocked. This is not a posting about whether or not to get a circumcision, just at the astronomical costs involved.”

Stephanie continues:

My son was born 14 mo ago and because he was born in a Birth Center, he could not get circumcised at birth. Our hospital (Cambridge Hospital in Mass.) does not have a pediatric surgeon for this procedure so we were given a referral for a doctor at Mass General (Boston). When I called Mass General to get a quote on the price, I got the following:

$23,000
(includes Facility, Physician, Anesthesia)

This procedure is less than 30 minutes; the doctor himself even stated that this is one of the easiest procedures. I’ve researched prices for other countries and found a high of $1200. Continue reading