Should males be circumcised? This is clearly an issue about which many people feel strongly, for a host of social, religious and personal reasons, but there are a number of facts related to the issue that clearly came under consideration in the American Academy of Pediatrics guidelines just released related to circumcision of male infants and published in Pediatrics. The guidelines basically state that the benefits of the procedure outweigh the risks and access to circumcision should be available to parents of male infants. Rick and I wholeheartedly agree in this week's PodMed.
These guidelines were last updated in the late 1990s, and since then, several studies have provided compelling evidence for the health benefits of the procedure. Interestingly, much of this evidence comes from studies in Africa, prospective studies investigating whether males who were circumcised acquired HIV infection more readily than their uncircumcised peers. The answer was resounding, and showed clearly that uncircumcised males became infected much more frequently. Historical data and studies have already shown that other STIs are also more likely in men who remain uncircumcised, as are UTIs and penile cancer.
These facts fly in the face of perceptions that since many infectious diseases may seem under control in the US, circumcising male infants isn't as important domestically. Thus an increasing number of parents have chosen not to circumcise their male infants in the last decade or so. Hopefully the new guidelines will help reverse this trend.
The Academy does acknowledge that circumcision needs to be performed by a well-trained provider who also employs adequate pain relief and sterile technique. Such a provider need not be a physician but can be another medical or religious professional who is proficient in the procedure. Specific methods that don't provide adequate analgesia include infant positioning or sucrose pacifiers, and the guidelines specifically name penile nerve blocks as effective and caution about the use of analgesic creams in preterm infants as a potential source of irritation.
Parents also must be educated about circumcision, and the paper cites the rather sobering statistic that only about 4% of parents report having discussed circumcision with their clinician before pregnancy. The speculation is that information about the procedure is gleaned from family and friends rather than clinicians or education. A suggestion is made that circumcision should be a topic in childbirth education classes so parents have factual information.
Rick emphasizes in the podcast that these guidelines apply to infant male circumcision, the least problematic time in a male's life in which to undergo the procedure. The guidelines do mention that some parents are reluctant to make this choice for their male children, preferring to defer such a decision until the individual is old enough to choose for himself, yet the likelihood that an older male will do so, especially once he's become sexually active, is remote. I would also say that at this year's International AIDS conference in Washington, DC, a very courageous African man was extolling the virtues of adult circumcision and revealing his own personal journey with it, but men such as him are rare indeed. Seems like one place where parents need to step up to the plate.
Other topics this week include a CDC recommendation that all persons born between 1945 and 1965 undergo a one time screening for hepatitis C, the effect of midlife exercise on chronic disease in later life in Archives of Internal Medicine, and marijuana use in adolescence in the Proceedings of the National Academy of Sciences (PNAS). Until next week, y'all live well.
The Circumcision Debate,2 Comments