The American Academy of
Pediatrics (AAP) recently published (Pediatrics, September
2012) a policy statement on the medical circumcision of male newborns.
While determining that the procedure’s benefits outweigh its risks, AAP does
not go so far as to recommend universal newborn circumcision, saying instead
that the decision should be left to parents “to make in the context of their
religious, ethical and cultural beliefs.”
The preventive and public health benefits associated with
newborn male circumcision, however, “warrant third-party reimbursement of the
procedure,” including Medicaid, says AAP. It goes on to recommend that
circumcision in infancy be performed by “trained and competent providers, using
sterile techniques and effective pain management.”
Circumcision is the surgical removal of the foreskin, a flap of
skin that covers the tip of the penis. The first revision of its circumcision
stance in 13 years, the AAP’s new policy takes into account significant
studies, including a recent one from Johns Hopkins, that link circumcision to
decreased risk over a lifetime for some forms of cancer, including penile and
cervical, and the spread and heterosexual acquisition of HIV, human papilloma
virus (HPV), genital herpes and syphilis. Much of the new scientific research,
since the previous AAP policy of 1999, has taken place in Africa, where the
prevalence of sexually transmitted infections, HIV in particular, is high and
increasing.
Such newly and widely documented health benefits, says the AAP
in related literature, are great enough that the insurance should cover the
cost of circumcision, “which would increase access to the procedure for
families who choose it.”
A recent Johns Hopkins study (Archives of Pediatrics &
Adolescent Medicine, online, Aug. 20) goes further. Declining rates
of U.S. infant male circumcision will lead to dramatically higher rates of
sexually transmitted disease and related cancers in men and their female
partners, researchers warn, and add up to more than $4.4 billion in avoidable
costs if circumcision rates in the U.S., now averaging 55 percent (down from 76
percent in the 1970s and 1980s), drop to levels now seen in Europe (around 10
percent on average) over the next decade.
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