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Circumcision debate: What would you do?

If you're the expectant parent of a baby boy, you face an age-old question that's now a roiling, 21st-century controversy: Will your son be circumcised?

Circumcision debate: What would you do?

A brand-new position statement from the American Academy of Pediatrics lines up the health benefits -- lower risk for urinary-tract infections and HIV, less chance he’ll pass on other sexually-transmitted diseases like HPV (responsible for cervical cancer).  (AP Photo/Ed Andrieski)
A brand-new position statement from the American Academy of Pediatrics lines up the health benefits -- lower risk for urinary-tract infections and HIV, less chance he’ll pass on other sexually-transmitted diseases like HPV (responsible for cervical cancer). (AP Photo/Ed Andrieski)

If you’re the expectant parent of a baby boy, you face an age-old question that’s now a roiling, 21st-century controversy: Will your son be circumcised? Or, as the Journal of Men’s Health put it, bluntly, in a 2010 survey of Canadian doctors on the subject: “To cut or not to cut?.”

A brand-new position statement from the American Academy of Pediatrics lines up the health benefits -- lower risk for urinary-tract infections and HIV, less chance he’ll pass on other sexually-transmitted diseases like HPV (responsible for cervical cancer).

But the AAP stopped short of endorsing circumcision. And the procedure’s less popular than ever.

This procedure, which removes the foreskin of the penis, was performed in hospitals on 61 percent of boys in 2000. The rate dropped to between 54 and 57 percent by 2008, according to the Centers for Disease Control and Prevention. One big reason: Money. Eighteen states no longer provide Medicaid coverage -- and rates there are 24 percent lower than elsewhere, UCLA researchers say. Colorado was the latest, dropped Medicaid coverage in 2011; attempts to get the funding back were defeated this year by budget-conscious legislators and anti-circumcision advocates. (The numbers don’t include out-of-hospital circumcisions; Jewish families, for example, often have a mohel perform the circumcision, a bris, at home.)

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But there’s another reason for the decline. “Intactivists” -- circumcision opponents who say boys have the right to an intact foreskin -- say the procedure’s as barbaric as female genital mutilation. That it’s painful despite advances in pain relief for babies. And that the health benefits have been over-stated. Some experts say boys should decide for themselves after age 16.

Last fall, a ban on male circumcision ban nearly made it onto the November ballot in San Francisco -- until a judge ruled that the issue should be decided by the state rather than by one city’s voters. And this summer, a German court ruled that circumcision violated the “fundamental right of the child to bodily integrity,” and should be decided by the child himself once he gets older. Germany's Medical Association had told doctors not to perform circumcisions following the court ruling. But this week, German chancellor Angela Merkel weighed in, pledging to protect circumcisions performed for religious reasons.

Twelve years ago, anti-circumcision groups attempted to stop Medicaid funding for circumcisions in Pennsylvania, but failed.

Does circumcision matter for health? One new study says yes. Disease experts and health economists from Johns Hopkins say if rates fell to 10 percent -- the level in European countries that don’t cover it -- the result could be:

  • 211 percent more urinary tract infections in baby boys.
  • 12 percent more HIV cases in men.
  • 29 percent more human papillomavirus (HPV) cases in men.
  • 18 percent more high-risk HPV infections in women.

There could also be more cases of cervical and penile cancer linked to HPV and more cases of HIV. The decline in American circumcisions over the past 20 years has already cost the nation upwards of $2 billion in health care costs, the researchers say. The future tab could top $4.4 billion.

What do you think? What would you do?

About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, M.D., Ph.D Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Mario Cruz, M.D. St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, M.D., Ph.D Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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