The oldest recorded documentation of circumcision dates back to ancient Egyptian times, it also has biblical references, so it's been around for centuries. Circumcision in the United States took hold in the 1930s and by the 50s it was estimated that 90% of infant males were being circumcised. Today it's at about 56 % according to The Centers for Disease Control and Prevention (CDC.)
What is circumcision? Boys are born with a hood of skin, called the foreskin, covering the head (also called the glans) of the penis. In circumcision, the foreskin is surgically removed, exposing the end of the penis. Routine circumcision is usually performed in a hospital, often within 48 hours, after birth.
Circumcision has become much more controversial in the last decade. Anti-circumcision activists call the procedure genital mutilation and unnecessary. Proponents believe that it promotes better overall health as the infant grows into manhood.
The American Academy of Pediatricians (AAP) has recently updated its policy on circumcision for the first time in 13 years. It now states that the preventative health benefits of infant circumcision, clearly outweighs the risks. That is more definitive than their previous policy statement that circumcision provided "potential medical benefits," but was "not essential to the child's current well-being."
AAP task force formed in 2007 examined scientific studies conducted between 1995 through 2010 to evaluate if a revision was needed. The new, stronger language is a result of emerging evidence that found links between circumcision and decreased risk of urinary tract infections, some kinds of cancer, HPV, HIV, and other sexually transmitted diseases.
"The evidence was becoming clearer, and it's now obvious there's a preventative effect," says Dr. Michael Brady, chairman of the department of pediatrics at Nationwide Children's Hospital in Columbus, Ohio, and a member of the AAP task force.
Passionate opponents of circumcision, who sometimes describe themselves as "intactivists," call the procedure barbaric and liken it to female genital cutting. The internet, and its increasing use as a resource for medical decisions, has helped anti-circumcision groups get their message out."We believe that circumcision of children violates numerous legal rights of the child and is highly unethical, if not unlawful," said a public notice posted by Doctors Opposing Circumcision.
Some groups have even tried to make the practice illegal. Activists in San Francisco proposed a measure to ban circumcision, but it was struck down by California Governor Jerry Brown. Courts in Germany recently called circumcision "grievous bodily harm," and ruled that the "fundamental right of the child to bodily integrity outweighed the fundamental rights of the parents."
Religious beliefs also play a role in circumcision. Circumcision is a ritual obligation for infant Jewish boys, and a common rite among Muslims.
Research into the benefits of circumcision has produced several studies indicating that it does offer some protective measures.
Many studies on the benefits of circumcision have been performed in Africa, where, because of the prevalence of HIV and other STDs, the effect can be seen more quickly. The task force found evidence that circumcision has a preventative effect on:
HIV: Studies in Africa and a CDC math model study found that circumcision reduces HIV infection among heterosexual men.
HPV: Another African study found that circumcision reduces the spread of human papillomavirus, some strains of which can cause cervical cancer in women.
Other sexually transmitted diseases: A variety of studies suggest that circumcision is linked with decreased risk of contracting syphilis and genital herpes.
Urinary Tract Infections: Although still uncommon for boys, UTIs are more common among uncircumcised males in the first year of life. Treatment at this age can be painful and require hospitalization.
Penile cancer: An association was found between circumcision and decreased risk of this rare type of cancer.
Prostate cancer: A new study suggests that circumcision could be tied to a slightly lower rate of prostate cancer. While critics say circumcision decreases sexual pleasure, there are currently no scientific studies to support this claim. In fact, study participants in Africa who had been circumcised as adults reported either no effect or increased pleasure.
To have your baby circumcised or not? That's really a decision that should be made between parents and their pediatrician or family physician. No parent should feel pressured to have their baby circumcised or not circumcised.
Brady suggests discussing with your doctor the health benefits and risks, and doing your homework to make sure that if you're considering circumcision, whoever is performing it has been properly trained. It should be performed in a sterile environment with analgesia for pain relief. Parents should be clear on how to care for their newborn's penis, cut or uncut.
"Parents need to make the decision they feel is the best for their child," says Brady. "We don't want to put anyone in a position where they are being told what they have to do."
The new policy statement will be published in the September issue of Pediatrics. It is also endorsed by the American College of Obstetricians and Gynecologists.