Fewer Boys Are Being Circumcised

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Many factors may contribute to the decreasing circumcision rates seen in hospitals across the U.S., including the fact that good hygiene and practicing safe sex can provide similar benefits

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Circumcision of newborn male infants, the surgical removal of the foreskin covering the tip of the penis, may be performed for both health and religious reasons. It is an elective, and somewhat controversial, procedure.

The potential health benefits of male circumcision include a decreased risk of urinary tract infections and sexually transmitted diseases, protection again penile cancer and decreased risk of cervical cancer in female sex partners, prevention of inflammation of the glans and foreskin, and prevention of phimosis and paraphimosis, the inability to retract and return the foreskin to its original position. The risks of circumcision include pain, bleeding, infection, inflammation, and penile injury.

Three studies have been published recently which show that circumcision of adult African men reduces their risk of HIV and other sexually transmitted diseases. It is not clear that such risk reductions would be the same in more developed nations. This information prompted researchers to assess the current rate of newborn circumcision in the U.S. Their findings were reported by the Centers for Disease Control in their Morbidity and Mortality Weekly Report (MMWR).

Using data from three different sources that looked only at the circumcision rates in hospitals, they determined that between 1999 and 2010, circumcision rates had decreased compared with previous years. In one instance, the incidence decreased from 62.5 percent in 1999 to 56.9 percent in 2008. In another it decreased from 63.5 percent in 1999 to 56.3 percent in 2008; and in the third it decreased from 58.4 percent in 2001 to 54.7 percent in 2010. Since many circumcisions are done as an outpatient procedure or as an out-of-hospital religious ritual, these figures are likely to be underestimates of the actual numbers of circumcised males

The researchers suggest that many factors may contribute to the decreasing circumcision rate seen in all three samples. There is evidence that good hygiene and safe sexual practices can provide some of the same health benefits of circumcision. The American Academy of Pediatrics in their 1999 policy statement noted that although "existing scientific evidence demonstrates potential medical benefits of newborn male circumcision, these data are not sufficient to recommend routine neonatal circumcision...." Economics may also play a major role. Medicaid currently covers newborn male circumcision in 33 states. In those states with coverage, the rate was 24 percent higher than in states without such coverage.

As the AAP statement articulates: "To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to medical factors, when making this decision."

Image: REUTERS/Zohra Bensemra.


This article originally appeared on TheDoctorWillSeeYouNow.com.

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Esther Entin, M.D., is a pediatrician and clinical associate professor of Family Medicine at Brown University's Warren Alpert School of Medicine. She writes for TheDoctorWillSeeYouNow.com.

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