Newborn care

Circumcision benefits outweigh risks, says CDC

New draft recommendations on parent and patient counselling are reigniting the circumcision debate.

Photo: iStock

Photo: iStock

To circumcise or not to circumcise? The debate is heating up once again as the US Centers for Disease Control and Prevention (CDC) is now saying that the benefits outweigh the risks.

The CDC released draft recommendations this week on how healthcare providers should counsel parents about circumcision, a procedure to remove the foreskin from the penis. While the organization maintains that circumcision is a personal decision, the CDC’s Dr. Jonathan Mermin told the Associated Press that “the scientific evidence is clear that the benefits outweigh the risks.” This is in line with the American Academy of Pediatrics, which revised its position to also say the benefits outweigh risks in 2012.

The CDC is recommending healthcare providers counsel parents about circumcision, including health benefits, risks and other social factors (such as religion or social norms), so that parents can ultimately make an informed but personal decision.

Read more: Should you circumcise your son?>

The medical benefits of circumcision in male newborns, children and adolescents outlined by the CDC include:

  • circumcised male infants are less likely to develop urinary tract infections than uncircumcised infants (though it’s noted that UTIs are uncommon in boys)
  • circumcised boys are less likely to experience balanitis and balanoposthitis, conditions that cause swelling of the foreskin and penis
  • during adulthood, circumcised males are less likely to develop penile cancer, and possibly prostate cancer
  • when males become sexually active, circumcision can help reduce the risk of contracting HIV and other sexually transmitted infections (including genital herpes and cancer-causing HPV) through heterosexual intercourse

Most parents who opt for circumcision choose to do it when their son is a newborn, and timing makes a difference. Neonatal circumcision is “safer, and heals more rapidly than circumcision performed on older boys, adolescent males and men, and is less expensive,” according to the CDC’s draft recommendations. Additionally, circumcision performed after a male becomes sexually active may result in “missed opportunities” to protect him from STIs and HIV.

Read more: Can we circumcise our two-month-old son?>

Complications, which occur in less than 0.5 percent of infants, include bleeding and inflammation of the penis or the need for corrective procedures, and severe complications are rare. The risk of complications is greater (though still considered low) in circumcisions performed on males over the age of one, making circumcision in infancy the ideal time to take advantage of the health benefits.

These new guidelines for healthcare professionals have been a long time coming: the CDC began consultations with interested groups and experts in 2007, and a lengthy document details its extensive review of research on potential benefits and risks. The recommendations will be posted online for public comment until January 16, 2015, after which the CDC will finalize their recommendation.

Read more: Should circumcision be banned?>

Here in Canada, the rate of male infant circumcision hovered at 31.9 percent in 2006 to 2007 (the most recent data available from the Public Health Agency of Canada). The Canadian Paediatric Society (CPS) “does not recommend routine circumcision for newborn boys.” But the CPS’s position—last updated in 1996—is currently under revision.

“In the last year there have been several new studies and findings on circumcision. The CPS is currently reviewing this information to develop well-informed, evidence-based recommendations as they relate to the needs of Canadians,” says Francine Charbonneau, the CPS’s manager of public affairs. “The statement is currently making its way through our rigorous review process.”

Should the CPS recommend parents-to-be consider circumcision as a preventative health measure, it will inevitably raise questions about whether provincial healthcare plans should cover the cost.