Draft federal recommendations don't usually raise eyebrows, but this one certainly will — that males of all ages, including teenage boys, should be counseled on the health benefits of circumcision.
In the past 15 years, studies in Africa have found that circumcision lowers men's risk of being infected with HIV during heterosexual intercourse by 50 to 60 percent. Being circumcised also reduces men's risk of infection with the herpes virus and human papillomavirus.
Those health benefits prompted the Centers for Disease Control and Prevention's proposed recommendation that doctors counsel parents of baby boys and teenagers, as well as men, on the benefits and risks of circumcision.
"The compiling of the different data sources may really be sufficient for someone who is a heterosexual male to consider the benefit of circumcision," Dr. Susan Blank, a pediatrician and chairwoman of the American Academy of Pediatrics' circumcision task force, told Shots.
In 2012, the American Academy of Pediatrics said for the first time that the benefits of circumcision outweigh the risks, and that insurers should pay for the procedure.
But the pediatricians' focus was on parents considering infant circumcision. The CDC's proposal opens the door to circumcision becoming a topic of conversation any time an uncircumcised male goes to a medical appointment.
Although several surveys have found a decline in circumcision rates since the 1960s, the majority of men living in the United States were circumcised as newborns. The prevalence of the procedure varies widely, with big geographical and ethnic variations. It is typically less common in Asian and Hispanic communities.
Groups opposed to circumcision, such as Intact America, say the health benefits of circumcision in the U.S. remain unproven, and that the CDC is relying too heavily on studies done in Africa that may not be relevant here. The procedure, which removes the foreskin, has been criticized because infants can't consent to it.
"Parents need to recognize that they're effectively removing that decision from their son," says Dr. Douglas Diekema, a bioethicist at Seattle Children's Hospital who served on the pediatricians' task force. "And there are some men who will grow up being unhappy with the decision that their parents made."
The CDC's draft recommendation, which is open for public comment for 45 days, suggests that teenage boys be counseled along with their parents on the option, which presumably would give boys the option to say yea or nay.
"I want to emphasize that it's a voluntary procedure, and really requires conversation between the doctor and the patient," says Dr. Eugene McCray, director of the division of AIDS prevention at the CDC. "Our role is to insure that physicians have the information that they can then use to counsel or inform patients about the risk and benefits."
The risk of complications in infants is 0.4 percent, one large analysis found, 9 percent in boys ages 1 to 9, and 5 percent over age 10.
"It's really important to emphasize that circumcision doesn't protect somebody from contracting any STD," Diekema says. "It simply reduces risk." In other words, sexually active men still need to use condoms or other methods if they want to avoid exposure to HIV and other STDs.
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Transcript
DAVID GREENE, HOST:
For the first time, the Centers for Disease Control and Prevention - the CDC - is weighing in on circumcision. Federal health officials say the benefits of the procedure outweigh the risks. And in proposed guidelines, they suggest doctors counsel soon-to-be parents about the benefits of circumcision. NPR's Patti Neighmond reports.
PATTI NEIGHMOND: Federal health officials say the benefits of circumcision really occur later in life when males become sexually active. Dr. Eugene McCray directs the CDC's Division of HIV-AIDS Prevention. He says studies in Africa show men who are circumcised decrease their risk of becoming infected with HIV by as much as 60 percent.
EUGENE MCCRAY: Given the fact that HIV is such a serious disease, we believe that persons at risk should have all prevention tools available to them. And circumcision is one of those tools.
NEIGHMOND: During circumcision, the foreskin of the penis is removed. Health officials say that decreases susceptibility to HIV-contaminated fluid or blood and can also reduce the risk of infection by other viruses including herpes and human papillomavirus, or HPV, which can cause penile cancer. The proposed guidelines suggest doctors talk with parents of newborns as well as parents of teenage boys who may not be circumcised.
MCCRAY: I want to emphasize that it's a voluntary procedure. And it really requires a conversation between the doctor, the parent and that it's a really personal decision. And it really needs to take into account their own personal cultural beliefs and ethics.
NEIGHMOND: Over the past few decades, rates of circumcision in the U.S. have been on the decline. Today, estimates of circumcised males range from 55 to 77 percent. Groups opposed to circumcision, like Intact America, say the health benefits of circumcision in the U.S. remain unproven. They say the CDC is relying too heavily on studies done in Africa that may not be relevant here. Dr. Douglas Diekema is a pediatrician at Seattle Children's Hospital. He helped craft the American Academy of Pediatrics's policy which agrees that benefits outweigh risk.
DOUGLAS DIEKEMA: The risk of complications related to circumcision is very low, with minor bleeding and inflammation being the most common complications. Those are usually quite easily addressed and do not pose a significant risk to the child.
NEIGHMOND: Even so, Diekema says parents need to at least think about potential downsides.
DIEKEMA: It's important that parents recognize that they're effectively removing that decision from their son. And there are some men who will grow up and be unhappy with the decision their parents made.
NEIGHMOND: Diekema also cautions circumcision shouldn't be considered a shield against infection.
DIEKEMA: Circumcision doesn't protect somebody from contracting any sexually transmitted disease. It simply reduces the risk. So it should not ever be seen as sufficient to protect somebody against contracting sexually transmitted diseases.
NEIGHMOND: In other words, protective measures like condoms are critical. The new guidelines will be open for public comment and reviewed by health experts for 45 days before being finalized. Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.
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