The American Academy of Pediatrics and the American Urological Assn. offer little guidance. The AAP policy states, "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision." The statement goes on to advise parents to determine what's in the best interest of the child and adds that it's legitimate to take cultural, religious and ethnic traditions into account along with medical factors.
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Delicate decision
To circumcise or not? As the practice grows less common in the U.S., parents weigh the medical, social and religious pros and cons.
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The urological association's policy is equally noncommittal: "Neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks. . . . Medical benefits and risks, and ethnic, cultural, religious and individual preference should be considered."
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New studies on HIV
However, both medical associations, as well as the Centers for Disease Control and Prevention, are reevaluating their positions based on new findings out of Africa. Three randomized controlled studies conducted in South Africa, Uganda and Kenya over the last several years, found that circumcised male adults were 51% to 60% less likely to acquire HIV from heterosexual vaginal sex with an infected woman.
Though these studies are significant, physicians warn that you can't directly apply these findings in the U.S. In sub-Saharan Africa, the HIV epidemic is much greater, and the primary mode of HIV infection is through male-to-female sex, not male-to-male sex as it is in the United States.
Dr. Peter Kilmarx, chief of epidemiology in the CDC's division of HIV/AIDS prevention, says the CDC is looking at how the findings apply here. "The early opinion from the consultants -- and not the position of the CDC, which involves a peer review process and public comment -- is that, given all the previous data on circumcision plus the recent HIV African studies, the medical benefits of male infant circumcision outweigh the risks and that any financial burden barring parents from making this decision should be lifted," he said.
The American Academy of Pediatrics developed its current guidelines on circumcision in 1999 and reviewed and upheld them in 2005. Last year, the association formed a task force to study the matter further in light of the new data. Freedman and Diekema sit on that task force, and say the refreshed guidelines should be out next year.
