European Pediatricians: American Academy of Pediatrics' Recommendation to Circumcise Baby Boys Is "Questionable, Weak"

After years of studying all the studies about circumcision, the American Academy of Pediatrics last year updated its policy about circumcision of infant boys. Whereas it had previously been neutral on the matter, the organization started recommending the procedure, advising that the benefits outweigh the risks.

This put the AAP at odds with pediatric groups in other countries, especially European ones.

See also:
- Interview With Dr. Doug Dietkema of the American Academy of Pediatrics

- Anti-circumcision Activists: Trimming a Bit off the Top Is Too Much

Yesterday, European doctors struck back in a scientific journal article, saying that "only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance" and that the other claimed health benefits "are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves."

Yesterday, the AAP, in its own scientific journal, Pediatrics, published the rebuttal article, called "Cultural Bias in the AAP's 2012 Technical Report and Policy Statement on Male Circumcision." It was written by representatives from the British Association of Paediatric Surgeons, the Swedish Paediatric Society, the Ethics Committee of the German Academy of Pediatrics and Adolescent Medicine, and dozens of other such groups from Iceland to Denmark to Latvia.

Only the abstract is avalable online for free; the full report states that:

- Preventive procedures on healthy people should follow "more and stricter justification" than medically necessary procedures, and even stricter justification should be required for children, "who cannot weigh the evidence themselves and cannot legally consent to the procedure."

- While the AAP says circumcision prevents urinary tract infections (UTIs), the European doctors counter that only one percent of boys will get these in their first years of life, and there are no randomly-controlled clinical trials proving that circumcision prevents them.

- The AAP says circumcision can stave off penile cancer, but the European docs counter that "the evidence is not strong; the disease is rare and has a good survival rate; there are less intrusive ways of preventing the disease; and there is no compelling reason to deny boys their legitimate right to make their own informed decision when they are old enough."

- The AAP says circumcision can offer protection against genital herpes and genital warts. The Europeans say that conclusion was based on studies in Africa that don't apply in the West; doesn't take into account syphilis, gonorrhea and chlamydia; and again is only relevant to adults, so "the decision of whether to circumcise can be postponed to an age when boys are old enough to decide for themselves."

- Perhaps most importantly, the AAP, relying on three studies done in Africa, suggested circumcision can have a preventive effect against HIV/AIDS. The Europeans argue that conclusion has been "contradicted by other studies, which show no relationship between HIV infection rates and circumcision status. The African findings are also not in line with the fact that the United States combines a high prevalence of STDs and HIV infections with a high per- centage of routine circumcisions. The situation in most European countries is precisely the reverse: low circumcision rates combined with low HIV and STD rates... There are alternative, less intrusive, and more effective ways of preventing HIV than circumcision, such as consistent use of condoms."

- The Europeans also noted the possible problems with circumcision --

infections, hemorrhages, metal strictures, deaths and (partial) amputations. (And if you want to be majorly grossed out, you can see pictures of circumcisions gone wrong here.)

- And lastly, the foreigners say not to underestimate the foreskin's role in sexy time: "the foreskin is a richly innervated structure that protects the glans and plays an important role in the mechanical function of the penis during sexual acts. Recent studies [which the AAP did not take into account] ..suggest that circumcision desensitizes the penis and may lead to sexual problems in circumcised men and their partners." (Translation: anteaters won't need so much Viagra.)

Yesterday's article is great ammunition for people who oppose circumcision of babies, such as the Florida moms protesting outside of Babies R Us or the groups who will be convening in Washington for an annual anti-circumcision rally later this month.

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Deirdra Funcheon