Efforts to ban circumcision may be harmful, infection experts say

Efforts in an increasing number of states to not provide Medicaid insurance coverage for male circumcision, as well as an attempted ballot initiative in San Francisco earlier this year to ban male circumcision in newborns and young boys, are unwarranted, say infectious disease experts from Johns Hopkins University, Baltimore.

Moreover, the experts say these actions ignore the last decade of medical evidence that the procedure can substantially protect men and their female partners from certain sexually transmitted infections.

The Johns Hopkins experts argue that implementing policy or financial barriers to safe circumcision could potentially disadvantage people most in need of publicly financed services to improve their health. These groups include minorities and the poor, among whom sexually transmitted infection rates are often the highest.

Critics of infant or childhood circumcision claim, among other things, that the procedure should not be considered until males can give legal informed consent at age 18.

In an editorial published in JAMA (2011; 306:1479-80), co-authors Aaron Tobian, MD, PhD, and Ronald Gray, MD, highlight the most recent medical research showing the considerable life-long health benefits of circumcision performed during infancy and the potential disadvantages associated with waiting until adulthood before undergoing the procedure.

The authors point out that there are medical benefits during childhood, as many young men are already sexually active before age 18 and at greater risk of infection from sexually transmitted infections. Circumcision at older ages is also associated with more complications and cost than having the surgery in infancy.

"Our goal is to encourage all parents to make fully informed decisions on whether to circumcise their infant boys based on medical evidence and not conjecture or misinformation put out by anti-circumcision advocates," Dr. Tobian said.

Among the data cited by Dr. Tobian and Dr. Gray are those from multiple studies conducted within the last 5 years showing that, in heterosexuals, circumcision reduced HIV infection risk by 60%, genital herpes by 30%, and cancer-causing human papillomavirus by 35% in men.

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