Efforts to defund or ban infant male circumcision are unfounded and potentially harmful

October 04, 2011

Johns Hopkins infectious disease experts say the medical benefits for male circumcision are clear and that efforts in an increasing number of states (currently 18) 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. Moreover, they 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 to be published in the Journal of the American Medical Association online Oct. 5, Johns Hopkins health epidemiologist and pathologist Aaron Tobian, M.D., Ph.D., and health epidemiologist Ronald Gray, M.D., 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 experts 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 minimal 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," says Tobian, an assistant professor at the Johns Hopkins University School of Medicine.

Among the research cited by Tobian and Gray, a professor at the University's Bloomberg School of Public Health, are multiple studies conducted within the last five years showing that in heterosexuals, circumcision reduced HIV infection risk by 60 percent, genital herpes by 30 percent and cancer-causing human papillomavirus (HPV) by 35 percent in men. Females benefit from a 40 percent or greater reduced risk of bacterial vaginosis or parasitic trichomonas spread during sex, as well as HPV infection, which causes cervical cancer.

In addition, the experts say the data clearly show that having the procedure in infancy reduces the risk of urinary tract infections, as well as inflammation in the opening or head region of the penis. Risk of infection from surgically removing the foreskin, considered a minimal and simple surgery, is already low overall but even lower during infancy, at between 0.2 percent and 0.6 percent. In adults, infection and complication rates are higher, between 1.5 percent and 3.8 percent.

In contrast to what circumcision's opponents claim, Tobian and Gray say that research shows no reduction in sexual satisfaction or male performance. Indeed, they add, circumcised men in the trials, the gold standard of medical evidence, reported no difference or even increased penile sensitivity during intercourse and enhanced orgasms compared to uncircumcised men. The majority of female partners also reported either no change or increased sexual satisfaction, largely because of improved hygiene.

The Johns Hopkins experts argue that delaying circumcision until adulthood, when young men can legally decide for themselves, not only carries added risk of infection, but also challenges the long-held rights and responsibilities of many parents to make decisions about the long-term health of their children, including vaccinating them against hepatitis B, measles, polio, whooping cough and influenza. The proposed ban or delays also counter the religious rights for parents who observe Jewish and Muslim faiths, in which infant male circumcision is a prescribed religious obligation.

In the editorial, Tobian and Gray conclude that if a vaccine comparable in disease-prevention benefits to male circumcision was available, with the same disease-preventing benefits, "the medical community would rally behind the immunization, and it would be promoted as a game-changing public health intervention." They say that banning male circumcision would be "ethically questionable."

Tobian and Gray say Medicaid and other insurers should cover male circumcision costs if parents opt for the procedure, and that leading medical groups, such as the American Academy of Pediatrics and the U.S. Centers for Disease Control, need to recognize the health benefits of male circumcision and do more to educate parents and physicians about them.

More than 500 U.S. and international observational studies and 13 studies from randomized trials, Tobian says, have been published in the most influential medical journals, including the New England Journal of Medicine and the Lancet, in the past decade -- reaffirming the benefits of male circumcision in preventing sexually transmitted infections.

However, the Academy's policy on male circumcision, last issued in 1999 and re-affirmed in 2005, is ambiguous with respect to medical benefits. The CDC's policy also takes no firm position on the medical benefits of male circumcision, but that policy is expected to be updated shortly.

"In light of the latest medical evidence, the medical community and government officials at all levels would do well to revisit their policies on male circumcision, so as best to counsel parents on the potential health benefits to their children well into adulthood," says Gray.

Jewish and other community groups successfully challenged the San Francisco ballot initiative in court, and in July, the male circumcision ban was taken off the city's November ballot because of a legal technicality. The most recent states to stop Medicaid funding for infant circumcision are Colorado in June, and South Carolina, in February 2011. States that already had funding bans in place include Louisiana, Idaho and Minnesota, all since 2005; Maine, since 2004; Montana, Utah and Florida, since 2003; and Missouri, Arizona and North Carolina, since 2002. California, North Dakota, Oregon, Mississippi, Nevada and Washington -- all had stopped funding before 1999.
-end-
Johns Hopkins Medicine
Media Relations and Public Affairs
Media contact
David March
410-955-1534
dmarch1@jhmi.edu

For additional information, go to:

http://jama.ama-assn.org/content/current

http://www.hopkinsglobalhealth.org/researchers/profile/5175/Tobian/Aaron

http://www.jhsph.edu/faculty/directory/profile/928/Gray/Ronald

Johns Hopkins Medicine

Related Public Health Articles from Brightsurf:

COVID-19 and the decolonization of Indigenous public health
Indigenous self-determination, leadership and knowledge have helped protect Indigenous communities in Canada during the coronavirus disease 2019 (COVID-19) pandemic, and these principles should be incorporated into public health in future, argue the authors of a commentary in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.200852.

Public health consequences of policing homelessness
In a new study examining homelessness, researchers find that policy such a lifestyle has massive public health implications, making sleeping on the street even MORE unhealthy.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

Pandemic likely to cause long-term health problems, Yale School of Public Health finds
The coronavirus pandemic's life-altering effects are likely to result in lasting physical and mental health consequences for many people--particularly those from vulnerable populations--a new study led by the Yale School of Public Health finds.

The Lancet Public Health: US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality
US policymakers considering physical distancing measures to slow the spread of COVID-19 face a difficult trade-off between closing schools to reduce transmission and new cases, and potential health-care worker absenteeism due to additional childcare needs that could ultimately increase mortality from COVID-19, according to new modelling research published in The Lancet Public Health journal.

The Lancet Public Health: Access to identification documents reflecting gender identity may improve trans mental health
Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.

The Lancet Public Health: Study estimates mental health impact of welfare reform, Universal Credit, in Great Britain
The 2013 Universal Credit welfare reform appears to have led to an increase in the prevalence of psychological distress among unemployed recipients, according to a nationally representative study following more than 52,000 working-age individuals from England, Wales, and Scotland over nine years between 2009-2018, published as part of an issue of The Lancet Public Health journal on income and health.

BU researchers: Pornography is not a 'public health crisis'
Researchers from the Boston University School of Public Health (BUSPH) have written an editorial in the American Journal of Public Health special February issue arguing against the claim that pornography is a public health crisis, and explaining why such a claim actually endangers the health of the public.

The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.

Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.

Read More: Public Health News and Public Health Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.