For the first time, the federal Centers for Disease Control and Prevention (CDC) has weighed in on the hot-button issue of circumcision, or removal of the foreskin. Yesterday, the agency published draft guidelines that say doctors should educate boys and men who were not circumcised as newborns, as well as parents of newborn boys, about the health benefits of circumcision.
The guidelines point to research, much of it done in sub-Saharan Africa, showing that circumcision reduces the transmission of STDs, including HIV and the human papillomavirus, which can cause cancer. The foreskin creates an ideal environment for bacterial and viral infections to thrive.
“Given the urgency of the HIV epidemic in the United States, CDC believes it is essential to maximize the impact of all available prevention options and is working to provide clinicians the best possible information on the full range of proven approaches. Male circumcision is one strategy that may help reduce the continued spread of HIV in the U.S.,” the agency said in an official statement.
Circumcision rates are lower in African-American and Hispanic communities, according to the CDC. These communities also have higher rates of HIV than the American population overall. About 1.2 million American adults have HIV.
American Doctors Say Yes to Circumcision
The CDC’s move contributes to a shift in the American scientific community toward stronger support for circumcision. Circumcision rates fell 10 percent in the United States from 1979 to 2010, reaching their lowest point of 55 percent in 2007.
In 2012, the American Academy of Pediatrics (AAP) revised its circumcision guidelines to offer stronger support for the practice than it had in the past. Circumcision rates seem to have ticked upward since the AAP changed its stance.
Both the CDC and AAP guidelines suggest doctors educate parents and adult men on the health benefits of circumcision, but leave the final decision up to them.
The CDC will be accepting public comments on the proposed guidelines until mid-January.
Circumcision and the ‘Culture Wars’
The revised government rules come at a time when anti-circumcision activists have grown more vocal. Critics of circumcision say the American scientific community overlooks drawbacks of the procedure, performed with local anesthetic and a clamp, including pain and reduced sexual pleasure. They question the logic of research that shows circumcision slows HIV transmission.
“The whole premise is totally flawed. HIV is not caused by foreskin,” said Dr. Adrienne Carmack, a urologist in Austin, Texas, who is a medical adviser for Intact America, an anti-circumcision group. “The problem is there’s too much fear because in our culture the norm has been to circumcise and people don’t understand healthy male genitals in this culture if they haven’t experienced them.”
A group of high-profile European doctors levied a similar critique against the AAP’s 2012 recommendations.
Evidence that circumcision protects against sexually transmitted diseases is “questionable, weak, and likely to have little public health relevance in a Western context,” the doctors wrote, pointing out that in Western countries where circumcision is less common, HIV rates are no higher than they are in the United States.
Moreover, STD transmission rates do not “represent compelling reasons for surgery before boys are old enough to decide for themselves,” the European doctors wrote. However, circumcision on post-pubescent men is a much more serious procedure with greater risk of complications, such as bleeding and loss of sensation.
As a sign of just how toxic the circumcision debate has become, the AAP’s response accused the European doctors of having their own “cultural biases” against the procedure.
The CDC, the AAP, and the American Congress of Obstetricians and Gynecologists did not make anyone available for interview.