AAP weighs in on the circumcision decision

  • Fri Sep 14th, 2012 2:18pm
  • Life

By Andy Rathbun, Herald Writer

To circumcise or not to circumcise?

It’s one of the first choices parents have to make for their newborn, and there is no simple answer.

In August, however, the American Academy of Pediatrics changed its recommendations on circumcision, a procedure that involves trimming off the skin covering the end of the penis.

The shift potentially offers a little more clarity on a complex choice.

Previously, the group did not routinely recommend circumcisions. Now, it says the health benefits outweigh the risks. It stops short of offering a ringing endorsement, though, noting parents ultimately must decide for themselves.

The academy singled out two major benefits. First, the procedure reduces the rate of urinary tract infections. Uncircumcised boys are about 10 times more likely to get a urinary tract infection in their first year of life than circumcised boys.

Granted, those infections often are easily treated with antibiotics. The bigger issue relates to sexually transmitted diseases.

Evidence shows that circumcision reduces the spread of disease, including HIV, which leads to AIDS, and the human papillomavirus, or HPV, which, when transmitted from a man to a woman, can cause cervical cancer.

Dr. Cheryl Beighle, a pediatrician with the Everett Clinic, said that evidence likely led to the academy’s shift.

“It makes lots of sense, if you can get anything to decrease the spread of pretty awful viruses,” she said.

Beighle agreed, however, with the academy’s view that there is no right or wrong choice, noting other factors play a part in the decision.

Those include cultural, social and religious traditions, the cost of the procedure, and the desire by a parent to protect their son from pain or the risk of infection.

“There are pluses and minuses,” Beighle said. “It really depends on what you’re comfortable with.”

Beighle herself has performed dozens of circumcisions. She said that the concerns about pain, while genuine, can be overstated.

Infections are rare and sugar-coated pacifiers can ease a newborn’s discomfort, she said. Beighle specializes in integrative medicine, which emphasizes natural treatments for disease.

Beighle has seen infants fall asleep during circumcisions. She said that birth itself, a traumatic event, may have blunted the newborn’s senses.

“Their pain fibers are kind of done,” she said. “They don’t seem to react as much as if they were a year old.”

The procedure is best done on newborns, Beighle said. Postponing it until later in life — waiting until the teenage years, for instance, when a young man may decide for himself — has drawbacks. For one, the older you get, the longer it takes to recover.

“Older people have significant discomfort,” she said.

Ultimately, she encourages parents to weigh the evidence and make the choice that feels right. And if they end up in a circumcision stalemate, disagreeing on what to do, Beighle often tells mothers to defer to the father for a simple reason.

“No teenage boy is going to come to you with penis concerns,” she said. “Dad has to be comfortable with the choice.”