Revised AAFP policy on circumcision

[buckeyedoc]

Maybe this was already discussed when it came out in August:

They are still essentially fence-sitting, although they give credence to several anti-circ claims, including the ethics of infant circumcision. They also pretty much dismiss the HIV angle as not important to boys in the US and mention risks/complications before any putative benefits. To me, that makes it an improvement over the AAP policy statement.

http://www.aafp.org/online/en/home/c...cumcision.html

[pdx.mothernurture]

WOW WOW WOW...Did you catch this???

Neonatal circumcision has an estimated complication rate ranging from 0.1% to 35%.

Unfortunately they're classifying "failure to remove enough foreskin" as a complication???

Some things sound good at first and then they seem to do a complete about-face, like:

Meatitis and meatal stenosis are more serious complications that have been reported to occur in 8% to 21% of circumcised infants, (6) however no well-controlled cohort study has clearly identified a causal relationship between circumcision and meatitis. (7) Although meatitis is believed to occur more frequently in circumcised infants, balanoposthitis is believed to occur more frequently in uncircumcised children. (8)

WTH?

This was good...

The studies, which are methodologically challenged, have had conflicting results, yet most have found no association. (23) Clearly identified independent risk factors for developing cervical cancer include early age of first sexual activity, multiple partners, and smoking.

This irked me because it implies that a.) boys should be retractable by age 3 and, b.) phimosis=need for circumcision:

A frequent indication is phimosis, which cannot be diagnosed in the newborn because the cleavage plane between the glans and the deep preputial layer of the penis in not developed at birth; often the foreskin is not retractable until 3 years of age. An estimated 10% of men will develop phimosis. (28,29) Although neonatal circumcision has fewer complications than adult circumcision, evidence to support routine neonatal circumcision in order to prevent the need for adult circumcision is not available.

Yay to this!

A physician performing a procedure for other than medical reasons on a nonconsenting patient raises ethical concerns.

While routine circumcision is widely practiced, the small medical benefits of circumcision lead many to consider routine circumcision to be a cosmetic procedure. This leads to questions regarding medical ethics and whether and how to present to a parent a balanced discussion of the relative benefits and harms of the procedure.

Thumbs down to this...

Key to the ethical discussion is respect of the parent’s religious, ethnic, or other cultural beliefs for which circumcision is practiced.

Also, good to see this as the first statement of the summary:

Considerable controversy surrounds neonatal circumcision.

Also really good:

The evidence indicates that neonatal circumcision prevents UTIs in the first year of life with an absolute risk reduction of about 1% and prevents the development of penile cancer with an absolute risk reduction of less than 0.2%. The evidence suggests that circumcision reduces the rate of acquiring an STD, but careful sexual practices and hygiene may be as effective. Circumcision appears to decrease the transmission of HIV in underdeveloped areas where the virus is highly prevalent. No study has systematically evaluated the utility of routine neonatal circumcision for preventing all medically-indicated circumcisions in later life. Evidence regarding the association between cervical cancer and a woman’s partner being circumcised or uncircumcised, and evidence regarding the effect of circumcision on sexual functioning is inconclusive. If the decision is made to circumcise, anesthesia should be used.

I agree, it's an improvement.

Jen

[glongley]

Actually I think this is the same position statement as their 2002 statement, you can see they just say "reaffirmed 2006". There are no additional references post-2002.

Gillian

[MilkTrance]

I wonder if part of what drives the research or the acceptance of research is the money to be made off of circumcisions. In Canada, it would have been paid for by our healthcare system, but because it is a cosmetic procedure, it is not (I guess because it is not medically necessary but obviously, too, because it would cost the system more $$$). In the US, do companies make money off of circumcisions? If so, I can see the reluctance for the general public or colleges of physicians to accept research which most other countries already condone.