The American Academy of Pediatrics recently released its new Tech- nical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report’s conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non–US-based physi- cians and representatives of general medical associations and so- cieties for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoret- ical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves. Pediatrics 2013;131:796–800
Circumcision rates are steadily decreasing in most Western countries around the world, including the United States.1 Still, a majority of newborn male infants undergo the procedure in the United States. In its newly released Technical Report and Policy Statement on male cir- cumcision,2,3 the American Academy of Pediatrics (AAP) has changed from a neutral to a more positive attitude toward circumcision, claiming that possible health benefits now outweigh the risks and possible negative long-term consequences. The AAP does not recom- mend routine circumcision of all infant boys as a public health measure but asserts that the benefits of the procedure are sufficient to warrant third-party payment. In Europe, Canada, and Australia, where infant male circumcision is considerably less common than in the United States, the AAP report is unlikely to influence circumcision practices because the conclusions of the report and policy statement seem to be strongly culturally biased.
AUTHORS: Morten Frisch, MD, PhD,a Yves Aigrain, MD, PhD,b Vidmantas Barauskas, MD, PhD,c Ragnar Bjarnason, MD, PhD,d Su-Anna Boddy, MD,e Piotr Czauderna, MD, PhD,f Robert P.E. de Gier, MD,g Tom P.V.M. de Jong, MD, PhD,h Günter Fasching, MD,i Willem Fetter, MD, PhD,j Manfred Gahr, MD,k Christian Graugaard, MD, PhD,l Gorm Greisen, MD, PhD,m Anna Gunnarsdottir, MD, PhD,n Wolfram Hartmann, MD,o Petr Havranek, MD, PhD,p Rowena Hitchcock, MD,q Simon Huddart, MD,r Staffan Janson, MD, PhD,s Poul Jaszczak, MD, PhD,t Christoph Kupferschmid, MD,u Tuija Lahdes-Vasama, MD,v Harry Lindahl, MD, PhD,w Noni MacDonald, MD,x Trond Markestad, MD,y Matis Märtson, MD, PhD,z Solveig Marianne Nordhov, MD, PhD,aa Heikki Pälve, MD, PhD,bb Aigars Petersons, MD, PhD,cc Feargal Quinn, MD,dd Niels Qvist, MD, PhD,ee Thrainn Rosmundsson, MD,ff Harri Saxen, MD, PhD,gg Olle Söder, MD, PhD,hh Maximilian Stehr, MD, PhD,ii Volker C.H. von Loewenich, MD,jj Johan Wallander, MD, PhD,kk and Rene Wijnen, MD, PhDll
aDepartment of Epidemiology Research, Statens Serum Institut, Copenhagen and Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; bDepartment of Pediatric Surgery, Hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France; cLithuanian Society of Paediatric Surgeons, Kaunas, Lithuania; dDepartment of Pediatrics, Landspitali University Hospital, Reykjavik, Iceland; eChildren’s Surgical Forum of the Royal College of Surgeons of England, London, United Kingdom; fPolish Association of Pediatric Surgeons, Gdansk, Poland; gWorking Group for Pediatric Urology, Dutch Urological Association, Utrecht, Netherlands; hDepartments of Pediatric Urology, University Children’s Hospitals UMC Utrecht and AMC Amsterdam, Netherlands; iAustrian Society of Pediatric and Adolescent Surgery, Klagenfurt, Austria; jPaediatric Association of the Netherlands, Utrecht, Netherlands; kGerman Academy of Paediatrics and Adolescent Medicine, Berlin, Germany; lCenter for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; mDepartment of Pediatrics, Rigshospitalet, Copenhagen, Denmark; nDepartments of Pediatric Surgery, Landspitali University Hospital, Reykjavik, Iceland, and Karolinska University Hospital, Stockholm, Sweden; oGerman Association of Pediatricians, Cologne, Germany; pDepartment of Pediatric Surgery, Thomayer Hospital, Charles University, Prague, Czech Republic; qBritish Association of Paediatric Urologists, London, United Kingdom;
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