# American Academy of Pediatrics Now Says Circumcision's Benefits Outweigh Risks
**URL:** https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857
**Category:** Great Debates
**Created:** [August 27, 2012, 9:04pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857 "2012-08-27T21:04:17Z")
**Posts on this page:** 20
**Page:** 1
### Author:  [@Frylock](https://boards.straightdope.com/u/Frylock)
#### Post date: [August 27, 2012, 9:04pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/1 "2012-08-27T21:04:17Z")
> **[US paediatricians back circumcision](https://www.smh.com.au/politics/federal/us-paediatricians-back-circumcision-20120827-24w6f.html)**
>
> Circumcision of newborn boys, the procedure that has polarised Western medical opinion, has been given the tick by the influential American Academy of Paediatrics.
Does this mean we need to get to hacking?
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### Author:  [@Simple\_Linctus](https://boards.straightdope.com/u/Simple_Linctus)
#### Post date: [August 27, 2012, 9:07pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/2 "2012-08-27T21:07:36Z")
**At best** , their reasoning makes sense for the population as a whole if nothing else changes (that is to say that parents don’t teach their boys to clean their dicks). What it doesn’t take account of is that a parent can bring their child up to pratice good hygeine without mutilating them. That is what a sensible parent would choose to do.
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### Author:  [@Inner\_Stickler](https://boards.straightdope.com/u/Inner_Stickler)
#### Post date: [August 27, 2012, 9:15pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/3 "2012-08-27T21:15:08Z")
It’s a tad academic since I have no children nor plans to acquire them in the future, but if my hypothetical child wanted to benefit from the reduced STD risks of a circumcised penis, I will leave that to him to decide as an adult regardless of what this study purports.
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### Author:  [@John\_Mace](https://boards.straightdope.com/u/John_Mace)
#### Post date: [August 28, 2012, 12:13am UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/4 "2012-08-28T00:13:06Z")
I’m glad it turns out my parents weren’t sex offenders afterall!
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### Author:  [@levdrakon](https://boards.straightdope.com/u/levdrakon)
#### Post date: [August 28, 2012, 12:18am UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/5 "2012-08-28T00:18:57Z")
It’s important to note they have not recommended routine circumcision. They have said if you elect to do it, you should do it at our clinics while we bill the government for it.
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### Author:  [@lance\_strongarm](https://boards.straightdope.com/u/lance_strongarm)
#### Post date: [August 28, 2012, 2:48am UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/6 "2012-08-28T02:48:05Z")
There are medical benefits to female genital mutilation too. Doesn’t mean it’s ethical either.
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### Author:  [@Ibn\_Warraq](https://boards.straightdope.com/u/Ibn_Warraq)
#### Post date: [August 28, 2012, 3:26am UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/7 "2012-08-28T03:26:17Z")
> [@lance\_strongarm](#):
>
> There are medical benefits to female genital mutilation too. Doesn’t mean it’s ethical either.
What medical benefits are there to female genital mutilation?
Moreover, can you name any respectable medical organizations that support it?
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### Author:  [@Tim\_T-Bonham.net](https://boards.straightdope.com/u/Tim_T-Bonham.net)
#### Post date: [August 28, 2012, 7:02am UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/8 "2012-08-28T07:02:12Z")
Since these are the people who get paid to do circumcisions, it’s not exactly an unbiased source. (Though they do seem to have valid studies.)
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### Author:  [@Malthus](https://boards.straightdope.com/u/Malthus)
#### Post date: [August 28, 2012, 1:17pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/9 "2012-08-28T13:17:16Z")
> [@lance\_strongarm](#):
>
> There are medical benefits to female genital mutilation too. Doesn’t mean it’s ethical either.
I have never heard of any seriously proposed and supported by medical research. Can you provide an example?
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### Author:  [@Malthus](https://boards.straightdope.com/u/Malthus)
#### Post date: [August 28, 2012, 1:28pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/10 "2012-08-28T13:28:53Z")
> [@Simple\_Linctus](#):
>
> **At best** , their reasoning makes sense for the population as a whole if nothing else changes (that is to say that parents don’t teach their boys to clean their dicks). What it doesn’t take account of is that a parent can bring their child up to pratice good hygeine without mutilating them. That is what a sensible parent would choose to do.
This is not an accurate summary.
From the article:
> [@](#):
>
> It said benefits from male circumcision included the prevention of urinary tract infections, **acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer.**
[Emphasis added]
While presumably the prevention of HIV can be accomplished by universal condom use, hygene pratices will not have a big influence. And I dunno how parents can “prevent penile cancer” by teaching hygene.
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### Author:  [@Frylock](https://boards.straightdope.com/u/Frylock)
#### Post date: [August 28, 2012, 1:36pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/11 "2012-08-28T13:36:44Z")
> [@Malthus](#):
>
> I have never heard of any seriously proposed and supported by medical research. Can you provide an example?
No more cancer of the clitoris.
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### Author:  [@AK84](https://boards.straightdope.com/u/AK84)
#### Post date: [August 28, 2012, 1:57pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/12 "2012-08-28T13:57:47Z")
> [@Inner\_Stickler](#):
>
> It’s a tad academic since I have no children nor plans to acquire them in the future, but if my hypothetical child wanted to benefit from the reduced STD risks of a circumcised penis, I will leave that to him to decide as an adult regardless of what this study purports.
If you have a shread of mercy in you, no you will not.
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### Author:  [@naita](https://boards.straightdope.com/u/naita)
#### Post date: [August 28, 2012, 2:20pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/13 "2012-08-28T14:20:11Z")
> [@Malthus](#):
>
> While presumably the prevention of HIV can be accomplished by universal condom use, hygene pratices will not have a big influence. And I dunno how parents can “prevent penile cancer” by teaching hygene.
The actual statement from the AAP, rather than an Australian news article says this:
> [@](#):
>
> but the benefits are not great enough to recommend universal newborn circumcision.
> **[Error | AAP](https://www.aap.org/en/error?code=404)**
>
> Error landing page
Furthermore, the full text a) explains that the increased risk of cancer in uncircumcised men is most likely due to increased risk of infection. That’s how parents can prevent penile cancer by teaching hygiene. And b) the increased cancer risk is outweighed by the risk of complications when you don’t look at other potential benefits of circumcision.
There are no significant risks from having a foreskin that can’t be reduced by methods other than circumcision and unlike circumcision those other methods have zero risk of complications, which for circumcision does include a small risk of death.
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### Author:  [@levdrakon](https://boards.straightdope.com/u/levdrakon)
#### Post date: [August 28, 2012, 2:41pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/14 "2012-08-28T14:41:54Z")
> [@Malthus](#):
>
> This is not an accurate summary.
>
> From the article:
>
> [Emphasis added]
>
> While presumably the prevention of HIV can be accomplished by universal condom use, hygene pratices will not have a big influence. And I dunno how parents can “prevent penile cancer” by teaching hygene.
Where do you live you can’t teach your kids basic hygiene? It’s odd you care enough about your child to slice up his cock but not teach him how to not be an illegal drug injecting street prostitute in equatorial Africa.
That is truly odd.
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### Author:  [@Malthus](https://boards.straightdope.com/u/Malthus)
#### Post date: [August 28, 2012, 2:45pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/15 "2012-08-28T14:45:18Z")
> [@naita](#):
>
> The actual statement from the AAP, rather than an Australian news article says this:
>
> [Error | AAP](http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Newborn-Male-Circumcision.aspx)
>
> Furthermore, the full text a) explains that the increased risk of cancer in uncircumcised men is most likely due to increased risk of infection. That’s how parents can prevent penile cancer by teaching hygiene. And b) the increased cancer risk is outweighed by the risk of complications when you don’t look at other potential benefits of circumcision.
>
> There are no significant risks from having a foreskin that can’t be reduced by methods other than circumcision and unlike circumcision those other methods have zero risk of complications, which for circumcision does include a small risk of death.
Firstly, the new article pretty accurately summarises the abstract of the statement, which states:
> [@](#):
>
> Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV.
So it’s not a case of source distortion.
Secondly, the issue is not whether all newborns _should_ get it as a matter of routine, but the opposite - whether there oughtta be a law or policy agianst anyone using the procedure on newborns. Adding back in to your selectively-cropped quote:
> [@](#):
>
> Although health benefits are not great enough to recommend routine
> circumcision for all male newborns, **the benefits of circumcision are
> sufficient to justify access to this procedure for families choosing it and
> to warrant third-party payment for circumcision of male newborns.**
[Emphasis added]
Third, here is a link to the full text of the technical report.
[http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-1990](http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-1990)
> [@](#):
>
> Phimosis is a condition in which the
> foreskin cannot be fully retracted from
> the penis. A history of phimosis alone
> confers a significantly elevated risk of
> invasive cancer (OR: 11.4). In fact, in
> men with an intact prepuce and no
> phimosis, there is a decreased risk of
> invasive penile cancer (OR: 0.5). When
> excluding phimosis, the risk disappears,
> which suggests that the
> benefit of circumcision is conferred by
> reducing the risk of phimosis and that
> the phimosis is responsible for the
> increased risk.
- And -
> [@](#):
>
> It is difficult to establish how many male
> circumcisions it would take to prevent
> a case of penile cancer, and at what
> cost economically and physically. One
> study with good evidence estimates that
> based on having to do 909 circumcisions
> to prevent 1 penile cancer event,
> 2 complications would be expected for
> every penile cancer event avoided.121
> However, another study with fair
> evidence estimates that more than
> 322 000 newborn circumcisions are required
> to prevent 1 penile cancer event
> per year.122 This would translate into
> 644 complications per cancer event, by
> using the most favorable rate of complications,
> including rare but significant
> complications.123 The clinical value
> of the modest risk reduction from circumcision
> for a rare cancer is difficult
> to measure against the potential for
> complications from the procedure.
In short, both of your statements are incorrect:
a. The cancer risk appears at least in part related to phimosis, not hygene; and
b. Contrary to your account, the report does _not_ state that “the increased cancer risk is outweighed by the risk of complications when you don’t look at other potential benefits of circumcision”. Rather, it states that rating the risk/reward ratio is “difficult”, and that the study with “good” evidence demostrates 1 cancer is prevented for every 2 complications! While I suppose one could make the argument that 1 cancer per 2 complications still shows that ‘complications [numerically] outweigh cancers’, that would be an extremely misleading argument to make, as the vast majority of complications are in no way as severe as cancer. The risk to health of 1 cancer is obviously more severe than 2 complications. Admittin of course that the other study showed 644 complications per cancer (but only based on “fair” evidence).
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### Author:  [@Malthus](https://boards.straightdope.com/u/Malthus)
#### Post date: [August 28, 2012, 2:46pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/16 "2012-08-28T14:46:49Z")
> [@levdrakon](#):
>
> Where do you live you can’t teach your kids basic hygiene? It’s odd you care enough about your child to slice up his cock but not teach him how to not be an illegal drug injecting street prostitute in equatorial Africa.
>
> That is truly odd.
Not half as odd as your post. 😃
What your response has to do with the prevelence of penile cancer I cannot imagine.
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### Author:  [@Thudlow\_Boink](https://boards.straightdope.com/u/Thudlow_Boink)
#### Post date: [August 28, 2012, 3:07pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/17 "2012-08-28T15:07:20Z")
When I saw the article in the newspaper a day or two ago, I of course immediately thought of the SDMB and the heated (on the part of a few posters with a bee in their bonnet) threads that have come up here.
What I took away from the article is, not _Now they’re saying circumcision is a good thing and everyone should do it_, but _There are legitimate medical reasons to circumcize boys, so parents who choose to have their baby boys circumcized have made a reasonable choice._ They’re not evil; and it’s not just a matter of religion or custom.
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### Author:  [@naita](https://boards.straightdope.com/u/naita)
#### Post date: [August 28, 2012, 3:08pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/18 "2012-08-28T15:08:26Z")
> [@Malthus](#):
>
> Secondly, the issue is not whether all newborns _should_ get it as a matter of routine, but the opposite - whether there oughtta be a law or policy agianst anyone using the procedure on newborns. Adding back in to your selectively-cropped quote:
No, that’s the issue in the Australian article. The topic of this thread, as per the OP is “Does this mean we need to get to hacking?”
> [@](#):
>
> a. The cancer risk appears at least in part related to phimosis, not hygene; and
Yes, I admit I simplified that part to respond to your incredulity that cancer risk could be reduced by improving hygiene. Phimosis however is still treatable without surgery and the probable cause of a link between phimosis and cancer is the problems it presents for foreskin hygiene.
> [@](#):
>
> b. Contrary to your account, the report does _not_ state that “the increased cancer risk is outweighed by the risk of complications when you don’t look at other potential benefits of circumcision”. Rather, it states that rating the risk/reward ratio is “difficult”, and that the study with “good” evidence demostrates 1 cancer is prevented for every 2 complications! While I suppose one could make the argument that 1 cancer per 2 complications still shows that ‘complications [numerically] outweigh cancers’, that would be an extremely misleading argument to make, as the vast majority of complications are in no way as severe as cancer. The risk to health of 1 cancer is obviously more severe than 2 complications. Admittin of course that the other study showed 644 complications per cancer (but only based on “fair” evidence).
I agree. My brain shortcircuited on “complication”, which would of course include all the minor stuff. That still leaves cancer risk as something that, like the other risks, can be reduced by hygiene and non-surgical treatment of phimosis.
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### Author:  [@Sicks\_Ate](https://boards.straightdope.com/u/Sicks_Ate)
#### Post date: [August 28, 2012, 3:09pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/19 "2012-08-28T15:09:10Z")
I do wonder…how may of the American Academy of Pediatrics are Jewish?
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### Author:  [@Malthus](https://boards.straightdope.com/u/Malthus)
#### Post date: [August 28, 2012, 3:26pm UTC](https://boards.straightdope.com/t/american-academy-of-pediatrics-now-says-circumcisions-benefits-outweigh-risks/632857/20 "2012-08-28T15:26:11Z")
> [@naita](#):
>
> No, that’s the issue in the Australian article. The topic of this thread, as per the OP is “Does this mean we need to get to hacking?”
I took the OP to be rhetorical. No-one is seriously suggesting, least of all the policy, that people be required routinely to obtain the procedure. The debate is, and always has been for the last few decades, about whether it is ethical.
> [@](#):
>
> Yes, I admit I simplified that part to respond to your incredulity that cancer risk could be reduced by improving hygiene. Phimosis however is still treatable without surgery and the probable cause of a link between phimosis and cancer is the problems it presents for foreskin hygiene.
My understanding is that the primary treatment for phimosis which is actually causing acute complications is in fact surgical. And certainly it has never been alleged that surgical treatment for phimosis is unethical or improper.
Moreover, it is not in evidence that nonsurgical treatment for phimosis reduces or elimninates cancer risk. It _is_ in evidence that circumcision reduces or eliminates cancer risk.
> [@](#):
>
> I agree. My brain shortcircuited on “complication”, which would of course include all the minor stuff. That still leaves cancer risk as something that, like the other risks, can be reduced by hygiene and non-surgical treatment of phimosis.
Scientific evidence of this lacks. Again, we have no evidence that non-surgiacl treatment of phimosis reduces or eliminates cancer risk.
However, all this is to say that there do exist medical benefits that cannot, on the state of the evidence as in this report, be reproduced merely by enforcing hygene, or otherwise by “non-surgical treatments”.
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