Monday March 1 4:54 PM ET

U.S. Pediatricians Renew Doubts About Circumcision

By Michael Conlon

CHICAGO (Reuters) - The American Academy of Pediatrics Monday issued its most detailed policy statement to date on circumcision, saying the medical benefits are not sufficient to recommend the procedure.

In a report published in the March issue of the academy's journal Pediatrics, the group also said for the first time that pain relief should be provided when circumcisions are performed.

The statement was based on a review of medical literature by a seven-member task force which reassessed the group's previous policy pronouncement issued in 1989.

``I believe we have gone farther than in the past on two fronts,'' said Carole Lannon, a physician at the University of North Carolina, Chapel Hill, who headed the task force.

``With the benefit of additional medical research we agree there are potential medical benefits but they are not compelling,'' she said in an interview.

``The academy does not recommend a policy of routine newborn circumcision. We encourage parents to discuss the subject with their pediatrician and make an informed choice,'' she added.

Secondly, Lannon said, the policy recommends for the first time that pain relief be provided when circumcision is performed. The six-page policy statement cites research showing that infants suffer pain when the foreskin is removed, a procedure sometimes done in the past with little or no regard to analgesia.

Lannon said the statement is the academy's most detailed comment on circumcision to date.

The pediatrics academy, with 55,000 primary care physicians, is the largest pediatrics medical group in the United States and Canada -- two countries where circumcision is widely carried out on male children for health reasons.

Two medical reasons for which circumcision had been advocated -- the prevention of urinary tract infections and penile cancer -- do not appear to be major problems, the report said.

While uncircumcised males run a higher incidence of urinary tract infections during the first year of life, it said, the risk is still relatively low -- around 1 percent overall.

And while penile cancer rates run three times higher in uncircumcised men, the disease is rare -- affecting only 10 or fewer men in a million annually worldwide, it added.

A debate over the merits of circumcision has raged for a number of years. Some advocates say it cuts down on disease, including the risk of sexually transmitted diseases and AIDS.

The practice also has vocal opponents.

R. Wayne Griffiths, who founded a California-based group which advocates foreskin restoration through various non-surgical skin-stretching methods, said ``now it is clear that the greatest danger to a baby boy's penis is from a doctor's knife.''

His group, the National Organization of Restoring Men, issued a statement saying the pediatrics academy should have been more forceful in criticizing circumcision. Recommending anesthesia, the group added, does not begin to address the ''emotional trauma experienced by boys and men when they learn that a very normal and pleasurable part of their body was unnecessarily taken from them...''

The Circumcision Resource Center, a Boston-based educational group, estimates about 60 percent of males in the United States are circumcised at birth, down from a peak of 85 percent in the late 1960s.

In Canada the rate is 48 percent, but the practice is uncommon in Asia, South and Central America and most of Europe, according to the pediatrics academy report.

Ronald Goldman, executive director of the Boston group, said the new academy policy confirms that there is no proven medical benefit to circumcision and the focus of debate should now be turned to the ``significant but generally unrecognized psychological and sexual harm'' resulting from the procedure.

He said recent studies ``on infants response to pain clearly demonstrates that it's traumatic and there is evidence that behavioral changes result that are not just temporary.''

One study found that circumcised infants had a much greater response to pain when they were vaccinated at the age of six months, a sign of ``post-traumatic stress'' that indicated neurological changes, he said.

He said there also questions about decreased sexual sensitivity as a result of removal of the foreskin.

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