Call to Circumcise All Baby Boys
September 24, 1997

Every boy should be circumcised at birth as a preventive health measure, according to a report in the British journal Archives of Disease in Childhood.

In his summary of previous research, Dr. Edgar Schoen, director of regional perinatal screening at the Kaiser Foundation Research Institute in Oakland, California, says routine circumcision can significantly reduce the risk of urinary tract infection, sexually transmitted diseases (STDs) including HIV, and penile cancer.

"Newborn circumcision is a valuable preventive health measure, analogous to immunization, which offers protection against a number of diseases throughout a man's lifetime," writes Schoen, the former chairman of the American Academy of Pediatrics Task Force on Circumcision.

"And the best time to do it is in the newborn period," he adds, noting that studies in the past 10 years associate circumcision with a lower rate of both urinary tract or kidney infections in infants.

"Kidney infection in the infant are most dangerous in the first two years of life when the kidneys are still developing and can lead to permanent kidney damage," notes Schoen.

According to the researcher, studies have shown that uncircumcised infants less than 1 year old have about 10 times the risk of urinary tract infections than circumcised infants.

"And the mechanism for that is clear -- dangerous bacteria from the intestinal tract adhere to the warm, moist membrane of the foreskin and then they ascend up the urinary tract to cause severe infections of the bladder, kidney, and sometimes severe bloodstream infections," he explains.

Schoen points out that a second series of data summarized in his report points to a greater risk of STDs "involved with abrasions or tears in the foreskin" among uncircumcised men. These include genital herpes, human papilloma virus, and HIV -- the virus that causes AIDS.

"In terms of HIV, specifically, studies in sub-Saharan Africa found about a fourfold greater risk among men heterosexually exposed to the virus through contact with infected women, including prostitutes, compared with circumcised males," Schoen says.

Schoen contends that study results support the health benefits of newborn circumcision, even beyond STDs and urinary tract infection. "The evidence that circumcision protects against penile cancer is overwhelming," he states. "The United States incidence of penile cancer in circumcised men is essentially zero -- about one reported case every five years -- but in uncircumcised men about 1,000 cases are reported annually."

"When properly done, newborn circumcision is a quick, simple procedure with a low complication rate," writes Schoen, noting that circumcision does not appear to adversely affect either emotional health or sexual performance.

But Dr. Angus Nicoll of Great Britain's Public Health Laboratory Service HIV and STD Division in London, England, argues against universal circumcision of baby boys.

"There is a small but persistent complication rate from male circumcision, and the public health value of a routine circumcision policy has not been proved," he writes in an editorial in the same journal.

Over 70% of men in the U.S. are circumcised compared with just 21% in the U.K., Nicoll notes.

"It is noticeable that being heavily circumcised has not prevented the USA from becoming the industrialized country most burdened with HIV, while the opposite is true for the U.K.," he writes.

"The U.K. national survey found no difference in rates of STD clinic attendance among circumcised and uncircumcised men," states Nicoll. "This suggests that any protective effect against HIV-1 in industrialized countries is small and many circumcisions would be needed to prevent a single HIV infection in an American or European setting."