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US draft guidance on circumcision at odds with trends overseas

CDC says ‘benefits outweigh risks,’ but opponents claim cultural bias underpins new advice

U.S. health officials have released a draft of what is likely to become the first federal guidelines on circumcision, stating that the benefits of the procedure "outweigh the risks" — a position that runs counter to medical advice in other countries and has enraged advocacy groups that believe the surgical procedure is in large part unnecessary and comes with risks.

The Centers for Disease Control and Prevention (CDC) on Tuesday suggested that parents of newborn males and all uncircumcised men who are at risk of becoming infected with HIV should receive “comprehensive counseling” on circumcision. The CDC advised similar counseling of sexually active adolescents who haven’t undergone the procedure.

"The benefits of male circumcision have become more and more clear over the last 10 years," said Dr. Aaron Tobian, a Johns Hopkins University researcher involved with the CDC's research on circumcision and HIV transmission.

But there are health risks involved with the practice, such as bleeding, inflammation and reports of reduced sensation of sexual pleasure of circumcised men, according to advocacy groups such as Mothers Against Circumcision. And a study conducted released in 2010 said that every year, more than 100 babies in the United States die from the procedure's complications.

The U.S. is the only developed country that practices routine infant circumcision for nonreligious reasons, anti-circumcision activists say. A little more than half of U.S. newborns are circumcised during their birth hospitalization, according to CDC statistics. That number far exceeds the circumcision rate of other industrialized nations.

But Jonathan Mermin, director of the CDC's National Center for HIV/AIDS, said that "the scientific evidence is clear that the benefits outweigh the risks." He cited CDC studies that found the risk of transmission of HIV during heterosexual sex for circumcised men was reduced by up to 60 percent. Removing the foreskin also decreased the likelihood of transmission of genital herpes and types of human papilloma virus by 30 percent.

But circumcision opponents contest this premise. They say that by promoting the procedure among teenage boys and the parents of male newborns, the CDC has adopted a controversial public health measure that policymakers elsewhere have largely banned.

The studies the CDC cites in its report were conducted in poor rural areas of sub-Saharan Africa nearly a decade ago, said Georganne Chapin, executive director of Intact America, a group that opposes circumcision.

“These studies have never been replicated elsewhere — let alone in the United States — and have no relevance to children or men in the developed world,” she said in a statement. “There have been no systematic studies conducted anywhere about the short- or long-term adverse consequences resulting from circumcision."

“In the U.S. circumcision is very culturally ingrained into us. It is something that’s never discussed. It’s something that is just done,” said Sarah Kuester, a representative at the WHOLE Network, a U.S.-based advocacy organization.

Kuester, who traces the roots of the practice to the late 1800s "to keep young men from masturbating," said speaking out against circumcision has become taboo. The silence persists, she added, even in the face of studies that contradict the CDC's findings. One International AIDS Society study found that in only one of eight African countries surveyed did circumcised men run a lower risk of incurring HIV if they had their foreskin removed.

A German court ruled recently that doctors need to discuss circumcision procedures with the child, “in a manner appropriate to his age and development,” arguing that cutting an infant’s foreskin without informing the patient violated the country’s constitutional protection of individuals' physical integrity. The ruling followed debate over the case of a circumcised 4-year old who was taken to an emergency room because of profuse bleeding, Spiegel online reported. And in the U.K., the British Association of Paediatric Surgeons advises that there is rarely a medical need for circumcision. Moreover, doctors are also told that they can refuse to perform the procedure for reasons of conscience.

“It’s really just a euphemism. You call it female genital mutilation, and you turn around and call it male circumcision. It’s two sides of the same card,” Kuester said.

The CDC will accept public comment on the draft guidelines for 45 days before finalizing guidelines next year.

With wire services

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