Whether male babies undergo procedure has become a personal decision between families and their doctors, experts say
THURSDAY, Aug. 22, 2013 (HealthDay News) -- Male circumcision rates in the United States declined 10 percent between 1979 and 2010, federal health officials reported Thursday.
Over 32 years, the rate of newborn circumcision -- the surgical removal of foreskin from a penis -- performed in hospitals dropped from 64.5 percent to slightly more than 58 percent, according to the U.S. Centers for Disease Control and Prevention.
"It hasn't been a stable decline," said report co-author Maria Owings, a health statistician at CDC's National Center for Health Statistics.
Over the decades the rate of circumcision in hospitals varied from a high of nearly 65 percent in 1981 to a low of slightly more than 55 percent in 2007, Owings said.
The rates also fluctuated over time, generally dropping during the 1980s, going up in the 1990s and dropping again in the early years of the 21st century, she said.
Part of the variation in rates reflects changes in guidance from medical groups, such as the American Academy of Pediatrics (AAP), according to the report.
In the 1970s the AAP said routine circumcision had no medical benefit. However, in 1989 the academy revised its position and said there were potential benefits to the procedure after all. But in 1999 the academy said that despite these benefits there was not enough evidence to recommend routine circumcision.
Current AAP guidelines offer evidence of the benefits of circumcision, especially in terms of preventing the transmission of HIV, the virus that causes AIDS.
The guidelines also say that circumcision lowers the risk of urinary tract infections in infants, genital herpes, human papillomavirus, cervical cancer in women and penile cancer.
Even so, the AAP still stops short of recommending circumcision for all baby boys.
AAP President Dr. Thomas McInerny said he thinks the change in circumcision rates is due to changes in the way doctors and families interact when deciding on the procedure.
"Parents are making shared, or what we call informed, decisions now," he said. "In years gone by, when you told patients they should do this or that, most of the time they said 'yes doctor' and they didn't ask any questions."
These days, doctors are giving more "family-centered" care and shared decision making, he said. "I think that's a healthy way of practicing medicine," McInerny said.
"In addition, there are a significant number of people who feel circumcision is unnatural," he said.
McInerny noted that the procedure does have a slight risk of excessive bleeding and infection. During the procedure infants can feel some pain, but doctors use Novocaine to reduce the pain, he said.
"The benefit of circumcision outweighs the very small risk, and therefore it is recommended, but it is not strongly recommended," McInerny explained.
McInerny said circumcision is more common in the United States than it is in Europe. "I am not sure why that is," he added. The reasons may be religious and cultural, he suggested.
Dr. Kenneth Bromberg, chairman of pediatrics at the Brooklyn Hospital Center in New York City, said that whether to circumcise an infant is really not a medical decision.
"It may well be there is an increase in the number of religious groups that believe in circumcision and when done in a religious fashion it is not necessarily done in the hospital," he said. "So there might not be the decrease the researchers suggest."
For Jews and Muslims it's a religious decision, not a medical one. "It's a personal decision and has moved outside the medical world," Bromberg said.
In addition to the national trend, changes in the circumcision rate reflect regional differences across the nation.
In the Northeast, the trend remained flat over the 32 years, with no evident pattern, the investigators found. Annual circumcision rates, however, did vary from nearly 70 percent in 1994 to about 61 percent in 2007.
In the Midwest, changes in rates mirrored the national trend. Circumcisions declined until the mid-1980s, increased until 1998, and then declined through 2010. Rates ranged from about 83 percent in 1998 to roughly 69 percent in 2009, the researchers found.
In the South, rates increased from 1979 until 1998, then declined, ranging between about 54 percent in 1988 to 66 percent in 1995.
In the West, changes were magnified. There, rates decreased 37 percent overall, from about nearly 64 percent in 1979 to just above 40 percent in 2010. The biggest decrease occurred in the 1980s, when the rate dropped to 41 percent in 1989, continued to decrease through 2010 and reached a low of about 31 percent in 2003, according to the report.
CDC researchers used data from the National Hospital Discharge Survey for their report.
To learn more about circumcision, visit the U.S. National Library of Medicine (http://www.nlm.nih.gov/medlineplus/circumcision.html ).
SOURCES: Maria Owings, Ph.D., health statistician, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention; Thomas McInerny, M.D., president, American Academy of Pediatrics; Kenneth Bromberg, M.D., chairman of pediatrics, Brooklyn Hospital Center, New York City; Aug. 22, 2013, report, Trends in Circumcision Among Male Newborns Born in U.S. Hospitals: 1979-2010