Pediatras: Los beneficios de la circuncisión superan los riesgos …Circumcision pluses outweigh risks: Pediatricians …5 Things You Didn’t Know About Circumcision
CHICAGO.- El grupo pediátrico más influyente de Estados Unidos cree que los beneficios de la circuncisión para la salud de los varones recién nacidos son mucho mayores que cualquier riesgo y que las aseguradoras deberían financiarla.
En su declaración más reciente sobre la circuncisión, un procedimiento quirúrgico cuya práctica ha disminuido en todo el país, la Academia Estadounidense de Pediatría se mostró mucho más favorable, aunque considera que los padres son quienes deben tomar la decisión.
«No es un veredicto que provenga del cielo», dijo el doctor Andrew Freedman, coautor de la recomendación. «No hay una respuesta que se aplique a todos por igual».
Sin embargo, desde el punto de vista médico, los beneficios de la circuncisión para reducir el riesgo de contraer enfermedades superan sus pequeños riesgos, dijo Freedman, pediatra especializado en urología en Los Angeles.
La circuncisión consiste en retirar el prepucio que cubre la punta del pene, procedimiento que puede reducir los gérmenes que prosperan debajo del prepucio. Las complicaciones, entre ellas sangrado y/o infecciones, son inusuales, dice la Academia.
Las investigaciones recientes que refuerzan la evidencia de que la circuncisión disminuye las posibilidades de infectarse con VIH y otras enfermedades de transmisión sexual, así como de sufrir infecciones de las vías urinarias o cáncer de pene influyeron para la Academia actualizara su política al respecto, establecida hace 13 años.
La posición anterior decía que los beneficios médicos potenciales eran insuficientes como para que garantizaran el recomendar que todos los varones recién nacidos sean circuncidados. La nueva afirma: «Los beneficios de la circuncisión para los varones recién nacidos justifican que las familias que así lo deseen tengan acceso a este procedimiento».
La Academia también considera esencial darle a los bebés un remedio más adecuado que sólo un chupador recubierto de azúcar. En general se elige una inyección para anestesiar la zona.
Los Centros para el Control y la Prevención de Enfermedades (CDC, un organismo federal), calculan que los costos de la circuncisión van entre 200 y 600 dólares. La cobertura entre las aseguradoras es variable y varios estados han suspendido el financiamiento a las circuncisiones por parte del programa gubernamental Medicaid, que paga los gastos médicos de los estadounidenses de pocos recursos.
La nueva política fue publicada el lunes en el sitio de la revista Pediatrics en internet, mientras hay un creciente debate en torno a si la circuncisión es médicamente necesaria o sólo es un procedimiento cosmético que según los críticos equivale a una mutilación genital.
En Alemania, líderes judíos y musulmanes han protestado contra un fallo de una corte regional en junio que afirmó que la circuncisión equivale a hacerle daño al cuerpo.
Circumcision pluses outweigh risks: Pediatricians
The nation’s most influential pediatricians group says the health benefits of circumcision in newborn boys outweigh any risks and insurance companies should pay for it.
In its latest policy statement on circumcision, a procedure that has been declining nationwide, the American Academy of Pediatrics moves closer to an endorsement but says the decision should be up to parents.
«It’s not a verdict from on high,» said policy co-author Dr. Andrew Freedman. «There’s not a one-size-fits-all-answer.» But from a medical standpoint, circumcision’s benefits in reducing risk of disease outweigh its small risks, said Freedman, a pediatric urologist in Los Angeles.
Recent research bolstering evidence that circumcision reduces chances of infection with HIV and other sexually spread diseases, urinary tract infections and penis cancer influenced the academy to update their 13-year-old policy.
Their old stance said potential medical benefits were not sufficient to warrant recommending routinely circumcising newborn boys. The new one says, «The benefits of newborn male circumcision justify access to this procedure for those families who choose it.» The academy also says pain relief stronger than a sugar-coated pacifier is essential, usually an injection to numb the area.
The federal Centers for Disease Control and Convention has estimated circumcision costs range from about $200 to $600 nationwide. Coverage varies among insurers and several states have stopped Medicaid funding for circumcisions.
The new policy was published online Monday in Pediatrics. It comes amid ongoing debate over whether circumcision is medically necessary or a cosmetic procedure that critics say amounts to genital mutilation. Activists favoring a circumcision ban made headway in putting it to a vote last year in San Francisco but a judge later knocked the measure off the city ballot, ruling that regulating medical procedures is up to the state, not city officials.
In Germany, Jewish and Muslim leaders have protested a regional court ruling in June that said circumcision amounts to bodily harm.
Meantime, a recent study projected that declining U.S. circumcision rates could add more than $4 billion in health care costs in coming years because of increased illness and infections.
Circumcision involves removing foreskin at the tip of the penis. The procedure can reduce germs that can grow underneath the foreskin, and complications, including bleeding and infection, are rare, the academy says.
Despite the U.S. decline, about half of baby boys nationwide still undergo circumcision, or roughly 1 million each year. The country’s overall rate is much higher than in other developed nations, but U.S. rates vary by region and are higher in areas where it is a cultural or religious tradition, including among Jews and Muslims.
Psychologist Ronald Goldman, director of an anti-circumcision group, the Circumcision Resource Center, said studies show circumcision causes loss of sexual satisfaction — a claim the academy said is not supported by the research it reviewed — and can be psychologically harming. Goldman contends medical studies showing benefits are flawed and that the academy’s new position is «out of step» with medical groups in other developed countries.
The American Congress of Obstetricians and Gynecologists took part in the research review that led to the new policy and has endorsed it. Circumcisions in hospitals are typically performed by obstetricians or pediatricians.
The CDC also participated in the review, and will consider the academy’s updated policy in preparing its own recommendations, a CDC spokesman said. The agency has a fact sheet summarizing circumcision’s potential health benefits and risks but no formal guidelines.
The American Medical Association and American Academy of Family Physicians have neutral policies similar to the pediatrics academy’s previous position.
Philadelphia social worker Shannon Coyne examined medical research on circumcision before her son was born last September and had a tough time making a decision. She learned that a relative’s boy needed reconstructive surgery after a botched circumcision, and that another’s son who wasn’t circumcised developed urinary infections.
Coyne said she and her husband ultimately decided against circumcision, because she didn’t want her baby to have what she considers cosmetic surgery without being able to consent.
Her advice to other parents is «just make an informed decision. Do your research, be open-minded.»
Some 18 states have eliminated Medicaid coverage for circumcision, a trend that could contribute to rising health care costs to treat infections if circumcision rates continue to decline, according to a study published Aug. 20 in Archives of Pediatrics & Adolescent Medicine.
Dr. Aaron Tobian, a Johns Hopkins University assistant professor who co-authored the study, said the academy’s updated policy «is a very good step.»
5 Things You Didn’t Know About Circumcision
A new policy statement from the American Academy of Pediatrics (AAP) is likely to throw fuel on the fiery controversy surrounding male infant circumcision.
The AAP’s statement touts the medical benefits of circumcision while stopping short of recommending the procedure, which opponents decry as painful and unnecessary. For instance, new research has found that circumcision lowers the risk of acquiring sexually transmitted infections, including HIV, genital herpes, human papillomavirus and syphilis.
Circumcision seems to be on the decline in the United States (a 2005 Agency for Healthcare Research and Quality study put the rate at about 56 percent), but the practice has long religious and cultural roots. Here are five circumcision facts that may come as a surprise.
1. It was once touted as a cure for paralysis
In the late 1800s, doctors turned to circumcision to «cure» an array of ailments, from childhood fevers to brass poisoning to paralysis. This era was a boom time for genital surgery — women were losing their ovaries to the knife in the name of curing hysteria — but it was an 1870 case that shone the spotlight on circumcision.
Writing in the journal Transactions of the American Medical Association, Lewis Sayre, a professor of orthopedic surgery at Bellevue Hospital Medical College, told the tale of being called to the bedside of a 5-year-old boy whose knees were flexed and paralyzed, preventing him from walking.
During his examination, Sayre discovered that the boy’s foreskin had contracted, causing the child great pain. Speculating that the foreskin problem could be the source of the boy’s «physical prostration and nervous exhaustion,» Sayre conducted a circumcision the next day. In less than two weeks, Sayre reported, the boy was walking again.
Whatever the cause of the boy’s paralysis and miraculous cure, the foreskin can occasionally become trapped over the head of the penis, a condition called phimosis. Modern cures include circumcision, manual stretching of the foreskin, or preputioplasty, an operation to widen the foreskin. [Macho Man: 10 Wild Facts About His Body]
2. The foreskin is more complex than you might think
The foreskin isn’t just skin. Think of it as more like an eyelid for male genitals. On the inside, the foreskin is made up of mucous membrane, analogous to the inside of the eyelid or the inside of the mouth. It’s this moist environment that seems to be responsible for the foreskin’s association with sexually transmitted infections. The foreskin also contains a large number of Langerhans cells, a type of immune cell targeted by HIV infection.
Women have a foreskin equivalent, too: the clitoral hood, which protects the clitoris much as the foreskin covers the glans. The foreskin and the clitoral hood, known in gender-neutral terms as the prepuce, evolve from the same tissue in the womb. [10 Odd Facts About the Female Body]
3. The first-recorded circumcision happened in Egypt
As far as we know from the historical record, the land of the pharaohs pioneered circumcision. The earliest reference to the procedure dates back to around 2400 B.C. A bas-relief in the ancient burial ground of Saqqara depicts a series of medical scenes, including a flint-knife circumcision and a surgeon explaining, «The ointment is to make it acceptable,» likely referring to some form of topical anaseptic.
Ancient Egyptian circumcisions were not done in infancy, but instead marked the transition from boyhood to adulthood. The Greeks saw their Mediterranean neighbors’ tradition as rather bizarre. In the fifth century, Herodotus made his opinion known in his work «The History of Herodotus.»
«They practice circumcision for the sake of cleanliness,» he wrote of the Egyptians, «considering it better to be cleanly than comely.»
4. It may have caught on as a status symbol
An increase in hospital births and a perception of circumcision as promoting cleanliness certainly contributed to the rise of the procedure in the United States. But the procedure may have been a status symbol as well.
Writing in the University of Cincinnati Law Review in 2003, Seton Hall University law professor Sarah Waldeck points out that Sayre and his circumcision-promoting colleagues came onto the scene just as hospital births were becoming more common. The wealthy were more likely to go to the hospital and have a physician-attended birth; thus, circumcision became a marker of class. The need to circumcise essentially became a social norm, Waldeck writes. It was what «good» parents chose. As more and more parents made the choice, it became odder and odder not to, which then put more pressure on parents to choose circumcision so their child would be «normal.»
5. Circumcisions leave unique marks
Most circumcisions in the United States are done with one of three devices: the Mogen Clamp, the Plastibell and the Gomco clamp. The Mogen clamp is a scissorlike device consisting of two flat blades used that are clamped over the foreskin, cutting off blood flow. A scalpel is then used to slice away the tip of the foreskin.
The Plastibell is a plastic device that is placed over the head of the penis, under the foreskin. The doctor or nurse then ties a string around the foreskin, cutting off circulation. The string may be used as a guide for the surgical removal of the foreskin, or the Plastibell may be left on for a week or so, after which the dead foreskin will fall off on its own.
The Gomco clamp is also inserted between the head of the penis and the foreskin. Again, the surgeon clamps the device over the foreskin, cutting off circulation. After about five minutes, the blood around the clamp will begin to clot, and the surgeon uses a scalpel to cut away the foreskin. This method sometimes leaves a distinctive light brown scar on the head of the penis.