Health; Benefits only begin during teen years
It's an idea that will make grown men squeamish, but a leading Canadian infectious disease expert says it is time to consider circumcising prepubescent boys, and not newborns.
With three large trials from Africa concluding that male circumcision cuts the risk of acquiring HIV by approximately 60 per cent in heterosexual men- data the World Health Organization calls "compelling" - Dr. Noni MacDonald says there may be merit in offering circumcision to young boys "rather than their baby brothers."
Writing in the Canadian Medical Association Journal, the professor of pediatrics at Halifax's Dalhousie University says the potential benefits of circumcision only begin to set in once males become sexually active.
"There's been a lot written about how important circumcision is now that we know about the African data," MacDonald told Postmedia News. The data also show a decrease in the risk of contracting human papilloma virus, or HPV, a virus that can cause genital warts, as well as penile cancer.
"The (infant) isn't at risk of HIV and sexually transmitted diseases, because they're not sexually active, so why are we rushing to do it at that time?" MacDonald said. "If you're really going to do this, we need to think of the timing. Why aren't we offering it to peripubertal boys, when it's going to be relevant?"
Men - and women - may squirm at the idea of routinely offering circumcision to older boys, worried it would be too painful and uncomfortable, she said. But babies feel the same pain.
"Why are we fine with doing it to a baby but not a young man?
"It's curious that a painful elective procedure of no major benefit to the infant until years later would ever be deemed more acceptable than the same procedure for a peripubertal boy," Mac-Donald writes in the CMAJ. What's more, unlike infant boys, older boys can give consent.
"The baby gets no choice, the parents make the decision," she said. "An 11-, 12-, or 13-year-old boy could really make a decision on their own about this."
It would also be an opportune time for parents to broach the subject of sex, she says.
"We could really talk about the other ways that you can decrease your risks."
"I think most boys would choose not to have it done. But it would be a prime time to discuss it."
Just how relevant the African studies - which all involved adult male circumcision - are for Canada and other countries that have far lower HIV rates isn't clear. A recent U.S. analysis estimated that neonatal circumcision would reduce the 1.87-per-cent lifetime risk of HIV among men by only about 16 per cent.
"It's not a huge decrease," says MacDonald. In addition, giving boys the HPV vaccine might be cheaper and far more effective at preventing HPV than circumcision, she said.
The Canadian Paediatric Society is in the process of trying to decide what to say about the topic. Several committees are reviewing the African data, said executive director Marie Adèle Davis.
The Ottawa-based group's current position is that the benefits and harms of circumcision are so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns.
Circumcisions, which are uncommon in northern European countries, Central and South America and Asia, are largely a North American phenomenon.
The procedure involves cutting away the inner and outer layers of the foreskin. The cells of the foreskin are thought to be more susceptible to HIV infection.
Read more:http://www.montrealgazette.com/health/Circumcision+best+older+boys/4552918/story.html#ixzzBcXUs6fgQ
