WHO

Dr. Marvin L. Wang

WHAT

In late August, the American Academy of Pediatrics changed its 13-year stance on circumcision, saying that it can be medically beneficial, but stopping short of recommending the procedure. Wang, codirector of the Newborn Nurseries at the MassGeneral Hospital for Children, performs hundreds of circumcisions a year.

Q. Can you explain the American Academy of Pediatrics’ decision?

‘Mostly from [Ancient Egypt] until all the way up to the 20th century, the prevailing thought was that circumcision was a means for hygiene.’

A. Back in 1999, the AAP found there wasn’t quite enough of a health benefit to perform routine neonatal circumcision. Parents were asked to put aside beliefs of health benefits and weigh their decision more on things like religion, cultural, social, or family reasons. Now, they say we’ve found enough evidence to say there is some benefit.

Q. And the main impact of this decision will be on insurance, which will now be more likely to cover the procedure?

A. The AAP, I think, wants to make the stance that if we know that there is a potential health benefit here, parents should not feel like there is a financial barrier to getting a circumcision if they want it.

Q. The organization changed its position based on research suggesting that adult African men who are circumcised are less likely to contract HIV and AIDS. But some have criticized the relevance of those studies.

A. You have studies of adult men in [developing] countries where HIV is prevalent. Does that necessarily translate to newborns in developed countries where HIV is not prevalent? You can abstract some theories behind that but you can’t really make absolute conclusions from it.

Q. What are the risks of circumcision?

A. I believe it is considered the most frequently performed surgery in the United States. [But] it doesn’t always go smoothly. There’s always the risk of bleeding, infection, and as I tell parents every time when I do this, there is the possibility of damage to the area you’re cutting into. In well-trained hands, the numbers come up to about 1 in every 500 have complications, usually bleeding-related.

Q. What about pain? Circumcisions used to be done with no painkiller at all, but now babies receive nerve blockers, right?

A. As far as we can tell, the infant is not feeling pain from the actual cutting and the surgery. We have to keep the legs strapped down to make sure the baby doesn’t move. I think the babies are typically more stressed [by this lack of mobility] than they are feeling pain.

Q. What do you think about the idea of deferring circumcision until a boy is old enough to make the decision on his own, instead of his parents making the decision for him?

A. The difficulty is that after about 2 months of age, the technique for doing circumcision has to change, and it’s usually done in an operating room under general anesthesia. The risks of the procedure [increase] once you are dealing with circumcision at an older age.

Q. Historically, was circumcision first begun because it was easier to keep a circumcised penis clean?

A. The earliest known depiction is back in the times of Ancient Egypt. Mostly from then until all the way up to the 20th century, the prevailing thought was that circumcision was a means for hygiene. By being cleaner, the penis would be healthier and therefore fertility would be maintained.

Q. On balance, do you think it’s better for baby boys to be circumcised or not?

A. If a parent asked me that, I would say that’s not a fair question to ask. Culture, family, religious and social reasons are [personal]. You should not be weighing my personal social, cultural or religious reasons.