Circumcision remains in the United States a personal decision between parents and their doctor, but how old is too old when it comes to this common surgery? The study’s findings, which were published in JAMA Pediatrics on Monday, reveal a rise in complications as boys get older. It may have doctors encouraging parents to choose to circumcise their baby boys when they’re first born.

Researchers at the Institute for Health Metrics and Evaluation at the University of Washington, Seattle, analyzed data sets from literature reviews and medical billing codes that totaled more than 1.4 million males. What they found was that the males who had undergone a circumcision before they turned 1 year old had a 0.5 percent chance of experiencing an adverse event. The risk of an adverse event occurring in boys between the age of 1 to 10 is 10 to 20 times greater.

“Our study provides more detailed evidence about the rate and types of adverse events associated with male circumcision. It is consistent with prior studies which have found that the rate of adverse events after circumcision in older children and adults is much higher than seen in infants,” said Dr. Charbel El Bcheraoui, lead author and professor of Global Health at the Institute for Health metrics and Evaluation at the University of Washington.

Adverse events, as defined by the World Health Organization (WHO), include pain, excessive bleeding, excessive skin removal, damage to the penis, difficult urinating, scarring or disfigurement, excessive swelling, and infection.

According to the study, researchers found damage to the urethra occurred in about 0.8 per one million circumcisions. Meanwhile, leaving too much foreskin occurred in about 702 per one million circumcisions.

Despite possible surgical complications, 58.3 percent of newborns were circumcised in the United States in 2010, which has decreased from 64.9 percent recorded in 1981, according to the Centers for Disease and Prevention (CDC). The decrease may be due to the American Academy of Pediatrics (AAP), when in 1989, said that there were potential benefits to circumcision. However, 10 years later, the organization said that there wasn’t enough evidence for them to recommend the procedure.

“Current AAP guidelines published in 2012 state that the benefits outweigh the risks of male circumcision, a change from their 1999 policy statement which was a neutral stance,” Bcheraoui told Medical Daily.

The procedure, which involves the surgical removal of the foreskin that covers the tip of the penis, is a decision based on several factors. Parents choose when and why their sons are circumcised for various reasons, including religious, social, cultural, or for health benefits. However, noting the clear 10 to 20 time risk increase, if parents do opt for the surgery the safest time is in that one-year window.

“Sometimes circumcision is delayed due to health problems in newborns or infants or lack of insurance coverage. In other situations, the choice to delay might be simply personal,” Bcheraoui told Medical Daily.

Now that researchers have revealed that age does play a definitive role in the risk level of the surgery, parents may feel the pressure to decide sooner than later. According to HealthyChildren.org, circumcision is typically performed within days after birth and, though painful, should be alleviated with pain medications. Decreasing the risk of any surgery by circumcising in a newborn boy’s first year should be taken into consideration, and doctors will inform parents of all the benefits and risks.

Doctors already advise parents of the markedly lower risk of acquiring the human immunodeficiency virus (HIV), the virus that causes AIDS, and a number of other sexually transmitted diseases including genital herpes and the human papilloma virus (HPV), according to the AAP. Circumcision is encouraged by the WHO in order to cut down the rates of HIV, which can lower the risk of infection by up to 60 percent.

“HIV is only one of many considerations for male circumcision. Sometimes the procedure is necessary, and medically indicated due to certain conditions. Our study provides clinicians and parents with information on the risk of its adverse events,” Bcheraoui said.

The study recognizes the current debate on whether male circumcision, “should be delayed from infancy to adulthood for autonomy reasons.” The researchers believe, “our results are timely and can help physicians counsel parents about circumcising their sons."

 

Source: Bcheraoui C, et al. Low Rate Of Adverse Events Associated With Male Circumcision. JAMA Pediatrics. 2014.