- The Washington Times - Thursday, January 15, 2015

A federal proposal to encourage discussions about circumcision for baby boys and at-risk men of all ages has drawn nearly 2,000 mostly negative comments and a planned protest in front of a federal agency this month.

The proposal from the Centers for Disease Control and Prevention (CDC) doesn’t explicitly recommend circumcision, but it urges health care providers to proactively discuss the benefits and risks of circumcision with parents of baby boys and “uncircumcised at-risk heterosexual males” to allow people to make well-informed decisions about the procedure.

A public comment period on the proposal in the Federal Register ends Friday.

Circumcision, which cuts away a section of the tissue covering the head of the penis, is associated with a lower risk for acquiring HIV, genital herpes and human papillomavirus, as well as penile cancer and infant urinary tract infections in male infants, the CDC said in its draft recommendations.

The overall risk of adverse events is “low,” with minor bleeding and inflammation cited as the most common complications, the agency said.

“The scientific evidence is clear that the benefits outweigh the risks,” Dr. Jonathan Mermin, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, told The Associated Press when the proposal was unveiled in November.

But the vast majority of the 1,978 public comments on the CDC proposal opposed it — often furiously.

“Stop mutilating helpless babies,” wrote one commenter named Lucy Brenton. “There is no reason to cut healthy tissue of a normally functioning organ, especially without the permission of the owner,” she wrote.

Others decried the physical harm and deaths that have occurred with circumcision, as well as lifelong trauma associated with the loss. An online organization called foreskin-restoration.net said it had more than 5,000 members, some of whom “are so bothered by the imposed loss of their foreskin that they endure a tedious process of nonsurgical foreskin restoration to undo some of the sexual damage.”

Other critics noted that circumcision is unlikely to dent HIV transmission in the U.S. since most HIV cases are among men who have sex with men. The CDC proposal recognized this, saying that the studies showing circumcision as an effective HIV-prevention strategy only involved men who had sex with women.

U.S. health care providers “should inform men who exclusively have sex with men that male circumcision has not been proven to reduce the risk of HIV or [sexually transmitted infections] during anal sex,” the CDC said, adding that circumcision is still advised for bisexual men as well as men who have sex with HIV-infected women, commercial sex workers, injection-drug users and women who live in areas with a high HIV prevalence in the population.

The CDC proposal got a few supportive comments.

“Please don’t listen to the hysterical nay-sayers. Look at the evidence,” wrote one medical doctor, while a man writing as “Anonymous” said his bouts with balanitis, a swelling condition of the penis in uncircumcised men, “could have been prevented if I had been circumcised as an infant.”

Another circumcision supporter, Dr. Jeffrey Klausner, urged the CDC to recommend that the U.S. Preventive Services Task Force review the issue of newborn circumcision. If that task force would endorse newborn circumcision with “an A or B recommendation,” he wrote, it would require Medicaid and Medicare to pay for the procedures as a preventive intervention.

A peer review panel will also be assembled to examine the evidence for the proposal and offer expert opinion on whether the CDC recommendations are justified and appropriate for the intended audience. Final recommendations are likely to be published later this year in the Morbidity and Mortality Weekend Report, the CDC said.

The agency did not directly respond to a question about whether its expert-review panel would include anyone who is critical of circumcision. But it said its peer reviewers would be selected because of their expertise in such matters as urology, pediatrics, public health, infant circumcision and prevention of sexually transmitted diseases such as HIV/AIDS.

Anti-circumcision advocates in Atlanta said on their Facebook page that they are planning a rally Jan. 22 outside the CDC offices to protest the proposal.

“We all know that there are no benefits to the amputation of healthy body parts,” said organizers, including members of Bloodstained Men & Their Friends, who protest while wearing white pants with bright red circles at the crotch.

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