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Update on Male Circumcision
(04/20/2007) by Annette Owens
There is mounting evidence that circumcised men are less vulnerable to some STIs (sexually transmitted infections), including HIV, than those who remain uncircumcised. This adds fuel to the already fiery debate about circumcision.
In 1999 the American Academy of Pediatrics (AAP) published its policy statement on circumcision (see resources, below). They analyzed almost 40 years of available medical research on circumcision, and concluded that the benefits from circumcision were not significant enough for the AAP to recommend circumcision as a routine procedure. This policy statement was re-affirmed in 2005. At the time, it was noted that there was some evidence that circumcision might protect against some STIs and cervical cancer in female partners of circumcised males. The noted benefits for men included:
1) Circumcised men have a slightly lower risk of urinary tract infection (UTI). Research indicates that during the first year of life an uncircumcised male has at most about a 1 in 100 chance of developing a UTI, while a circumcised male has about a 1 in 1000 chance.
2) The risk of a circumcised man developing penile cancer is only about a third of that of an uncircumcised man. However, the AAP policy notes that in the United States only 9 to 10 cases of this rare disease are diagnosed per year per 1 million men, indicating that while the risk is higher for uncircumcised men, their overall risk is extremely low.
3) Circumcised men may be at a reduced risk for developing syphilis and HIV infections. Despite some evidence already present in 1999, the AAP policy emphasized that behavioral factors were far more important in determining a person’s risk of contracting STIs than circumcision status. Lately new evidence has accumulated, prompting AAP president Jay Berkelhamer to announce that it is time to take another look at the data (USA Today, 11-6-2006).
For more general discussion of this subject, take a look at the Male Circumcision video here on Love and Health.
Two recent trials of circumcision for HIV prevention, conducted by research teams in East Africa, have been stopped early (retrieved from http://www.sciencedaily.com/releases/2006/12/061213174708.htm). Both studies found that the rate of new HIV infections was lower in circumcised men, compared with uncircumcised men. Continuing the trials therefore was considered unethical. As of February 2007, the full results of the East African trials had not yet been published.
The male foreskin is made up of cells that absorb HIV and are apparently more vulnerable to HIV infection. The foreskin is also vulnerable to tearing and ulcers that act as entry points for HIV. Once a male undergoes circumcision and the surgical scar is healed, researchers say the new skin is covered with a protective lining called keratin that is less vulnerable to HIV infections and other STIs.
It needs to be emphasized that being circumcised does not eliminate, but apparently only reduces the risk of HIV infection. Other measures to prevent infection, such as using condoms, are still essential (Kahn et al. 2006). And according to Marilyn Milos, director of the National Organization of Circumcision Information Resource Centers (NoCirc): "Even if it does bring down STDs, cutting normal tissue of an unconsenting minor is a human rights violation" (USA Today, 11-6-2006).
Resources
American Academy of Pediatrics (AAP) 1999 Circumcision Policy Statement
http://aappolicy.aappublications.org/cgi/content/full/pediatrics%3b103/3/686
Kahn JG, Marseille E, Auvert B (2006) Cost-effectiveness of male circumcision for HIV prevention in a South African setting. PLoS Med 3(12): e517.
http://dx.doi.org/10.1371/journal.pmed.0030517
National Organization of Circumcision Information Resource Centers (NoCirc)
http://www.nocirc.org
USA Today article (11-6-2006): Routine circumcision could reduce STD rate By Marilyn Elias
http://www.usatoday.com/news/health/2006-11-05-circumcisions_x.htm
Source: www.loveandhealth.info
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