For the Good of the Hood

Posted on by Paul Turek, MD

Circumcision Pros & Cons

To circumcise or not? It’s a loaded subject to be sure. The practice of male circumcision is ancient, likely far older than the biblical account of Abraham in Genesis. The Jewish faith, but not that of the Greeks or Romans, routinely recommended circumcision for newborn males. In the past century, it became “medicalized” as a preventative procedure, only to be debunked in the last decade. Well, it may now be a procedure on the rise once again.

What Is Circumcision?

Circumcision is the removal of some or all of the foreskin or prepuce from the penis. states that circumcision is medically unnecessary, that it lacks any proven benefit, and that it should not be performed routinely in newborns. Maybe that is why the incidence of neonatal circumcision in the U.S. has continued to decline, from 80% in the 1960s to 60% of boys currently.

Why should circumcision be avoided? Issues of neonatal pain, behavioral changes, and the potential for loss of sexual sensitivity from removal of the prepuce are age-old arguments for its discontinuation. However, a military study showing that there is a higher rate of urinary tract infections (UTIs) in non-circumcised men and the fact that penile cancer tends to occur almost exclusively in uncircumcised men has kept the procedure alive and well.

Preventing HIV

In a somewhat radical departure from earlier recommendations, public health officials now argue that circumcision of men is a key weapon in the fight against human immunodeficiency virus (HIV) in Africa. Three recent, large, controlled studies have shown that circumcision reduces infection rates by 50% to 60% among heterosexual African men. These studies stem from three different parts of the continent: South Africa, Uganda, and Kenya. In fact, two of the three clinical trials were stopped early because of overwhelmingly positive results. Experts now estimate that more than 3 million lives could be saved in sub-Saharan Africa alone if the procedure becomes widely used. And more recent data shows that the incidence of syphilis, herpes virus and HPV (Human Papilloma Virus) is also be reduced by 1/3 to 1/2 in circumcised men.

How circumcision prevents HIV transmission is not completely understood, but it is believed that the foreskin acts as a reservoir for HIV-containing secretions, increasing the contact time between the virus and target cells in the foreskin.

The Latest Dope

Since the discovery that circumcision reduces STD transmission, we now understand the following to also be true:

  • STD risk reduction with circumcision has been confirmed in the real world, outside of formal studies.
  • While circumcision reduces the chances of the male host acquiring HIV, it does not necessarily reduce the transmission of HIV to female partners.
  • Male circumcision also reduces the risk of HPV-related cervical cancer, Trichomonas vaginalis, and bacterial vaginosis in women.
  • Circumcision does not prevent the transmission of STDs so barrier contraception is still critically important in STD prevention.

The problem with HIV and circumcision is that it is much more than a simple “behavior-based” intervention and this may ultimately be its biggest obstacle to wide acceptance. Changing social mores and behavior is one thing, but the “cold, hard steel” aspect of this public health initiative may not survive in the long run. It may take years to convince the world that a clean penis and a clean life may be all that’s needed to replace the knife.