On Circumcision Debate, Studies Cut Both Ways
Reader Comments
Human Rights Issue
Isn't mutilating the genitals of men for a scientific study unethical? Wouldn't that be similar to giving people a disease to study the cure?
Aside from that, it is irresponsible to send a message to young men that they are any more protected from STD's, especially HIV, because of their circumcision.
I'm sure there are plenty of circumcised men in this country with HIV who can oppose that theory.
We need to focus our energy on teaching our kids to use condoms in order to be safe, and that is the only way.
Performing cosmetic surgery on an infant's sex organ is fundamentally wrong. Period. It needs to be stopped.
Beware of the medical literature on circumcision
Dear Adam:
The medical literature on male circumcision is different from most medical literature. The medical literature in favor of circumcision tends to be written by male medical doctors who were themselves circumcised as infants and by some others who were reared in a circumcising culture. Objectivity usually is lacking.
Circumcision has emotioal effects on the circumcised male. Those emotions manifest themselves in the circumcision literature. The result is a debate that has lasted for more than a century. Some circumcised doctors seek to justify their personal wounding as having some medical benefit, while other doctors seek to refute the false claims that are made.[1]
This started in Germany back in the early nineteenth century when Jewish doctors developed medical arguments to defend ritual circumcision against charges that Jewish circumcision is barbaric.[2]
The bottom line is that the medical literature in favor of circumcision is a bunch of BS and that intact non-circumcised males generally enjoy better health and well-being.
References
1. Hill G. The case against circumcision. J Mens Health Gend 2007;4(3):318-23. PDF at http://www.doctorsopposingcircumcision.org/pdf/Hill_2007.pdf
2. John M. Ephron. Medicine and the German Jews. New Haven: Yale University Press, 2001: 222-233. (ISBN 0-300-08377-7) Extract at: http://www.cirp.org/library/history/ephron1/
CDC should treat Sensitivity issue seriously
The Fact Sheet from the CDC has one section about the effects of circumcision on sexual sensitivity. They reference the Sorrells study, but fail to mention the important findings from it. What's important is not reduced glans sensitivity, it's reduced foreskin sensitivity.
The foreskin was found the be by far the most sensitive of all penile tissue. Why did the CDC not mention that circumcision removes the most sensitive part of the penis?
Instead they said this:
"Effects of Male Circumcision on Penile Sensation and Sexual Function
Well-designed studies of sexual sensation and function in relation to male circumcision are few, and the results present a mixed picture. Taken as a whole, the studies suggest that some decrease in sensitivity of the glans to fine touch can occur following circumcision [18]. However..."
[18] is the Sorrells study which is available in full at:
http://www.nocirc.org/touch-test/bju_6685.pdf
Condoms are the answer
Those who believe the foreskin is just extra skin may be interested in reading Sorrels, 2007. [http://www.cirp.org/library/anatomy/sorrells_2007] The most sensitive part of the circumcised penis is the circumcision scar. A significant number of nerve endings are removed during the procedure.
Some pro-circumcision activists have claimed that HIV-transmission risk is reduced by circumcision - even calling it a "vaccine" against HIV. The clinical trials done in Africa do not even begin to meet the standards of USA medical research. And the alleged "protective effect" applies only to men, not to women. This "alternative" to condom usage will cost many women in Africa their lives.
An interesting book about the state of medical care in Africa is Sizwe's Test by Jonny Steinberg. Anyone who thinks circumcision could be done with proper sterile technique should read this book. And by the way, there are documented cases of HIV transmission during both male and female circumcisions in Africa.
The CDC's own studies show that circumcision has no "protective effect" to reduce HIV transmission in the USA. Condom usage needs to be emphasized in school-based sex education. Condoms are proven to reduce risk of HIV, STDs, and even unplanned pregnancy - something that circumcision cannot offer.
My husband is not circumcised. Our son, now 5 years old, is not circumcised. We have no regrets. When he goes off to college, I will buy him a big box of condoms and tell him to have fun, safely.
A few men
Yes, "a few men" changing status made a big difference to the claimed outcomes, because though they started with a total of 10,908 men, only 201 (64 circumcised, 137 controls) got HIV in the curtailed time-span of the trials. When they claim "circumcision could protect millions" they just multiply those small numbers by whole populations, ignoring the enormous uncertainties individual behaviour differences cause.
There are many other problems with the trials, notably:
* the drop-out rate of 673 men (327 circumcised 376 control) which could easily overturn the findings if circumcised men who found they were HIV were more likely to drop out (as you would be).
* the role of non-sexual and same-sex transmission (the experimenters assigned ALL transmission to male-female sex). "Needle men" who inject with the same needle for any ailment are common in Africa. Same-sex activity is a big no-no and would go unreported. Researchers ignored men contracting HIV and reporting no sexual activity or no unprotected sexual activity in the relevant period.
not even close to 76%
I think your article has an error in saying In one of the studies, the risk was reduced by as much as 76 percent. The three main studies were in the low 50% range of lowering risk. The studies have no real information on who really wore a condom and how much sex the men had. Certainly the cut men had less time for sex as the circumcision kept the cut (mutilated) inactive for the first months or so of the studies. The cut men got different condom advice and may well have practiced safer sex. No one is mentioning that male circumcison has resulted in higher HIV transmission rates from men to women.
A study indicates that female circumcsion (FGM) can also cut HIV risk. If you are a man and have this sensitive part of the penis, you know it feels really good. Is the argument for MGM to reduce HIV risk that mens sexual pleasure is less important than womens? Or are men easier to manipulate and sell a barbaric procedure to as a cure?
Adam Voiland's reply:
The CDC explains why you’re picking up that discrepancy in the risk reduction percentages here. Some of the data was reanalyzed after it was first published. Here's how CDC explains it:
“In these studies, men who had been randomly assigned to the circumcision group had a 60% (South Africa), 53% (Kenya), and 51% (Uganda) lower incidence of HIV infection compared with men assigned to the wait-list group to be circumcised at the end of the study. In all three studies, a few men who had been assigned to be circumcised did not undergo the procedure, and vice versa. When the data were reanalyzed to account for these occurrences, men who had been circumcised had a 76% (South Africa), 60% (Kenya), and 55% (Uganda) reduction in risk for HIV infection compared with those who were not circumcised.”
Your point about female circumcision possibly lowering the risk of HIV is intriguing. I’ve seen one study on this so far. Hopefully, future research will reveal more.
Condoms, not circumcision, prevented HIV in NZ
Yes, HIV is comparatively rare in New Zealand, largely because of heroic efforts in the 1980s by the gay community, somewhat reluctantly adopted by the government, to make protected sex a community norm.
Meanwhile, circumcision, near universal in the 1950s, fell out of favour through the rest of the century so that hardly any non-Polynesian babies are now circumcised, and most men under 35 - those most at risk of exposure to HIV - are intact.
"The benefits seen in the circumcision trials" not only don't necessarily translate to the US, they don't even translate to AFRICA. In Cameroon, Ghana, Lesotho, Malawi, Rwanda and Tanzania, a higher proportion of the CIRCUMCISED men have HIV than the non-circumcised.
