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Circumcision has always had a lot of cultural and religious baggage around it, and the last few years saw more of a medical trend against the procedure. I personally didn’t feel that there was much benefit more than fitting a cultural norm, and since the harm and pain outweighed the benefits, I tended not to recommend it. But now there’s a lot of new data showing real health benefits in male circumcision.
The major recent data came from studies in Africa, showing a dramatic decrease (more than 50%) in risk of HIV transmission among circumcised men. That benefit has been repeated and verified in other studies. Now, there are other studies showing additional benefits in decreasing herpes viral infections as well as the HPV virus. These diseases can cause herpes flares as well as genital warts and penile cancers.
There’s also good data that this benefits their female sexual partners as well. Not only would they benefit from the decreased risk of HIV, HPV and HSV, but women partners of circumcised men also have less frequent trichomonas infections and bacterial vaginosis.
All this data was reviewed in the latest issue of Archives of Pediatrics and Adolescent Medicine, and discussed in a Medscape article (New Data Support Long-Term Health Benefits of Male Circumcision). You can also read the official policy statement from the American Academy of Pediatrics, which was last revised in 2005 and does not reflect this new data.
The Bottom Line?
I find these latest studies very powerful and now am much more inclined to recommend male circumcision. As always, parents making this decision need to make sure that proper pain control techniques are used.
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This is interesting new evidence for circumcision. Practically most health insurance companies do not cover the cost. It is important that the procedure be done before one month of age. I do the procedure under local anesthesia using a nerve block similar to that use by the dentists. If the procedure is not done within the first 30 days it should be deferred until preschool age and done under general anesthesia. Don't forget like any surgical procedure there are risks which include bleeding, infection, scarring, poor cosmetic result and damage to the penis.
Unfortunately, these Trials only tell part of the story. Another study shows that women who have circumcised partners have an increased rate of HIV infection. Fewer men get infected at the cost of more women getting infected with HIV. Not a good tradeoff.
Also, other studies show circumcision has little effect for men having sex with men. Some of the African HIV epidemic is due to gay sex, but, culturally, Africans cannot admit to gay sex (Uganda tried to make gay sex punishable by death). There is a lot more to the story of HIV in Africa and the few studies do not reflect all the variables nor the long-term effects.
I’m not sure where you’re getting your data, but clearly there are significant benefits to women as well. I see no studies showing an increased risk to women; but I also don’t see strong studies showing decreased rick. In fact, the 2008 UNAIDS report specifically states: “There is no strong evidence that male circumcision reduces the risk of HIV transmission to a female partner, or that male circumcision reduces the risk of HIV transmission during anal sex to the receptive partner, whether male or female.” But clearly, the benefit for women is in their partner not getting HIV from some other person in the first place, and the African trials showing over 50% drop in HIV transmission in men means that a huge amount of men will no longer be infecting woman. There’s no tradeoff there.
Circumcision has long been controversial. See my brief practical article on information for parents of newborn males at http://www.alanmease.com
For those who decline the Vitamin K shot at newborn, you can consider timing the circumcision the Jewish way. Jews circumcise on day 8 as this normally gives enough time for natural Vitamin K production to begin (via the gut flora). Liora
At my first hospital, it was routine to get circumcised before they even leave the hospital (day 2-3)…