Code Name: Mama

Researching Circumcision, Part 3: Common Concerns

Monday, March 1st, 2010

This article is the third in a series I am writing to help expectant parents get a jump start on their research about circumcision. Part one discussed the foreskin and its normal, necessary functions. Part two provided information on the procedure itself (what it removes, how it is performed, and some of the consequences). Part three presents information on many of the common concerns parents have when considering circumcision (including an examination of the research on STD’s, cancer, and other health issues).

Intact v. Cut: Common Concerns

There is an abundance of misinformation floating around about circumcision. Some of this is due to outdated (and subsequently proven untrue) “scientific” articles, some to current studies that were not conducted using scientifically acceptable methods, some simply to old wives’ tales. Thankfully, there are several trustworthy sources available that can help parents sift through the misinformation to discover the truth about circumcision and its consequences. Following are facts and links to more resources on the topics that often concern parents about intact v. cut penises.

1. Circumcision does not prevent HIV/AIDS: “Transmission of HIV infection is caused by risky behaviors, such as multiple sex partners, failure to use condoms, and contaminated instruments or needles.” Recent studies, however, claim that circumcised men in Africa have a lower chance of contracting the AIDS virus than men who are intact. Aside from the fact that scientists and scholars have questioned the methods and results of those studies, there are several compelling reasons that the African research is inapplicable when discussion routine infant circumcision. (1)

First, other studies provide evidence that the exact opposite is true: circumcised men in Africa are actually more likely to contract the AIDS virus than are intact men. (2) Second, it makes no scientific sense to compare the behavior of adult men in Africa to the behavior of infants in the United States. The populations “have too little in common . . . .”

Third, “the US has the highest rate of medically unnecessary, nontherapeutic infant circumcision in the world – about 56 percent of male babies today undergo the procedure, . . . and yet the HIV infection rate in North America is twice the rate in Europe, where circumcision rates are low.” If circumcision prevented HIV, it should logically follow that the United States would have some of the lowest rates of AIDS, since men have traditionally been circumcised here. That is not the case. (3) Fourth, the average sexually active heterosexual American male has a 0.03% chance of becoming infected with HIV in his lifetime. If that heterosexual male was high risk? He still only has a 0.3% chance of contracting HIV in his lifetime. Circumcision has no effect on that number, but the use of condoms will drastically decrease the risk. (4)

“Circumcision cannot prevent the spread of HIV; circumcised men contract HIV, transmit HIV, and die from AIDS. ” Moreover, circumcision does nothing to prevent the transmission of HIV to a female partner. (5) Circumcision is not an HIV vaccine. To protect your children from HIV and other STDs, educate them about safe sex practices and teach them how to use condoms.

2. Circumcision does not prevent STDs: Again, the United States “has the highest rate of circumcision of any Western nation (by FAR the highest as our rates are about 50% and the next closest is Canada with a rate around 10%). We also have the HIGHEST rate of all STDs of any Western nation (including HIV). Developed nations where 98-99% of their boys/men remain intact have the lowest rates of STDs (including HIV). If circumcision ‘protected’ against diseases[,] . . . we would NOT see these figures to such an extreme and obvious degree.” (6)

To be more specific, here is a collection of scientific research on circumcision and STDs:

Cook et al. (1994) were unable to show a definite benefit for circumcision—finding a slight tendency for non-circumcised men to have more syphilis and gonorrhea, but less tendency to have genital warts. Donovan et al. (1994) reported no significant difference between non-circumcised and circumcised men. Van Howe (1999) found circumcised men may be slightly more likely to have urethritis and uncircumcised males may be more prone to genital ulcer disease (GUD). Dickson et al. (2008) found more STD in circumcised men but the difference was not statistically significant. The Fetus and Newborn Committee of the Canadian Paediatric Society found that “circumcision had no significant effect on the incidence of common STDs.” The AAP Task Force (1999) reported that “behavior factors appear to be far more important than circumcision status.” The medical evidence does not support the practice of neonatal circumcision to prevent STDs. (7)

3. Circumcision does not prevent cancer: “Circumcision is ineffective for the prevention of penile cancer.” Scientific research has shown that it makes no difference whether a man is circumcised or intact – his risk of getting penile cancer is virtually unchanged.

What about cervical cancer? Same story. “The risk factors for cervical cancer are infection with human papilloma virus (HPV) and smoking. Risk of infection with HPV is increased by early onset of sexual intercourse and multiple sex partners. There is no clear evidence that male circumcision decreases the risk of infection.” (8)

The American Cancer Society has actually written a letter to combat the myth that circumcision prevents cancer in either men or women. The American Cancer Society’s purpose in writing the letter was “to discourage the American Academy of Pediatrics from promoting routine circumcision as a preventive measure for penile or cervical cancer. The American Cancer Society does not consider routine circumcision to be a valid or effective measure to prevent such cancers.” (9)

Do you still need to be convinced? Think of it this way: “Men have a higher chance of getting BREAST CANCER (0.7% likelihood) than they do of getting penile cancer (0.09%).” (10)

Cutting off an infant’s foreskin to “prevent cancer” is ludicrous.

4. Circumcision does not prevent urinary tract infections (UTIs): UTIs are very rare in boys, whether they are intact or circumcised. “[I]n the first six years of life, the incidence of UTI in boys [is] 1.8 percent[;] in girls it [is] 6.6 percent. . . . When UTI does occur, it is easily treated medically. . . . The consensus of medical opinion is that circumcision is of little, if any, value in reducing UTI.” (11)

The most effective way to combat UTIs in boys and girls? Breastfeeding. Studies have shown that “breastfed infants have only 38% as many UTIs as non-breastfed infants.” (12) The following sticker is incredibly apropos:

Get this sticker and more FREE (or leave a donation) at http://www.tlctugger.com/prodStickers.htm

5. Intact penises are actually cleaner: I love Dr. Dean Edell’s response to this argument:

The most common myth is that it’s cleaner to be circumcised. It’s hard to imagine how this has persisted in an era of soap and running water. But certainly it’s understandable that people do get upset with moist places in the body.

A woman’s reproductive tract is certainly moist and contains lots of bacteria, yet no one would suggest circumcising females to make them cleaner. Intact boys and children have nothing to ‘clean’ and a post-puberty man can rinse his penis just as he would wash any other part of his body, and just as a woman washes her genitals. (13)

The intact penis has special properties to keep itself cleaner than a cut penis. Both the immunological properties and the design of the foreskin help keep the penis properly rinsed and moisturized, much like the eyelid does for the eye. (14)

6. Intact penises do not require special care: The number one rule in raising an intact son? Only clean what is seen.

As mentioned in the last article in this series, the foreskin is actually attached to the glans of the penis at birth, much like your fingernail is attached to the bed of your finger. Parents should NEVER retract an intact penis, the foreskin will separate naturally over the course of years. Remember, the glans is meant to be an internal organ – you do not need to expose, touch, or clean it.

Retracting an intact child before he is ready is painful and can cause bleeding and infections. Parents must be vigilant that no one – not babysitters, doctors, or other well-meaning but ignorant individuals – retract their child’s foreskin. (15)

7. Fathers and sons are not identical – their penises do not have to “match”: We differ from our children in many ways, there is no reason that an infant should be circumcised to “match” his father. Many enlightened circumcised men are raising intact sons.

You do not need to repeat the cycle of ignorance.

Similarly, there is no merit in the “locker room argument,” or the belief that children should “match” their peers. Circumcision rates are falling: in the United States, your intact son has just about as much of a chance as “looking like” the boy in the neighboring locker as he does “looking different” – nationwide, only 56% of our boys are cut. (16)

The decision to physically alter your child’s genitals should never be based on aesthetics. It should be an informed decision based on your child’s lifelong heath and well-being, and it should only be made if there is a valid medically necessary reason.

What Are the Benefits of Circumcision?

Are there benefits to circumcision? Its advocates would have you believe there are, and for some men circumcision might be preferable to staying intact.

Whether there are benefits of circumcision, and more importantly whether those benefits outweigh the risks, is a question that each man should be able to consider himself. Circumcision should be an option for a fully informed individual; it should not be a routine, medically unnecessary procedure performed on infants.

More Resources on Circumcision

Are You Fully Informed? (a comprehensive list of articles and websites devoted to circumcision; the author of “peaceful parenting” holds a PhD in Human Sexuality – she works to educate the public on and put an end to this unnecessary medical procedure)

Circumcision: A Response to Skeptics

The Intactivism Pages

National Organization of Circumcision Information Resource Centers

Third Year Medical Student Describes His First Circumcision Surgery

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Please see the following sources and the citations within for more information:

(1) Fauntleroy, Gussie, “The Truth About Circumcision and HIV,” http://www.nocirc.org/2008-07_Mothering-Fauntleroy.pdf
(2) Okwemba, Arthur, “HIV Increases in Africa Where Most Men Circumcised,” http://www.drmomma.org/2009/09/hiv-increases-in-africa-where-most-men.html
(3) The Truth About Circumcision and HIV
(4) Coias, Jennifer, “The Nuts and Bolts of HIV in the USA and Why Circumcision Won’t Protect Men,” http://www.drmomma.org/2009/08/nuts-and-bolts-of-hiv-in-usa-and-why.html (The percentages given in the article are actually based on the risk of contracting HIV over a span of sixty years; I said “lifetime” for ease of discussion. Please read the article for clarity.)
(5) Preidt, Robert, “Circumcision Doesn’t Lessen HIV Transmission,” http://abcnews.go.com/Health/Healthday/story?id=8105119&page=1; The Truth About Circumcision and HIV
(6) “Circumcision: A Response to Skeptics,” http://www.drmomma.org/2009/07/circumcision-response-to-skeptics.html
(7) “Doctors Opposing Circumcision Genital Integrity Policy Statement, Chapter 3: Alleged Medical Benefits of Circumcision,” http://www.doctorsopposingcircumcision.org/DOC/statement03.html#n18; see also “Circumcision and Sexually Transmitted Infections,” http://www.cirp.org/library/disease/STD/
(8) Doctors Opposing Circumcision Genital Integrity Policy Statement, Chapter 3: Alleged Medical Benefits of Circumcision
(9) “Letter from the American Cancer Society,” http://www.fathermag.com/health/circ/acs/
(10) “A Dad’s View of Circumcision,” http://www.drmomma.org/2009/10/dads-view-of-circumcision.html
(11) Doctors Opposing Circumcision Genital Integrity Policy Statement, Chapter 3: Alleged Medical Benefits of Circumcision
(12) “Position Statement: The Effects of Circumcision on Breastfeeding,” http://www.nocirc.org/statements/breastfeeding.php; see also “How the Foreskin Protects Against UTI,” http://www.drmomma.org/2009/12/how-foreskin-protects-against-uti.html
(13) Edell, Dean, M.D., “Dr. Dean Edell Statement on Circumcision,” http://www.drmomma.org/2010/02/dr-dean-edell-statement-on-circumcision.html
(14) “Functions of the Foreskin: Purposes of the Prepuce,” http://www.drmomma.org/2009/09/functions-of-foreskin-purposes-of.html
(15) “Raising Intact Sons,” http://www.drmomma.org/2009/11/raising-intact-sons.html; see also National Organization of Circumcision Information Resource Centers, “Answers to Your Questions About Your Young Son’s Intact Penis,” http://www.nocirc.org/publish/4pam.pdf
(16) “United States Circumcision Incidence,” http://www.cirp.org/library/statistics/USA/

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