At the time this post was first written in 2011, 18 states, including Colorado and South Carolina, had eliminated Medicaid coverage for male circumcision. Furthermore, ballot initiatives, including one attempted in my hometown San Francisco, were being discussed that would ban the procedure altogether.
I always worry when politics and political agendas start to mess with public health. How about inserting some facts into the decision-making process?
Well, here goes: The American Academy of Pediatrics 1999 policy on circumcision, reaffirmed in 2005 and soon to be updated again states,
“The procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision.”
Ok, that is sensible…informed choice should be an essential part for all health decisions.
Medical benefits of male circumcision
So here is some more useful information that the public and policy makers should consider. Aaron Tobian, MD, Ph.D and Ronald Gray, MD, MSc, of John Hopkins School of Medicine and Bloomberg School of Public, respectively, reviewed recent medical evidence about the risks and benefits of male circumcision in their commentary, “The Medical Benefits of Male Circumcision,” featured in the November 23, 2011 issue of JAMA.
Here is a summary of their key findings:
- Studies in Africa have demonstrated that adult male circumcision decreases human immunodeficiency virus (HIV) acquisition in men by 51% to 60%. They go on to say that “there is substantial evidence that removal of the foreskin reduces the risk of male heterosexual HIV acquisition, however, the effect of male circumcision on reducing HIV acquisition among men who have sex with men is unclear.“
- Male circumcision reduces the risk of acquiring and transmitting certain heterosexually acquired sexually transmitted diseases (STDs), such as genital herpes, bacterial vaginosis, and trichomoniasis.
- The risk of acquiring high-risk human papillomavirus (a cause of penile and cervical cancers) is reduced by about a third.
- Although these studies were conducted in Africa, STDs, including heterosexually transmitted HIV, are common in the U.S.
- Neonatal male circumcision provides other potential benefits during childhood such as prevention of infant urinary tract infections, meatitis, balanitis, and phimosis.
- The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the WHO have adopted a policy advocating male circumcision in countries with heterosexual HIV epidemics; and the U.S. Centers for Disease Control and Prevention (CDC) found economic benefits to the procedure based on reducing HIV infections alone.
Opposition to male circumcision
Opponents of male circumcision consider the procedure to be a form of genital mutilation sometimes comparing it to female circumcision which involves removing some or all of the clitoris, a procedure that is associated with a lot of morbidities and even mortality.
Newborn male circumcision is usually performed in the hospital a few days after birth. It is a relatively simple procedure that involves snipping of the foreskin.
I have attended a couple of brits, the Jewish ceremonial circumcision that takes place when the boy baby is 8 days old. Neither the hospital-performed nor the religious circumcision seem to cause much distress to the infant. They cry for a bit but are easily soothed by the parents (or by a drop of wine in the case of a brit).
Their reactions don’t seem any worse than after the first sprained ankle or skinned knee. Further, I personally don’t know any circumcised men who are obsessed by the trauma of their early childhood penile operation or their sprained ankle/skinned knees.
That being said, I must say that the torrent of comments from men after this post first went live in November 2011, suggests that there is a subset of men who believe strongly that circumcision has really messed with their lives. Many of them said that their circumcision is responsible for their sexual dysfunction in adulthood.
This is clearly different from the conclusions of Tobian and Gray who stated the following,
“The male circumcision trials evaluated sexual satisfaction in adult men and their female partners before and after the procedure and compared men randomized to male circumcision with uncircumcised controls. There were no significant differences in male sexual satisfaction or dysfunction among trial participants, and in one trial, circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm. In addition, 97% of female partners reported either no change or improved sexual satisfaction after their male partner was circumcised.”
Weighing in the facts
As is true with all healthcare interventions, consumers and policymakers need to weigh the pros and cons—but they need solid information upon which to base their decision. It would be a shame if, like the hysteria over vaccinations related to faked research, the politics surrounding male circumcision lead to public health policies that are not sound and safe.
Featured Photo Credit: Monash University
This post was originally written in November 2011 and updated on June 26, 2015.