Circumcision and STDs
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Attitudes from the early days of opinion-based medicine that have long been disproved in the era of science-based medicine continue to influence thought today. Peter Charles Remondino's 1891 book said:
It is not alone the tight-constricted, glans-deforming, onanism-producing, cancer-generating prepuce that is the particular variety of prepuce that is at the bottom of the ills and ailments, local or constitutional, that may affect man through its presence. The loose, pendulous prepuce, or even the prepuce in the evolutionary stage of disappearance, that only loosely covers one-half of the glans, is as dangerous as his long and constricted counterpart. If we look over the world’s history, since in the latter years of the fifteenth century syphilis came down like a plague, walking with democratic tread through all walks and stations in life, laying out alike royalty or the vagrant, the curled-haired and slashed-doubleted knight, or the tonsured monk, we must conclude that syphilis has caused more families to become extinct than any ordinary plague, black death, or cholera epidemic. Without wishing to enter into a history of syphilis, it is not outside of the province of this book to allude to its frequency and spread.
The absence of the prepuce and the non-absorbing character of the skin of the glans penis, made so by constant exposure, with the necessary and unavoidably less tendency that these conditions give to favor syphilitic inoculation, are not evidently without their resulting good effects. Now and then syphilitic primary sores are found on the glans, or even in the urethra or on the outside skin of the penis, or outer parts of the prepuce; but the majority are, as a rule, situated either back of the corona or on the reflected inner fold of the prepuce immediately adjoining the corona, or they may be in the loose folds in the neighborhood of the frenum, the retention of the virus seemingly being assisted by the topographical condition and relation of the parts, and its absorption facilitated by the thinness of the mucous membrane, as well as by the active circulation and moisture and heat of the parts.
Abraham Leo Wolbarst (1914), an ardent promoter of circumcision, collected the opinions of several physicians and published those opinions as evidence for his argument that circumcision was beneficial and healthful. He published an opinion-based article that claimed without evidence that circumcision prevented "venereal disease" now known as sexually transmitted disease. Wolbarst claimed that non-therapeutic neonatal circumcision prevented numerous diseases, including venereal disease (now known as sexually transmitted disease).
The world at war
Wolbarst's paper was published in January 1914. World War I started in August 1914.
Military commanders have a duty to keep their military personnel in good health and ready for action. With no better data than the false data supplied by such as Remondino and Wolbarst, many commanders, knowing that soldiers may visit prostitutes, ordered their personnel to be circumcised.
When World War II started in September 1939, the situation was little changed and again circumcision was ordered by many commanders.
This practice was abandoned at least 60 years ago, but it left the impression in American minds that circumcision somehow prevented contracting a sexually transmitted disease.
Contemporary view based on medical science
Evidence-based medicine does not support the opinion of the early circumcision-promoters.
The circumcision promoters claimed that the sub-preputial space was a filth and disease bearing repository of illness that was best eliminated by circumcision. However, Parkash et al. (1982) showed that the sub-preputial moisture contained lytic material with antiseptic qualities that protected the area from disease.
Smith et al. (1987) found evidence that the foreskin protected against acquisition of non-gonococcal urethritis, possibly "by effecting the physiologic milieu of the glans penis, by association with post-coital hygiene behavior, or by local immune defense mechanisms acting against the agent."
Cook et al. (1993) reported their findings that circumcised men are more likely to have genital warts than intact men. The authors speculated, "the presence of the foreskin may confer nonspecific protection of the proximal penis from acquisition of HPV infection."
Cook et al (1994) compared the incidence of sexually transmitted disease in intact males with circumcised males who attend the STD clinic at the Harborview Medical Center in Seattle. They reported that intact men were more likely than circumcised men to have syphilis and gonorrhea and were less likely to have visible warts.
Donovan et al. (1994) surveyed men at a sexual disease clinic in Sydney, NSW, Australia. They reported:
In this clinic-based prospectively collected survey we found no association between male circumcision status and STDs that are common in our population. Perhaps importantly, our study group was relatively racially homogeneous, lack of circumcision was not a marker of lower socioeconomic status (using the index of education level; Table 2), and we controlled for a major parameter of sexual behaviour (lifetime number of sexual partners).
Laumann et al. (1997) used data from the National Health and Social Life Survey (NHSLS) (1992) to report on the effects of the practice of male circumcision in the United States. With regard to STDs, Laumann et al. reported:
With respect to STDs, we found no evidence of a prophylactic role for circumcision and a slight tendency in the opposite direction. Indeed, the absence of a foreskin was significantly associated with contraction of bacterial STDs among men who have had many partners in their lifetimes. These results suggest a reexamination of the prevailing wisdom regarding the prophylactic effect of circumcision. While circumcision may have an impact that was not picked up by the NHSLS data, it seems unlikely to justify the claims made by those who base their support for widespread circumcision on it.
Circumcised men have more risky sexual behavior
Frequently overlooked when considering the effect of circumcision on sexually transmitted infection is the difference in sexual behavior of circumcised men as compared with intact men. Hooykaas et al. (1991) report that the sexual behavior of migrant circumcised men is more risky than that of intact Dutch men. Laumann et al. (1997), in a study of American men, found
NHSLS data indicate that circumcised men engage in a somewhat more elaborated set of sexual practices than do men who are not circumcised. For each of the practices examined, lifetime experience of various forms of oral and anal sex and masturbation frequency in the past year, circumcised men engaged in these behaviors at greater rates.
- (10 March 2008).
Circumcision and Sexually Transmitted Infections, www.cirp.org, Circumcision Reference Library. Retrieved 22 May 2020.
- Hill, George (14 June 2008).
Ch. 3: Alleged Medical Benefits of Circumcision (DOC Genital Integrity Statement), Research hub, Doctors Opposing Circumcision. Retrieved 22 May 2020.
Sexually Transmitted Infections (STIs), www.doctorsopposingcircumcision.org, Doctors Opposing Circumcision. Retrieved 22 May 2020.
- Remondino, Peter (1891):
Chapter XVI, in: The History of Circumcision. pp. iii. Philadelphia: F. A. Davis. Retrieved 22 May 2020.
- Wolbarst, Abraham L. (10 January 1914): Universal Circumcision as a Sanitary Measure, in: JAMA. 62 (2): 92-97. Retrieved 22 May 2020.
- Parkash, S / R Raghuram, et al. (July 1982): Sub-preputial wetness - Its nature., in: Ann Nat Med Sci. 18 (3): 109-112. Retrieved 24 May 2020.
- Smith, Gregory L. / Robert Greenup / Ernest Takafuji (1987): Circumcision as a risk factor for urethritis in racial groups, in: Am J Public Health. 77: 452-4, PMID, PMC, DOI. Retrieved 24 May 2020.
- Cook, LS / LA Koutsky / KK Holmes (August 1993): Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic, in: Genitourin Med. 9: 262-4, PMID, PMC, DOI. Retrieved 24 May 2020.
- Cook, Linda S. / Laura A. Koutsky / King K. Holmes (February 1994): Circumcision and sexually transmitted diseases, in: Am J Public Health. 84 (2): 197-201, PMID, PMC, DOI. Retrieved 24 May 2020.
- Donovan, Basil / I Bassett / NJ Bodsworth (October 1994): Male circumcision and common sexually transmissible diseases in a developed nation setting, in: Genitourin Med. 70: 317-20, PMID, PMC, DOI. Retrieved 24 May 2020.
- Laumann, Edward O / Christopher M. Masi / Ezra W Zuckerman (1997): Circumcision in the United States., in: JAMA. 277 (13): 1052-7, PMID. Retrieved 24 May 2020.
- Hooykaas, C / F W van der Velde / M M van der Linden / G J van Durnum / R A Coutinho (October 1991): The Importance of Ethnicity as a Risk Factor for STDs and Sexual Behaviour Among Heterosexuals, in: Genitourin Med. 67 (5), PMID, PMC, DOI. Retrieved 24 May 2020.