Circumcision and STDs: Difference between revisions
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'''{{FULLPAGENAME}}''' discusses the claims that male [[circumcision]] reduces the incidence of STDs other than [[HIV]]/[[AIDS]]. For a discussion of the claims made regarding [[HIV]], see [[Circumcision and HIV]]. | |||
==Circumcision promotion== | ==Circumcision promotion== | ||
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== The immunological function of the foreskin == | == The immunological function of the foreskin == | ||
The foreskin's inner fold and the glans of the penis are comprised of [[Preputial mucosa| mucous membrane]] tissue. These are also present in your eyes, mouth, and all other bodily orifices including the female genitals. These are the first line of immunological defense for the body's orifices. These mucous membranes perform many immunological and hygienic functions. | The [[foreskin]]'s inner fold and the [[glans]] of the [[penis]] are comprised of [[Preputial mucosa| mucous membrane]] tissue. These are also present in your eyes, mouth, and all other bodily orifices including the female genitals. These are the first line of immunological defense for the body's orifices. These mucous membranes perform many immunological and hygienic functions. | ||
Certain components such as [[Langerhans cells]],<ref>{{REFjournal | Certain components such as [[Langerhans cells]],<ref>{{REFjournal | ||
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|last4=Chaudhuri | |last4=Chaudhuri | ||
|init4=S | |init4=S | ||
|url= | |url=https://www.cirp.org/library/anatomy/parkash/ | ||
|title=Human subpreputial collection: its nature and formation | |title=Human subpreputial collection: its nature and formation | ||
|journal=J Urol | |journal=J Urol | ||
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|last=Hill | |last=Hill | ||
|author-link=George Hill | |author-link=George Hill | ||
|url= | |url=https://www.cirp.org/library/disease/HIV/hill1/ | ||
|title=Summary of evidence that the foreskin and lysozyme may protect against HIV infection | |title=Summary of evidence that the foreskin and lysozyme may protect against HIV infection | ||
|publisher=[[CIRP]] | |||
|date=2003-09-07 | |date=2003-09-07 | ||
|accessdate=2019-10-20 | |accessdate=2019-10-20 | ||
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|accessdate=2019-10-20 | |accessdate=2019-10-20 | ||
}}</ref> which is a very important non-antibody protein that generates immune response when in contact with specific agents. Plasma cells which increase in number in response to pathogens levels, secrete immunoglobulin.<ref name="flower1983"/> | }}</ref> which is a very important non-antibody protein that generates immune response when in contact with specific agents. Plasma cells which increase in number in response to pathogens levels, secrete immunoglobulin.<ref name="flower1983"/> | ||
It is also very important to note that [[Langerhans cells]] that are present in the foreskin produce ''Langerin'', a substance that has been proven to kill human immunodeficency virus ([[HIV]]) on contact.<ref>{{DeWitte etal 2007}}</ref> | It is also very important to note that [[Langerhans cells]] that are present in the [[foreskin]] produce ''Langerin'', a substance that has been proven to kill human immunodeficency virus ([[HIV]]) on contact.<ref>{{DeWitte etal 2007}}</ref> | ||
All of these function to sequester and “digest” foreign pathogens. All these substances play an important role in protecting the penis from viral and bacterial pathogens. The immunological functions of the human prepuce have been extensively documented by respected researchers for quite some time.<ref name="fleiss-hodges-vanhowe1998">{{FleissP HodgesF VanHoweRS 1998}}</ref> | All of these function to sequester and “digest” foreign pathogens. All these substances play an important role in protecting the penis from viral and bacterial pathogens. The immunological functions of the human prepuce have been extensively documented by respected researchers for quite some time.<ref name="fleiss-hodges-vanhowe1998">{{FleissP HodgesF VanHoweRS 1998}}</ref> | ||
Circumcision destroys the natural immunological protections of the [[foreskin]] and results in increased risk of contracting infection. | [[Circumcision]] destroys the natural immunological protections of the [[foreskin]] and results in increased risk of contracting [[infection]]. | ||
==Contemporary view based on medical science== | ==Contemporary view based on medical science== | ||
Evidence-based medicine does not support the subjective opinion of the early circumcision-promoters.<ref name="vanhowe2013">{{REFjournal | Evidence-based medicine does not support the subjective opinion of the early [[circumcision]]-promoters.<ref name="vanhowe2013">{{REFjournal | ||
|last=Van Howe | |last=Van Howe | ||
|first=Robert S. | |first=Robert S. | ||
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}}</ref> | }}</ref> | ||
Circumcision advocates had falsely claimed that the sub-preputial space was a filthy [[cesspool]] of infection that was eliminated by circumcision. However, Parkash et al. (1982) showed that the sub-preputial moisture actually contained lytic material with antiseptic qualities that protected against disease.<ref>{{REFjournal | [[Circumcision]] advocates had falsely claimed that the sub-preputial space was a filthy [[cesspool]] of [[infection]] that was eliminated by [[circumcision]]. However, Parkash et al. (1982) showed that the sub-preputial moisture actually contained lytic material with antiseptic qualities that protected against disease.<ref>{{REFjournal | ||
|last=Parkash | |last=Parkash | ||
|init=S | |init=S | ||
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|author2-link= | |author2-link= | ||
|etal=yes | |etal=yes | ||
|title=Sub-preputial wetness - Its nature | |title=Sub-preputial wetness - Its nature | ||
|journal=Ann Nat Med Sci | |journal=Ann Nat Med Sci | ||
|date=1982-07 | |date=1982-07 | ||
|volume=18 | |volume=18 | ||
|issue=3 | |issue=3 | ||
|pages=109-112 | |pages=109-112 | ||
|url= | |url=https://www.cirp.org/library/anatomy/prakash/ | ||
|accessdate=2020-05-24 | |accessdate=2020-05-24 | ||
}}</ref> | }}</ref> | ||
Smith et al. (1987) found evidence that the foreskin protected against acquisition of non-gonococcal urethritis, possibly "''by affecting the physiologic milieu of the glans penis, by association with post-coital hygiene behavior, or by local immune defense mechanisms acting against the agent''."<ref name="smith1987">{{REFjournal | Smith et al. (1987) found evidence that the [[foreskin]] protected against acquisition of non-gonococcal urethritis, possibly "''by affecting the physiologic milieu of the [[glans penis]], by association with post-coital hygiene behavior, or by local immune defense mechanisms acting against the agent''."<ref name="smith1987">{{REFjournal | ||
|last=Smith | |last=Smith | ||
|first=Gregory L. | |first=Gregory L. | ||
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}}</ref> | }}</ref> | ||
Cook et al. (1993) reported their findings that circumcised men were more likely to have genital warts than intact men. The authors concluded, "''the presence of the foreskin may confer nonspecific protection of the proximal penis from acquisition of HPV infection''."<ref name="cook1993A>{{REFjournal | Cook et al. (1993) reported their findings that [[circumcised]] men were more likely to have genital warts than [[intact]] men. The authors concluded, "''the presence of the [[foreskin]] may confer nonspecific protection of the proximal [[penis]] from acquisition of HPV infection''."<ref name="cook1993A>{{REFjournal | ||
|last=Cook | |last=Cook | ||
|init=LS | |init=LS | ||
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}}</ref> | }}</ref> | ||
Cook et al. (1994) compared the incidence of sexually transmitted disease in intact males with circumcised males who attend the STD clinic at the [https://www.uwmedicine.org/locations/harborview-medical-center Harborview Medical Center] in Seattle, Washington, USA. They reported that genitally intact men were more likely than circumcised men to have syphilis and gonorrhea and were less likely to have visible warts.<ref name="cook1994">{{REFjournal | Cook et al. (1994) compared the incidence of sexually transmitted disease in [[intact]] males with [[circumcised]] males who attend the STD clinic at the [https://www.uwmedicine.org/locations/harborview-medical-center Harborview Medical Center] in Seattle, Washington, USA. They reported that genitally [[intact]] men were more likely than [[circumcised]] men to have syphilis and gonorrhea and were less likely to have visible warts.<ref name="cook1994">{{REFjournal | ||
|last=Cook | |last=Cook | ||
|first=Linda S. | |first=Linda S. | ||
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}}</ref> | }}</ref> | ||
Bassett et al. (1994) investigated the factors associated with HSV-2 infection in heterosexual men at a sexual disease clinic in Sydney, Australia. They reported that, "''we found no evidence of the presence of an intact foreskin being a risk factor for HSV-2 infection''."<ref name="bassett1994">{{REFjournal | Bassett et al. (1994) investigated the factors associated with HSV-2 infection in heterosexual men at a sexual disease clinic in Sydney, Australia. They reported that, "''we found no evidence of the presence of an [[intact]] [[foreskin]] being a risk factor for HSV-2 infection''."<ref name="bassett1994">{{REFjournal | ||
|last=Bassett | |last=Bassett | ||
|first=Ingrid | |first=Ingrid | ||
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|pubmedCID= | |pubmedCID= | ||
|DOI= | |DOI= | ||
|format=PDF | |||
|accessdate=2020-05-25 | |accessdate=2020-05-25 | ||
}}</ref> | }}</ref> | ||
Donovan et al. (1994) also surveyed men at a sexual disease clinic in Sydney, {{AUSC|NSW}}, Australia. They reported: | Donovan et al. (1994) also surveyed men at a sexual disease clinic in Sydney, {{AUSC|NSW}}, [[Australia]]. They reported: | ||
<blockquote> | <blockquote> | ||
''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)''.<ref name="donovan1994">{{REFjournal | ''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)''.<ref name="donovan1994">{{REFjournal | ||
|last=Donovan | |last=Donovan | ||
|first=Basil | |first=Basil | ||
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</blockquote> | </blockquote> | ||
Laumann et al. (1997) used data from the ''National Health and Social Life Survey'' (NHSLS) (1992) to report on the effects of male circumcision in the United States. With regard to STDs, Laumann et al. reported: | Laumann et al. (1997) used data from the ''National Health and Social Life Survey'' (NHSLS) (1992) to report on the effects of male [[circumcision]] in the [[United States]]. With regard to STDs, Laumann et al. reported: | ||
<blockquote> | <blockquote> | ||
''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''.<ref name="laumann1997">{{REFjournal | ''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''.<ref name="laumann1997">{{REFjournal | ||
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|author3-link= | |author3-link= | ||
|etal=no | |etal=no | ||
|title=Circumcision in the United States | |title=Circumcision in the United States | ||
|journal=JAMA | |journal=JAMA | ||
|location= | |location= | ||
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|issue=13 | |issue=13 | ||
|pages=1052-7 | |pages=1052-7 | ||
|url= | |url=https://www.cirp.org/library/general/laumann/ | ||
|pubmedID=9091693 | |pubmedID=9091693 | ||
|pubmedCID= | |pubmedCID= | ||
|accessdate=2020-05-24 | |accessdate=2020-05-24 | ||
}}</ref> | }}</ref> | ||
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}}</ref> | }}</ref> | ||
[[Morten Frisch]] and Jacob Simonsen (2021) carried out a large scale empirical population study in [[Denmark]] of 855,654 males regarding the alleged value of male [[circumcision]] in preventing [[HIV]] and other sexually transmitted infections in men. They found that circumcised men have a higher rate of STI and [[HIV]] infection overall than [[intact]] men.<ref name="frisch2021">{{FrischM SimonsenJ 2021}}</ref> | [[Morten Frisch]] and Jacob Simonsen (2021) carried out a large scale empirical population study in [[Denmark]] of 855,654 males regarding the alleged value of male [[circumcision]] in preventing [[HIV]] and other sexually transmitted infections in men. They found that [[circumcised]] men have a higher rate of STI and [[HIV]] infection overall than [[intact]] men.<ref name="frisch2021">{{FrischM SimonsenJ 2021}}</ref> | ||
==Circumcised men have more risky sexual behavior== | ==Circumcised men have more risky sexual behavior== | ||
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Claims of prophylactic prevention of STDs and STIs can no longer be used to support the harmful practice of destructive male circumcision. | Claims of prophylactic prevention of STDs and STIs can no longer be used to support the harmful practice of destructive male circumcision. | ||
{{SEEALSO}} | {{SEEALSO}} | ||
* [[Preputial sac]] | * [[Preputial sac]] | ||
{{LINKS}} | {{LINKS}} | ||
* {{REFweb | * {{REFweb | ||
|url= | |url=https://www.cirp.org/library/disease/STD/ | ||
|title=Circumcision and Sexually Transmitted Infections | |title=Circumcision and Sexually Transmitted Infections | ||
|publisher= | |publisher=[[CIRP]] | ||
|date=2008-03-10 | |date=2008-03-10 | ||
|accessdate=2020-05-22 | |accessdate=2020-05-22 | ||
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{{REF}} | {{REF}} | ||
[[Category:Immunology]] | [[Category:Immunology]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Sexually transmitted disease]] | [[Category:Sexually transmitted disease]] | ||