Circumcision and STDs: Difference between revisions
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==Contemporary view based on medical science== | ==Contemporary view based on medical science== | ||
Evidence-based medicine does not support the 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 claimed that the sub-preputial space was a filthy cesspool of infection that was | Circumcision advocates had 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 | ||
|first=S | |first=S | ||
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}}</ref> | }}</ref> | ||
Smith ''et al''. (1987) found evidence that the foreskin protected against acquisition of non-gonococcal urethritis, possibly "''by | 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 | 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 | ||
|first=LS | |first=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 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.<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 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> | ||
Donovan ''et al''. (1994) surveyed men at a sexual disease clinic in Sydney, NSW, Australia. They reported: | Donovan ''et al''. (1994) also surveyed men at a sexual disease clinic in Sydney, 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 | ||
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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 | 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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</blockquote> | </blockquote> | ||
Van Howe (1999) carried out a | Van Howe (1999) carried out a review of the medical literature concerning sexually transmitted infection. He referenced no fewer than 104 published papers in his review and concluded: | ||
<blockquote> | <blockquote> | ||
''What began as speculation has resulted a century later in 60-75% of American boys being circumcised with no clearly confirmed medical benefit. In the interim, no solid epidemiological evidence has been found to support the theory that circumcision prevents STDs or to justify a policy of involuntary mass circumcision as a public health measure. While the number of confounding factors and the inability to perform a random, double-blind, | ''What began as speculation has resulted a century later in 60-75% of American boys being circumcised with no clearly confirmed medical benefit. In the interim, no solid epidemiological evidence has been found to support the theory that circumcision prevents STDs or to justify a policy of involuntary mass circumcision as a public health measure. While the number of confounding factors and the inability to perform a random, double-blind, prospective trial make assessing the role of circumcision in STD acquisition difficult, there is no clear evidence that circumcision prevents STDs. The only consistent trend is that uncircumcised males may be more susceptible to GUD, while circumcised men are more prone to urethritis. Currently, in developed nations, urethritis is more common than GUD [34]. In summary, the medical literature does not support the theory that circumcision prevents STDs''.<ref name="vanhowe1999">{{REFjournal | ||
|last=Van Howe | |last=Van Howe | ||
|first=Robert S | |first=Robert S | ||
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</blockquote> | </blockquote> | ||
Dave ''et al''. (2003) studied data from the 2000 ''British National Survey of Sexual Attitudes and Lifestyles'' (Natsal 2000). They "'' | Dave ''et al''. (2003) studied data from the 2000 ''British National Survey of Sexual Attitudes and Lifestyles'' (Natsal 2000). They found "''no significant associations between circumcision and being diagnosed with any one of the seven specific STIs.''"<ref name="dave2003">{{REFjournal | ||
|last=Dave | |last=Dave | ||
|first=S S | |first=S S | ||