Circumcision and STDs

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This article discusses the claims that male circumcision reduces the incidence of STDs other than HIV/AIDS. For a discussion of the alleged claims made regarding HIV, see Circumcision and HIV.

Circumcision promotion

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.[1]

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).[2]

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.[3]

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."[4]

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."[5]

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.[6]

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, "we found no evidence of the presence of an intact foreskin being a risk factor for HSV-2 infection."[7]

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).[8]

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.[9]


Van Howe (1999) carried out a survey of the medical literature concerning sexually transmitted infection. He referenced 104 documents in his survey and concluded:

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, propective 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.[10]

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."[11]

Circumcised men have more risky sexual behavior

Frequently overlooked when considering the effect of circumcision on sexually transmitted infection is the more risky 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.[12] 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.[9]

Michael et al. (1998) compared sexual behavior in Britain with sexual behavior in the United States. They reported that condom use was "significantly higher" in the United Kingdom where most men are intact as compared to the United States where most men are circumcised.[13]


External links

References

  1. ↑ REFbook Remondino, Peter (1891): Chapter XVI, in: The History of Circumcision. Philadelphia: F. A. Davis. Pp. iii. Retrieved 22 May 2020.
  2. ↑ REFjournal Wolbarst, Abraham L.. Universal Circumcision as a Sanitary Measure. JAMA. 10 January 1914; 62(2): 92-97. Retrieved 22 May 2020.
  3. ↑ REFjournal Parkash, S, Raghuram, R, et al. Sub-preputial wetness - Its nature.. Ann Nat Med Sci. July 1982; 18(3): 109-112. Retrieved 24 May 2020.
  4. ↑ REFjournal Smith, Gregory L., Greenup, Robert, Takafuji, Ernest. Circumcision as a risk factor for urethritis in racial groups. Am J Public Health. 1987; 77: 452-4. PMID. PMC. DOI. Retrieved 24 May 2020.
  5. ↑ REFjournal Cook, LS, Koutsky, LA, Holmes, KK. Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic. Genitourin Med. August 1993; 9: 262-4. PMID. PMC. DOI. Retrieved 24 May 2020.
  6. ↑ REFjournal Cook, Linda S., Koutsky, Laura A., Holmes, King K.. Circumcision and sexually transmitted diseases. Am J Public Health. February 1994; 84(2): 197-201. PMID. PMC. DOI. Retrieved 24 May 2020.
  7. ↑ REFjournal Bassett, Ingrid, Donovan, Basil, Bodsworth, Neil J, Field, Peter R, Ho, David W T, Jeanssome, Stig, Cunningham, Anthony L. Herpes simplex virus type-2 infection of heterosexual men attending a sexual health centre. Med J Aust. June 1994; 160(11): 697-700. PMID. Retrieved 25 May 2020.
  8. ↑ REFjournal Donovan, Basil, Bassett, Ingrid, Bodsworth, NJ. Male circumcision and common sexually transmissible diseases in a developed nation setting. Genitourin Med. October 1994; 70: 317-20. PMID. PMC. DOI. Retrieved 24 May 2020.
  9. ↑ a b REFjournal Laumann, Edward O, Masi, Christopher M., Zuckerman, Ezra W. Circumcision in the United States.. JAMA. 1997; 277(13): 1052-7. PMID. Retrieved 24 May 2020.
  10. ↑ REFjournal Van Howe, Robert S. Does circumcision influence sexually transmitted diseases?: A literature review. BJU Int. February 1999; 83 Suppl 1: 52-62. PMID. DOI. Retrieved 25 May 2020.
  11. ↑ REFjournal Dave, S S, Johnson, A M, Fenton, K A, Mercer, C A. Male circumcision in Britain: findings from a national probability sample survey. Sex Trans Infect. December 2003; 79(6): 499-500. PMID. PMC. DOI. Retrieved 25 May 2020.
  12. ↑ REFjournal Hooykaas, C, van der Velde, F W, van der Linden, M M, van Durnum, G J, Coutinho, R A. The Importance of Ethnicity as a Risk Factor for STDs and Sexual Behaviour Among Heterosexuals. Genitourin Med. October 1991; 67(5) PMID. PMC. DOI. Retrieved 24 May 2020.
  13. ↑ REFjournal Michael, Robert T, Wadsworth, Jane, Feirleib, Joel, Johnson, Anne M., Laumann, Edward O., Wellings, Kaye. Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison. Am J Public Health. May 1998; 88(5): 749-54. PMID. DOI. Retrieved 25 May 2020.
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