BENEFITS OF MALE CIRCUMCISION
Male circumcision is one of the oldest and most common surgical procedures worldwide, and is undertaken for many reasons: religious, cultural, social and medical.
There is conclusive evidence from observational data and three randomized controlled trials that circumcised men have a significantly lower risk of becoming infected with the human immunodeficiency virus (HIV) [i] among many other medical conditions.
Medical research has also determined that male circumcision reduces the incidence of penile cancer, prostate cancer and STI’s such as human papillomavirus (HPV), syphilis, chancroid, HSV-2 and others as outlined below.
"1 in 3 uncircumcised men will require medical attention due to a condition stemming from their uncircumcised state"
Worldwide 30-33% of males, that is between 661.5 million and 727.6 million are circumcised [ii] according to the World Health Organisation. In the USA, over 1.2 million new-born males are circumcised annually and this figure is rising [iii]. In the Middle East 10 million Muslim and 100,000 Jewish circumcisions are performed annually and in Africa the number is 9 million.
"the benefits of circumcision exceed the risks by a factor of more than 100 to 1"
Medical Indications for Male Circumcision
The most frequent medical condition which requires circumcision is:
Phimosis, a condition in which is characterized by a constriction of the preputial orifice so that the prepuce cannot be retracted back over the glans.
Several other conditions exist such as:
Untreatable paraphimosis: a retraction of phimotic foreskin proximally past the corona, causing a painful swelling of the glans and foreskin. Severe cases may cause dry gangrene
Balanoposthitis: inflammation of the foreskin and glans
Balanitis Xerotica Obliterans: a chronic sclerosis and atrophic process of the glans of the penis and foreskin. This is a risk factor for penile cancer.
Benefits of Male Circumcision
Male circumcision:
Provides an immediate ten-fold protection against urinary tract infections (UTI) and thus kidney damage in male infants [iv].
Prevents balanoposthitis and phimosis, a common cause of sexual problems in adolescent males and men and also a major risk factor for penile cancer.
Reduces the risk of Prostate cancer, which is otherwise 1.6 - 2.0 times higher in uncircumcised men[v] [vi].
Reduces the risk of penile cancer, which is otherwise over 22 times higher in men that are uncircumcised [vii] [viii] [ix]. The probability of uncircumcised men developing penile cancer in developed countries is 1 in 600-900, whereas for circumcised men it is 1 in 50,000-12,000,000[x] [xi]
Protects against certain sexually transmissible infections (STI’s) and most notably human papillomavirus (HPV), the pathogen responsible for most cervical cancers in women and a proportion of penile cancers in men [xii].
Reduces the incidence of ulcerative STI’s including syphilis, chancroid, thrichomonas vaginalis and herpes simplex virus type 2 (HSV-2)[xiii].
Results in a lower incidence of male genital ulcer disease and a reduction in penile injury arising from tearing of the foreskin and frenulum during sexual activity.
The table below shows that circumcised men are at significantly lower risk of developing urinary tract infections, HIV, syphilis, and chancroidii.
After analysing the above information, it can be deduced that:
1 in 3 uncircumcised men will require medical attention due to a condition stemming from their uncircumcised state [xiv].
The benefits exceed the risks by a factor of more than 100 to 1 without considering the severity of the consequences including mortality, morbidity and the effects on the sexual partners in adulthood.
Male circumcision also provides a public health benefit to women by mitigating the risk of various STI’s including:
High risk HPV types causing cervical cancer
HSV-2
Chlamydia Trachomatis which can cause pelvic inflammatory disease
Ectopic pregnancy and infertility
Reduces risk of bacterial vaginosis
The World Health Organisation and Circumcision
In 2007 male circumcision was formally endorsed by the World Health Organisation (WHO) and the Joint United Nations Programme on HIV/AIDS [xv] as being an important and proven strategy for the prevention of heterosexually-transmitted HIV in high prevalence settings. The endorsement was the result of more than 20 years of research which culminated in the findings of three large randomized controlled trials in different parts of sub-Saharan Africa[xvi] [xvii] [xviii].
[i] Neonatal and child male circumcision: a global review; Authors: UNAIDS, WHO; Publication date: April 2010
[ii] Male circumcision: global trends and determinants of prevalence, safety and acceptability; Authors: World Health Organization, Department of Reproductive Health and Research and Joint United Nations Programme on HIV/AIDS (UNAIDS); Publication details; Publication date: 2007
[iii] Nelson CP, Dunn R, Wan J, Wei JT. 2005. The increasing incidence of newborn circumcision: data from the nationwide inpatient sample. J Urol 173:978–981.
[iv] Brian J. Morris, Chris Eley. Male Circumcision: An Appraisal of Current Instrumentation. Biomedical Engineering – From Theory to Applications 14 315-354
[v] Morris BJ. 2007. Benefits of circumcision: medical, health and sexual. [Review] http://www.circinfo.net (over 400 refs).
[vi] Morris BJ, Waskett J, Bailis SA. 2007. Case number and financial impact of circumcision in prostate cancer reduction. BJU Int 100:5–6.
[vii] Micali G, Nasca MR, Innocenzi D, Schwartz RA. 2006. Penile cancer. J Am Acad Dermatol 54:369–391.
[viii] Schoen EJ, Oehrli M, Colby CJ, Machin G. 2000. The highly protective effect of newborn circumcision against invasive penile cancer. Pediatrics 105: http://www.pediatrics.org/sgi/content/full/105/3/e36.
[ix] Schoen EJ. 1991. The relationship between circumcision and cancer of the penis. CA Cancer J Clin 41:306–309.
[x] Wiswell TE. 1995. Neonatal circumcision: a current appraisal. Focus Opin Pediat 1:93–99.
[xi] Wiswell TE. 1997. Circumcision circumspection. N Engl J Med 36: 1244–1245.
[xii] B.J. & Castellsague, X. (2011). The role of circumcision in the prevention of sexually transmitted infections. Sexually Transmitted Diseases. Gross, G.E. & Tyring, S. Heidelberg, Springer: 715-739
[xiii] Weiss, H.A., Thomas, S.L., Munabi, S.K. & Hayes, R.J. (2006). Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect 82, 101-109.
[xiv] Morris, B.J., Castellsague, X. & Bailis, S.A. (2006). Re: Cost analysis of neonatal circumcision in a large health maintenance organization. E. J. Schoen, C. J. Colby and T. T. To. J Urol, 175: 1111-1115, 2006. J Urol 176, 2315-2316.
[xv] WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention; 28 MARCH 2007 | PARIS/GENEVA - In response to the urgent need to reduce the number of new HIV infections globally, WHO and the UNAIDS Secretariat convened an international expert consultation to determine whether male circumcision should be recommended for the prevention of HIV infection.
[xvi] Auvert, B., Taljaard, D., Lagarde, E., Sobngwi-Tambekou, J., Sitta, R. & Puren, A. (2005). Randomized, controlled intervention trial of male Circumcision for reduction of HIV infection risk: The ANRS 1265 Trial. PLoS Med 2 (e298), 1112-1122.
[xvii] Bailey, R.C., Moses, S., Parker, C.B., Agot, K., Maclean, I., Krieger, J.N., Williams, C.F., Campbell, R.T. & Ndinya-Achola, J.O. (2007). Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 369, 643-656.
[xviii] Gray, R.H., Kigozi, G., Serwadda, D., Makumbi, F., Watya, S., Nalugoda, F., Kiwanuka, N., Moulton, L.H., Chaudhary, M.A., Chen, M.Z., Sewankambo, N.K., Wabwire- Mangen, F., Bacon, M.C., Williams, C.F., Opendi, P., Reynolds, S.J., Laeyendecker, O., Quinn, T.C. & Wawer, M.J. (2007). Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 369, 657-666.
