The Truth About Circumcision & HIV/HPV

The World Health Organization recently published that circumcision may offer some protection against HIV for men. It did not, however, reveal the exact details of the studies. Furthermore, all of the studies took place in Africa, which is very different from America in many ways. America is a more wealthy country where condoms are more easily attained, and citizens are more educated about safe sex practices. The study did not describe the education levels, sexual tendencies, or social status of the individuals that were observed. This information and other factors are crucial.

If the circumcised men had better financial situations, education levels, and/or higher social standings, it could be the reason why they were less likely to contract HIV. We do not know this, because the study is too vague. A person with access to healthcare and a sound financial situation is more likely to be circumcised than an impoverished individual with inadequate healthcare. It is possible that the circumcised men were more educated and thus knew about safer sex practices, from using condoms to refraining from promiscuous sexual activity.

The uncircumcised men may have been more likely to contract HIV for a number of reasons. Perhaps the reason they are uncircumcised is because they are impoverished. It is thus possible that they are less educated about safe sex, less capable of affording condoms, and have less access to healthcare. Rather than blaming their intact penises right off the bat, we need to take a look at their sexual practices, their level of education, and their financial situations. Could it be that, in Africa, uncircumcised men have less resources--and that this is the reason they remain intact, amongst other things?

Access to water in Africa is limited in many places. We have already established that it may be possible that many men remain intact because they are underprivileged and impoverished, lacking access to healthcare. It could also be true that these men have even less access to water than circumcised men, who may or may not be better off financially. Without water to wash with, dirt is going to accumulate on a person's body, under a person's fingernails, and in a man's foreskin. Anytime you don't bathe appropriately and frequently, you are inviting various infections.

Furthermore, the WHO did not report on the fact that circumcised males were more likely to pass HIV on to their partners. Perhaps the risk of a circumcised man contracting HIV is diminished, but his chances of passing it on once he contracts it are higher. I am more apt to trust these findings than believe having a foreskin increases a man's risk of HIV infection. So many other factors may be involved in the likelihood of an uncircumcised African male to contract HIV than are most likely involved in the likelihood of a circumcised African male passing it on. The problem here is that the study was done in Africa, not America.

While there is plenty of reason to believe that an uncircumcised African male may not have access to condoms or knowledge about safe sex, there is no reason to believe the same about circumcised men in Africa. They were able to afford the circumcision; clearly they have decent finances and healthcare, which means they can afford condoms and are probably educated about safe sex. That may not be true of uncircumcised African males; the fact that they are uncircumcised suggests they may not have those resources. Until a study is done that controls all of these many factors, there is not enough evidence to conclude that circumcision alone is responsible for lower HIV rates.

Other studies have concluded that uncircumcised males are more likely to contract and spread HPV, which can cause penile and cervical cancer and genital warts. However, the results were grossly exaggerated, and the studies were flawed. One study basically proved that older men, born before circumcision was routine, were more likely to contract penile cancer. I don't see why they decided to conclude that was because of circumcision rather than various other social factors involved--or even because of the age difference. Another study found no difference between circumcised in intact men as far as the number of men infected by HPV. The truth is circumcision decreases the risk of penile cancer by less than %0.01.

The American Cancer Society states that the information circulating the internet about circumcision lowering the risk of a man contracting HPV is misleading. They believe socio-ethnic factors must be taken into consideration. They say, "The consensus among studies that have taken these other factors into account is circumcision is not of value in preventing cancer of the penis. Proven penile cancer risk factors include having unprotected sexual relations with multiple partners (increasing the likelihood of human papilloma virus infection), and cigarette smoking." An even better way to protect oneself against HPV might be to get the new vaccine that provides immunity to most of the strains which can cause cancer.

Perhaps it's not that older men were more likely to contract penile cancer because they were uncircumcised. Maybe today's young men are more promiscuous. There is no proof that circumcision is the deciding factor. Maybe smoking is more common today, and that is the reason why penile cancer occurs slightly more often. (The truth is that penile cancer is actually one of the rarest forms of cancer anyway.) Clearly the ACS doesn't agree that circumcision has anything to do with HPV and do not feel that the studies are accurate. Without taking these factors into consideration, the research is inconclusive and untrustworthy.

Once, someone told me that the AAP's stance on circumcision is that it is "preventative" -- then later stated that the American Academy of Pediatrics doesn't have a policy on circumcision at all. The AAP does indeed have a policy. "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision."

Parents are not usually given balanced information. They are told of the "benefits," which are exaggerated, and little mention is made of the cons or the reasons for leaving a penis intact. The sexual impact is not mentioned, nor are treatment options for ailments like UTI (said to be less common in circumcised males) discussed. They are simply asked "Will you be circumcising your son?" and given a brief run-down of the procedure. Barely any detail is given as to what the surgery actually entails, the function of the foreskin and what the child is losing, or the risks associated with circumcision. The condition of the individual child, family history, and other factors are rarely discussed.

The American Medical Association also says that routine circumcision is not medically necessary and does not recommend elective circumcision for reasons outside of religious practice. This opinion is held by the most trusted medical organizations in the US, the UK, Canada, & Australia. The AMA also states that medical concerns are not usually the reason for the choice of parents to circumcise their infant boys. Social and cultural norms are much more likely to be the motivating factor in the decision.

Unfortunately, circumcision is still routine. As another writer on here said, many people do it simply because they believe it is just what is done, which in and of itself suggests a routine. That a parent can opt to refuse it, which can be done with any procedure, does not mean it is not routine. We can refuse vaccinations and prenatal testing, but that doesn't mean those procedures are not still routine. The majority of men in America are circumcised, and the percentage of people who chose to circumcise their male babies is still very high. This is alarming, considering the fact that the AAP states there are only "potential" benefits, meaning they may or may not exist, and that the data is "not sufficient" to recommend that circumcision be routine. For a procedure that isn't recommended to be routine, infant circumcision is still extremely common.

Rather than lopping off a functional organ and useful part of a baby boy's body, changing his sex life forever, and taking away his choice in the matter, why don't we employ other proven methods to prevent infection? Educating our young people about safe sex, providing them access to condoms, and encouraging them to practice good hygiene are fantastic ways to decrease their risk of contracting HIV and HPV. A healthy lifestyle with a nutritious diet that excludes smoking is also beneficial. There is even a vaccine that prevents most of the cancerous strains of HPV, which could protect our children from that without robbing them of their foreskins.

Sources:
American Academy of Pediatrics, "Circumcision Policy Statement." AAP Publications. URL: http://aappolicy.aappublications.org/cgi/content/full/pediatrics%3b103/3/686
Rich Winkel, "Remarkable Bias in Medical Journalism." URL: http://www.math.missouri.edu/~rich/MGM/blog/HIV.txt
Unknown, "Circumcision and HIV." Circumstitions. URL: http://www.circumstitions.com/HIV.html#hetero
American Cancer Society, "Misleading Information." Cancer.org. URL: http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Misleading_Information.asp
Unknown, "Circumcision." Wikipedia. URL: http://en.wikipedia.org/wiki/Circumcision