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Sex Health Blog

Should Boys Be Circumcised?

Jan 28, 2013

Should boys be circumcised?

That’s a controversial question these days and there’s no easy answer.

Circumcision is a procedure that removes the foreskin from the tip of the penis. It’s done for a variety of reasons. For some families, circumcision is a religious or cultural custom, one that has been followed for generations. Other parents decide to circumcise their sons because they believe there are health benefits. Or, they may want their son to “match” his circumcised peers.

Other parents choose not to circumcise. They may not feel that it’s necessary. They may not want to cause their son physical pain or have him go through a procedure when he’s not old enough to make his own decisions. Also, circumcision does have risks. Complications like bleeding, inflammation, and infection are rare, but possible.

Last summer, the American Academy of Pediatrics (AAP) revised its policy on circumcision. While the organization did not directly recommend circumcision, it did state that the health benefits outweighed the risks and that parents should have access to the procedure.

What are those health benefits? Many believe circumcision protects boys and men from infections, especially sexually-transmitted infections like HIV, genital herpes, and some high-risk types of human papillomavirus (HPV), which may cause certain cancers and genital warts.

How? Bacteria and viruses can become trapped beneath the foreskin. Removing the foreskin through circumcision takes away this warm, moist breeding ground so bacteria and viruses are less likely to thrive.

So it would seem that reducing the risk of infection would make circumcision an easy choice.  But new research suggests that there may be more to the story. Today, we’ll take a look at circumcision and how it may, or may not, reduce the risk of infections.

Studies from Africa

In August 2012, the Centers for Disease Control and Prevention (CDC) analyzed medical research on circumcision and revised its fact sheet on the topic. It included some encouraging statistics and examples, many based on research conducted in Africa:

  • Circumcision was found to protect men from HIV in several studies. The risk of HIV infection was lower for circumcised men.
  • Some countries with circumcision rates of less than 20% had higher rates of HIV infection than countries where more than 80% of the men were circumcised.
  • There was little evidence to show that the female sex partners of circumcised men were protected from HIV transmission.
  • It was unclear whether circumcision protected against HIV transmission for men who have sex with men.
  • Circumcised men generally had lower rates of the high-risk HPV types that are associated with cervical, anal, penile, vulvar, and vaginal cancers.
  • Research showed that penile cancer was more common in uncircumcised men.
  • Urinary tract infections tended to be less common in circumcised infants. However, these infections are not common in baby boys overall.
  • Lower rates of genital herpes and genital ulcer disease were reported in circumcised men.

Also in 2012, researchers from the Fred Hutchinson Cancer Research Center in Seattle found that men who had been circumcised before their first sexual intercourse were 15% less likely to develop prostate cancer later on.

Research in Puerto Rico

Given these statistics, it would seem like circumcision would be a popular choice. However, recent research from Puerto Rico sheds some new light on these findings.

Scientists wanted to know whether circumcision protected men from STIs and HIV infections in their region, the Caribbean. To learn more, they examined data from 660 men who were treated at an STI/HIV clinic in San Juan. About a third of the men had been circumcised.

The researchers discovered that, contrary to what research out of Africa might suggest, the circumcised men from Puerto Rico were more likely to be infected with HIV. They were also more likely to have had genital warts and more likely to have had more than one STI in their lifetime.

Does this research debunk the previous studies? Not at all. The researchers themselves acknowledged that this was just one study and that the results could not necessarily be applied Puerto Rico or the Caribbean as fact. They could not explain exactly why their findings were so different, although they suggested the social and cultural factors be explored in future research.

However, the Puerto Rican researchers did point out that perhaps circumcision does not always protect against STIs and HIV, at least not in all locations and societies. They encouraged health care providers to be cautious about considering circumcision as an HIV prevention method.

The Verdict

So, does circumcision protect men against infections? It does, in certain circumstances. It may not prevent diseases, but it has been shown to reduce the risk in certain areas of the world. Whether this is true across the globe remains to be seen.

And to get back to our original question: should boys be circumcised? Again, that is a matter of personal choice. A pediatrician can best advise parents on the health-related risks and benefits of circumcision.

Resources

Centers for Disease Control and Prevention

“Male Circumcision”

(Page last reviewed: August 22, 2012)

http://www.cdc.gov/hiv/malecircumcision/

The Journal of Sexual Medicine

Rodriquez-Diaz, Carlos E., PhD, et al.

“More than Foreskin: Circumcision Status, History of HIV/STI, and Sexual Risk in a Clinic-Based Sample of Men in Puerto Rico”

(Full-text. First published online: August 15, 2012)

http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2012.02871.x/abstract

KidsHealth.org (Nemours Foundation)

“Circumcision”

(August 2012)

http://kidshealth.org/parent/system/surgical/circumcision.html#a_The_Circumcision_Decision

Sexual Medicine Society of North America

“Circumcision and Prostate Cancer”

(March 22, 2012)

http://www.sexhealthmatters.org/news/circumcision-and-prostate-cancer