Science Scene: Decision to circumcise is far from clear cut

Robert Starr

The AIDS epidemic continues to devastate the world, particularly in Southern Africa, where the World Health Organization estimates that some countries have infection rates as high as 26 percent. Without a cure, the best way to combat the disease is through prevention, which, in recent years, has led many to look to circumcision as a possible way to reduce the spread of HIV.

Three major studies in South Africa, Kenya and Uganda have shown that removing foreskin results in about a 50 percent reduction in the risk of HIV contraction. Though these findings are still somewhat controversial because the mechanism for this reduction isn’t understood, they are generally accepted.

Even if we take the results of the study at face value, a 50 percent reduction is not nearly as impressive as the 90-95 percent reduction offered by latex condoms, when used correctly. Those in favor of circumcision point out that the two prevention techniques could be used in tandem. Additionally, while condoms need to be used consistently, circumcision is a one-time procedure.

As opposed to condoms, this 50 percent reduction is one-way only. It protects heterosexual men from their infected female partners. Circumcised men who are HIV positive are at least as likely to pass the disease on as uncircumcised men. 

In regions plagued by HIV, circumcision may be a small part of the solution. But in this country, where less than 1 percent of the population is infected and heterosexual men are among the least at risk, foreskin removal is a solution in search of a problem. While circumcisions may have been performed as many as 15,000 years ago, the procedure’s origins in the U.S. date back to the late 19th century, when John Harvey Kellogg recommended it — along with his new corn flakes cereal — as a means to prevent children from masturbating. There’s no compelling evidence that either method is effective.

Today in the U.S., somewhere between 50 and 60 percent of all newborns leave the hospital circumcised, though this number varies significantly from year to year and from region to region. In 2009, for instance, 24.6 percent of children born on the West Coast underwent the procedure, compared to 75.2 percent in the Midwest. The reasons for circumcision are largely religious or cultural, and, though there are some medical benefits to performing the surgery, it’s difficult to justify it to the degree that it’s currently employed.

One of the more significant positive effects of circumcision is that circumcised individuals are less likely to suffer from urinary tract infections. Though the risk is fairly small in boys, with only about 1 or 2 percent experiencing the infections in the first 10 years of their lives, one way to look at it is that for every 111 circumcisions performed, one infection is prevented.

It’s worth noting that these infections are typically treated fairly easily with a round of antibiotics and aren’t especially debilitating. There are also other specific conditions such as phimosis, the inability for foreskin to retract, that circumcision can treat or prevent, though this is much less common than a urinary tract infection, and can be dealt with on a case-by-case basis. But while the positive effects are minor, it’s unclear if there are any negative consequences that come from removing the foreskin.

Studies have looked into personal satisfaction of those who have undergone circumcision as adults and the results are mostly just confusing. A paper from a 2002 issue of Journal of Urology states, “We found that adult circumcision appears to result in worsened erectile function, decreased penile sensitivity and improved satisfaction.” Because of the nature of these studies, and the impossibility of achieving a genuine double-blind control, it’s not surprising that the results varied from person to person, likely influenced by cultural and psychological cues.

Unfortunately, science can’t tell us what to do — it can only inform our decisions and, in the case of circumcision, it’s clear there are some benefits. But at the same time, these benefits may be overstated and, even with very few risks of complications — when performed by a qualified doctor — it’s not immediately obvious if performing unnecessary surgeries is a great idea, especially on newborns.