Circumcision and The Infection Myth
We've all heard this line before- "A circumcised boy won't get infections."
I come to you this morning to discuss the aura of medical authority being used as a smoke screen by supporters of Routine Infant Circumcision. Undoubtedly, we've heard many a reason why circumcision is beneficial. "It's more esthetically pleasing." Parents can usually shrug off an excuse like this if they're unsure about circumcising their son. "It's more hygienic." At this point, some parents may be irked into considering it, but others may still be on the fence because they can teach hygiene. "It prevents infections." Boom. To any parent who hasn't done the proper research, this false promise of better health will win them to the side of circumcision.
I am here to dispel what is probably the most prevalent medical lie.
The only infection that is decreased by circumcision before sexual maturity is UTIs. However, this decrease is so minor that it is basically meaningless: 2% of circumcised boys will still get UTIs, as opposed to only 4% of intact children. No doctor in his right mind would recommend amputation as preventative medicine when the risk reduction is so marginal. (If they did, we would be having our appendixes removed at birth.) In fact, circumcision is the ONLY surgical procedure done routinely for "preventative" reasons.
This is put even further into the "BS category" when it's weighed against problems as the result of circumcision. 3% of all circumcised infants will experience complications before even leaving the hospital: 1% from hemorrhage, 0.5% from infection, and the remaining 1.5% being made up of various other problems ranging from stenosis to adhesions to secondary phimosis. And that's of "successful" circumcisions. After being discharged from the hospital, 22% of children with circumcisions will require General Practitioner/Pediatrician care for a problem related to circumcision. During one pediatric hospital's study, 4.7% of all surgical procedures were related to a prior circumcision and circumcision resulted in 7.4% of all outpatient urological care cases. When you combine all of the potential complications of "successful" circumcision, some studies place the estimated complication rate as high as 35%.
Again, let's compare those figures to a 2% decrease in UTIs, which only affect 4% of intact boys.
After sexual maturity, circumcision has been linked to a decreased risk of certain STIs, particularly HIV. However, this decrease is associated with an increase of high-risk behaviors and transmission rates to partners, as well as being tainted by method of study.
In three, tightly controlled clinical studies (which are not as reliable as "real world" studies in this area,) it was found that circumcision resulted in a 50-60% reduction in female-to-male transmission. However, this is in stark contrast to the fact that HIV is not considered to be highly communicable in heterosexual partners, and that there are more effective and less invasive methods of prevention already available. In a real world study, it was found that heterosexual couples who consistently used condoms experienced no transmission between partners, while the couples who used condoms inconsistently had a ~10% transmission rate. This means that typical condom use has a 90% prevention rate. Additionally, anti-retroviral drugs offer a 92% reduction in transmission rates.
To repeat- Typical condom use is 90% effective. Drugs are 92% effective. Circumcision is only 50% effective for one partner in the best of circumstances.
Even more holes are poked into the weave of this fabric as we examine several other facts. Not all men are heterosexual. Homosexual intercourse is the highest risk category for HIV transmission, and no studies have been done on the effects of circumcision and HIV transmission rates in gay couples. In heterosexual relationships, when examining adult circumcision, it is proven that risk of HIV transmission to a female partner is increased until the wound has healed and a study by WHO has found that only 75% of adult circumcisions are healed within two months of the procedure. Regardless of whether a man was circumcised as a child or as an adult, it has been proven that vaginal tearing increases risk of male-to-female transmission of all STIs, including HIV -- and vaginal tearing (especially micro-tearing) is a common side effect of sex with a circumcised partner.
Furthermore is the issue of condom use. Circumcised men who have heard that being circumcised decreases their risk are lulled into a false sense of security and may engage in high risk behaviors such as neglecting condom use as a result. While I could not find statistics regarding this particular aspect of sexual behavior, it is a frequently mentioned issue when discussing circumcision as an STI prevention method and I have personally heard men say things such as "I'm less likely to catch something because I'm circumcised."
Going back to evidence based facts, however, studies have shown that circumcised men are less confident about using and less likely to use condoms than intact men are. The exact reasons behind this are not known, but I'd say it's not much of a stretch to believe that they would be receiving inadequate sexual health advice from the same adults who presumed that a forced circumcision was "good for them." In any case, we need not give circumcised men any more reason to use condoms less frequently, especially not by giving them a Superman Complex about sexually transmitted diseases and infections.
When putting all of this information into context, it's pretty easy to see that using circumcision as a "vaccine" against infections in the developed world is probably one of the greatest medical lies ever told. And that's before we even begin to factor in the many other problems related to circumcision, like the aspects of emotional upset and sexual dysfunction.
Please, if you ever hear someone say "it prevents infections," inform them of the facts.