Saturday, January 17, 2009

Now let’s get down to business…

Circumcision has some pros, but are they sufficient enough to warrant cutting your son's foreskin off?
It would be unfair, impartial and futile for me to deny that circumcision carries some benefits. The extent of these benefits however, are not as great as I once thought. Especially in a country like mine where hot water runs out of our taps, and people can purchase condoms from their local store.

Let's explore the apparent advantages, one by one:

STI (Sexually Transmitted Infection)

  • Its never been more essential to use a condom or other reliable contraceptive.
  • Whether a man is 'cut' or 'intact' actually appears to have little or no affect on his exposure to STDs. Studies are often conflicting and complex, but the most recent one showed that circumcision offers a tiny 1% reduction. Every study however notes that there are much more significant factors, such as use of condoms and promiscuous behavior, in the acquisition of STDs, than whether the man has a foreskin or not.
  • As mentioned earlier, I would also like to compare a mostly-circumcised region to a mostly-uncircumcised region. The USA has a greater incidence of STDs than several Western European countries, despite having most of its males 'cut' compared to most of their males 'intact'.

UTI (Urinary Tract Infections)

  • Females are far more prone to UTIs than males.
  • Again, the risk of UTIs in developed countries like the U.S. are markedly reduced compared to the third-world, yet one-third of adult Americans reported getting a UTI at some point in their lives. This is in a country where 80% are circumcised...
  • In the UK however, where 80% of males have foreskins, only 1 in 30 boys reported having a UTI by the age of 16.
  • The effect of circumcision on risk of UTIs is also minimal, and risk in adulthood is more commonly associated with increased and vigorous intercourse with a new partner.

Penile cancer

  • Cancer scares the shit of people. And rightly so.
  • In 'cut' men, the cancer usually forms on the actual circumcision scar itself, whereas in 'intact' men, it usually forms on the foreskin if the man has particularly poor hygiene. But penile cancer is very rare, affecting less than 1 in 100,000 men.
  • The American Cancer Society declared that having a foreskin does not increase the risk of penile cancer any more than having unprotected sex with multiple partners and smoking cigarettes.
  • The American Medical Association (and Australia's equivalent body) also declared that circumcising an infant in hope of preventing penile cancer is "unjustified".
  • Again, comparing the prevalence of penile cancer in the USA to a non-circumcising region such as Scandinavia, showed no difference at all.

Cervical cancer

  • Cervical cancer is most commonly caused by the HPV virus and a promiscuous sexual history. Not all strains of HPV can be transmitted and not all are dangerous; believe it or not, 80% of sexually-active Americans will carry some form of HPV at some point in their lives.
  • In 2006, the HPV Vaccine for girls was approved, which showed protection against 70% of cervical cancer-causing HPV strains and 90% of strains which cause genital warts.
  • The affect of male circumcision on female cervical cancer is "insignificant" according to one study, especially if the 'intact' man practises good hygiene and the woman keeps her sexual behavior at a low-risk. Bigger factors which affect a woman's risk to cervical cancer are having multiple sex partners, having sex before the age of 18, and having sex with a man who has had previously had sex with someone with the cancer.

HIV (Human Immunodeficiency Virus)

  • You, like me, may have come across headlines sensationally declaring circumcision reduces a man's risk to HIV by up to 60%. This is all very well in some African countries, where there is an epidemic and contraception is rarely (or never) available nor used.
  • In the U.S., prevalence of HIV is much lower though, and contraception is always available and usually used. Attitudes towards maintaining relationships instead of having multiple sex partners is also different in the West than in Africa.
  • The USA has the highest prevalence of HIV/AIDs than any developed country, at 0.6%. We also have a male population that is 80% circumcised.

    In France, its 0.4%. In the UK its 0.2%. Its only 0.1% in Finland, Ireland, Sweden and New Zealand, and 0.01% in Germany. Most men in those countries are 'intact'.
  • My point is that circumcision is being used as a seemingly "desperate" measure in Africa to help curb the HIV epidemic. But in the developed world, its irrelevant.

To sum up, I concluded that the advantages of circumcision are minimal and insignificant, and that if a man cleans his foreskin area regularly and properly, and sensibly uses contraception, then he is no more at risk of any health problem.

I also read the testimonies of 'intact' men who actually decided to get cut as adults.
Ouch right? Well, one common theme was that the operation itself was painless and that the recovery from it was entirely manageable.

So if men can easily undergo circumcision as adults without a traumatic experience, then why not let our babies make the decision for themselves when they're old enough?

This would bring me onto the ethical issues of circumcising baby boys, but like our ped said to us, that depends on your point of view.

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