Male circumcision reduces risk of some diseases

[The Reaper]

http://www.physorg.com/news157221867.html

Male circumcision reduces risk of genital herpes and HPV infection, but not syphilis
March 25th, 2009

Heterosexual men who undergo medical circumcision can significantly reduce their risk of acquiring two common sexually transmitted infections--herpes simplex virus type 2 (HSV-2), the cause of genital herpes, and human papillomavirus (HPV), which can cause cancer and genital warts, according to a report in the March 26 issue of the New England Journal of Medicine (NEJM). In the study, circumcision had no effect on their risk of becoming infected with the bacterium that causes syphilis, however.

The findings build upon earlier clinical research funded by the National Institute of Allergy and Infectious Disease (NIAID), part of the NIH, which found that circumcision decreases a man's risk of acquiring HIV infection through heterosexual intercourse by more than 50 percent.

"Medically supervised adult male circumcision is a scientifically proven method for reducing a man's risk of acquiring HIV infection through heterosexual intercourse," says NIAID Director Anthony S. Fauci, M.D. "This new research provides compelling evidence that circumcision can provide some protection against genital herpes and human papillomavirus infections as well."

The study was conducted by scientists at the Rakai Health Sciences Program in Uganda in collaboration with researchers at the Johns Hopkins University Bloomberg School of Public Health in Baltimore, Makerere University in Kampala, Uganda, and NIAID's Division of Intramural Research. The collaborators examined samples from two parallel clinical trials in Rakai that successfully proved male circumcision as an HIV prevention method and also assessed the surgical procedure's ability to prevent other sexually transmitted infections, including syphilis and HSV-2. These infections cause genital ulcers and are associated with an increased risk of HIV acquisition. The research team also assessed circumcision's effect on HPV infections, which can cause anal, cervical and penile cancers and genital warts.

The two trials, one funded by NIAID and the other by the Bill & Melinda Gates Foundation, enrolled 3,393 uncircumcised men between the ages of 15 and 49 who initially tested negative for both HIV and HSV-2. The men were assigned at random to one of two study groups: 1,684 received immediate circumcision performed by trained medical professionals in an outpatient setting (intervention group); and 1,709 received medical circumcision after a delay of 24 months (control group). The researchers evaluated the volunteers at six, 12 and 24 months for HSV-2 and syphilis infection. Additionally, a subgroup of 697 volunteers (352 participants in the intervention group; 345 in the control group) was evaluated for HPV infection at enrollment and at 24 months.

In analyzing the effect of circumcision on HSV-2 acquisition across both studies, the researchers found that the cumulative probability of HSV-2 infection was significantly lower among those volunteers who received immediate circumcision (7.8 percent) than among those in the control group who were circumcised at 24 months (10.3 percent). Overall, the researchers found that medically supervised circumcision reduced the men's risk of HSV-2 infection by 28 percent.

The combined results from both trials also demonstrated a 35 percent reduction in HPV prevalence among men in the intervention group. In evaluating a subgroup of volunteers at 24 months, high-risk HPV strains associated with certain cancers were detected in 42 of 233 men in the intervention group and in 80 of 287 men in the control group.

Circumcision did not, however, affect the incidence of syphilis. At 24 months, syphilis was detected in 50 men in the intervention group and 45 members of the control group.

"The cumulative scientific evidence supporting the public health value of medically supervised male circumcision is now overwhelming," says Thomas C. Quinn, M.D., study co-investigator, chief of the International HIV/STD Section in NIAID's Laboratory of Immunoregulation and co-author of the study. "This new research confirms the substantial health benefits of male circumcision, including reduced acquisition of HIV, genital herpes, HPV and genital ulcer disease."

Dr. David Serwadda, co-principal investigator and dean of Makerere University's School of Public Health, adds that "these findings have significant public health implications for the control of HIV, genital herpes and HPV in areas of high prevalence, such as Africa, and further suggest that efforts to scale-up male circumcision could have tremendous benefit."

"The next focus of our research will be to analyze additional data collected in the Rakai trials to assess the degree to which male circumcision may reduce transmission of HPV to female sexual partners," says Johns Hopkins professor Ronald H. Gray, M.D., co-principal investigator. "This would be of substantial significance because HPV causes cervical cancer."

The biological reasons why circumcision may reduce the risk of HSV-2 and HPV infection, but not syphilis, are not entirely known. HSV-2 and HPV multiply in epithelial cells found in the surface skin of the penis, and the foreskin may facilitate virus entry into those cells. Once circumcision has been performed, the risk of epithelial infection may be reduced, the authors note. Additionally, the analysis used to determine the effects of circumcision on syphilis had limited statistical power, and therefore, it is difficult to draw a firm conclusion as to whether or not circumcision may reduce syphilis incidence, the researchers add.

During each clinic visit, volunteers were given physical examinations, counseled on safe sex practices and offered condoms, voluntary HIV counseling and testing. Study staff also interviewed each volunteer to record sociodemographic characteristics and rates of specific sexual risk behaviors. Volunteers who acquired HIV infection during the two clinical trials were referred to Rakai Health Science Program clinics for HIV care funded by the U.S. President's Emergency Plan for AIDS Relief. Volunteers who acquired genital ulcers or syphilis were also provided with appropriate medical care and treatment.

As with most strategies to prevent sexually transmitted infections, including HIV, adult male circumcision is not completely effective. Therefore, the authors note, safe sex practices, including consistent condom use, are still necessary to provide the best protection against such infections.

Source: NIH/National Institute of Allergy and Infectious Diseases

[Gunfingers]

Makes girls more likely to blow you, too.

[Jahoclave]

Makes girls more likely to blow you, too.

This - It is your ad campaign.

[Chfan]

Ah, to be snipped. Please don't make me talk about it.

[gmalivuk]

Makes girls more likely to blow you, too.

Only in countries like the US where there is a weird cultural preference for circumcision would that be the case. In much of the rest of the world, they'd wonder why you'd had a bit of your junk cut off.

[mandalynn]

Can someone please explain to me how removing the foreskin prevents STDs? I don't quite understand what difference it makes...

[gmalivuk]

If hygiene is bad otherwise, I imagine it's because fluids can remain longer under the foreskin than when it's removed.

I'm not sure why it would be as much of an issue in populations where clean water and soap are readily available and people are expected to use them regularly.

[Gunfingers]

Makes girls more likely to blow you, too.

Only in countries like the US where there is a weird cultural preference for circumcision would that be the case. In much of the rest of the world, they'd wonder why you'd had a bit of your junk cut off.

Yes, in countries where they have a weird cultural preference for uncircumcised penises they will...erm...prefer uncircumcised penises.

[Shivahn]

Makes girls more likely to blow you, too.

Only in countries like the US where there is a weird cultural preference for circumcision would that be the case. In much of the rest of the world, they'd wonder why you'd had a bit of your junk cut off.

Yes, in countries where they have a weird cultural preference for uncircumcised penises they will...erm...prefer uncircumcised penises.

I somehow doubt it'll help either way. I can't imagine a whole lot of sexual encounters that got started because someone was naked and in a particular state that would'nt have otherwise.

If hygiene is bad otherwise, I imagine it's because fluids can remain longer under the foreskin than when it's removed.

I'm not sure why it would be as much of an issue in populations where clean water and soap are readily available and people are expected to use them regularly.

That's one reason, perhaps. Honestly, the availability of condoms in the US kind of makes the protection offered moot, I'd think.

[Gunfingers]

The only site i've ever been able to find on the subject indicates a strong preference toward circumcision in american women.

From an individual perspective, i have a friend who is in Europe and doesn't want to get involved with any of the guys there because they are rarely circumcised. She thinks uncircumcised schlongs are gross.

[gmalivuk]

a strong preference toward circumcision in american women.

Um, no shit? You remember that part where I said that's only to be expected in a country with absurdly high circumcision rates compared to most of the rest of the world?

[aleflamedyud]

Who actually cares?

[The Reaper]

Thats a good question o_O

[Gunfingers]

a strong preference toward circumcision in american women.

Um, no shit? You remember that part where I said that's only to be expected in a country with absurdly high circumcision rates compared to most of the rest of the world?

I was responding to the other guy, the one who didn't think anyone in any country cared.

[Dr.Robert]

Makes girls more likely to blow you, too.

bad joke.

[Diadem]

Who actually cares?

Ah yes, who cares about millions of babies being mutilated at birth. After all, it's culture.

[EsotericWombat]

Oh man, try and argue personal preference where female circumcision is involved. Try it. I dare you. I fucking dare you.

POP QUIZ

Given two options for improving your child's risk of STD infection, would you:

(a) cut off a piece of his dick
(b) teach him how to use condoms and instil in him habits of proper hygene

You have thirty seconds. When you're done, pass your papers forward to the front of the row. If you fail this quiz, you fail the class, and you get BEATEN WITH CLUBS

[Shivahn]

a strong preference toward circumcision in american women.

Um, no shit? You remember that part where I said that's only to be expected in a country with absurdly high circumcision rates compared to most of the rest of the world?

I was responding to the other guy, the one who didn't think anyone in any country cared.

I meant what I said. Which was:

I somehow doubt it'll help either way. I can't imagine a whole lot of sexual encounters that got started because someone was naked and in a particular state that would'nt have otherwise.

There's a difference between preferring something and actually taking action based upon that preference. Though I don't have statistics to back it up, I find it doubtful that there've been a lot of women who didn't want to give oral sex and changed their mind once a guy pulled his pants down, revealing his altered penis.

Oh man, try and argue personal preference where female circumcision is involved. Try it. I dare you. I fucking dare you.

POP QUIZ

Given two options for improving your child's risk of STD infection, would you:

(a) cut off a piece of his dick
(b) teach him how to use condoms and instil in him habits of proper hygene

You have thirty seconds. When you're done, pass your papers forward to the front of the row. If you fail this quiz, you fail the class, and you get BEATEN WITH CLUBS

The study's not really externally valid, given how easily obtained condoms are here, I agree. But this study was done in older men in a region of Africa, and I don't think suggesting circumsision to competent adults is bad in any way, so long as they're informed. Though I'm very suspicious that the study is more likely to create a "have your boy circumsized" drive rather than an "offer it when he turns 12" drive, which I will vehemently disagree with.

[BattleMoose]

Can someone please explain to me how removing the foreskin prevents STDs? I don't quite understand what difference it makes...

The foreskin is quite a thin and delicate piece of skin, thingy. It can easily get damaged during intercourse, small cuts and the like, providing a route for infection. And this much, actually kinda makes sense.

Although, I can't imagine that circumcission offers any additional protection if your already using a condom, and lets be honest, you should be using a condom.

Also, uncircumsised, higher sensitivity where it matters. *grin*

[EsotericWombat]

The study's not really externally valid, given how easily obtained condoms are here, I agree. But this study was done in older men in a region of Africa, and I don't think suggesting circumsision to competent adults is bad in any way, so long as they're informed. Though I'm very suspicious that the study is more likely to create a "have your boy circumsized" drive rather than an "offer it when he turns 12" drive, which I will vehemently disagree with.

But if we're talking about Africa, well, there's plenty of international aid, particularly from the United States, put towards combating AIDS there. Spend more of that money on making condoms readily available and oh hey look we don't have to cut dicks after all.

[Shivahn]

But if we're talking about Africa, well, there's plenty of international aid, particularly from the United States, put towards combating AIDS there. Spend more of that money on making condoms readily available and oh hey look we don't have to cut dicks after all.

I guess all I'm saying is that if people want to get cut, they should be able to, but I can't imagine a situation where there's that option and people aren't going to be pressured to do it to their infants.

Another thing to consider, though, that might blow the study's validity to hell, is that the men likely didn't know that it was going to have this effect. Someone who gets circumsized and paid in a study isn't likely to be going out purposely having more unprotected sex than the guy getting paid to be normal. Someone who's circumsized specifically for disease resistance is... well, probably going to act differently. I see that they were offered condoms at the hospitals, so I don't know if condoms specifically are being used. Which leads to a problem not with supply, but with demand. I'm not an expert on condom education, so I don't know how best to approach that (I'm assuming that condom use is low, given the disease rates).

[BattleMoose]

Just a few points. (I am South African btw, living in South Africa)

Alot of people in the african cultures, don't use condoms, for a variety of reasons, don't like the way it feels, an assault on their manhood, they don't believe that AIDS kills people and I am sure there are some more.

Also, again part of some of the cultures, as part of a cultural ritual, cirucumsission is performed, not sure exactly when, but as part of a rite of passage, when a boy becomes a man.

So alot of this seems moot, they aren't using condoms and they are getting cirucmsissed already. Ofcourse, very generally speaking. *very*

[EsotericWombat]

If people aren't using condoms and don't believe that AIDS kills, then there has been an overwhelming failure of education that needs to be addressed here. And there exists a capacity to correct that problem. Advocating circumcision as a remedy seems to be a means of kicking that can down the road.

[BattleMoose]

If people aren't using condoms and don't believe that AIDS kills, then there has been an overwhelming failure of education that needs to be addressed here.

That is the absolute truth.

Small problem tho, the South African government, generally seems to endorse this view. :/

[psyck0]

Can someone please explain to me how removing the foreskin prevents STDs? I don't quite understand what difference it makes...

The foreskin is quite a thin and delicate piece of skin, thingy. It can easily get damaged during intercourse, small cuts and the like, providing a route for infection. And this much, actually kinda makes sense.

Although, I can't imagine that circumcission offers any additional protection if your already using a condom, and lets be honest, you should be using a condom.

Also, uncircumsised, higher sensitivity where it matters. *grin*

Actually, that's wrong. The foreskin covers the head most of the time, keeping it from being overstimulated normally, so sensitivity is higher when it is pulled back.

[BattleMoose]

Can someone please explain to me how removing the foreskin prevents STDs? I don't quite understand what difference it makes...

The foreskin is quite a thin and delicate piece of skin, thingy. It can easily get damaged during intercourse, small cuts and the like, providing a route for infection. And this much, actually kinda makes sense.

Although, I can't imagine that circumcission offers any additional protection if your already using a condom, and lets be honest, you should be using a condom.

Also, uncircumsised, higher sensitivity where it matters. *grin*

Actually, that's wrong. The foreskin covers the head most of the time, keeping it from being overstimulated normally, so sensitivity is higher when it is pulled back.

I was comparing the sensitivity of the head of an uncircumsised penis with that of a circumsised one..... (ofcourse with the foreskin pulled back)

[cathrl]

The only site i've ever been able to find on the subject indicates a strong preference toward circumcision in american women.

From an individual perspective, i have a friend who is in Europe and doesn't want to get involved with any of the guys there because they are rarely circumcised. She thinks uncircumcised schlongs are gross.

(shrugs) So the European guys find out instantly she's a narrowminded bigot for whom physical appearance is everything, without wasting their time getting to know her? I don't see a downside here for anyone except her.

Now waiting for the first "but I thought I was safe from STDs because I'd been circumcised!" newspaper sob story.

[Lucrece]

I'm circumcised, and my sensitivity is just fine, if actually too much on the head. In fact, it can be so sensitive sometimes, that preference in attention to the shaft happens.

And for the melodramatic BS about mutilation, I'm fairly sure most circumcised guys don't feel robbed in any way. I actually like my circumcised penis, since it's prettier (to me) .

That does not rule out that there are some who like foreskin.

Back to the topic, though. This is some nice information to have for those who would make a decision, but it should in no way be a justification for pressuring these people into going through the procedure.

[BattleMoose]

I'm circumcised, and my sensitivity is just fine, if actually too much on the head. In fact, it can be so sensitive sometimes, that preference in attention to the shaft happens.

To be fair, its not like you have any means of comparison....

[Exotria]

I believe the issue is that the people having the knife taken to their nads don't exactly have a choice in the matter, whether they'd prefer it or not. I'd have liked the option for it not to happen.

[Aikanaro]

I've also heard that since a circumsized penis has the head constantly exposed, it tends to get more used to it, and isn't quite as sensitive, which ultimately results in the guy lasting longer in bed before orgasm. This is just hearsay, I don't have anything really to back it up.....but if it were true, I might think of doing my son a favor in advance and getting him circumsized when he was newborn, on the basis that it'd result in (presumably) greater happiness for him later in life.

[uncivlengr]

Kind of a funny argument - if parts of your body have some risk of disease, chop 'em off, even if it's not the most effective solution to the problem.

It would seem like people are trying to justify certain controversial cultural practises.

[Lucrece]

I'm circumcised, and my sensitivity is just fine, if actually too much on the head. In fact, it can be so sensitive sometimes, that preference in attention to the shaft happens.

To be fair, its not like you have any means of comparison....

There's no comparison there. I'm stating whether the experience is unsatisfying and not appealing enough to engage in sex as frequently as an uncut male ;p.

As for not having options, well, you don't get to choose whether you want your umbilical cord cut or not. Nor do you get a choice as a child as to whether you want to be vaccinated or not. That motherfucking doctor sat on me and plunged that syringe full of penicillin on me whether I liked it or not.

[psyck0]

Can someone please explain to me how removing the foreskin prevents STDs? I don't quite understand what difference it makes...

The foreskin is quite a thin and delicate piece of skin, thingy. It can easily get damaged during intercourse, small cuts and the like, providing a route for infection. And this much, actually kinda makes sense.

Although, I can't imagine that circumcission offers any additional protection if your already using a condom, and lets be honest, you should be using a condom.

Also, uncircumsised, higher sensitivity where it matters. *grin*

Actually, that's wrong. The foreskin covers the head most of the time, keeping it from being overstimulated normally, so sensitivity is higher when it is pulled back.

I was comparing the sensitivity of the head of an uncircumsised penis with that of a circumsised one..... (ofcourse with the foreskin pulled back)

As was I.

[SDIX]

I've also heard that since a circumsized penis has the head constantly exposed, it tends to get more used to it, and isn't quite as sensitive, which ultimately results in the guy lasting longer in bed before orgasm.

definitely hearsay. I will have to find the source of where it shows they are more likely to orgasm quicker. I've been in the heated debate or twelve over this topic.
It is hard to find information that is not biased, but if you google anti-circ and pro-circ groups and read the information before drawing your own conclusion... you can find a lot of interesting tidbits that contradict each other as well as confirm the other's stance.

Before you decide which stance to take, read both sides with an open mind and draw your own conclusion. As of yet, there is no concrete proof of one being overall better than the other. They each have their own pros and cons.

[Shivahn]

And for the melodramatic BS about mutilation, I'm fairly sure most circumcised guys don't feel robbed in any way. I actually like my circumcised penis, since it's prettier (to me) .

Yeah, while that's great for you, some people DO feel robbed. If they want to do it later, that's fine, but doing it to a child on the basis of "most guys don't feel robbed" is a pretty poor basis.

And before you call it "melodramatic BS about mutilation", you'd best supply a definition of mutilation that it doesn't fall under. Just because it happens regularly and you don't mind doesn't mean there aren't people who hate that it was done to them.

This is just hearsay, I don't have anything really to back it up.....but if it were true, I might think of doing my son a favor in advance and getting him circumsized when he was newborn, on the basis that it'd result in (presumably) greater happiness for him later in life.

Ok, for permanent "favors" that can be done on consenting adults too and are irrevocable, you might consider letting him decide on his own, rather than forcing unneccessary surgury on newborns.

[Aikanaro]

About the "irrevocable" bit....what's the drawback? Not to mention I'm saving him the price of the surgery
Bear in mind again this is just me musing about it, I wouldn't DEFINITELY do so, and I'd definitely be consulting with a doctor first about it. I'm not hard-and-fast committed to this, it's just something I've considered about it before.

[uncivlengr]

what's the drawback?

Yeah, what possible downside could there ever be to something as harmless as cutting pieces from a person's sexual organs?

[Aikanaro]

(Currently) nonfunctional pieces, that many seem to do fine and dandy without?
EDIT: Actually, lemme rephrase it: There are quite possibly lifestyle benefits to being circumcized (improved sex life). I have yet to hear of a benefit to NOT being circumsized (in this modern day and age). If I'm mistaken about that, please inform me of it.
EDIT 2: with regards to improved sex life, I'm referring to a base mechanical level (being able to last longer), as opposed to what girls are more/less likely to find physically appealing.

[uncivlengr]

(Currently) nonfunctional pieces, that many seem to do fine and dandy without?
EDIT: Actually, lemme rephrase it: There are quite possibly lifestyle benefits to being circumcized (improved sex life). I have yet to hear of a benefit to NOT being circumsized (in this modern day and age). If I'm mistaken about that, please inform me of it.
EDIT 2: with regards to improved sex life, I'm referring to a base mechanical level (being able to last longer), as opposed to what girls are more/less likely to find physically appealing.

I think the scope of your investigation into this matter is tellingly limited given you only seem to be considering so-called "lifestyle benefits" lacking any actual supporting evidence.