1940s, Nazi soldiers looked for the missing foreskin to identify Jews, for whom the process has been sacred for centuries. Today, male circumcision is one of the most common neonatal surgeries, even outside of Islamic and Jewish communities, yet it has currently come under ethical and financial scrutiny.
Many opponents of circumcision argue that boys should be given the option to wait until they are 18-years-old to choose whether they would like to be circumcised. Others believe that circumcision should be completely banned. 18 U.S. states have already eliminated circumcision from the umbrella of Medicaid-covered treatments, and areas of San Francisco have tried to vote on the banning of circumcision.
Recently, Aaron Tobian and Ronald Gray of Hopkins Bloomberg School of Public Health published an editorial that carefully examines both sides of the argument, but stands firmly in favor of neonatal male circumcision.
Tobian enumerated the various health benefits of circumcision. "We have looked at the randomized trial data from Uganda, and male circumcision reduces HIV transmission by 60 percent and Human Papilloma Virus, which can cause penile cancer, by 30 percent, as well as genital herpes," Tobian said in an interview with The News-Letter.
"And those are just the male benefits. Females also reap several rewards from their circumcised partners; they greatly reduce their risk for bacterial vaginosis, trichomoniasis and HPV, which can cause cervical cancer."
Gray and Tobian's randomized data spans not only several years, but several countries as well. Although the topic of circumcision is hotly debated in the United States, the researchers focused specifically on various regions in Africa. "We have studies from Kenya, Uganda and South Africa," Tobian said. "There are 40 observational studies showing how circumcision may reduce HIV transmission, and so we asked ourselves, 'Why do Western African and Middle Eastern countries have lesser rates of HIV?'"
West African and Middle Eastern populations have a Muslim majority, and so it was believed that more men in these areas are circumcised as opposed to men in countries such as Kenya, Uganda and South Africa. "In these countries, there is a low prevalence of Muslim men, and so there was not a high rate of circumcision prior to trials," Tobian said.
From those populations, they found 5,000 uncircumised men fitting their search criteria and circumcised half of them. "This is the data that shows all of these public health benefits for male circumcision," Tobian said. "This is the gold standard of medical science."
The trials showed decreased transmission rates of certain infections, and a majority of the men in the trials reported higher penile sensitivity during sex. However, adult circumcision can be very painful, and that is one of the many reasons that Tobian supports neonatal circumcision.
"There are multiple advantages to circumcision for baby boys compared to that for adults," Tobian said. "There are not as many urinary tract infections, and there are reduced penile inflammatory disorders as a child. The risk of complications is exponentially lower in kids. The published rate is less than half a percent for neonatal boys, while for adults it is 1.5-3.8 percent."
The most common risk of circumcision is oozing or bleeding from the site of the cut, or sometimes an infection. Tobian noted that such complications are minor and easily treated and that the tissue heals much faster in infants than it does in adults.
Sexual satisfaction is one of the central arguments for the anti-circumcision campaign. Tobian compared it to anti-vaccination campaigns. "Many people get it in their heads that male circumcision or vaccinations cause problems from anecdotal reports and become passionate on that issue," Tobian said. He cited their statistics, showing that from the Kenyan trial, 64 percent of circumcised men showed enhanced penile sensitivity while 40 percent reported improved satisfaction. However, he is concerned that states such as South Carolina and Colorado have stopped covering circumcision under Medicaid.
The procedure is not difficult, and for baby boys, often involves a clamp of some sort, most notably a Plastibell or a Mogen Clamp, to remove the foreskin. "This procedure is normally a couple hundred dollars," said Tobian, "but Medicaid is helping those who have the least amount of money, so a few hundred dollars can become a major hindrance." Tobian also worries about the supposed implications of removing circumcision from the Medicaid umbrella. "It gives the message that there are no medical benefits [of circumcision], and so if you're on the fence about it and find that insurance covers everything else but not circumcision, then you think there's no reason to consider it."
Around the world, states have established legislature that prohibits non-medical staff from performing the procedure. Some see this as culturally restrictive, especially considering that it is a sacred tenet in both Islam and Judaism. Beyond religion, Tobian stresses the medical benefits that male circumcision provides and emphasizes how their data have been corroborated by hard evidence as opposed to anecdotes. "I think that if there were a vaccine that produced reduced risk of HIV, genital herpes, bactieral vaginosis, and trichomoniasis, then the medical community would really rally behind that intervention."
