Jan 102011

A new study has found that circumcised men transmit HPV to women less frequently than uncircumcised men in a 2-year period (SourceStudy). This was a statistically significant difference (it probably wasn’t caused by chance). Also, when circumcised, it lessens the risk of phimosis. Individuals who aren’t circumcised might experience pain in their foreskin; this might be a sign that he has phimosis. Check with a physician to discuss phimosis and phimosis cure to help you. The authors go on to suggest that circumcision should thus be used to prevent the spread of HPV, with a warning that it’s only a partial protection (a 23% difference between the groups). The study was published in The Lancet

After reviewing the study, although it mostly seems sound, I have one objection: couldn’t the statistical difference come from a change in sexual behavior and not the procedure? A circumcision requires healing time and may affect sexual response, which may lead to a change in sexual habits. The authors tracked number of sexual partners, but not the activities themselves. It strikes me that the activities should have been tracked, even by a self-reported estimate.

I also question the conclusion: wouldn’t it be better to vaccinate the population, instead of risking infection and sexual side effects? However, I am biased about this subject.

Research Citation:

Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women: a randomised trial in Rakai, Uganda (Link)
Prof Maria J Wawer MD,Dr Aaron AR Tobian MD,Godfrey Kigozi MBChB,Xiangrong Kong PhD,Patti E Gravitt PhD,David Serwadda MMed,Fred Nalugoda MHS,Frederick Makumbi PhD,Victor Ssempiija ScM,Nelson Sewankambo MMed,Stephen Watya MMed,Kevin P Eaton BS,Amy E. Oliver BA,Michael Z Chen MSc,Steven J Reynolds MD,Prof Thomas C Quinn MD,Prof Ronald H Gray MD
The Lancet – 7 January 2011
DOI: 10.1016/S0140-6736(10)61967-8

  6 Responses to “Circumcision reduces HPV transmission rates in heterosexual couples”

  1. As far as different sexual behaviors in circumcised v. uncircumcised men, I suspect that at least the majority of the men surveyed were circumcised before they were sexually active (ie at birth, or shortly thereafter), meaning that any differences in sexual behavior would be cultural (beyond inherent differences between individuals, the behavioral differences would be based on who their parents are and how they were raised). I would think that the argument against vaccination is an argument against over-vaccination in general: The more diseases we vaccinate against, the more mutation will arise (theoretically). It is, undoubtedly, better to use good hygiene practices to prevent the spread of disease where possible rather than vaccinating everyone against it. On the other hand, that leads me to another question: Could the spread of HPV be reduced by better hygiene on the part of uncircumcised men? In theory, the spread of disease is reduced by circumcision because that little flap of skin creates a healthy environment and catch-all for bacteria. Is it possible that more emphasis on teaching boys how to clean themselves properly would have as positive an effect as circumcision?

    • Ahh – I neglected to mention enough of the methods. The study’s intervention group was circumcised immediately, and the control group circumcised at the end of 24 months – this was possible because of its location in Uganda. So it was a recent circumcision. It wasn’t clear to me from the paper whether or not time was given for healing before the 24 months of the study. Sorry for the confusion there…I’ll include more information on the methods next time.

      You have very good points about over-vaccination. I hadn’t thought of that. As long as the hygiene doesn’t include anti-bacterials, of course. 😉 But seriously, I referred to the vaccine instead of condoms because of the CDC’s warning the condoms may not be completely effective, because HPV spreads by mere skin-to-skin contact.

      I haven’t yet found any good research determining the effect of hygiene on disease transmission. It’s something I’ve wondered myself, and seriously wish researchers would account for. I’ll keep looking though, and definitely post if I find anything.

  2. I’ve heard this sort of stat before, and I’m wary of promoting circumcision as a method to combat HPV infection. It seems to me that the surgical alteration of human genitals to lower the chances of an infection by 23% – where prevention is also feasible via utilizing safer sex – is a dubious strategy.

    However disadvantaged people don’t often have access to the education or materials necessary to practice safer sex. Circumcision might help improve the health of the population at large, but I personally doubt that factor can fully rationalize the practice of cutting off a healthy, functional structure (particularly on an infant or child, who are unable to give consent).

    In other words, I’d rather hand out condoms than snip off foreskins. 😉

    • I’m definitely of your opinion re: circumcision. I’m dubious that it has any statistically significant health benefit when compared with a population using safe sex and cleanliness. Circumcision certainly has health risks of its own.

      I remember that condoms only have a 70% prevention rate with HPV, even when used correctly (though I don’t have a citation handy…), which is why I mention vaccines instead of condoms.

      • The thing about condoms only being 70% effective in stopping the spread of HPV, unless I’m sorely mistaken, has to do with the fact that the condom doesn’t cover all of the skin in the genital area. Considering that circumcision only affects the tip of the penis, a part of the body which would be fully covered by the condom, I don’t feel that the two methods of HPV prevention are stackable.

        23% chance of preventing anything is hardly something which can be relied upon. When you’re talking about things such as this there’s a threshold of usefulness that must be reached before something becomes pragmatic, especially when it comes to something as radical as genital cutting. Furthermore, I strongly doubt that the procedure will remain consensual.

        As far as the argument that it could help because the people which this procedure is targeted at do not have access to reliable information and materials for safer sex: The solution to that is to fix the underlying problem of not having adequate safer sex materials and information!

        As an aside, I’d like to point out that one of the major driving forces behind nonconsensual circumcision is that it reduces pleasure from masturbating and thus will discourage boys from masturbation which is supposed to be somehow bad for them.

        • You’re absolutely correct about the 70% effective rate – that’s what I saw in my research. And I generally feel as you do with this subject…but you knew that. 🙂

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