André Picard
Public Health Reporter — From Tuesday's Globe and Mail Published on Tuesday, Jan. 12, 2010 5:45AM EST Last updated on Tuesday, Jan. 12, 2010 5:50AM EST
While it is the most common surgical procedure in the world, there is virtually no demonstrable health benefit derived from circumcision of either newborns or adults, a new study concludes.
The sole exception seems to be using circumcision to reduce the risk of transmission of HIV-AIDS in adult males in sub-Saharan Africa, though it is unlikely that benefit carries over to other parts of the world where rates of HIV-AIDS are much lower.
The research, published in Tuesday’s edition of the Annals of Family Medicine, shows that, despite claims, there is little evidence that circumcision can prevent sexually transmitted infections, urinary tract infections and penile cancer.
There are also risks to the surgery that, while rare, range from sexual dissatisfaction through to penile loss.
“Patients who request circumcision in the belief that it bestows clinical benefits must be made aware of the lack of consensus and robust evidence, as well as the potential medical and psychosocial harms of the procedure,” said Guy Maddern, of the department of surgery at The Queen Elizabeth Hospital in Adelaide, Australia, and lead author of the study.
In newborns, he said, the surgery is “inappropriate” because it offers no therapeutic benefit.
About one-third of males worldwide undergo circumcision, the surgical removal of the prepuce (or foreskin).
The procedure is done principally for religious, cultural and social reasons.
Religious male circumcision is practised under both Jewish and Islamic law, and it is an integral part of some aboriginal and African cultural practices.
The main social reasons the practice has continued is a widespread desire that boys resemble their fathers, and a belief that boys who undergo circumcision have fewer health problems.
The new study, a systematic review (a compilation and analysis of previously published research), looked only at the latter point.
Dr. Maddern and his research team found no evidence that uncircumcised men have higher rates of penile cancer. In fact, they noted penile cancer is extremely rare and seemingly unrelated to the presence of a prepuce.
The belief that urinary tract infections are more common in uncircumcised males is not backed up by research. Dr. Maddern noted the fewer than 2 per cent of boys suffer urinary tract infections which “makes it unlikely that preventive circumcision of normal boys would outweigh the adverse events associated with the procedure.”
Finally, there was no evidence at all that there are fewer sexually-transmitted infections among circumcised males. The exception was a study in sub-Saharan Africa that showed doing the surgery on adult males reduced their risk of contracting HIV-AIDS. (However, rates of HIV-AIDS were not reduced in their female partners.)
Rather, Dr. Maddern said, the prepuce seems to act as a barrier against contamination and, by helping maintain a moist environment, enhance sexual pleasure.
According to the study, the only medical justification for circumcision is to treat boys or men with penile abnormalities.
