The Reason Some Doctors Argue Men Should Get Circumcised

A new paper claims men should get circumcised to help stop the spread of STDs.

Circumcised banana
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Male circumcision is a “powerful tool to reduce the global burden of STIs on women,” claims a new article published in the journal Frontiers in Public Health. The authors, an international team of physicians, suggest that the benefits of the procedure to women’s health are compelling enough that women should be actively involved in advocating for male circumcision.

They argue that women can help reduce female STI and cervical cancer rates by circumcising their sons, urging male family members and friends to opt for the procedure, choosing circumcised sex partners, and—if they have an uncircumcised partner—encouraging him to “snip the tip.”

They’re basically saying that foreskin is such a major threat to women’s health that women should support global efforts to eradicate it. To be clear, they think that men should support these efforts, too, because they believe circumcision offers STI protection regardless of gender.

But does circumcision really have such a dramatic impact on sexual health? And is it even a good idea to use public health as a justification for routinely cutting off part of the body?

Some research supports the idea that circumcision reduces men’s risk for STIs, including HIV; however, there are serious limitations of these studies. Most importantly, much of the research has been conducted on heterosexual men in Africa, which means it’s not clear whether we can assume similar benefits for men of other sexualities or in different cultures.

It may be that circumcision offers limited HIV protection to straight men in Africa, where the rate of infection is very high (as many as 10 percent have it in some countries) and effective tools for preventing HIV (like condoms and PrEP) are scarce. In the United States, however, the situation is radically different. The rate of HIV is much lower to begin with (less than one-tenth of one percent of the population has it) and safe-sex tools are easier to come by. Plus, the most at-risk group in the US is gay and bisexual men, for whom we don’t even know whether circumcision offers a protective benefit.

When you look at it this way, the potential health benefits of circumcision for men in America aren’t clear-cut. In terms of benefits for women, the authors of the new Frontiers paper claim that male circumcision reduces the risk of some bacterial infections of the vagina; however, those infections are treatable with antibiotics and, according to the CDC, it’s “not clear what role sexual activity plays” in the development of these infections anyway, so it seems like a stretch to promote male circumcision as a means of preventing them.

That said, the authors also claim that male circumcision can reduce women’s risk for HPV and, by extension, cervical cancer (most cases of which are caused by this virus). We now have a vaccine against HPV, however, that works in men and women alike. And with an effective vaccination program, like the one they’re working to implement in Australia, researchers claim that HPV-related cervical cancer could be “eliminated as a public health problem” in the next two decades.

Given how effective this vaccine is, it raises the question of whether advocating for circumcision to prevent HPV is worth it. Besides, if circumcision were really so effective at reducing HPV, we would expect the rate of it to be lower in countries like the United States where most men are circumcised—but that’s not what the research shows.

For example, consider the United States and the United Kingdom, where the rates of male circumcision are dramatically different and estimated to be 71% and 21%, respectively. The rate of high-risk genital HPV infection in the United States is 25.1% for men and 20.4% for women, according to the CDC. By contrast, in Britain, the rate is 9.6% in men and 15.9% in women, according to a nationally representative study.

In other words, despite the US having way more circumcisions, we don’t seem to have less HPV at the population level. However, since introduction of the HPV vaccine, rates of cervical cancer and HPV infection have started dropping in America, which tells us that vaccination—not circumcision—is the key to combating this problem.

There are questions to be raised about how much public health benefit there is to male circumcision, especially when weighed against the potential risks. Some studies report complication rates as high as two percent and, in extremely rare cases, disfigurement and death have occurred.

But even if we conclude there’s a net health benefit to male circumcision for men, women, or both, is that a good basis for arguing in favor of routine removal of foreskin? Maybe not.

Several cultures practice female circumcision, in which the clitoris and, in some cases, other parts of the vulva are removed. Westerners consider this practice cruel and abhorrent (especially because it’s often performed in unsanitary conditions without anesthesia), but what if data (like this study) showed that female circumcision was linked to lower rates of HIV? What if people started using these data to say that female circumcision was justified because there are sexual health benefits?

As you can see, the “health benefits” argument has the potential to backfire. You can find data showing health benefits of a lot of procedures, but this does not necessarily mean that they should be done. Benefits to public health must be weighed against ethics.

Some ethicists argue that no one should have the right to decide what happens to your genitals but you. After all, what’s more personal to you than your penis (or vulva)? So should we be in the business of permanently altering kids’ genitals without taking into account what they want, especially when we know that some men regret having been circumcised and are now going to great lengths to have their foreskin restored?

I can’t help but think about how people are increasingly recognizing that intersex children (those born with genitals that do not appear to be completely male or female) shouldn’t be subjected to genital surgeries until they are old enough to consent.

In the past, doctors would “assign” intersex babies a gender and perform surgery to make their genitals consistent with that gender. However, psychologists have discovered that it’s not uncommon for intersexed people to later adopt a gender identity inconsistent with the one they were assigned and to be distressed about the irreversible decisions made by their parents and doctors.

In order to address this, California lawmakers recently proposed a first-in-the-nation ban on medically unnecessary surgery for intersex children in order to recognize their autonomy over their bodies. This bill raises an important question: If we agree that intersex children should have final say over surgical alteration of their genitals, should everyone else have the same right, too?

Justin Lehmiller, PhD is a Research Fellow at The Kinsey Institute and author of the blog Sex and Psychology. His latest book is Tell Me What You Want: The Science of Sexual Desire and How It Can Help You Improve Your Sex Life. Follow him on Twitter @JustinLehmiller.

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