Potential Benefits of Circumcision?
As a medical procedure, circumcision is performed to treat problems involving the foreskin and as a means to help prevent certain diseases. Recently, three randomized controlled trials have convincingly demonstrated that male circumcision reduces female to male heterosexual transmission of HIV.
The following are the potential benefits of the procedure :
1. Improved male hygiene – It is well known that microorganism colonies and glandular secretions accumulate under the foreskin and harbour inflammation due to stasis. This can lead to conditions such as Balanitis / Balanoposthitis (inflammation of the glans penis and/or foreskin). The incidence of Balanitis is twice as high in those who are uncircumcised. Smegma, which is a cheese coloured secretion, can accumulate under the foreskin. Bacterial alterations of smegma can produce an offensive odour.
2. Reduced risk of Urinary Tract infections (UTI)– Due to the fact that microorganisms can accumulate under the foreskin and adhere to it, bacteria have a greater chance of migrating up the urethra which is next to foreskin causing urinary tract infections (UTIs) especially in children. Studies suggest a 10-fold decrease in risk of urinary tract infection in circumcised males. Urinary Tract Infection (UTI) is associated with burning pain during urination, and is a potentially dangerous condition if complications such as bacteremia or kidney infection and scarring occur.
3. Reduced risk of Phimosis – Phimosis is a condition in which the foreskin becomes so tight that it cannot be pulled back fully over the glans penis and leaves a very small sometimes pinhole passage for the urine to flow out. This results in :
a) Increased risk of urinary tract infections due to back pressure and stasis,
b) Local skin infections,
c) Retention of urine,
d) Kidney stones,
e) Sexual dysfunction
Circumcision virtually eliminates the risk of phimosis, which affects 1 in 20 older boys and men.
4. Prevention of Paraphimosis – This is a rare condition that occurs when the foreskin is pulled back and gets trapped in the retracted position below the glans penis. The tissue can become swollen and obstruct the blood flow to the tip of the penis requiring urgent surgery to correct the problem. Male circumcision can prevent this complication.
5. Prevention of Balanitis and Posthitis – Dirt, fine sand and other irritants alongside microorganisms can collect under the foreskin and cause inflammation of the glans penis (Balanitis) and foreskin (Posthitis). These two conditions can be present at the same time called Balanoposthitis. Circumcision treats and helps to prevent these conditions by making it easier to keep the head of the penis clear of possible irritants and microorganism.
6. Reduced risk of penile cancer — Studies have shown an over 20-fold reduction in the risk of invasive penile cancer which is thought to arise from adherence of high-risk human papilloma virus to the underside of foreskin and smegma causing chronic inflammation and recurrent infections resulting in phimosis. Invasive penile carcinoma is often associated with a history of phimosis.
7. Reduced risk of prostate cancer – Some studies show that uncircumcised men may have a higher incident of prostate cancer.The precise nature of this co relation is unknown.
8. Reduced risk of sexually transmitted diseases – this is due to the fact that viruses enter through the inner lining of the foreskin which is thin and has favourable moist environment for carcinogenic viruses. Ulceration and tearing of the foreskin are not uncommon in uncircumcised men, increasing the risk of virus entry. The incidence of following diseases are reduced by circumcision:
a) Human immunodeficiency virus (HIV) is reduced by up to 60%. The inner foreskin is much less keratinised than other genital mucosa, so its numerous Langerhan’s cells and other immune cell targets are unusually susceptible to HIV infection.
b) Herpes simplex virus type 2 (HSV-2) is reduced by up to 35%.
c) Human papilloma virus (HPV) is reduced by up to 35%.
d) Among female partners of circumcised men, bacterial vaginosis is reduced by up to 40%.
e) Trichomonas vaginalis infection is reduced by up to 50%.
Hence, as above, there may be significant decrease in incidence and risk of sexually transmitted disease.
9. Reduced cervical cancer in women – Male circumcision reduces the risk of cervical cancer of a circumcised man’s female partner by 5.6 times as there is less risk of adherence and colonisation of human papilloma virus in circumcised men, which is a recognised cause of cervical cancer in women and venereal warts in both sexes.
Male circumcision provides several potential medical benefits, as described above. In 2007, UNAIDS and WHO concluded from studies that the efficacy of male circumcision in reducing female to male transmission of HIV had been proved beyond reasonable doubt.
