Dr Andres agrees that circumcision is a potent preventive measure against infant kidney infections and HIV, but downplays the significance. Infant kidney infections cannot be dismissed; they occur when the kidney is still developing and often result in renal damage with scarring. As for HIV protection, HIV is a serious plague of our times, resulting in more than 20 million deaths over the past 2 decades, mainly in sub-Saharan Africa. Even in developed countries such as the United States and Canada, with a lower prevalence than Africa, there is public health concern. In April 2007 the Centers for Disease Control and Prevention convened a conference of experts to take up the question of adult circumcision for high-risk men in the United States.
The protective effects of circumcision against other serious disorders have been well documented in major medical journals in recent years. 1 – 4 These include lowering the risks of human papillomavirus, penile cancer, cervical cancer in female sexual partners, Chlamydia infection, syphilis and chancroid, phimosis, local infection, and genital dermatoses. Circumcised men have easier lifetime genital hygiene. Depending on how you lump these, there are 7 to 11 proven preventive health benefits of circumcision versus the single risk of surgical complications, which the American Academy of Pediatrics lists as occuring in 0.3% to 0.5% of cases and as usually minor. That is at least a 7:1 benefit-to-risk ratio. How can Dr Andres conclude that the risks outweigh the benefits?
In bringing up the issues of masturbation, female genital surgery, and human rights, Dr Andres is echoing the mantra of the lay anticircumcision groups that dominate the media and the Internet. The masturbation myth is ancient history that no one takes seriously today. The ritual of “female circumcision” consists of removal of the clitoris and labia, comparable to removing the entire male penis and part of the scrotum.
Parents have the right, if not the duty, to agree to a proven preventive health measure for their infants. The proven medical benefits of circumcision far outweigh the risks, and a circumcised newborn boy has a lifetime health advantage.
Footnotes
Competing interests
None declared
References
- 1. Schoen EJ . Ed Schoen, MD, on circumcision: timely information for parents and professionals from America’s #1 expert on circumcision . Berkeley, CA : RDR Books ; 2005 . [Google Scholar]
- 2. Weiss HA , Thomas SL , Munabi SK , Hayes RJ . Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis . Sex Transm Infect . 2006 ; 82 : 101 – 10 . doi: 10.1136/sti.2005.017442. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Castellsagué X , Bosch FX , Muños N , Meijer CJ , Shah KV , de Sanjosé S , et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners . N Engl J Med . 2002 ; 346 : 1105 – 12 . doi: 10.1056/NEJMoa011688. [DOI] [PubMed] [Google Scholar]
- 4. Schoen EJ . Ignoring evidence of circumcision benefits . Pediatrics . 2006 ; 118 : 385 – 7 . doi: 10.1542/peds.2005-2881. [DOI] [PubMed] [Google Scholar]