Male Circumcision, Take 2

Male circumcision is such a controversial topic. Last July, Dr Maurice Bernstein posted about it in an article titled, "Male Circumcision: Should It Now Be A Crime?" and he got inundated with more than 400 reactions. My friend Moof followed it up with "The Male Circumcision Controversy," and she only got 40 strong reactions when she tried to stop it because of rude commenters. Two years ago, I wrote on the same subject, and got the same response, but lost most of the comments because Haloscan disposes comments after some time.

I think there is such controversy because most males fear it. Mutilation is the first word that goes into their heads. The more sound ones quote scientific and medical studies that show that male circumcision is really not that necessary and can be made an optional procedure. Much of the objection and strong response come from Western countries, where most males --- believe it or not --- are uncut, and would prefer to be uncut for the rest of their lives.

In the Philippines, this is not the case. If you are an adult male here and your peers heard you were uncircumcised, you will be the topic of rude jokes --- behind your back, most of the time --- and suffer from too much social embarrassment being called a "supot," or simply, a person who refused to be circumcised. Being a "supot" makes you less of a man here, and in the macho-predominated male Philippine society, that can devastate you. It has also become a tradition here during summertime to have adolescent boys circumcised by an albolaryo (faith healer), if you live in the rural areas, and by top-notch surgeons with proper anesthesia and antibiotic coverage, if you live in the metropolis.

In my previous post two years ago, I asked if male circumcision was still necessary, in the light of the medical studies coming out that shows there is not much benefit doing it, and also to highlight the group of local doctors who are campaigning against the procedure.

Why do men undergo circumcision?

A prospective behavioral study done in Kenya by Kawango Agot of the Impact Research and Development Organisation found that:

1. the most common reason was an already-existing perception among men and especially among their partners that circumcision was more hygienic


2. a high proportion of men coming forward for circumcision had erection problems of one sort or another, and circumcision was seen as a last-resort attempt to correct these

In the Philippines, the second reason would be laughed at. The main reasons here, I think, remain to be: rite of passage or initiation to manhood, basic adherence to tradition, and lastly, to maintain good personal hygiene (not necessarily in that order, ok?)

This time around, I will present some scientific studies and results that show male circumcision can reduce the risk of female-to-male transmission of HIV --- as much as 60 percent, according to one study. These studies come from the scientific abstract pool of the ongoing XVI International Aids Conference in Toronto, Canada.

• Kericho Kenya study - After 1.5 years of follow-up, the overall HIV incidence rate was statistically significantly lower among circumcised men compared to uncircumcised men.


• KAP study in Swaziland - Swaziland has the world´s highest HIV prevalence and a low prevalence of male circumcision. Substantial numbers of men are interested in becoming circumcised, and that this number is likely to further increase if the findings from multiple randomized trials confirm a strong protective effect against HIV


• Is male circumcision protective of HIV infection? - researchers find a protective effect of circumcision in only one of the eight countries for which there are nationally-representative HIV seroprevalence data.


• Male circumcision, religion, and infectious diseases: An ecologic analysis of 118 developing countries - Male circumcision was significantly associated with lower cervical cancer incidence and lower HIV prevalence in sub-Saharan Africa, independent of Muslim and Christian religion.


• Impact of male circumcision on the AIDS epidemic in Africa - while the protective benefit to HIV-negative people will be immediate, the full impact of MC on HIV-related illness and death will not be felt for ten to twenty years


• Circumcision Razor a Preventive tool or a Strategic HIV Vector? - repeated use of un-sterile razors in circumcision is likely to undo the successes that circumcision may play in stopping HIV and may contribute seriously to HIV/AIDS epidemic.


• Potential Benefits of Expanded Male Circumcision Programs in Africa - modest programs offering male circumcision would confer enormous benefits in terms of HIV infections averted


• Prevalence of Circumcision in Men in the US - the prevalence of circumcision is high, but differs by race-ethnicity. The prevalence of circumcision decreased in those born in the 1980s compared to those born in the 1970s.


• Men´s Circumcision Status and Women's HIV Risk - findings suggested that women who partnered with circumcised men may be at lower HIV risk, but the association weakened with adjustment for other risk factors, particularly age and recruitment population


• Role of Male Circumcision in the Prevention of STDs and HIV - results showed that uncircumcised STD-clinic attendees were more prone to genital ulcer diseases (GUD), which is definitely a contributory factor for the spread of HIV infection. Male circumcision can play an important role in the prevention of STDs and HIV disease.