Male Circumcision & Cervical Cancer

Position Statement by the National Organization of Circumcision Information and Resource Centers and Doctors Opposing Circumcision

pro-intact tees & onesies available here

Male circumcision is an operation for which innumerable claims of medical or prophylactic benefit have been advanced through the years.¹ The claims invariably have been proven to be without substance.¹

History

Amongst these is the claim that male circumcision can reduce the incidence of cervical cancer in the female sexual partner, which first appeared in 1954 when a study by Ernst L. Wynder et al. appeared in the medical literature.² Wynder claimed that Jewish women with circumcised partners had fewer cases of cervical cancer than non-Jewish women. The true cause of cervical cancer was unknown at the time so almost any claim could be made. Wynder obtained his information on the circumcision status of the husband by asking the female patient.² Many were unable to provide the circumcision status, so Wynder’s results are suspect.

Jones, Macdonald, and Breslow also studied the etiology of cervical cancer. The report of their findings was published in 1958. In contrast to that of Wynder’s group, this study found no relationship between cervical cancer and the circumcision status of the male partner.

Circumcision of the marital partner has been claimed by some workers to be the most important difference between cervix cancer cases and controls. Our interviews showed that circumcision of the first husband, or partner of longest duration, was equally frequent in cases and controls when the Jewish patients were eliminated from the study (Table III). The data was enough different from previously published reports that our colloborating statisticians rematched cases and controls by various techniques of regrouping. All approaches verified the initial conclusion, namely, that circumcision, or lack of circumcision, was as frequent in partners of cases with cancer as in the partners of controls [emphasis added].³

Wynder then attempted to validate his 1954 study by a second study to determine the accuracy of reported circumcision status.⁴ Wynder, however, found that fully 25% of the men in his study did not know their circumcision status and only 62% of wives accurately knew their husband’s circumcision status. He concluded that only direct examination by a physician was accurate.⁴ Therefore, the results of his 1954 study, which relied on a report by the female patient to assign circumcision status, were cast into doubt.

Stern and Neely also investigated the etiology of cervical cancer using multiple regression analysis:

The discovery rate for cancer of the cervix among non-Jewish women whose marital partners were circumcised was no different from the rate among non-Jewish women with non-circumcised husbands⁵

Circumcision status did not emerge as a factor. Multiple marriages, however, did emerge as a risk factor.⁵

Boyd and Doll addressed the question of the cause of cervical cancer in a study published in 1964.⁶ Boyd and Doll also did not confirm Wynder’s 1954 conclusion that lack of male circumcision was a cause of cervical cancer.² They did point to some factor associated with coitus as a cause of cancer but they were unable to identify that factor.⁶They also discovered that low socioeconomic status was a risk factor for cervical cancer.⁶

The matter rested there until 1965 when a study by Aitken-Swan and Baird was published in the medical literature.⁷ Aitken-Swan and Baird conducted yet another study in which the circumcision status of the husband of patients and controls was determined by physical examination by a physician. Aitken-Swan found that the husband stated his circumcision status correctly in 84 percent of the cases, and the wife’s opinion was correct in 62 percent of the cases. They found 54 percent of husbands were not circumcised, 22 percent were “partially circumcised” and 24 percent were completely circumcised. Aitken-Swan and Baird found that “there was no significant difference in these proportions between patients and controls.”⁷

The year 1970 saw the appearance of two articles that reviewed the alleged health benefits of male neonatal circumcision. Leitch in Australia reviewed the evidence for circumcision’s value in prevention of cervical cancer and concluded that low socio-economic status and low personal hygiene, not lack of circumcision, are the predominant etiological factors.⁸ Noel Preston in the United States independently reviewed the evidence for circumcision’s value in prevention of cervical cancer. He concluded that coitus, not lack of circumcision, is a factor in the etiology of cervical cancer and proposed the use of barrier contraceptives.⁹

Terris, Wilson, and Nelson (1973) undertook a study of the relationship, if any, between cervical cancer and circumcision of the male partner.¹⁰ Terris et al. found no significant difference in the circumcision status of the partners of cervical cancer cases and controls.

Sumithran investigated the incidence of cervical cancer amongst the aboriginal Orang Isli people of Malaysia, who do not practice male circumcision. They have a strict moral code, however, that limits extra-marital sexual activity. The rate of cervical cancer was found to be very low despite the lack of circumcision of the males.¹¹

Megafu investigated the incidence of cervical cancer amongst the Ibo people of Nigeria. The males in that population are ritually circumcised. The rate of cervical cancer was found to be high although the males are circumcised.¹²

Smegma, a natural substance, is normally found under the foreskin in both males and females, human and animal. Reddy investigated smegma to see if it could possibly be carcinogenic, and concluded that smegma is not a carcinogen.¹³

After all of this investigation, it became clear that lack of male circumcision is not a risk factor for cervical cancer, however, the main etiological factor still had not been identified. Whatever the cause, it was associated with low socio-economic status, early and frequent sexual activity, and multiple partners. Cervical cancer was seen to be a sexually transmitted disease. Discovery of the true cause would have to await advances in the science of molecular biology.

The True Cause

Studies carried out in the 1980s reported finding DNA from human papillomavirus (HPV) types 16 and 18 in human cervical cancer cells.¹⁴ Thus it became clear by 1990 that HPV infection, which is contracted by coital activity, is a risk factor for cervical cancer.¹⁵ Other risk factors include malnutrition, smoking, use of oral contraceptives, sexual behavior, infection with sexually transmitted diseases, having a husband whose previous wife had cervical cancer, a husband who has penile cancer,¹⁵ or a husband with genital warts.¹⁶

Later research further confirmed the role of HPV in cervical cancer. Walboomers et al.now state that HPV is found in 99.7 percent of cervical cancers,¹⁷ and HPV infection is seen to be a necessary condition for the development of cervical cancer.¹⁷ Some researchers believe that another factor, in addition to HPV infection, is required to start the cancer process. Smoking is one such factor.^18,19

Health Measures

Walboomers et al. suggest that it is time to supplement or replace the venerable Pap smear with testing for HPV.¹⁷ Also, it now is clear that a woman may put herself at increased risk of cervical cancer by her own behavior.

Recent Developments

The Centre International de Recherche sur le Cancer (CIRC) [International Agency for Research on Cancer (IARC)], with headquarters in Lyon, has been carrying out studies into the risk factors for cervical cancer in several nations for some years. Recently, CIRC doctors prepared three reports. Two were published in The Lancet.^20,21 The third report, however, was not published by The Lancet, but was published in The New England Journal of Medicine.²²

The New England Journal of Medicine gave the article great fanfare with an accompanying editorial²³ and an inaccurate press release that was carried in most major newspapers and electronic media. In actuality, Castellsaqué and colleagues concluded that circumcision was associated with a modest non-significant decrease in cervical cancer in the female partners of circumcised men.²² In the special case of a male partner who was a “high risk” partner—that is, one who had had intercourse before the age of 17, had had six or more sexual partners, or a history of contact with prostitutes—Castellsaqué et al. reported that there was a statistically significant increase in risk to the female partner.²²

Clinicians determined circumcision status by physical examination in Brazil, Thailand, and the Philippine Islands.²² Circumcision status in the other countries apparently was not determined by examination. The authors report an error rate in self-determined circumcision status of 5.3 percent.²² This is substantially lower than that found by Wynder and Licklider⁴ who reported an error rate of 24 percent for self-determination and, therefore, is suspiciously low. The authors did not question their findings although only 41.5 percent of the men were examined.²²

In the end, the authors used self-reported status, not status determined by physical examination. This is surprising because several studies have shown self-reported circumcision status to be highly unreliable.^4,7,25 This flaw alone may be enough to invalidate the study.

Clinicians detected HPV in the males by taking swabs from the distal urethra and the coronal sulcus.²² It is difficult to understand how or why this could be done without simultaneously noting circumcision status, but that apparently is the case.

The report combines data from five previous studies that were carried out in five different countries,²² which is spurious because it attempts to compare data from widely diverse regions of the earth and from population groups with different levels of HPV infection, different levels of cigarette smoking, different sexual habits, and other differences. Poland quite accurately observes that circumcision does not occur randomly.¹⁶ This is true in the present study because 65 percent of the circumcised men were concentrated in the Philippine Islands, where circumcision of male children is an engrained social practice. This study did not consider variations in incidence of HPV infection amongst the various populations studied, nor does it consider the incidence of cigarette smoking, use of oral contraceptives, and parity amongst the female patients and controls and their variance between population groups.

Castellsaqué et al. only considered women who reported that they had had only one sexual partner. Since, in some cultures, virginity at marriage is highly prized, women may have been unwilling to admit to a previous sexual partner. The study focuses on the present partners of women with cervical cancer. Cervical cancer has a long incubation period that may span several decades.²³ Many women in the study could have become infected with HPV by a previous partner earlier in their sexually active years. Aitken-Swan and Baird⁷ and Adami and Trichopoulos²³ note that extra-marital partners cannot be ruled out.

Castellsaqué et al. report that intact men have a greater rate of HPV infection.²² Aynaud et al., however, found that there is no significant difference in HPV infection between circumcised and intact males.^26,27

Castellsaqué et al. studied the HPV infection incidence of men whose wives were patients with cervical cancer.²² It is highly probable that at least some of these men were infected by their wives.²⁷ Apparently, the possibility that men were infected by their wives was not considered. This could seriously distort the outcome of the study.

Castellsaqué et al. made “adjustments” to their data to get to their conclusion.²²However, they did not publish the factors used to make these adjustments, so their validity cannot be independently verified.

The three CIRC articles used “unconditional logistic regression” statistical analysis to control for confounding factors.^20-22 The circumcision study included the male factors of level of education, age of first sexual intercourse, lifetime number of sexual partners, and self-reported frequency of genital washing; and female factors of age, lifetime number of sexual partners, and age of first sexual intercourse. Factors of smoking, parity, and use of oral contraceptives were not controlled. Skegg noted that

“Logistic regression analyses can become unstable when there is adjustment for many variables in relation to the number of events.”²⁸

The failure of Castellsaqué et al. to control for parity and use of oral contraceptives²² is astonishing because CIRC simultaneously published two companion studies of those factors.^20,21

Scientific studies of etiology of disease must adequately control for known confounding factors or their results are inconclusive. It now appears that, although HPV infection is a necessary condition for the development of ano-genital cancers, including cervical cancer, some other factor may be necessary to trigger the development of neoplasia. Known factors include low socio-economic status,⁷ smoking,^18,19 use of hormonal contraceptives,²⁰ and multiparity.²¹ The study by Castellsaqué et al. fails to control for these factors.²²

As noted above, Castellsaqué et al. found a non-significant association of male circumcision with a decline in the risk of cervical cancer.²² However, when they considered only “high-risk” males, they reported a significant reduction in the risk of cervical cancer.²²

Nevertheless, Castellsaqué et al. conclude that more study is needed.²² They decline to recommend routine non-therapeutic circumcision.²²

Conclusion

The findings of Castellsaqué’s team in regard to self-determination of circumcision status is sharply at variance with a number of studies that were carried out in the 1950s and 1960s.^3,4,7 Their finding that circumcision status generally is not significant confirms previous findings.^5-7,10-12 Their finding, however, that non-circumcised males who are “high-risk” pose an additional danger to their marital partners greater than circumcised “high-risk” males is new. There are many methodological flaws in their study, so the study must be regarded as non-conclusive. The weight of medical evidence shows that male circumcision is not of value in preventing HPV infection in women. The Castellsaqué study does little or nothing to change that. No change in NOCIRC’s longstanding evidence-based position that male circumcision is not of value in preventing cervical cancer can be made on the basis of the slight and dubious evidence provided by the Castellsague study.

Cervical cancer is caused by a sexually transmitted virus, and it may be activated by certain factors that are under the control of the individual. Early sexual activity, multiple sexual partners, and failure to use condoms increase the risk of contracting HPV infection. Smoking, use of oral contraceptives, and multiple numbers of births also increase the risk of cervical cancer. Women have a duty to protect themselves by healthful behavior from cervical cancer. Education is needed to enable women to better protect themselves from HPV infection.

The medical profession also has a duty to make regular screening by pap smears³⁰and/or the newer, better HPV test³¹ available to women everywhere. Wiping with vinegar turns HPV infected tissue white. The cervix may be wiped with vinegar and then visually inspected to determine if HPV infection exists.³² A better or less expensive test could hardly be imagined.

Male circumcision does not insure protection from HPV infection.^6-14 The possible reduction in risk is slight at best. Even if it were to be proven effective, the difficulties of instituting worldwide mass male circumcision seem insurmountable.

There are also legal and ethical obstacles. HPV infection occurs in sexually active older persons. It is not a disease of childhood. Childhood circumcision should be used only for the very rare instances of penile maladies in children that are not responsive to conservative treatment. With regard to prevention of adult diseases, the decision should be postponed until the young man may make a decision for himself.^32,33

Male circumcision excises irreplaceable functioning human tissue from the genital organs, so it violates a person’s legal right to bodily integrity. Circumcision would not be performed for the benefit of the individual but for the benefit of some other person. Legally, parents actually lack the power to consent to non-therapeutic excision of human tissue from children.^34-36 Consent is necessary before a circumcision can be performed. This may be difficult to obtain even in the case of adult males. The foreskin is erogenous tissue.³⁷ Adult males may be unwilling to give up documented sexual pleasure^38,39 in the slight hope of reducing incidence of HPV infection in others.

Along with education, and the introduction of HPV testing, the best hope of bringing cervical cancer under control may be introduction of a vaccine.^40,41 HPV vaccine is now in stage 3 trials.⁴²

References

1. Gollaher DL. From ritual to science: the medical transformation of circumcision in america. Journal of Social History 1994;28(1):5-36.
2. Wynder EL, Cornfield J, Schroff PD, Doraiswami KR. A study of environmental factors in carcinoma of the cervix. Am J Obstet Gynecol 1954;68:1016-52.
3. Jones EG, MacDonald I, Breslow L. A study of epidemiologic factors in carcinoma of the uterine cervix. Am J Obstet Gynecol 1958;76(1):1-10.
4. Wynder EL, Licklider SD. The question of circumcision. Cancer 1960;13(3):442-445.
5. Stern E, Neely PM. Cancer of the cervix in reference to circumcision and marital history. J Am Med Womens Assoc 1962;17(9):739-70.
6. Boyd JT, Doll R. A study of the aetiology of carcinoma of the cervix uteri. Brit J Cancer 1964;XVIII(3):419-28.
7. Aitken-Swan J, Baird D. Circumcision and cancer of the cervix. Brit J Cancer 1965; XIX(2):217-227.
8. Leitch IOW. Circumcision - a continuing enigma. Aust Paediatr J 1970;6:59-65.
9. Preston EN. Whither the foreskin. JAMA 1970; 213(11):1853-1858.
10. Terris M, Wilson F, Nelson JH. Relation of circumcision to cancer of the cervix. Am J Obstet Gynecol 1973;117(8):1056-66.
11. Sumithran E. Rarity of cancer of the cervix in the Malaysian Orang Asli despite the presence of known risk factors. Cancer 1977;39(4):1570-2.
12. Megafu U. Cancer of the genital tract among the Ibo women in Nigeria. Cancer1979;44(5):1875-8.
13. Reddy DG, Baruah IK. Carcinogenic action of human smegma. Archives of Pathology 1963;75(4):414-420.
14. Reeves WC, Rawls WE, Brinton LA. Epidemiology of genital papillomaviruses and cervical cancer. Rev Infect Dis 1989;11(3):426-39.
15. Poland RL. The question of routine neonatal circumcision. N Eng J Med 1990; 322:1312-1315.
16. Kjaer SK, de Villiers EM, Dahl C, et al. Case-control study of risk factors for cervical neoplasia in Denmark. I: Role of the "male factor" in women with one lifetime sexual partner. Int J Cancer 1991;48(1):39-44.
17. Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999;189(1):12-9.
18. Ho GY, Kadish AS, Burk RD, et al. HPV 16 and cigarette smoking as risk factors for high-grade cervical intra-epithelial neoplasia. Int J Cancer 1998;78(3):281-5.
19. Wyatt SW, Lancaster M, Bottorff D, Ross F. History of tobacco use among Kentucky women diagnosed with invasive cervical cancer: 1997-1998. J Ky Med Assoc2001;99(12):537-9.
20. Moreno V, Bosch FX, Muñoz N, et al. Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control studyPDF. Lancet 2002; 359:1085-92.
21. Muñoz N, Fransceschi, Bossetti C, et al. Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control studyPDF. Lancet 2002; 359:1093-101.
22. Castellsaqué X, Bosch FX, Muñoz, et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. New Engl J Med2002;346(15):1105-12.
23. Adami H, Trichopoulos. Cervical cancer and the elusive male factor. New Engl J Med 2002; 346(15):1160-1.
24. Dunn Jr JE, Buell P. Association of cervical cancer with circumcision of sexual partner. J Nat Cancer Inst 1959;22(4):749-64.
25. Aynaud O, Ionesco M, Barrasso R. Penile intraepithelial neoplasia. Specific clinical features correlate with histologic and virologic findings. Cancer 1994;74(6):1762-7.
26. Aynaud O, Piron D, Bijaoui G, Casanova JM. Developmental factors of urethral human papillomavirus lesions: correlation with circumcision. BJU Int 1999;84(1):57-60.
27. Barrasso R, De Brux J, Croissant O, et al. High prevalence of papillomavirus-associated penile intraepithelial neoplasia in sexual partners of women with cervical intraepithelial neoplasia. N Engl J Med 1987;317(15):916-23.
28. Skegg, DCG. Oral contraceptives, parity, and cervical cancerPDF. Lancet2002;359:1080-2 [citing Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996;12:1373-79].
29. Austoker J. Cancer Prevention in Primary Care: Screening for cervical cancer. BMJ1994;309:241-248.
30. Lytwyn A, Sellors JW, Mahony JB, et al. Comparison of human papillomavirus DNA testing and repeat Papanicolaou test in women with low-grade cervical cytologic abnormalities: a randomized trial. CMAJ 2000; 163 (6):701-7.
31. Kmietowicz Z. Vinegar and visual inspection used to detect cervical cancer. BMJ1999;318:757.
32. Bollgren I, Winberg J. Letter. Acta Paediatrica Scandinavia 1991; 80: 575-7.
33. American Academy of Pediatrics Committee on Bioethics. Informed consent, parental permission, and assent in pediatric practice. Pediatrics 1995;95(2):314-317.
34. Somerville MA. Therapeutic and Non-Therapeutic Medical Procedures -- What are the Distinctions? Health Law in Canada 1981;2(4):85-90.
35. Gregory J Boyle, J Steven Svoboda, Christopher P Price, J Neville Turner.Circumcision of Healthy Boys: Criminal Assault? 7 J Law Med 301 (2000).
36. J. Steven Svoboda, Robert S. Van Howe, James G. Dwyer. Informed Consent for Neonatal Circumcision: An Ethical and Legal Conundrum. 17 J Contemporary Health Law Policy 61 (2000).
37. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291-295.
38. Pang MG, Kim DS. Extraordinarily high rates of male circumcision in South Korea: history and underlying causes. BJU Int 2002;89:48-54.
39. Fink KS, Carson CC, DeVellis RF. Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction. J Urol2002;167(5):2113-2116.
40. Josefson D. Vaccine against cervical cancer virus passes phase 1 trials. BMJ2001;322:510.
41. Franco EL, Duarte-Franco E, Ferenczy A. Cervical cancer: epidemiology, prevention and the role of human papillomavirus infection. CMAJ 2001;164(7):1017-25.
42. Lehtinen M, Dillner J. Preventive human papillomavirus vaccination. Sex Transm Inf2002;78:4-6.

Cervical Cancer & Circumcision

A research summary brief by the Circumcision Information and Resource Pages
[Note: DrMomma.org does not advocate for the use of Gardasil (an HPV vaccine) in minor aged girls.]

In February 1996, representatives of the American Cancer Society stated in a letter to the American Academy of Pediatrics:

The American Cancer Society does not consider routine circumcision to be a valid or effective measure to prevent [genital] cancers. Research suggesting a pattern in the circumcision status of partners of women with cervical cancer is methodologically flawed, outdated and has not been taken seriously in the medical community for decades.

The hypothesis that cervical cancer is caused by smegma of the male foreskin was invented in 1954 by Wynder. His study was found to be invalid, because most of the cervical cancer patients in his study incorrectly reported that their husbands were intact. These women had no idea whether their husbands were circumcised or not. They gave the answer they thought the doctor wanted to hear. Wynder later recognized and admitted the error in 1960. (1) This hypothesis was formally and scientifically disproven in 1962 by Stern. (2)

Stern and Neely examined some of the early research on this subject (2):

Since the recommendation had been made that circumcision should be used as a preventative measure against cancer of the cervix, we sought further confirmation of this hypothesis. An almost ideal population was that of the well women attending a cancer detection facility, where the population was split almost equally between women whose husbands were circumcised and those whose husbands were not. The discovery rate for cancer of the cervix among non-Jewish women whose marital partners were circumcised was no different from the rate among non-Jewish women with intact husbands. Further, the use of a sheath contraceptive by the marital partner, which has an effect equivalent to circumcision in that the cervix is protected from contact with the smegma, was found not to be associated with rate differences for cancer of the cervix.

This study, more than the others, exposed the myth that the presence of a foreskin or smegma had any association with the incidence of cancer of the cervix. (See also 3-5)

Ho et al. (6) have established that co-factors such as cigarette smoking may be necessary to advance HPV infected cervical epithelial cells toward a cancerous condition. Ho et al. (3) have also suggested that high levels of antioxidants in the blood serum may provide some protection, although more study is needed.

Walboomers reported that HPV DNA is found in more than 99.7 percent of cervical cancer cells in 1999. HPV infection is a necessary condition for cervical cancer. (7)

The known etiologies of cervical cancer are:

*early onset of sexual activity

*number of sexual partners

*smoking

*the presence of HPV (8)

Based on currently available evidence, it would be mistaken to suggest an association between cervical cancer and the presence of the foreskin in the male partner.

The New England Journal of Medicine published an article by Castelsagué and others in 2002. This article purported to show that circumcision reduced the risk of infection to the wives of circumcised men. This article has experienced severe and unrelenting criticism due to numerous methodological flaws, its conflict with other published research, and other research by the same authors that showed that different types of HPV were found in husbands and wives. (9-14) Editorial problems previously had been reported at The New England Journal of Medicine. The publication of this flawed article may have been the result of those editorial problems.

See the National Organization of Circumcision Information and Resource Centers position statement for more information on cervical cancer and circumcision. (12)

Menczer reports that genetics, not male circumcision, limits the incidence of cervical cancer in Jewish women. (15) The argument that Jewish women have a lower incidence of cervical cancer because their husbands are circumcised appears to be destroyed by this finding.

Vaccine.

Infection with human papillomavirus (HPV) is a necessary condition for the formation of cervical cancer. (7) A bi-valent vaccine that offers substantial protection from infection with HPV has been successfully tested. (16) It is expected that approval of this vaccine will receive approval from regulatory authorities and that when it will greatly reduce the incidence of HPV infection, cervical cancer, and death when vaccination against HPV becomes widespread. (17) Male circumcision has never been proved to offer any real protection against HPV infection in the female partner, but even if it did, it still would not be necessary because the vaccine will offer protection. (18)

References

1) Ernest L. Wynder; Samuel D. Licklider. "The Question of Circumcision," Cancer, vol. 13, no. 3 (May-June 1960): pp. 442-445.


2) Elizabeth Stern; Peter M. Neely. "Cancer of the Cervix in Reference to Circumcision and Marital History," Journal of the American Medical Women's Association, vol. 17, no. 9 (September 1962): pp. 739-740.


3) American Cancer Society. Dispelling Miscommunications: Statement on Penile Cancer. ACS News Today, Atlanta, (1998).


4) Ho GY, Kadish AS, Burk RD, et al. HPV 16 and cigarette smoking as risk factors for high-grade cervical intra-epithelial neoplasia. Int J Cancer 1998;78(3):281-5.


5) Ho GY, Palan PR, Basu J, et al. Viral characteristics of human papillomavirus infection and antioxidant levels as risk factors for cervical dysplasia . Int J Cancer 1998;78(5):594-9.


6) Cold CJ, Storms MR, Van Howe RS. Carcinoma in situ of the penis in a 76-year-old circumcised man. J Fam Pract 44(4), April 1997, pp. 407-410. [Demonstrates: Circumcision has no statistically-significant effect on the rate of penile cancer, when Maden's data are properly adjusted for age.]


7) Maiche AG. Epidemiological aspects of cancer of the penis in Finland. Eur J Cancer Prev 1992;1(2):153-8.


8) Brinton LA, Reeves WC, Brenes MM, et al. The male factor in the etiology of cervical cancer among sexually monogamous women. Int J Cancer 1989;44(2):199-203.


9) Dillner J, von Krogh G, Horenblas S, Meijer CJ. Etiology of squamous cell carcinoma of the penis. Scand J Urol Nephrol Suppl 2000;(205):189-93.


10) Wyatt SW, Lancaster M, Bottorff D, Ross F. History of tobacco use among Kentucky women diagnosed with invasive cervical cancer: 1997-1998. J Ky Med Assoc 2001;99(12):537-9.


11) Oliver JC, Oliver RT, Ballard RC. Influence of circumcision and sexual behaviour on PSA levels in patients attending a sexually transmitted disease (STD) clinic. Prostate Cancer Prostatic Dis 2001:4(4):228-31.


12) Milos M. NEJM Cervical Cancer Study Has Fatal Flaws. BMJ 2002 Rapid Response Letter, 27 April 2002.


13) Travis J. Misuse of the medical literature. BMJ 2002 Rapid Response Letter, 29 April 2002.


14) Comments on Male Circumcision, Penile Human Papillomavirus Infection, and Cervical Cancer. New Engl J Med 2002;47(18):1448.


15) National Organization of Circumcision Information Resource Centers. Position Statement on the Use of Male Circumcision to Prevent Cervical Cancer. San Anselmo: National Organization of Circumcision Information Resource Centers, 2002.


16) Menczer J. The low incidence of cervical cancer in Jewish women: Has the puzzle finally been solved? IMAJ 2004;5:120-3.


17) Harper DM, Franco EL, Wheeler C, et al. Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial. Lancet 2004;364(9447):1757-65.


18) Crum C, Jones C, Kirkpatrick P. Fresh from the pipeline: Quadrivalent human papillomavirus recombinant vaccine. Nat Rev Drug Discov 2006;5:629-630.

Sandra Bullock Cuts Her Newly Adopted Son

A peaceful parenting reader passed along this Jezebel article today and we were hoping for a very different take than the news highlighted in the May special edition of People magazine.

Sandra Bullock is pictured on the front page with her newly adopted (from New Orleans) son, Louis, fully clad in an African-style necklace made by Sunny (her stepdaughter). According to Bullock, the necklace "represents all the kids." She continues [emphasis mine]:

I want him to know no limits on where he can go. I want him to experience all culture, nationalities, countries and people like I did. I want his mind to be open and free. We were raised that we are all the same. No one greater, smarter, more powerful. We are all equal. I would love for Louis to know that . He has a big, beautiful, diverse family. As long as he knows he is loved and protected and given the opportunity to touch and see everything, then I will have done my job as a momma.

Bullock seems hard pressed to stress her inclusiveness of all people, all culture, all nations, all religions -- especially after the recent media hoopla surrounding her husband, Jesse James, and his 'Nazi' photo from US Weekly that was splashed across pop culture headlines.

Bullock, who is not Jewish, explains to People:

The photo shocked me and made me sad. This is not the man I married. This was stupid, this was ignorant. Racism, antisemitism, sexism, homophobia, anything 'Nazi,' and a boatload of other things, have no place in my life. And the man I married felt the same. This is something I hope Jesse will address one day, but it is not the world I live in, or have ever lived in, and have any tolerance for.

So how does this tie into peaceful parenting and the fact that genital autonomy advocates have just lost any ounce of admiration ever held for Sandra Bullock? She continues to describe what was done to her adopted son [emphasis mine]:

A friend of ours helped arrange for a bris [Jewish genital cutting ceremony] at our house, because we couldn't go [to a hospital for surgery]. The mohel came to us. You have never seen adults more panicked about what was about to happen to their son, but the celebration and the amount of love we felt and the pride in the little man whom we love so, so much became the greatest moment I have ever had in my life.

Really?!

The GREATEST moment you have ever had in your entire life was the moment your new son had a 1/3 his penis painfully amputated? Violating HIS basic human right to bodily integrity? Forever impacting HIS development and sexuality? And not because you were naively misguided by some societal myth, but because you needed to dispel those nasty 'Nazi' rumors flying around overhead? Hmmm...

Maybe there is a reason his birth mother protected him from such things.

Note: Peaceful Parenting is 100% fully and completely in support of the adoption of babies who do not have mothers to care for them, and to loving, protective parents who will provide for and nurture them. We are not in support of these parents then cutting their new children. 

Update: It appears Facebook users have started a page in response to this Hollywood event.

For further information on the prepuce organ and circumcision, see resources at: Are You Fully Informed?

2018 Update

Sandra Bullock jokes about using the foreskin of "Korean babies" on her face in what she calls a "penis facial." Starts at Minute 2:45 below: 

Death from Circumcision Equals SIDS Cases for U.S. Baby Boys

Report from the International Coalition for Genital Integrity.

 

A new study published yesterday in Thymos: Journal of Boyhood Studies estimates that more than 100 baby boys die from circumcision complications each year, including from anesthesia reaction, stroke, hemorrhage, and infection. Because infant circumcision is elective, all of these deaths are avoidable.

The International Coalition for Genital Integrity applauds that, for the first time, a rational attempt has been made to estimate the scale of the problem, and is simultaneously appalled by how many baby boys needlessly die each year in the United States.

The study concluded: “These boys died because physicians have been either complicit or duplicitous, and because parents ignorantly said ‘Yes,’ or lacked the courage to say ‘No.’” And called the deaths “an unrecognized sacrifice of innocents.”

The study found that approximately 117 neonatal (first 28 days after birth) circumcision-related deaths occur annually in the United States, one out of every 77 male neonatal deaths. The study also identified reasons why accurate data on these deaths are not available, some of the obstacles to preventing these deaths, and some solutions to overcome them.

Previous studies estimated the death rate as low as two per year to as many as 230. The study collected data from hospital records and government sources to attempt to provide a more accurate magnitude of the problem.

To put this in perspective, about 44 neonatal boys die each year from suffocation, and 8 from auto accidents. About 115 neonatal boys die annually from SIDS, nearly the same as from circumcision.

Because of the inadequacies of the death-certificate system and the apparent lack of investigation, it is easy to see how the medical system could either unwittingly or intentionally obscure the true cause of these deaths.

To hospital residents, the birth of a boy is celebrated as an opportunity to practice surgery, but a resident’s first surgery upon a live human being does not always go as planned.

Many factors combine to explain the lack of reliable mortality data or why this problem has not received more attention. To ignore or hide the likely cause of so many infant deaths for so many years requires a significant amount of denial or obfuscation—by: parents, physicians, hospital staff, insurers, medical associations, and legislators.

Boys have been lost to circumcision in the United States from the time it was first practiced to the present day, for a variety of reasons, as the following examples illustrate. The first two, known reported circumcision-related deaths were in New York City, in 1856 and 1858, where circumcision was introduced.



Additional information about death from circumcision can be found here.

Books, research, and websites on the prepuce (foreskin), intact care and circumcision at: Are You Fully Informed?

~~~~

Induced Lactation

The following is an excerpt from the excellent resource book, The Breastfeeding Mother's Guide to Making More Milk, by Diana West, IBCLC, and Lisa Marasco, M.A., IBCLC. If you work with new mothers and/or breastfeeding women, or if you are a nursing mom concerned about your supply now or in the future, pick up a copy of Making More Milk today.


Induced lactation is the process of creating a milk supply for a child you have not birthed. With a long historical tradition in native societies, it is becoming more common as women learn that it is possible. (1, 2) For both adoptive mothers and mothers of surrogate babies, breastfeeding is about more than the milk-it's a way to connect at a deeper level with your new baby and contribute to his growth beyond the pregnancy. Although it will require time, motivation, perseverance, tenacity, and patience, breastfeeding your baby can be tremendously rewarding.

As with relactation, the younger the baby, the more likely he is to latch onto the breast easily. A baby older than three months is liable to have more difficulty learning what to do than a newborn. All babies nurse more willingly when there is more milk, so it helps to do all you can to maximize your production. Achieving a full supply may be possible provided there aren't underlying problems such as hormonal dysfunctions or underdeveloped breast tissue. If you struggled with infertility in particular, there may be a hormonal problem that could limit your milk-making capability. However, most mothers can make at least some milk, and the total amount of milk need not interfere with a satisfying breastfeeding relationship. While you won't produce true colostrum, the milk you make will be the same quality as a birth mother's mature milk. (3)

If you're currently nursing but want to breastfeed a new baby you did not birth, you may not be able to increase milk production enough to meet the new baby's needs fully because you are in the autumn season of lactation now. But it's always worth trying because your new baby will benefit from whatever extra you can make.

Methods of Inducing Milk Production

In traditional cultures, women have successfully stimulated milk production just by putting the baby to the breast very frequently. Our Western approach relies more often on breast pump technology, but pumping is an imperfect way to induce milk production because it is cold, mechanical, and vacuum-centered only. Plus, it takes time to become comfortable and proficient at pumping. Even birth mothers with excellent milk production aren't always able to pump effectively, especially in the beginning. A nursing baby adds a positive emotional element; not only does suckling stimulate milk ejection, but the psychological effect of baby's smell, sight, and sounds triggers additional oxytocin releases that a pump can not. If possible, combining pumping with nursing baby using an at-breast supplementer can provide the best of both worlds. Adding galactogogue medications and/or herbs can result in significantly higher milk production.


Basic Pumping Protocol for Induced Lactation

1. Two to four weeks (or more) prior to the baby's arrival, begin manual massage of nipples and breasts for ten minutes eight to ten times per day for two weeks.

2. After two weeks, begin double pumping with a hospital grade pump for ten to fifteen minutes eight to ten times per day. If you find pumping without a flow of milk to be uncomfortable, try putting a bit of breastfeeding-grade lanolin on your nipples or lubricate the funnel with a bit of vegetable or olive oil before pumping.

3. When baby arrives, use an at-breast supplementer to provide feedings at the breast (pictured above). [Note: Commonly used at-breast supplementers include the Lact-Aid (preferred by most mothers interviewed by DrMomma.org) and the Supplemental Nursing System. Find human milk donations to use in the supplementer through a variety of resources.] Pump after feedings or several times per day, as time permits (this is also called "Power Pumping"). Keep a close watch on baby's weight gain to ensure that he is getting enough nutrition.

4. As your breasts begin to feel full, heavy, and slightly tender, see if baby will nurse at the· breast without supplementation for the first few minutes of the feeding ifhe is willing. Continue to watch diapers or track weight gain.

5. As long as hunger cues aren't frantic and weight gain is sufficient, gradually decrease either the amount of milk in the supplementer or the length of time the milk is allowed to flow from the supplementer during the feeding. Eventually, you may reach a point where you can no longer decrease the amount of supplement you offer without leaving baby hungry. That is the amount that will be needed for now, and maybe for the long term.

In the beginning, you have only your standby skeletal crew of lactocytes to start up milk production. Be patient. Induced lactation really is more like building a milk factory by hand from bricks and mortar instead of having the construction company, pregnancy, do it with all their specialized parts and equipment. Not as fancy and takes longer, but sooner or later new workers and assembly lines will slowly start to kick in, and your production will pick up.

Hormonal Simulation

Hormonal protocols for inducing lactation attempt to artificially simulate a pregnancy in order to build a milk factory. The amount of hormones used is less than what is normally produced during pregnancy. A birth control pill containing estrogen and progesterone is taken for a specific amount of time in order to stimulate the growth of more milk-making breast tissue. Then a prolactin-stimulating medication is introduced. Finally, pumping is begun to remove milk and further stimulate milk production.

In most cases, hormonal protocols result in more milk production than simple pumping. The more time you spend in the pregnancy-mimicking phase, the more milk-making tissue will be created. Starting at least four months before baby is expected to arrive produces the best results. You can initiate a protocol even after your baby arrives, but the shorter the lead time, the less you should expect to produce.

Milk does not come in until the pumping phase and first appears as clear drops that eventually become more opaque and white in color. As the milk volume increases, you may begin to see small sprays that eventually become streams of milk. The amount of time it takes to reach the streaming phase varies from mother to mother and depends on the type of protocol that she follows. It may take days, weeks, or months for milk production to begin. You'll know your body is gearing up to make milk when your breasts increase at least one bra cup size and feel full, heavy, and slightly tender. If you don't experience at least some tenderness within fifteen days, it may be necessary to increase your progesterone intake.

Because hormonal protocols entail the use of prescription drugs, it is essential to consult a physician. Present the entire protocol and explain that the birth control pill is not being used as a contraceptive but rather to develop lactation tissue. The medication can be started at any point in the menstrual cycle because the purpose is to simulate a pregnancy rather than prevent one.

Mothers who have blood clotting problems (a history of thrombosis), heart conditions, or severe blood pressure problems (hypertension) should not use hormonal protocols. Nor should mothers who wish to tandem nurse, because the existing milk supply will be reduced initially.

The Newman-Goldfarb protocols were developed by Lenore Goldfarb, B.Comm., B.Sc., IBCLC, in consultation with Dr. Jack Newman, as a result of her personal experience and subsequent work with other mothers, and are still evolving. They represent a new strategy that has not been formally tested in clinical trials but has been described theoretically by Dr. Peter Hartmann and his research group in Australia. (4) Many mothers have found the protocols to be effective. Similar but more limited protocols using medications to stimulate lactation hormones have been tested and found to be effective as well. (5, 6, 7, 8)

There are several versions of the Newman-Goldfarb protocol to accommodate the varying amounts of time available before baby arrives and the mother's hormonal situation. Mothers who prepare for six months or more by following the "regular protocol" are more likely to induce a full milk supply, while mothers who do so for fewer than six months and follow the "accelerated protocol" are often able to induce a 50% supply. Mothers who follow the "menopause protocol" may produce a 25% or less milk supply." Since these protocols are still evolving, visit the Ask Lenore website for specific details and more information.


For further information about induced lactation:

The Adoptive Breastfeeding Resource Website

Dr. Jack Newman & Enith Kernerman: Breastfeeding Your Adoptive Baby or Baby Born by Surrogate

Adoption.com's section on breastfeeding

One woman's experience: Breastfeeding My Adopted Child

Dr. Jack Newman Lactation Aid (homemade instructions)

Ask your local La Leche League leaders and/or lactation consultants for names of mothers who have nursed their adopted children.

Check out the book, Breastfeeding the Adopted Baby, by Debra Peterson.

Many of the same techniques used to trigger milk supply for working mothers who must be away from their babies all day, every day, are the same gentle parenting measures that will help adoptive moms increase supply as well. For further information on these natural-hormone boosting ideas, see: Balancing Breastfeeding: When Moms Must Work.

For breastmilk donations, look into a variety of resources available.

Additional breastfeeding resources can be found here.

References

1) Jelliffe, D & Jelliffe, E. Non-puerperal induced lactation. Pediatrics. 1972; 50(1):170-1.

2) Auerbach, K & Avery, J. Induced Lactation: A study of adoptive nursing by 240 women. Am J Dis Child. 1981; 135(4):340-3.

3) Kulski, J., Hartmann, P., Saint, W., Giles, P., Gutteridge, D. Changes in the milk composition of nonpuerperal women. Am J Obstet Gynecol. 1981;139(5):597-604.

4) Hartmann, P., Atwood, C., Cox, D., Daly, S. Endocrine and autocrine strategies for the control of lactation in women and sows. In: Hannah Research Institute Conference on Intercellular Signaling in the Mammary Gland. New York: Plenum Press; 1994:203-25.

5) Bryant C. Nursing the adopted infant. J Am Board Fam Med. 2006;19(4):374-9.

6) Biervliet, F., Maguiness, S., Hay, D., Killick, S., Atkin, S. Induction of lactation in the intended mother of a surrogate pregnancy: case report. Hum Reprod. 2001;16(3):581-3.

7) Petraglia, F., De Leo, V., Sardelli, S., Pieroni, M., D'Antona, N., Genazzani, A. Domperidone in defective and insufficient lactation. Eur J Obstet Gynecol Reprod Biol. 1985;19(5):281-7.

8) Nemba, K. Induced lactation: a study of 37 non-puerperal mothers. J Trop Pediatr. 1994;40(4):240-2.

Doctors Reject Circumcision As HIV Prevention

An international statement by Doctors Opposing Circumcision


Introduction.

There have been a number of exaggerated claims made for the alleged efficacy of male circumcision in preventing female-to-male infection with the human immunodeficiency virus (HIV) This statement examines those claims and puts them in proper perspective Cultural bias.When studying circumcision, cultural bias must be considered:

Circumcision practices are largely culturally determined and as a result there are strong beliefs and opinions surrounding its practice. It is important to acknowledge that researchers’ personal biases and the dominant circumcision practices of their respective countries may influence their interpretation of findings.

More than 50 percent of infant boys in North America still are subjected to non-therapeutic circumcision. There is a well known cultural bias in favor of circumcision in North America, which may influence doctors at the National Institutes of Health as well as those directing the studies. Doctors conducting these studies may not possess the necessary attributes of neutrality and objectivity. Ideally, researchers from circumcising cultures, circumcised themselves, would recuse themselves from considering the data.

The United States has the highest rate of HIV infection and the highest rate of male circumcision in the industrialized world. Male circumcision, therefore, cannot reasonably be thought to prevent HIV infection.

There are many methods of HIV transmission, including:
* mother-to-child infection,
* transfusion of tainted blood
* infection with non-sterile needles used in health care,
* infection by homosexual and heterosexual anal intercourse,
* infection by needle sharing to inject illegal drugs,
* traditional African scarring practices,
* tribal (ritual) circumcision,
* female circumcision,
* male-to-female heterosexual transmission, and female-to-male heterosexual transmission

Male circumcision might only reduce infection by the last method, so the overall influence on the HIV epidemic in Africa, at best, would be likely to be slight, however, the risk of male-to-female transmission is much higher than that of female-to-male transmission, so a means of partial prevention that targets only the second means at the expense of the first would be counterproductive.

There is no indication that male circumcision would protect women. Viral load is the chief predictor of the risk of HIV transmission. Malaria infection increases viral loads, so enhances infectivity. Male circumcision would not reduce viral loads and would not reduce infectivity to the female partner.

Condom usage.

Condoms have been shown to be effective at preventing HIV transmission. The use of condoms is necessary to prevent infection whether or not the male is circumcised.

Effect on condom use.

Male circumcision removes nerves from the penis and causes significant loss of sexual sensitivity and function. For this reason, many circumcised men are reluctant to use condoms. A program of mass circumcision may reduce condom usage and have an adverse effect on the overall HIV infection incidence.

Vaginal abrasion.

“Dry sex” is practiced in sub-Saharan Africa. Women place various drying agents in their vagina to absorb vaginal lubrication. This practice may itself cause abrasion and fissures that provide a portal for the HIV virus. Circumcision also reduces vaginal lubrication, curtails the gliding action, increases friction and vaginal abrasions, so, when combined with “dry sex”, may increase the risk of female HIV infection through abrasions. The combination of dry sex and circumcision appears to sharply increase the risk of male-to-female transmission of HIV. A recent preliminary report found that the female partners of circumcised males experience higher rates of HIV infection.

Relevance to developed nations.

These African studies were carried out in HIV “hot-spots” places where the incidence of HIV infection in the population is high and where the method of transmission is heterosexual intercourse. They are not relevant to developed nations, such as the United States, where the incidence of infection is low and where the predominant methods of transmission are through homosexual anal intercourse or through needle-sharing by drug addicts.

Circumcision of children.

These RCTs, which studied HIV transmission among adults in Africa, cannot be used to support the practice of non-therapeutic circumcision of children. Infant boys do not engage in sexual intercourse so they are not subject to sexually-transmitted HIV infection. They, however, are subject to various complications of circumcision, including infection through an open circumcision wound with various pathogens, such as deadly CA-MRSA. Other risks include hemorrhage, exsanguination, and death; and various surgical accidents, including urethral fistula, penile denudation, and traumatic amputation of the glans penis. By the time today?s newborn boys became sexually active, HIV vaccine is likely to be available so circumcision today, in an attempt to prevent HIV infection in the distant future, is contraindicated.

The high infant mortality rate in the African countries hardest hit by the HIV epidemic means many children will die before they become sexually active, further vitiating any protective effect of infant circumcision. The time, effort and money would be better spent on community health measures that would preserve their lives and those of their parents.

Because of their minority, children cannot grant consent, so any non-therapeutic circumcision of a child is a human rights violation and ethically inappropriate.


Discussion.

Effective methods of reducing HIV infection include education and behavior change. Abstinence before marriage and fidelity after marriage offer men and women the greatest protection in avoiding HIV/AIDS transmission.

Men who have been circumcised may consider themselves immune to HIV and at no risk to their female partner. That, however, is not the case. Circumcised men may still contract HIV and pass it on to their next partner.

The reported complication rate of 1.7 percent seems unreasonably low. Williams & Kapila estimated the incidence of complications at 2-10 percent; In the survey by Kim & Pang (2006), 48 percent reported decreased masturbatory pleasure, 63 percent reported increased masturbatory difficulty and 20 percent reported a worsened sex life after circumcision.

The authors of the RCTs have engaged in the promotion of circumcision. Van Howe and colleagues argue that their true motivation may be the introduction of universal male circumcision, using fear of HIV as the tool with which to accomplish their goals.

Social problems.

The introduction of male circumcision into a non-circumcising society may present problems such as:
* adverse psychological and sexual effects caused by the diminishment and desensitization of the penis,
* increased antisocial behavior,
* violations of human rights,
* violations of laws that protect children, and
* inability to discontinue male circumcision when the need for it no longer exists.

Politics.

The HIV/AIDS epidemic is quite severe in several African nations. In some areas, a high percentage of the population is HIV+.

Public health organizations are under intense pressure to solve the problem.

The use of male circumcision to prevent HIV infection is akin to a drowning man grasping at a straw. Although male circumcision is likely to be proposed for political reasons, it is likely to have little effect on the overall incidence of HIV infection and may cause later problems. According to Ntozi: It is important that, while circumcision interventions are being planned, several points must be considered carefully. If the experiment fails, Africans are likely to feel abused and exploited by scientists who recommended the circumcision policy. In a region highly sensitive to previous colonial exploitation and suspicious of the biological warfare origin of the virus, failure of circumcision is likely to be a big issue. Those recommending it should know how to handle the political implications.

Opposing evidence.

Both the public and the medical community must guard against being overwhelmed by the hyperbolic promotion of male circumcision and must receive these new studies with extreme caution. There is contradictory evidence that male circumcision is not as effective as proponents claim. One study found that male circumcision had no protective effect for women and another study found that male circumcision increased risk for women. Grosskurth found more HIV infection in circumcised men. Barongo et al. found no evidence that lack of circumcision is a risk factor for HIV infection. A study from India found little difference between circumcised and non-circumcised men in the conjugal relationship. A study carried out in South Africa found that male circumcision offered only a slight protective effect. A study carried out among American naval personnel found no difference in the incidence of HIV infection between non-circumcised and circumcised men.

The future.

The development of a vaccine is the best hope for the solution to the HIV epidemic. Several teams of scientists are working to develop vaccines that will prevent infection with HIV and other vaccines that will treat those already infected. The Bill & Melinda Gates Foundation has contributed $287 million to 16 research groups for development of a vaccine.

Conclusion.

Male circumcision is a highly emotive operation that generates strong feelings in many men, especially those who have been circumcised, as have most North Americans. The trauma associated with the operation may generate a desire to repeat or reenact the trauma. 62 Other men may feel a need to justify their own circumcision by the generation of claims of health benefits. The medical literature is full of protective claims for various diseases, such as sexually transmitted disease (formerly called venereal disease), male and female cancers, and urinary tract infection. All such claims have been disproved.

The RCTs on which the current claims are based have been carried out by men who have a previous history of promoting circumcision. DOC has little confidence in such studies, especially since contradictory evidence exists.

Male circumcision may increase male-to-female transmission of HIV and mitigate any reduction in female-to-male transmission. A preliminary report confirms the increased risk to women.

Instituting a program of male circumcision is of dubious value. It will divert resources from proven methods of epidemic control and it may generate a false sense of security in males who have been circumcised. The desensitization of the penis that frequently results from male circumcision is likely to make men less willing to use condoms. A program of male circumcision very likely may worsen the epidemic.

The epidemic in Africa may have little to do with lack of circumcision and everything to do with the percentage of the female population engaged in female sex work. Talbot (2007) has established a correlation between the number of female sex workers in the population and the level of HIV infection.

Calls are being heard for the circumcision of children although (assuming that male circumcision is effective at controlling female-to-male infection) this could not be helpful until the child becomes sexually active. As previously stated, the non-therapeutic excision of healthy body parts from non-consenting children is a violation of human rights and medically unethical. Therefore, the true motivation of the circumcision proponents must be questioned. It may be perpetuation of neonatal circumcision, not control of HIV.

DOC believes that more emphasis on education, behavior change?such as abstinence before marriage and fidelity after marriage, provision of condoms, treatment of other sexually transmitted diseases, treatment of genital ulcer disease, control of malaria, and provision of safe health care would be more likely to produce beneficial results.



Related Research:

Dr. Dean Edell Discusses Africa, AIDS, and Circumcision

The Nuts & Bolts of HIV in the USA and why Circumcision Won't Protect Men

Circumcision is Not a Cure-all for AIDS

Position Statement on the use of Male Circumcision to Limit HIV Infection

The Truth About Circumcision and HIV

Circumcision: Already Illegal?

Circumcision & HIV: Public Health Policy Site