Circumcisions, San Francisco and STDs | Fit Pregnancy

Circumcisions, San Francisco and STDs

12.07.10: Clearing up some misconceptions

I caught a short segment on The Dr. Oz show last week discussing the proposed San Francisco ban on circumcisions and some semi-recent studies connecting circumcisions to reduced risks for sexually transmitted diseases (STDs), like HIV/AIDS.  With so many readers facing the highly sensitive decision about whether or not to circumcise their son, I decided to consult a panel of experts to clear up a few misconceptions.

Headlines making claims like, “The government is cutting our right to circumcisions,” lead us to believe there’s a big conspiracy going on. Really, it’s just a guy in San Francisco gathering signatures and hoping to get a ballot measure together by next November. He’s part of a growing group of citizens who feel strongly that circumcision on babies is unnecessary cosmetic surgery that permanently alters their bodies without their permission.  They think parents should let babies wait until they’re adults and make the choice for themselves.

If they get enough signatures, then the ballot measure goes to voters, only in San Francisco. If it passes, the measure would make it a misdemeanor to circumcise, excise, cut or mutilate the genitals of boys and girls under 18 in San Francisco. Their thinking is that it's kind of like tattoos – you can’t do that to kids without their adult, informed consent either. Believe it or not, female circumcision was legal in the US and even paid for by some insurance companies into the 1970s.  

Now, about circumcisions and STDs:  Some say parents should get their sons circumcised because it reduces chances for getting or giving STDs and provides a major benefit for women’s health. Some say the foreskin of an uncircumcised man can harbor viruses and bacteria. In reality, it’s not quite as cut and dried as that. Circumcised men get plenty of STDs and it’s a mistake to imply they aren’t as capable of infecting their partners as guys with foreskins. If a guy is going from one STD-infected sex partner to another without using condoms, it isn’t his foreskin that’s the problem. Good hygiene and safe sex are the best ways to prevent disease.   

The studies that say circumcision reduces STDs are based in Africa, where it’s a whole different ballgame.  There’s a lot of misinformation about how STDs are transmitted and limited access to clean water, health education, condoms, medications and other key factors that prevent disease.  Some studies in Africa on adult males in heterosexual relationships say adult circumcision reduces HIV transmission. In the US however, HIV is predominantly transmitted in homosexual relationships and studies on whether circumcision significantly reduces that are still being evaluated. Circumcising all baby boys isn’t necessarily going to make a big difference in American STD rates.

Warning – the following information is pretty graphic.  Here’s what the Centers for Disease Control (CDC) say:

It is possible, but not yet adequately assessed, that male circumcision could reduce male-to-female transmission of HIV, although probably to a lesser extent than female-to-male transmission.

 The overall risk of HIV infection is considerably lower in the United States…. Studies to date have demonstrated efficacy only for penile-vaginal sex, the predominant mode of HIV transmission in Africa, whereas the predominant mode of sexual HIV transmission in the United States is by penile-anal sex among [men who have sex with men]. There are as yet no convincing data to help determine whether male circumcision will have any effect on HIV risk for men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner.

Since obstetricians do most newborn circumcisions, I called the American Congress of Obstetricians and Gynecologists and they referred me to their circumcision policy, which states:

ACOG agrees with and supports the 1999 American Academy of Pediatrics Circumcision Policy Statement. From this it is clear that ACOG cannot and does not recommend elective non-therapeutic circumcision of infant boys for medical reasons or for any other reason.

Then, I called Desiree Bley, M.D. a Portland OB-GYN who specializes in obstetrics, newborn and women’s health. She said:

Babies were routinely circumcised from the end of the 19th century through the 1980’s and 90’s, even without parental consent.  If this surgery were as effective at reducing STDs as implied, the USA would have been heralded as the pinnacle of genital health in the 20th century - which it isn't.

Circumcision is surgical alteration of an infant and fraught with risks for bleeding, infection, pain, damage and scarring.  It’s not to be taken lightly! In developing countries, it may be done in unclean conditions. Can we try education, condoms, immunization and clean water before disrupting normal, intact skin, which, by the way is our best defense from infection?”

The American Academy of Pediatrics is standing by their neutral statement that there’s not enough data to recommend routine circumcisions.  They’ve formed a task force to look into the latest studies and I called Doug Diekema, MD, a pediatrician and Professor in the Departments of Pediatrics, Bioethics and Public Health at the University of Washington School of Medicine and one of the circumcision task force members. Diekema said:

“Circumcision and STD reduction isn’t a slam dunk.  We’re not ready to make our final statement, but don’t expect it to be much different than our current policy. Circumcision may provide some benefits and  a small amount of risk reduction in the US, but also some risks. The biggest way to reduce STDs including HIV is still through safe sex, including condoms – circumcised or not.”

What about the argument that boys and dads should look alike?  Diekema says, “I disagree. Fathers can be bald, have mustaches, hairy bodies, etc, and their sons don't get concerned. I think parents can handle explaining why a child’s genitals look different than his father’s.”

Pediatrician Megan Neuman, MD at Emmanuel Children’s Hospital gives this good advice, “When making a decision about whether to circumcise or not, parents should look at current policies, national guidelines and the cultural and medical sentiments in our country. They should talk to a urologist, obstetrician or pediatrician and get their facts straight.”  

 Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to labornurse@fitpregnancy.com and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.

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