“If you are ever presented with a multifaceted social problem and the first solution that springs to your mind is “We’d better cut off part of everyone’s penis,” you might want to consider another line of work.”
Fatherhood For Geeks
I received a comment today on my circumcision series questioning whether I had fully considered the role of circumcision in reducing STIs (Sexually Transmitted Infections). Clearly this was from someone working in the field and who has a real interest in lowering STI rates in the US – a laudable effort, in my opinion – however, I immediately felt myself get annoyed because I find the issues surrounding STIs to be far more complex than just reducing it to circumcision.
First, let me say that the research has generally been mixed with some finding lower STI rates in circumcised men whereas others show no difference at all, though most importantly, most of this research has taken place in developing nations. Notably, studies in “developed” nations like the United States
And yet, I’m about to say it’s still crap. Not crap in that the research was bad – not at all, in fact the research was very well done as the authors controlled for many confounding variables that should be related to STIs and still found significant results. But crap in that the conclusions still ignore some very basic issues.
Let’s look…
- The study included 510 men in total.
- 42 individuals reports having an STI: 10.4% of the uncircumcised men and 4.6% of the circumcised men.
- 10.4% of the uncircumcised group is equal to 37 individuals.
- Routine infant circumcision would reduce the rate of STIs by 48%, or a reduction of 18 people in a sample of 356 (the number of uncircumcised men in the sample).
- An average complication rate of 1.5%[6] means that of the 356 boys who would be circumcised, approximately 5 would have complications from circumcision.
Okay, so if we’re completely utilitarian about it, we see that RIC would keep 18 people in this sample from having an STI but 5 of these people would have had complications from the surgery. The sheer numbers might suggest a benefit of RIC, but now we have to look at what we’re dealing with – sexually transmitted diseases for which other behaviour plays a large role.
- Notably, in this sample of 510 men, 77% reported having unprotected sex (88.6% of the people who actually had an STI).
- Furthermore, those with an STI reported an average of 20.6 sexual partners between the ages of 18 and 25 compared to 11.7 for those without an STI.
Call me weird, but shouldn’t THIS be the crux of the issue? Why did no one this to say, ‘Hey! Look, we’ve got kids who are running around having LOTS of unprotected sex. Maybe this will affect the STI rates? Perhaps we should focus on this?’ I realize public health policy wants a quick fix that can be implemented easily. Circumcision is that I suppose. But it is NOT the answer to this. If studies from other developed nations tell us anything, it’s that there may still be other factors at hand here.
Let me add this though: even if there was a benefit with respect to later sexual behaviour, it STILL doesn’t support circumcision for me.
Why? Because you’re talking about inflicting pain (sometimes a lot depending on the pain relief used, but even the best pain relief isn’t 100%, or even close) on a newborn. We know this increases the risk of problems breastfeeding[7] and that children who were circumcised show heightened pain responses to later pain like vaccinations[8], meaning that there are observable long-term effects that many have discounted. If months later, the pain response is that heightened, we can say we have physiologically altered our children’s neurological response to pain (even when pain relief is used). We know that no child can possibly consent to this procedure as they are too young, and that the argument that it is awful to have to have done as an adult (when done for medical reasons) should inherent mean we don’t want to do this to our newborns. If it’s awful for an adult, why would we subject infants – who have no real comprehension of what is happening to them – to such a procedure?
If you want to reduce STIs, let’s look at getting real, honest, good sex ed in the classroom. Let kids learn that sex can have very serious consequences and how they can reduce these risks but also how effective these methods are. I’m continually dismayed when I hear of younger people shocked they got pregnant or got an STI because they used some form of birth control so ‘how could it happen?’. Often people aren’t even using methods correctly which further reduces the effectiveness. THIS is what our kids need.
What we don’t need is to round up all the males and cut off a part of their body.
***
Update: Another study out of NZ contradicts the significant findings between circumcision status (early circumcision versus no circumcision) and STI status. Again looking at birth cohorts, these authors found no differences between the two groups which remained non-significant when controlling for other pertinent variables, including sexual behaviour. This adds to the literature from other countries that has found circumcision does not protect against STIs, despite some significant studies out of developing nations. Source: Dickson NP, van Roode T, Herbison P, Paul C. Circumcision and risk of sexually transmitted infections in a birth cohort. Journal of Pediatrics 2008; 152: 383-7.
[1] Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice. JAMA 1997; 277: 1052-7.
[2] Dave SS, Johnson AM, Fenton KA, Mercer CH, Erens B, Wellings K. Male circumcision in Britain: findings from a national probability sample survey. Sex Transm Infect 2003; 79: 499-500.
[3] Richters J, Smith AMA, de Visser RO, Grulich AE, Rissel CE. Circumcision in Australia: prevalence and effects on sexual health. Int J STD AIDS 2006; 17: 547-54.
[4] 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.
[5] Fergusson DM, Boden JM, Horwood J. Circumcision status and risk of sexually transmitted infection in young adult males: an analysis of a longitudinal birth cohort. Pediatrics 2006; 118: 1971-7.
[6] Weiss HA, Larke N, Halperin D, Schenker I. Complications of circumcision in male neonates, infants and children: A systematic review. BMC Urology 2010; 10: doi:10.1186/1471-2490-10-2.
[7] Hill G. Breastfeeding must be given priority over circumcision. J Human Lact 2003; 19: 21.
[8] Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. The Lancet 1997; 349: 599-603.
The problem is the liberal agenda which pushes graphic ‘comprehensive’ sex ed isn’t to reduce sex, pregnancies, or STDs, it’s to reduce traditional morality and increase expressions of sexuality. A perfect example: just this week two news articles hit from the UK. One in which exposure to porn was being blamed for a huge increase in minors sexually abusing other minors and the possibility of banning wi-fi access to porn in public places where children might view it, and the other about a new sex ed course which explicitly teaches children how to view porn on line ‘safely’. Another example, this week a group tried to run a full page add in the Washington Post and the New York Times consisting of cartoons recommended by Planned Parenthood for use in sex ed courses for children as young as 10. Both newspapers refused to run them without blurring the images because they were too graphic to show in a newspaper. Society wants a ‘quick fix’ for STDs (I refuse to use the ‘politically correct’ term STI because ‘infection’ is somehow supposed to be less stigmatizing than ‘disease’) like circumcision or condoms because what must be done to actually fix the problem, a return to traditional sexual morals, is unthinkable, even though the ABC approach (Abstience until marriage, always Be faithful after, and use a Condome when absolutely necessary) has been repeatedly proven effective worldwide in lower STDs and HIV rates. In fact the ONLY African countries which showed a decrease in these rates did so while pushing the ABC approach.
I gave a speech in my health class in high school, giving them the real world statistics on failure rates of birth controls and condoms for both pregnancy and STDs, the class was shell shocked, you could look around and see exactly which students had already engaged in sex and which had not. That was 15 years ago (give or take a year or so) and since then evidence continues to mount that shows ‘safe sex’ with a condom or birth control is anything but. But instead of reversing and teaching *real* sexual education to avoid risky sex/STDs/unwed pregnancies, the educational system is full steam ahead over the cliff, flinging condoms and birth control pills at younger and younger ages and doing everything they can to make sure children are sexualized and engaging in risky sex as soon as possible.
Jespren,
I’m a little confused as to where you get your evidence that abstinence only sex ed has better results that comprehensive sex education. Many studies recently are pointing to the exact opposite. Here are just a few I found:
http://www.americanbar.org/publications/human_rights_magazine_home/human_rights_vol38_2011/human_rights_spring2011/comprehensive_sex_education_vs_abstinence_only_until_marriage_programs.html
http://ari.ucsf.edu/science/reports/abstinence.pdf
http://www.advocatesforyouth.org/publications/597
I teach a scientifically based, comprehensive sexual education program (OWLs) that has had excellent results in increasing the age of first sexual intercourse, as well as helping teens to understand what birth control/protection methods are best for them, and the safest. We do encourage abstinence as the safest method, but we realize that teens are going to need the skills to cope with other situations are they arise (no pun intended…). We also educate our kids on how to make decisions about their readiness to engage in sexual intercourse so that if they do make a decision to have sex, they have the tools they need to make safe choices.
Our programs are available from kindergarten until end of life. And yes, our kindergartners are taught the mechanics of how babies are made – in an age appropriate way. They also learn the scientific names for their bits, and how to talk to an adult if someone has taken liberties with any of their private parts.
Having talked to many teens who went through the programs (there are 4 classes taught during the K-12 years, for varying age groups) they find themselves as the ones who are correcting horrible information that their friends are spreading, and generally speaking, abstaining from sexual behavior longer than their friends.
These classes are taught in my church, and are not a secular entity.
Another problem is see with teaching teens to wait until marriage is that you have very little recourse as LBGT teen. If you have no possibility of marriage, how exactly do you decide when you’re ready? These kids deserve to have safe choices available to them when they do decide they are ready.
Sorry for the extra-long .02. 🙂
THANK YOU for this article! I’ve been saying the same for ages now. Circumcision is not and should not be a substitute for condom use.
…so by your logic, because adult recovery from a tonsillectomy is terrible, it’s got to be just as terrible (if not worse) in children. Except the exact opposite is true.
As for the heightened pain response with vaccination, how can that even possibly be measured? Babies that are circumcised are generally circumcised as a week or less in age. The nerve development between then and their next vaccination is huge, and would play a significant factor – as does the stress level of the parent at the time of vaccination, because the baby will pick up on and feed off of that energy, as well as the fact that every child is different. There is no way to know if a baby would have reacted the same to a specific vaccination at a specific age had their parents’ decision to circumcise (or not) been different.
I’m not saying people should HAVE to circumcise their babies. I’m just saying that you have to use scientifically – NOT anecdotally, or assumed – proven facts to justifiably use them in an argument AGAINST something.
This 2008 birth cohort study, also conducted in New Zealand, yielded results that contradicted the study by Fergusson et al:
http://www.ncbi.nlm.nih.gov/pubmed/18280846
A major problem with the birth cohort of Fergusson et al, is that in their birth cohort, circ status was strongly correlated with upper middle class status. Upper middle class young men are less likely to indulge in the kind of irresponsible sex that propagates STDs. The New Zealand govt. ceased paying for RIC in 1969. After a few years, only the upper middle class was circumcised. By 1985 or so, RIC had more or less vanished from New Zealand.
Fergusson et al retracted hteir 2006 article, but I cannot find a reference to this retraction.
Thank you! Excellent to know. I will add an update to this 🙂