Dear Dr. Milrod:

My wife and I just found out that we are expecting a boy. Needless to say, we are overjoyed, however, we have this nagging issue of circumcision to deal with. I’m Jewish and my wife is Latina and Catholic. Neither one of us really care about religious traditions, but both sets of in-laws are now pestering us about the whole circumcision issue. Her parents don’t want it, while mine insist on a bris with all the trimmings.There is some controversy regarding circumcised vs uncircumcised penises. I heard about some studies that showed circumcision to reduce the risk of HIV. My question to you is, are there any substantiated health benefits to having a circumcised penis?

Harvey in the Hamptons

Dear Harvey in the Hamptons:

Adult male circumcision has been found to reduce the risk of acquiring HIV in men by around 55-60% in three randomized trial studies in Uganda, South Africa and Kenya, where HIV/AIDS is endemic. Heterosexual vaginal intercourse is the predominant mode of HIV transmission in these countries.
The studies found that circumcision did not provide complete protection against HIV, however the researchers concluded that circumcision reduced the risk of HIV acquisition in the study groups. While there were high rates of HIV acquisition in both arms of these studies – the circumcised and the uncircumcised – rates were lower in the former group. The results of the studies do suggest that widespread circumcision in Africa could reduce HIV transmission by hundreds of thousands. And while consideration is being given to implementing such programs in African countries, relying mainly on circumcision to prevent HIV presents some problems:

If more men decide not to use condoms because they have been circumcised, HIV transmission may increase.
Male circumcision has no effect on women’s HIV risk.
Circumcision may reduce women’s ability to negotiate condom use.
Circumcision is a complex cultural practice, with identity and religious connotations in many cultures.

Now I believe that parents in the US should NOT consider the results of these studies as a reason to have their child circumcised. Looking at heterosexual transmission in the United States, the protective factor for the male partner is very low (and again, male circumcision has no direct effect on female partners’ risk). An American male heterosexual, non-injecting drug user’s risk of HIV infection is very low. These low rates of transmission and risk do not justify widespread circumcision in the general population of the United States.

Circumcision for men who have sex with men is slightly more controversial. HIV risk is highest for the receptive partner during male-to-male anal intercourse, and research shows that most men who have sex with men will be both a receptive and insertive partner. For the realtively small number of men who are only insertive partners and who engage in unprotected anal intercourse with casual partners, circumcision may have a protective effect.
Circumcision does not prevent HIV; further, male circumcision has been shown to have no effect on transmission through receptive anal sex, which is the most common SEXUAL risk activity for HIV transmission in the US. Circumcision has no significant impact for heterosexual or homosexual transmission of HIV in the United States. Finally, condoms are still the most effective means of preventing sexual transmission of HIV and other STDs.

Christine Milrod, Ph.D.