April 10, 2002 -- To snip, or not to snip? For decades, the debate has raged over whether there are good medical reasons for the circumcision of newborn boys. New research now offers some of the best evidence yet that there are, but the main benefit may not be to the circumcised male.
The international study found that men circumcised at birth are less likely to infect their female sexual partners with a virus that's a well-known cause of cervical cancer. Men who had been circumcised were less likely to have penile human papilloma virus (HPV) infection. For men with a history of multiple sexual partners, circumcision translated into a reduced cervical cancer risk in their current female partner.
HPV infection causes genital warts in men and women, and it has been established as a main cause of cervical cancer.
The researchers examined data on 1,913 couples from seven studies. HPV infection was found in 19% of the uncircumcised men but only in 5.5% of those who were circumcised. And monogamous women whose male partners were at high risk for HPV -- due to having had six or more sexual partners -- were less likely to have had cervical cancer if the men were circumcised.
"Cervical cancer is the second most common cancer among women worldwide, and the most frequent one among women in many nondeveloped countries," lead researcher Xavier Castellsague, MD, PhD, of the International Agency for Research on Cancer, tells WebMD. If circumcision is confirmed to be effective and safe in reducing HPV infection in men, it could significantly reduce the spread of HPV -- and cervical cancer -- to their female partners.
Castellsague says the routine circumcision of newborn boys around the world may not only reduce HPV and cervical cancer, but also HIV and other common sexually transmitted diseases. Current global estimates suggest that 15% to 25% of men are circumcised.
While acknowledging that worldwide circumcision may, indeed, reduce the frequency of cervical cancer and other STDs, a noted epidemiologist says it is not a very realistic option. Hans-Olov Adami, MD, PhD, of Sweden's Karolinska Institute, says there are simpler preventive measures that can be just as effective in lowering cervical cancer rates, including the use of condoms and educational programs.
"It is not very likely that parents are going to change their traditions and have their newborn sons circumcised in order to lower the risk that a future sexual partner will develop cervical cancer decades later," he tells WebMD. "On a global scale it is far more feasible to make sure that young women and their doctors know about the disease and its symptoms. This is a highly curable disease if caught early, and patient education is a low-tech intervention that can work on a global level."
So what are the implications in the U.S., where circumcision is common but many new parents agonize over the decision? Circumcision rates have fallen in the U.S. in recent years, from a high of about 80% to about 65% today. But with the exception of Jewish and Muslim cultures, where boys are circumcised for religious reasons, circumcision rates are still much higher in the U.S. than in most other parts of the world.
In March of 1999, the American Academy of Pediatrics revised its policy on the practice, stating that the medical benefits are "not sufficient to recommend routine [newborn] circumcision." It was the fourth policy revision on the subject in three decades.