Other Health Benefits of Circumcision

In addition to the health benefits of reducing HIV/AIDS infection, and the risks of getting cancer, circumcision also has other health benefits for the male. It also results in a reduction in various kind of penile infections and a reduced risk of cervical cancer in female partners (please note this section is still work in progress).

Other Health Benefits

  1. Circumcision may lower risk of genital wart (Human Papilloma virus (HPV))
  2. Circumcision lowers men's risk of contracting HIV through heterosexual sex, and recent findings indicate that it also cuts the risk of infection with the human papillomavirus (HPV) in both HIV-positive and HIV-negative men (see abstract (1) below).

    HPV is a highly common virus with more than 100 strains, some of which cause genital warts. While the immune system clears the infection in most people, persistent infection with certain HPV strains can lead to cancer. HPV is the primary cause of cervical cancer in women, and it can also lead to penile and anal cancers.

    The researchers noted that HPV-related cancers are a serious public health problem in sub-Saharan Africa - in contrast to developed countries, where, for example, women have access to regular Pap tests to detect cervical cancer early and, in recent years, HPV vaccination.

    The current study published in the Journal of Infectious Diseases (see abstract below)found that circumcision appeared to lower the rate of infection with cancer-related HPVs in both HIV-negative and HIV-positive men -- by 33% and 23%, respectively, compared with uncircumcised men.

    The studies included 210 HIV-positive and 840 HIV-negative men between the ages of 15 and 49 who were randomly assigned to undergo immediate or delayed circumcision. At the outset, 39% of HIV-negative and roughly three-quarters of HIV-positive men carried at least one cancer-related strain of HPV.

    Circumcision appeared to lower the men's rates of new high-risk HPV infections, and, in HIV-negative men, it increased the rate at which their immune systems cleared established infections. Still, after two years, many circumcised men were still found to carry a cancer-related HPV: more than 20 percent of HIV-negative men and 55 percent of HIV-positive men.

    In addition another study (2) has shown that there is increased risk of getting HIV for men infected with Human Papilloma virus.

    Medical Abstract (1):

    Male Circumcision Decreases Acquisition and Increases Clearance of High-Risk Human Papillomavirus in HIV-Negative Men: A Randomized Trial in Rakai, Uganda.
    Gray RH, Serwadda D, Kong X, Makumbi F, Kigozi G, Gravitt PE, Watya S, Nalugoda F, Ssempijja V, Tobian AA, Kiwanuka N, Moulton LH, Sewankambo NK, Reynolds SJ, Quinn TC, Iga B, Laeyendecker O, Oliver AE, Wawer MJ.

    Methods. Uncircumcised human immunodeficiency virus (HIV)-negative men aged 15-49 years were randomized to immediate circumcision (intervention arm, 441 subjects) or delayed circumcision (control arm, 399 subjects). Human papillomavirus (HPV) was detected by Roche HPV Linear Array at enrollment, and at 6, 12, and 24 months. Incident high-risk HPV (HR-HPV) was estimated in men who acquired a new HR-HPV genotype. HR-HPV clearance was determined in men with prior genotype-specific HR-HPV infections. Rate ratios (RRs) and 95% confidence intervals (CIs) of HR-HPV acquisition were estimated by Poisson multiple regression. Results. Enrollment characteristics were comparable between study groups. HR-HPV incidence was 19.7 cases per 100 person-years (PYs) in the intervention arm (70 cases per 355.8 PYs) and 29.4 cases per 100 PYs (125 cases per 424.8 PYs) in the control arm (RR, 0.67; 95% CI, 0.51-0.89; [Formula: see text]). The incidence of multiple HR-HPV infections was 6.7 cases per 100 PYs in the intervention arm and 14.8 cases per 100 PYs in the control arm (RR, 0.45; 95% CI, 0.28-0.73), but there was no significant effect on single infections (RR, 0.89; 95% CI, 0.60-1.30). HR-HPV incidence was lower in the intervention arm for all genotypes and demographic/behavioral subgroups. The clearance of preexisting HR-HPV infections was 215.8 cases per 100 PYs (205 cases per 95 PYs) in the intervention arm and 159.1 cases per 100 PYs (255 cases per 160.25 PYs) in the control arm (adjusted RR, 1.39; 95% CI, 1.17-1.64). Conclusions. Male circumcision reduces the incidence of multiple HR-HPV infections and increases clearance of HR-HPV infections in HIV-uninfected men. Trial Registration. ClinicalTrials.gov identifier: NCT00425984 .

    J Infect Dis. 2010 Apr 6

    Medical Abstract (2):

    Increased Risk of HIV Acquisition among Kenyan Men with Human Papillomavirus Infection.
    Smith JS, Moses S, Hudgens MG, Parker CB, Agot K, Maclean I, Ndinya-Achola JO, Snijders PJ, Meijer CJ, Bailey RC.



    Few data on the effect of human papillomavirus (HPV) infection on human immunodeficiency virus (HIV) acquisition are available. Methods. HIV-seronegative, sexually active, 18-24-year-old Kenyan men participating in a randomized trial of male circumcision provided exfoliated penile cells from 2 anatomical sites (glans/coronal sulcus and shaft) at baseline. The GP5+/6+ polymerase chain reaction assay ascertained a wide range of HPV DNA types at the baseline visit. The risk of HIV infection was estimated using Kaplan-Meier methods and hazard ratios from proportional hazards models. Results. Of 2168 uncircumcised men with baseline HPV data, 1089 (50%) were positive for HPV DNA. The cumulative incidence of HIV infection by 42 months was 5.8% (95% confidence interval [CI], 3.6%-7.9%) among men with HPV-positive glans/coronal sulcus specimens, versus 3.7% [95% CI, 1.8%-5.6%] among men with HPV-negative glans/coronal sulcus specimens ([Formula: see text]). Controlling for subsequent circumcision status, baseline herpes simplex virus type 2 serostatus, and sexual and sociodemographic risk factors, the hazard ratio for HIV infection among men with HPV-positive glans/coronal sulcus specimens was 1.8 (95% CI, 1.1-2.9), compared with men with HPV-negative glans/coronal sulcus specimens. Conclusion. The results suggest an independent increased risk of HIV seroconversion among HPV-positive men. If this finding is confirmed in other studies, HPV prevention could be another tool for HIV prevention.

    J Infect Dis. 2010 Apr 23

  3. Circumcision and Reduced Risk of Penile Injuries during Sexual Intercourse

  4. The results of a study done in Kenya has shown that circumcised men appear less likely to sustain cuts, abrasions and other minor injuries to the pen1s during sex, which may help explain why circumcision lowers the risk of HIV transmission from heterosexual sex.

    For this study the researchers used data from an HIV clinical trial in Africa, where nearly 2,800 men between the ages of 18 and 24 were randomly assigned to undergo circumcision or remain uncircumcised. In 2005 and 2006, that trial and two others in Uganda, South Africa and Kenya showed that circumcision can reduce a man's risk of HIV infection through heterosexual sex by up to 60 percent.

    In the current study, the researchers found that, over two years, circumcised men were 39 percent less likely than their uncircumcised counterparts to report any type of penile injuries during sex.

    Medical Abstract:

    Circumcision and Reduced Risk of Self-Reported Penile Coital Injuries: Results From a Randomized Controlled Trial in Kisumu, Kenya.
    Mehta SD, Krieger JN, Agot K, Moses S, Ndinya-Achola JO, Parker C, Bailey RC.


    Injuries to the penis during intercourse represent a hypothesized mechanism by which uncircumcised men are at increased risk for HIV. There are no published, systematically collected data regarding mild penile coital trauma to our knowledge. We identified risks of self-reported penile coital injuries in men 18 to 24 years old in a randomized trial of circumcision to prevent HIV in Kisumu, Kenya.

    Each participant underwent standardized interview, medical history and physical examination at baseline, and 6, 12, 18 and 24 months after enrollment. Self-reported penile coital injuries were assessed at each visit, and were defined as pen1s feels sore during sex, penis gets scratches, cuts or abrasions during sex, and skin of the penis bleeds after sex. Generalized estimating equation analysis estimated odds ratios for penile coital injuries.

    From February 2002 to September 2005, 2,784 participants were randomized. At baseline 1,775 (64.4%) men reported any coital injury including 1,313 (47.6%) soreness, 1,328 (48.2%) scratches, abrasions or cuts and 461 (16.7%) bleeding. On multivariable analysis coital injury risk was lower for circumcised than for uncircumcised men with soreness (OR 0.71, 95% CI 0.64-0.80), scratches/abrasions/cuts (OR 0.52, 95% CI 0.46-0.59), bleeding (OR 0.62, 95% CI 0.51-0.75) and any coital injury (OR 0.61, 95% CI 0.54-0.68). Other significant risks included increasing age, multiple recent sex partners, HSV-2 seropositivity and genital ulcers (p less than 0.05 each).

    Self-reported penile coital injuries were common in these healthy young men. Circumcised men were at lower risk for coital injuries. Verifying penile coital injuries, the mechanism of acquisition and the association with HIV risk is needed.

    J Urol. 2010 May 16

Benefits for Female Partners of Circumcised Men

  1. Girls to be offered vaccine against papilloma virus
  2. Sewell J, Ranasinghe W et. al., Springerplus. 2015 Aug 14;4:420. doi: 10.1186/s40064-015-1191-4. eCollection 2015.

    Young girls from the age of nine will, starting next year, be able to get the vaccine that prevents the most dangerous types of cervical cancer, which is caused by the papilloma virus transmitted during sexual intercourse.

    This has been decided by the Health Ministry, even though for years its epidemiologists and executives said it was too expensive and not worth the expense, because this cancer is relatively rare here due to the very high rate of circumcision among both Jewish and Muslim men. The virus is spread much more easily by men whose foreskins are in place.

    The vaccination of young boys will apparently follow, as, when they get older, they are the ones who infect women.

    The Israel Cancer Association, which on Thursday is marking International Cancer Day on Thursday, expressed satisfaction with the ministry decision.

    Each year, 12 million people around the globe - and 27,000 Israelis - are diagnosed with some type of cancer and 7.6 million of them (including 9,500 in Israel) die of it.

    But 40 percent of all cancers can be prevented, said the ICA. Not smoking, exercising regularly, eating healthful food, limiting exposure to the sun and reducing alcohol consumption can cut cancer cases significantly, the ICA noted.

    About one-fifth of cancers are triggered by viral and bacterial infections. These include hepatitis B (leading to liver cancer) and papilloma virus (cervical cancer). Israeli babies now routinely get vaccinated against hepatitis B as part of the regular vaccination schedule, and protection against papilloma virus will begin in 2011. Prof. David Hill, president of the International Union Against Cancer and a leading behavioral scientist who directs the Cancer Council in the Australian state of Victoria, said that Thursday's international day is being devoted to the theme of pathogens that cause malignant tumors. His organization represents 300 cancer societies in 100 countries around the world, including Israel's.

    The ICA invites the public to sign electronically a world declaration to fight cancer at www.uicc.org/declaration. The text can be found at the ICA's Web site, www.cancer.org.il.

  3. The epidemiology of bacterial vaginosis in relation to sexual behaviour.
  4. Verstraelen H, Verhelst R, Vaneechoutte M, Temmerman M.,BMC Infect Dis. 2010 Mar 30;10(1):81.

    ABSTRACT: BACKGROUND: Bacterial vaginosis (BV) has been most consistently linked to sexual behaviour, and the epidemiological profile of BV mirrors that of established sexually transmitted infections (STIs). It remains a matter of debate however whether BV pathogenesis does actually involve sexual transmission of pathogenic micro-organisms from men to women. We therefore made a critical appraisal of the literature on BV in relation to sexual behaviour.

    DISCUSSION: G. vaginalis carriage and BV occurs rarely with children, but has been observed among adolescent, even sexually non-experienced girls, contradicting that sexual transmission is a necessary prerequisite to disease acquisition. G. vaginalis carriage is enhanced by penetrative sexual contact but also by non-penetrative digito-genital contact and 0ral sex, again indicating that sex per se, but not necessarily coital transmission is involved. Several observations also point at female-to-male rather than at male-to-female transmission of G. vaginalis, presumably explaining the high concordance rates of G. vaginalis carriage among couples. Male antibiotic treatment has not been found to protect against BV, condom use is slightly protective, whereas male circumcision might protect against BV. BV is also common among women-who-have-sex-with-women and this relates at least in part to non-coital sexual behaviours. Though male-to-female transmission cannot be ruled out, overall there is little evidence that BV acts as an STD. Rather, we suggest BV may be considered a sexually enhanced disease (SED), with frequency of intercourse being a critical factor. This may relate to two distinct pathogenetic mechanisms: (1) in case of unprotected intercourse alkalinisation of the vaginal niche enhances a shift from lactobacilli-dominated microflora to a BV-like type of microflora and (2) in case of unprotected and protected intercourse mechanical transfer of perineal enteric bacteria is enhanced by coitus. A similar mechanism of mechanical transfer may explain the consistent link between non-coital sexual acts and BV. Similar observations supporting the SED pathogenetic model have been made for vaginal candidiasis and for urinary tract infection. SUMMARY: Though male-to-female transmission cannot be ruled out, overall there is incomplete evidence that BV acts as an STI. We believe however that BV may be considered a sexually enhanced disease, with frequency of intercourse being a critical factor.