THE QUESTION OF SEXUALLY TRANSMITTED INFECTION
Prevention of sexually transmitted infection is frequently listed as one of the supposed advantages of circumcision. Is the foreskin a likely site to harbor such infections? Does its absence confer immunity to these diseases?
Few studies have attempted to answer these questions. The American Academy of Pediatrics’ Ad Hoc Task Force on Circumcision concluded in 1975:
“Adequate studies to determine the relationship between circumcision and the incidence of venereal disease have not been performed.” 1
STI has become epidemic within the United States. Our primarily circumcised male population has done little to abate this. One could hardly blame our widespread rates of these diseases on the small proportion of intact males within our population. Obviously circumcised males are not immune to sexually transmitted infection. Other countries which practice male circumcision frequently report similarly high rates of STI. According to Morgan:
“The Middle East, where the men are circumcised, has a venereal disease rate second to none.” 2
The rates of syphilis have dropped dramatically since the 1940s -‑ from 352,000 reported cases in 1945 to 20,000 reported cases in 1977. This has been primarily due to more widespread identification techniques and effective antibiotics. 3 However, the rates of gonorrhea and Herpes have been rapidly increasing. Some strains of gonorrhea have become resistant to antibiotics. There is no known cure for Herpes II. 4 According to Wallerstein, Dr. Stanley Falkin wrote in 1977 that:
“…gonorrhea is the most common bacterial disease in humans and that there are probably as many as 2 million cases in the United States.” 5
Some observations have revealed no differences in rates of STI among intact and circumcised men. Other observations have suggested that males with foreskins do contract the diseases more frequently.
Taylor and Rodin investigated the rates of Herpes II virus and circumcision status and found the disease to be somewhat less common among males without foreskins. 214 male patients with genital herpes were compared with a randomly selected group of 410 male patients without the disease. They found that 24.5% of the men in the control group were circumcised, and 12.1% of those in the herpes group were circumcised. 6 However, other factors besides whether or not the individual has his foreskin may be responsible for the difference. Knowledge of the rates of exposure to Herpes II among the unaffected men would reveal more definite answers.
According to Shepard:
“Venereal disease is no respecter of the host. Schrek and Lenowitz found that the incidence of venereal disease in hospitalized patients was no different in circumcised and uncircumcised. Studies in the Canadian Army (1947) showed that venereal disease was more common among uncircumcised soldiers. However, it is believed that most of the uncircumcised soldiers came from the lower socioeconomic group, and that this may have accounted for the higher rate.” 7
Socioeconomic factors, lifestyle, values, sexual practices, personal cleanliness, awareness of disease symptoms, and access to and willingness to seek medical treatment have considerably greater effect on whether or not one will contract a sexually transmitted infection than does the presence or absence of one’s foreskin. In past decades the middle and upper classes have been more likely to choose circumcision for their sons, while the lower classes were more likely to leave the penis intact. Members of the lower classes have also tended to be more sexually active, less attentive to personal hygiene, and less likely to seek medical treatment.
The foreskin is a site where STI infections can be harbored. A break in the skin can be a point of entry for disease germs. However, the same can be said for many other parts of the body. Wallerstein points out that sexually transmitted infection germs enter the body via the mouth, rectum, eyes, and that the urinary meatus is the main point of entry for males. 8 They can harbor in the labia, anus, mouth, underarms, and between the toes. He concludes:
“The major problem of venereal disease is to prevent it and, failing that, to treat it promptly. The surgical removal of a possible infection site is not a solution.” 9
Contraceptive use has a dramatic effect on the prevalence of STI: Obstructive contraceptives, particularly condoms, help prevent the spread of infection. 10 Some spermicidal preparations, foams, creams, and jellies tend to inhibit the growth of disease causing agents. 11 Use of birth control pills not only causes people to forego usage of obstructive contraceptives and spermicides, but changes the chemistry of the vagina, making women more susceptible to the infection. 12
According to the authors of Our Bodies, Ourselves:
“For women it is estimated that for one exposure to gonorrhea you have a 40‑50 percent chance of catching it if you use no protection and are not taking the Pill. If you use the Pill you have a nearly 100‑percent chance of catching gonorrhea during any exposure to it. The Pill makes the vagina more alkaline than normal and stimulates carbohydrate production in the vagina. This is an extremely favorable environment for the bacteria. The Pill also seems to help the spread of gonorrhea into the fallopian tubes, even as soon as two or three weeks after infection.
Yeast infection is not solely an STI. It can be spread by a variety of methods including sexual contact. However it can be a troublesome, nuisance infection. Circumcision status appears to have little or no effect on the prevalence of yeast infections among males according to two different studies.
Davidson studied 66 circumcised men and 69 intact men. He found the yeast isolation rate to be nearly the same in both groups. 14% of the circumcised men and 17% of the intact men had yeast infections. 13
In Rodin and Kolater’s study 175 men were tested for yeast infections. Of these 32 had yeast infections. Six of these 32 men were circumcised (19%). Of the remaining 145 unaffected subjects, 35 (24%) were circumcised. Therefore, a slightly higher percentage of circumcised males were found in the group without yeast infections. However, this study involved relatively small numbers. 14
Benign Transient Lymphagiectasis
A relatively rare condition that is sometimes STI related, “Benign Transient Lymphagiectasis” may be complicated by the fact that the individual has been circumcised. Benign means not cancerous or permanently harmful. Transient means lasting for only a short time. Lymphagiectasis is a dilation of the lymphatic vessels. The authors describe the condition as follows:
“The presence of a painless, hard nodular, translucent cord that suddenly appears in the penis and is usually confined to the coronal sulcus … not caused by infection, [apparently caused by] trauma during recent vigorous sexual activity…. It is possible that circumcision may disturb the normal lymphatic drainage of the glans and prepuce, making the trauma of coitus more likely to provoke this condition. 41.2% of their patients [in Britain with an expected rate of 25%] were circumcised.” 15
The lack of ease afforded by the gliding mechanism of the foreskin may also have contributed to the “trauma” of coitus.
Insufficient studies have been carried out to indicate whether or not the presence of a foreskin predisposes one to developing STI. Present studies indicate little or no relationship. Socioeconomic factors related to sexual activity, personal hygiene and access to medical treatment are apparently responsible for some instances of more sexually transmitted infections among intact males. Circumcised males are certainly not immune to sexually transmitted infections. Even if the foreskin were proven to predispose the individual to a greater chance of contracting a sexually transmitted infection, it is reasonable to conclude that regular washing, especially washing immediately after coitus, would inhibit its development. The problems that can result from the neglected, unwashed foreskins of a few individuals do not indicate any need for routine amputation of all infant foreskins!
“Venereal disease complications result from neglect of the infection, whether the man is circumcised or not. On the other hand, prompt treatment usually mitigates complications, regardless of the presence or absence of a foreskin.” 16
There are only two ways that a person can be assured of not contracting STI. One is abstinence from sexual contact. The other is long‑term fidelity of both partners of a marriage or relationship. STI is so prevalent that virtually anyone who has a number of sexual partners will inevitably get an infection of some sort. It is also not uncommon for one faithful partner of a marriage or relationship to contract an STI from the other partner who has had sexual contact elsewhere.
Parents who are concerned about their children contracting STI are best advised to teach them a sense of responsibility about sexual matters. Although most parents hope that their children will marry or at least form loving, committed relationships, rather than have numerous casual sexual encounters, this responsibility should also include advising any sexual partner(s) if an STI is discovered, and seeking prompt medical attention. Teaching one’s children important values along with the facts about these diseases is vastly preferable to subjecting them to unnecessary surgical procedures.
- Thompson, Hugh C., M.D.; King, Lowell R., M.D.; Knox, Eric, M.D.; and Korones, Sheldon B., M.D. “Report of the Ad Hoc Task Force on Circumcision” Pediatrics, Vol. 56, No. 4, Oct. 1975, p. 611.
- Topp, Sylvia “Why Not to Circumcise Your Baby Boy” Mothering, Jan. 1978, Vol. 6, p. 76.
- Wallerstein, Edward Circumcision: An American Health Fallacy Springer Publishing Company, New York, c. 1980, p. 83‑84. (Syphilis statistics source: U.S. Department of the Census, Statistical Abstract of the United States, Washington D.C., 88th ed., 1967, p. 86 for the years 1945‑1965: the 97th ed., 1976, p. 91 for the years 1970‑1974; for 1975, 1976, 1977 see Sexually Transmitted Diseases, Statistical Letter, U.S.D.H.E.W., issue no. 127, May 1978, p. 9.)
- Ibid., p. 84.
- Ibid., p. 83.
- Taylor, P.K., and Rodin, P. “Herpes Genitalis and Circumcision” British Journal of Venereal Diseases, Vol. 51, 1975, p. 274‑277.
- Shepard, Kenneth S., M.D. Care of the Well Baby J.P. Lippincott Co., Philadelphia, PA., c. 1968, p. 304‑305.
- Wallerstein, p. 85.
- Ibid., p. 87.
- Our Bodies, Ourselves The Boston Women’s Health Book Collective Simon and Schuster, N.Y., Second Edition, c. 1971, 1973, & 1976, p. 170. (Their reference: R. Cautley, G.W. Beebe, and R. Dickinson “Rubber Sheaths as Venereal Disease Prophylactics,” American Journal of the Medical Sciences, 1950 , p. 155‑63.)
- Ibid., p. 170 (Their reference: B. Singh, J.C. Cutler, and H.M.D. Utidjian “Studies on the development of a vaginal preparation providing both prophylaxis against venereal disease and other genital infections and contraception. II ‑ Effect in vitro of vaginal contraceptive and non‑contraceptive preparation on treponema pallidum and neisseria gonnorrhoeae.” British Journal of Venereal Diseases, Vol. 48, , p. 57‑64.)
- Ibid., p. 168‑169, 191.
- Wallerstein, p. 86.