What is Circumcision?
Circumcision is a procedure where the excess foreskin is removed. This ritual has been performed on boys for thousands of years. It is currently practised by many faiths and culture. In the states, it is usually done within the first few days of life. Among Muslims and Jews, it is highly encouraged for boys to be circumcised. In fact, it is highly encouraged because it promotes better hygiene among other benefits.
Male circumcision reduces the abundance of bacteria living on the penis and might help explain why circumcision offers men some protection against HIV, according to a study led by the Translational Genomics Research Institute (TGen).
Are circumcised men less likely to contract HIV?
One of the most interesting benefits of circumcision is the finding that circumcised men are less likely to contract HIV, the virus that causes AIDS. In 2005, a study of South African men found that circumcised men who had sex with an HIV-positive woman were 63 percent less likely than uncircumcised men to contract the virus. Other than HIV, Circumcision has also been shown to reduce the risk of contracting HPV, or human papillomavirus.
HPV is a virus that can cause cervical cancer in women. Another sexually transmitted virus is the herpes simplex virus type 2, better known as genital herpes. The risk of transmission of genital herpes is also reduced in men who were circumcised.
Bacteria and Sexually Transmitted Diseases (STDs)
Other than viruses, bacteria also are responsible for some of the common Sexually Transmitted Diseases (STDs). Circumcision has been proven to reduce incidence of Chlamydia Trachomatis infection. Interestingly, circumcision doesn’t just protect the men, but also protects the women as well.
In a study published in 2005 in American Journal of Epidemiology, there’s an 82% reduction of Chlamydia infection among women whose partners were circumcised as compared to women whose partners were uncircumcised.
A study of women in Kenya and Uganda enrolled in an RCT and followed up for 3 years found circumcision of their male partners was associated with a 59% reduction in incident syphilis among the women. A prospective study in Kenya by the same authors found that those with circumcised male partners had a 58% lower risk of incident Trachomatis vaginalis than did women with uncircumcised partners.
One of the main possible reasons behind lower risk of infection is the recent finding where there is a significant shift in the bacterial flora of the penis after circumcision. This was according to a study published by the online journal mBio. This international collaboration focused on 156 men in Rakai, Uganda — part of the world’s largest randomized-controlled trial on male circumcision.
Researchers showed that men who were circumcised as part of the study had 33.3 percent less bacteria on their penis than those who remained uncircumcised one year after the study began. Researchers further showed that the decrease was primarily found in 12 types of bacteria, most of which were intolerant to oxygen.
At the same time, understanding the mechanisms that underlie the benefits of male circumcision could help to identify new intervention strategies for decreasing HIV transmission, especially for populations with high HIV prevalence and in places where male circumcision is culturally less acceptable, the study says.
“We know that male circumcision can prevent HIV and other diseases in heterosexual men, but it is important to know why,” said Dr. Lance Price, the Director of TGen Center for Microbiomics and Human Health and the study’s senior author.
“We think that these dramatic changes in the penis microbiome may explain, at least in part, why male circumcision is protective, ” said Dr. Price, who is also a Professor of Environmental and Occupational Health in the School of Public Health and Health Services at the George Washington University.
In heterosexual transmission of HIV, the virus on the foreskin needs to reach its target cells, the CD4+ T-cells, which reside primarily in blood or the lymph nodes.
Researchers hypothesize that penis bacteria may facilitate this process in two ways: by both recruiting more HIV target cells to the foreskin and by triggering another set of immune cells, the Langerhans cells, to deliver the virus to susceptible T-cells. Without this trigger, the Langerhans cells will simply destroy the virus.
“Our findings are interesting from two perspectives. From a public health standpoint, we were finally able to detail the bacterial changes associated with male circumcision,” said Dr. Cindy Liu, Adjunct Professor at the Pathogen Genomics Division at TGen, and the study’s lead author.
“From an ecological perspective, our study shows how phenomena from the macro-world actually scale to the micro level. When you change a macro environment, such as clear cutting a forest, you affect the animals that live there. That’s intuitive. Here we show that changing the penis environment affects the microbes that live there as well.” said Dr. Liu, who also is a member of the Department of Pathology at the Johns Hopkins School of Medicine.
Currently circumcision among adults is carried out in Africa as a part of the campaign to fight HIV and AIDs. With increasing evidence of health benefits from circumcision, I am seeing more men coming forward to get circumcised voluntarily. These are men who have no medical problems that warrant a circumcision. They simply want to have better hygiene and reduce their risk of infection.
At Dr Tan & Partners, we use the Shang Ring Method of circumcision. With this method, there is no need for injections and the procedure is very quick, simple and painless. Only numbing cream is used and after 30 minutes of application, the procedure can commence. The procedure itself takes only 10-15 minutes. Our patients are usually surprised at how painless and quick the procedure is. Most importantly they like how the results look at the end of the day.
Speak to your doctor if you have any questions regarding circumcision.