Nursefriendly.com: Uncircumcised Penis

Wednesday, April 6, 2011

Male Circumcision and Risk for HIV Transmission: Implications for the United States | Factsheets | CDC HIV/AIDS

Several types of research have documented that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex.

Biologic Plausibility

Compared with the dry external skin surface, the inner mucosa of the foreskin has less keratinization (deposition of fibrous protein), a higher density of target cells for HIV infection (Langerhans cells), and is more susceptible to HIV infection than other penile tissue in laboratory studies [2]. The foreskin may also have greater susceptibility to traumatic epithelial disruptions (tears) during intercourse, providing a portal of entry for pathogens, including HIV [3]. In addition, the microenvironment in the preputial sac between the unretracted foreskin and the glans penis may be conducive to viral survival [1]. Finally, the higher rates of sexually transmitted genital ulcerative disease, such as syphilis, observed in uncircumcised men may also increase susceptibility to HIV infection [4].

International Observational Studies

A systematic review and meta-analysis that focused on male circumcision and heterosexual transmission of HIV in Africa was published in 2000 [5]. It included 19 cross-sectional studies, 5 case-control studies, 3 cohort studies, and 1 partner study. A substantial protective effect of male circumcision on risk for HIV infection was noted, along with a reduced risk for genital ulcer disease. After adjustment for confounding factors in the population-based studies, the relative risk for HIV infection was 44% lower in circumcised men. The strongest association was seen in men at high risk, such as patients at sexually transmitted disease (STD) clinics, for whom the adjusted relative risk was 71% lower for circumcised men.

via cdc.gov

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Friday, April 1, 2011

Medicirc.org: Circumcision Information Site - A Lifetime of Medicial Benefits

Compelling medical data, much of it accumulated in the past 2 decades, have conclusively shown that a boy circumcised as a newborn has multiple lifetime health advantages compared to one with an “intact” foreskin. These include protection against serious kidney infections in infancy, sexually transmitted infections (STIs) including human immunodeficiency (HIV) infections, Chlamydia infection, human papilloma virus (HPV), syphilis, chancroid and herpes simplex in young men, and invasive cancer of the penis in middle and old age. In addition, all through life uncircumcised males are more susceptible to penile infections (balanoposthitis) and a variety of skin disorders of the penis such as eczema and psoriasis, as well as more difficulty maintaining good hygiene. About 1% of boys are born with only a pinpoint opening at the tip of the foreskin (phimosis) preventing retraction, leading to painful erections, and requiring future circumcision, at a time when the procedure is more difficult, risky and costly. Further, women sexual partners of uncircumcised men with HPV infection are at significantly greater risk of developing cervical cancer.

How convincing is the scientific evidence of circumcision advantages? Overwhelming in the cases of infant kidney infections, penile cancer and local disorders, and compelling for HIV, Chlamydia, HPV and risk to female partners of uncircumcised men with HPV infections. In the mid 1980’s, Dr. Tom Wiswell, a military pediatrician initially opposed to newborn circumcision, examined the United States (US) Armed Forces records of over 200,000 newborn boys and to his surprise found that uncircumcised boys were 10 to 20 times more likely to develop severe kidney infections in the first year of life. Since then a dozen published reports confirm this protective effect of circumcision against infant urinary infections and explain how these infections occur. The warm, tight, moist undersurface of the infant foreskin provides an ideal home for the harmful fecal bacteria that cause kidney infections. These bacteria (“uropathic, fimbriated E. Coli”) have tentacles which attach to the foreskin and then climb up the urinary tract to the kidney. The resultant infection leads to kidney scarring in almost half the cases, as well as body salt loss and hormonal changes in some instances. Although there is no proven long-term evidence so far of permanent kidney damage, these renal effects are disturbing.

via medicirc.org