PDF
ePub
Citation
Print
Abstract
Recently the male circumcision becomes a hot issue not only in abroad but especially in Korea. Under this circumstance, it will be right that doctors and scholars restart to study about the merits and demerits of the male circumcision. There are little clear answers about its advantages in urinary infection, penile cancer, sexual function, etc. The only issue is that WHO and UNAIDS admit the male circumcision as a significant precautionary measure against HIV (human immunodeficiency virus) after finishing a large scale study. As a doctor, it will be desirable to explain to the patients or parents about the advantages and disadvantages of the male circumcision and help them make a choice considering its cultural, religious, legal, social, and emotional situation when the patient comes to the hospital for a male circumcision. However, it will be difficult to follow the Western statistics impetuously since the course of diffusion of HIV in Korea is different from that in USA, and there is no study in Korea about the merits and demerits of the male circumcision. Therefore, we conclude that it will be an impetuous assertion to argue that the male circumcision should be done before the adolescence, before starting an active sexual life, without any countermeasure.
Figures and Tables
Figure 1
The uncircumcised foreskin is susceptible to minor trauma and abrasion and can facilitate entry of pathogens (48).
Table 1
Association of penile infections with male circumcision
*For meta-analyses of HIV infections in adults, only studies with adjusted RRs are included, as crude RRs are likely to be misleading due to potential confounding with behavior and other factors. The meta-analyses of chancroid, syphilis and HSV-2 include "best estimates" of effect which are the adjusted RR if it was available, otherwise the crude RR
†Protective effect in 6 out of 7 studies, of which 4 had a significant protective effect
‡Protective effect in 18/19 studies, of which 14 were significantly protective
§Unpublished data presented by Weiss at the Consultation on STI interventions for preventing HIV: appraisal of the evidence WHO/Geneva, 11~13 July 2006
∥Protective effect in 9 out of 11 studies, of which 2 were significantly protective
References
1. Dunsmuir WD, Gordon EM. The history of circumcision. Br J Urol. 1999. 83:1–12.
2. Alanis MC, Lucidi RS. Neonatal circumcision: a review of the world's oldest and most controversial operation. Obstet gynecol. 2004. 59:379–395.
3. Kim DS, Lee JY, Pang MG. Male circumcision: a South Korean perspective. BJU Int. 1999. 83:28–33.
4. Lee SD, Park E, Choe BM. Parental concerns on the circumcision for elementary school boys: a questionnaire study. J Korean Med Sci. 2003. 18:73–79.
5. Oh SJ, Kim KD, Kim KM, Kim KS, Kim KK, Kim JS. Knowledge and attitudes of Korean parents towards their son's circumcision: a nationwide questionnaire study. BJU Int. 2002. 89:426–432.
6. Gairdner D. The fate of the foreskin. A study of circumcision. Br Med J. 1949. 2:1433–1437.
7. Lindhagen T. Topical clobetasol propionate compared with placebo in the treatment of unretractable foreskin. Eur J Surg. 1996. 162:969–972.
8. Harkarvy KL. The circumcision debate (letter). Pediatrics. 1987. 79:649–650.
9. Wiswell TE, Hachey WE. Urinary tract infections and the uncircumsied state: an update. Clin Pediatr. 1993. 32:130–134.
10. Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, Muttitt S. Comparision of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision: a randomized clinical trial. JAMA. 1997. 278:2157–2162.
12. Fergusson DM, Lawton JM, Shannon FT. Neonatal circumcision and penile problems: an 8-year longitudinal study. Pediatrics. 1988. 81:537–554.
18. Ryo SB, Kim KW, Kang TW, Min KD, Kwon DD, Oh BR. Study on consciousness of Korean adults for circumcision. Korean J Urol. 2003. 44:561–568.
19. KU JH, Kim ME, Lee NK, Park YH. Circumcision practice patterns in South Korea: community based survey. Sex Trasm Infect. 2003. 79:65–67.
20. OH SJ, Kim T, Lim DJ, Choi H. Knowledge of and attitude towords circumcision of adult Korean males by age. Acta Paediatr. 2004. 93:1530–1534.
21. Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: a systemic review of randomized trials and observational studies. Arch Dis Child. 2005. 90:853–858.
22. Weiss HA, Thomas SL, Munabi SK, Hayes RJ. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect. 2006. 82:101–109.
23. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005. 2:e298.
24. Weiss HA, Quigley MA, Hayes RJ. Male circumcision and risk of HIV infection in sub -Saharan Africa: a systemic review and meta-analysis. AIDS. 2000. 14:2361–2370.
25. Siegfried N, Muller M, Deeks J, Volmink J, Egger M, Low N, Walker S, Williamson P. HIV and male circumcision-a systematic review with assessment of the quality of studies. Lancet Infect Dis. 2005. 5:165–173.
26. Daling JR, Madeleine MM, Johnson LG, Schwartz SM, Shera KA, Wurscher MA, Carter JJ, Porter PL, Galloway DA, McDougall JK, Krieger JN. Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease. Int J cancer. 2005. 116:606–616.
27. Maden C, Sherman KJ, Beckmann AM, Hislop TG, Teh CZ, Ashley RL. History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J Natl Cancer Inst. 1993. 85:19–24.
28. Tseng HF, Morgenstern H, Mack T, Peters RK. Risk factors for penile cancer: results of a population-based case-control study in Los Angeles County (United States). Cancer Causes Control. 2001. 12:267–277.
29. Hutchinson J. On the influence of circumcision in preventing syphilis. Med Times Gazette. 1855. 32:542–543.
30. Parker JD, Banatvala JE. Herpes genitalis; clinical and virological studies. Br J Vener Dis. 1967. 43:212–216.
31. Hand EA. Circumcision and venereal disease. Arch Dermatol Syphilol. 1949. 60:341–346.
32. Moses S, Bailey RC, Ronald AR. Male circumcision: assessment of health benefits and risks. Sex Transm Infect. 1998. 74:368–373.
33. Van Howe RS. Does circumcision influence sexually transmitted diseases?: a literature review. BJU Int. 1999. 83:52–62.
34. American Academy of Pediatrics. Circumcision policy statement. Task Force on Circumcision. Pediatrics. 1999. 103:686–693.
35. Wilson RA. Circumcision and venereal disease. Can Med Assoc J. 1947. 56:54–56.
36. Smith GL, Greenup R, Takafuji ET. Circumcision as a risk factor for urethritis in racial groups. Am J Public Health. 1987. 77:452–454.
37. Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA. 1997. 277:1052–1057.
38. Fergusson DM, Boden JM, Horwood LJ. Circumcision status and risk of sexually transmitted infection in young adult males: an analysis of a longitudinal birth cohort. Pediatrics. 2006. 118:1971–1977.
39. Dickson NP, van Roode T, Herbison P, Paul C. Circumcision and risk of sexually transmitted infections in a birth cohort. J Pediatr. 2008. 152:383–387.
40. Learman LA. Neonatal circumcision: a dispassionate analysis. Clin Obstet Gynecol. 1999. 42:849.
41. Collins S, Upshaw J, Rutchik S, Ohannessian C, Ortenberg J, Albertsen P. Effects of circumcision on male sexual function: dedunking a myth? J Urol. 2002. 167:2111–2112.
42. Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United states: prevalence, prophylactic effects, and sexual practive. JAMA. 1997. 277:1052–1057.
43. Kim DS, Pang MG. The effect of male circumcision on sexuality. BJU int. 2006. 18:1–4.
44. Spira AI, Marx PA, Patterson BK, Mahoney J, Koup RA, Wolinsky SM. Cellular targets of infection and route of viral dissemination after an intravaginal inoculation of simian immunodeficiency virus into rhesus macaques. J Exp Med. 1996. 183:215–225.
45. Miller CJ. Localization of simian immunodeficiency virus-infected cells in the genital tract of male and female rhesus macaques. J Reprod Immunol. 1998. 41:331–339.
46. Hussain LA, Lehner T. Comparative investigation of Langerhans cells and potential receptors for HIV in oral, genitourinary and rectal epithelia. Immunology. 1995. 85:475–484.
47. Joint United Nations Programme on HIV/AIDS. The HIV/AIDS situation in mid 1996: global and regional highlights. 1996. Geneva: United Nations;UNAIDS fact sheet 1.
48. McCoombe SG, Short RV. Potential HIV-1 target cells in the human penis. AIDS. 2006. 20:1491–1495.
49. Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999. 75:3–17.
50. WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention. World Health Organization (WHO). Available:
http://www.who.int/hiv/mediacentre/news68/en/print.html.
51. Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007. 369:643–656.
52. Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007. 369:657–666.
53. 2007 AIDS epidemic update/Sub-Saharan Africa. Joint United Nations Programme on HIV/AIDS and World Health Organization. 2008. Available:
http://data.unaids.org/pub/Report/2008/jc1526_epibriefs_ssafrica_en.pdf.
54. 2007 AIDS epidemic update/north America, western and central Europe. Joint United Nations Programme on HIV/AIDS and World Health Organization. 2008. Available:
http://data.unaids.org/pub/Report/2008/jc1532_epibriefs_namerica_europe_en.pdf.
55. Grulich AE, Hendry O, Clark E, Kippax S, Kaldor JM. Circumcision and male-to-male sexual transmission of HIV. AIDS. 2001. 15:1188–1189.
56. John-Stewart GC, Nduati RW, Rousseau CM, Mbori-Ngacha DA, Richardson BA, Rainwater S. Subtype C Is associated with increased vaginal shedding of HIV-1. J Infect Dis. 2005. 192:492–496.
57. Buchbinder SP, Vittinghoff E, Heagerty PJ, Celum CL, Seage GR 3rd, Judson FN. Sexual risk, nitrite inhalant use, and lack of circumcision associated with HIV seroconversion in men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2005. 39:82–89.
58. Warner L, Ghanem KG, Newman D, Macaluso M, Erbelding E. Male circumcision and risk of HIV infection among heterosexual men attending Baltimore STD clinics: an evaluation of clinic-based data. Proceedings of the 2006 National STD prevention conference. 2006. Jacksonville, Florida: 326.
60. Kelly R, Kiwanuka N, Wawer MJ, Serwadda D, Sewankambo NK, Wabwire-Mangen F. Age of circumcision and risk of prevalent HIV infection in rural Uganda. AIDS. 1999. 13:399–405.
XML Download