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Circumcision May Prevent Sex-Related Penis Injuries

July 2, 2010

A recent study finds circumcised men were less likely than their uncircumcised peers to report penile cuts, abrasions, and other injuries from sex -- perhaps helping explain why circumcision is linked to a lower risk of female-to-male HIV transmission.

Investigators led by Dr. Supriya D. Mehta of the University of Illinois at Chicago analyzed data from almost 2,800 Kenyan men ages 18-24 randomly assigned to undergo circumcision or remain uncircumcised. At the end of two years, circumcised men were 61 percent as likely (95% CI 0.54-0.68) to report any type of any injury during sex (defined as soreness during sex, penile scratches, cuts or abrasions during sex, and bleeding of the skin of the penis after sex.)

The researchers discussed why penile injuries may affect the transmission of HIV. One theory is that circumcision reduces the amount of mucosal tissue exposed during sex and therefore limits HIV's access to susceptible cells. Another possibility is that thickened skin around the circumcision scar blocks HIV.

The current study addressed the premise that mild injuries such as cuts and scratches could provide an entry to HIV.

Overall, penile injury was common; at baseline, 64 percent of the men reported some type of soreness, abrasion or bleeding associated with sex in the past six months.

Men who were more likely to report injuries were older, had multiple recent sex partners, were positive for the genital herpes virus (HSV-2) and had genital ulcers. Fewer injuries were reported among men who used condoms, cleaned the penis soon after sex, and were monogamous.

The full report, "Circumcision and Reduced Risk of Self-Reported Penile Coital Injuries: Results from a Randomized Controlled Trial in Kisumu, Kenya," was published in the Journal of Urology (2010;184(1):203-209).

Back to other news for July 2010

Adapted from:
Reuters Health

This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.
See Also
Quiz: Are You at Risk for HIV?
10 Common Fears About HIV Transmission
Male Circumcision for HIV Prevention

Reader Comments:

Comment by: Hugh7 (New Zealand) Sat., Jul. 3, 2010 at 7:31 pm UTC
60% of men reporting penile injuries in the six months before the study began is a remarkable proportion. Something else is going on (possibly "dry sex" - the partners of non-circumcised men putting herbs inside their bodies). Then, six months into the trial, the non-circumcised men report a big decline in injuries - the "Hawthorne effect"; just going in a study makes a difference to the outcome.

And though it's obscured in the reporting, the decline in injuries among the circumcised men is not much greater, a difference of 11%. So circumcising nine men might prevent one penile injury in six months. It hardly seems worth the trouble, does it?

Not only that, but the measure of all the injuries is by self-reporting, which is notoriously unreliable. Maybe getting circumcised makes men less likely to report other penile injury (just by making it look trivial in comparison.)

While the lead author is someone called Mehta, as usual, at the end of the line of authors are the familiar names of S. Moses and RC Bailey. A tiny handful of authors are behind all the pro-circumcision studies.
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Comment by: Restoring Tally (USA) Sat., Jul. 3, 2010 at 7:15 pm UTC
The results of this study needs to be placed in context. The culture that engages in sex where 60% of the men suffer penile injury within 6 months is not the same culture as known in first world countries. In Africa, where these subject live, dry sex is often practiced. If nothting else, the results of this study may be more relevant to the damage caused by particular sexual practices rather than circumcision status.
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Comment by: P Hoath (UK) Sat., Jul. 3, 2010 at 4:13 am UTC
You wouldn’t cut your hand off to prevent injury to your fingers so why would you cause a major injury to your penis just to prevent the possibility of a minor injury.

The HIV circumcision studies only showed a decrease in infection in female to male transmission of 1.25% overall, infection during the study was 0.85% for circumcised and 2.1% for uncircumcised. The 60% sounds a lot but it is on a very small infection percentage. The infection rate for male to female transmission actually went up with circumcision (circumcised 18% infection, uncircumcised 12%) by 6%, so by these trials, for every infection in stops, circumcision causes almost five more.

The desensitising of the penis that is the result of the amputation of the foreskin merely pushes the genital injuries to the female as the male has to use more force to achieve the same stimulation and, as the HIV transmission results above suggest, with an even greater potential for damage and infection.
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Comment by: Mark Lyndon (Manchester, UK) Fri., Jul. 2, 2010 at 9:17 pm UTC
Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are *more* likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms. The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms".

The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw.

ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.
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