Circumcision and Sexually Transmitted Disease Prevention: Evidence and Reticence

Circumcision is one of the oldest surgical procedures and the most common surgical procedure performed on males. It is practiced for three main reasons: ritual or religious meanings, prophylactic hygienic purposes, and therapeutic indications. Male circumcision is advocated as an efficacious prevention strategy against sexually transmitted diseases. One of the main biological mechanisms responsible for the lower human immunodeficiency virus (HIV) infection rate in heterosexual circumcised men is the protective effect of keratinization of the glans. Moreover, male circumcision removes the inner part of the prepuce containing Langerhans cells that are targeted by HIV. Several observational studies showed a protective effect of male circumcision regarding the HIV acquisition in heterosexual men, in women with circumcised partners, and in men who have sex with men with an insertive anal role. Circumcision reduced the infection rate of other sexually transmitted diseases like human papillomavirus (HPV), mycoplasma, and genital ulcer disease. It seems now evident that circumcision has no negative effects on sexual function, sensitivity, sexual sensation, and satisfaction. When performed freely after informed consent, male circumcision is a lawful practice in adults. In children, the lack of an informed consent is overcome by the favorable risk/benefit ratio and the decision whether to circumcise or not pertains to the parents.