Circumcision 'does not curb sex'

Circumcision does not reduce sexual satisfaction and so there should be no reservations about using this method as a way to combat HIV, a study says.

Nearly 5,000 Ugandan men were recruited for the study. Half were circumcised, half had yet to undergo surgery.

There was little difference between the two groups when they were asked to rate performance and satisfaction, the journal BJU International reports.

Some studies suggest circumcision can cut male HIV infection by up to 50%.

There are several reasons why circumcision may protect against the virus.

Specific cells in the foreskin may be potential targets for HIV infection, while the skin under the foreskin may become less sensitive and less likely to bleed - reducing risk of infection - following circumcision.

Mixed picture

But despite this, it is thought there is some reluctance to be circumcised over fears that it may impact upon sexual experience.

Previous studies into circumcision and satisfaction have given a mixed picture.

But researchers from the Johns Hopkins University in the US say the size of their study and demographic profile of their participants made it one of the most reliable to date.

"Our study clearly shows that being circumcised did not have an adverse effect on the men who underwent the procedure when we compared them with the men who had not yet received surgery," said Professor Ronald Gray, who led the study.

"Other studies already show that being able to reassure men that the procedure won't affect sexual satisfaction or performance makes them much more likely to be circumcised."

Mixed armoury

While there were very slight differences in rates of sexual satisfaction between the two groups, these were not felt to be clinically significant.

Some 98.4% of the circumcised men reported satisfaction, compared to 99.9% in the control group.

In terms of ability to penetrate, 98.6% of the circumcised group reported no problem, compared with 99.4 of the non-circumcised group.

However marginally more circumcised men - 99.4% - reported that they had no pain during intercourse, compared with 98.8% of the other group.

continues at http://news.bbc.co.uk/1/hi/health/7174929.stm

Male Genital Odors Are History

Miami, FL (PRWEB) January 4 2008 — Synerfied Healthcare introduces NodorO™ on ismellperfect.com. 

NodorO™ is a safe and effective OTC (Over The Counter) medicated cream developed in accordance with an FDA approved monograph; This brand was specifically created to remove and prevent MGO (Male Genital Odors) and can be obtained immediately without a prescription exclusively on NodorO™ website.

President/CEO and NodorO™ Creator, Dominic Adams suffered from MGO since he was a teenager, until he realized his discovery. Adams personally tested the product for several years, which inspired him to share his discovery with the world and created NodorO™. "I could not imagine my sexual life without NodorO™ anymore. I have no more fears of repulsing my partner due to bad genital odors. For anyone who has ever dealt with MGO, it is a miracle cream. I went from being embarrassed because of the smell, to being confident." says Adams without embarrassment or shame anymore.

MGO affects men of different ages. It is more likely to occur to men who are not circumcised, due to the moist environment between the foreskin and the glans, which is a favorable ground for development of fungi cells. NodorO™ targets the micro-fungi called tinea corporis. However, MGO can also happen to men who are circumcised.

Statistically, during the past decade, circumcision has dropped from 90% to 56% (almost 50% of the US population*) and the number is increasing. At the present time, approximately one of every three American is not-circumcised. Therefore, there is a potential of approximately 33 million Americans who are at a high possibility of currently having MGO. The percentage is even greater worldwide. The WHO (World Health Organisation) stated in 2006, that about 70% of males are not circumcised worldwide. **

Unlike other products such as scented oils and perfumes, NodorO™ does not mask or cover up the smell; it kills, destroys, removes and prevents odors. "Men have had to deal with this problem for centuries, and women had to deal with their partners having MGO. This subject has been taboo for the longest time" says Adams.

"The truth is that, bad MGO is a real turn off to women, and too embarrassing to discuss. Now that NodorO™ is available, and that we are able to remove and prevent MGO, I predict that it will rejuvenate many couple's sex life for all users, due to the increased attraction from their partner, and men's increased confidence and happiness level. It inspired our slogan:"Lose the odor, keep your lover. NodorO, get some™".

NodorO™ is proudly manufactured in the United-States in compliance with the FDA's GMP (Good Manufacturing Practice) regulations.

NodorO™ is available for ordering on our website at: ismellperfect.com 

Male Circumcision: A New Defense Against HIV

Discover Magazine
18 December 2007
by Apoorva Mandavilli

Male circumcision cuts the risk of HIV transmission in men by about 60 percent and should be scaled up in countries hardest hit by the epidemic, the World Health Organization (WHO) announced in March, citing compelling evidence from three large trials in Kenya, Uganda, and South Africa.

Since the 1980s, dozens of smaller studies have suggested that countries with high rates of circumcision, like the Muslim nations of western Africa, have lower rates of AIDS, whereas southern* Africa, where circumcision is rare, has been ravaged by the epidemic. There, a 2006 study suggests, circumcision could prevent about 6 million HIV infections and 3 million deaths over 20 years. Still, the WHO held back its recommendation until 2007, citing the need for randomized clinical trials.

“Circumcision was ignored for ages,” says Daniel Halperin, an AIDS researcher at the Harvard School of Public Health, who laid out the case for circumcision in The Lancet as far back as 1999. “What I mainly criticize the WHO for is that, even with dozens and dozens of powerful studies, they refused to even talk about it.”

Circumcision is thought to prevent infection because the underside of the foreskin is rich in immune cells that are particularly vulnerable to HIV. Small tears in the foreskin during intercourse can also allow the virus to slip into the body.

Circumcision could reduce the odds of an infected man’s transmitting the virus to a female partner by 30 percent or more. For all its benefits, though, the WHO cautions that it should not replace standard methods of prevention like the use of condoms.

http://discovermagazine.com/2008/jan/male-circumcision-a-new-defense-against-hiv

What WHO and UNAIDS actually said:

New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications
http://data.unaids.org/pub/Report/2007/mc_recommendations_en.pdf

Conclusion: The research evidence is compelling

The research evidence that male circumcision is efficacious in reducing sexual transmission of HIV from women to men is compelling. The partial protective effect of male circumcision is remarkably consistent across the observational studies (ecological, cross-sectional and cohort) and the three randomized controlled trials conducted in diverse settings.

The three randomised controlled trials showed that male circumcision performed by well-trained medical professionals was safe and reduced the risk of acquiring HIV infection by approximately 60%.

The efficacy of male circumcision in reducing female to male transmission of HIV has been proven beyond reasonable doubt. This is an important landmark in the history of HIV prevention.

Recommendations :
1.1 Male circumcision should now be recognized as an efficacious intervention for HIV prevention.

1.2 Promoting male circumcision should be recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men.

Should male newborns be circumcised?

Can Fam Physician
Vol. 53, No. 12, December 2007, pp.2096 - 2098
Copyright © 2007 by The College of Family Physicians of Canada

Debates
Should newborns be circumcised? YES

Edgar J. Schoen, MD
Clinical Professor of Pediatrics at the University of California in San Francisco

Compelling published medical evidence, particularly over the past 20 years, has shown that circumcision offers protection against multiple medical conditions.1 The most important role of primary care physicians, particularly when caring for children, is preventive health care, as exemplified by childhood immunizations. Consider newborn circumcision as a vaccine that has a preventive health role against not one but many disorders. In chronological order from infancy through old age these include severe infant urinary tract infections (UTIs) during the first year of life; local penile infections (balanoposthitis) and mechanical retraction problems (phimosis) in childhood; sexually transmitted diseases, particularly HIV and AIDS, in young adults; and penile and cervical cancer in older adults. Circumcision makes genital hygiene easier throughout life.

Protective effects and benefits

Most excitement and public awareness has been engendered by 3 recent, separate randomized controlled studies from Africa that have shown that circumcision offers a 60% to 70% protective effect against the heterosexual acquisition of HIV,2 an effect equivalent to that of many vaccines. The results of these studies were so compelling that the trials had to be stopped early, as it was no longer ethical to put men in the uncircumcised control group. The protective effect of circumcision against HIV has been recognized since the 1980s and was confirmed by more than 30 observational studies before the randomized controlled trials, which are the criterion standard of clinical research. The mechanism whereby the foreskin predisposes to HIV acquisition has been elucidated. It was originally thought that the delicate foreskin tears during intercourse, creating tiny abrasions through which the virus enters, and, indeed, this probably plays a role. But considered more important are studies showing that the virus preferentially attaches to phagocytic cells in the foreskin (Langerhans cells), which cannot kill the virus, and it enters the body. The preventive effect of circumcision against HIV has now officially been accepted by the World Health Organization, the United Nations, and the National Institutes of Health, and some African countries have begun adult circumcision as a public health measure.

Protection against other sexually transmitted infections is well documented.3 It has long been known that the presence of a foreskin is a risk factor in acquiring syphilis and chancroid. Within the past decade, a large multinational study has shown that uncircumcised men are 3 times more likely than circumcised men to be carrying the human papillomavirus on the penis,4 and that antibodies against Chlamydia infection are twice as common in women with uncircumcised male partners. Protection against human papillomavirus and Chlamydia might be most important in developed countries, where the prevalence of heterosexual HIV infection is low.

Of greatest importance to pediatricians is the role of the foreskin in predisposing infants to severe UTIs during the first year of life.5,6 It was first recognized in the 1980s that, although UTIs later in childhood are most common in girls, as in women, during the first 12 months of life, severe UTIs (pyelonephritis) predominate in boys. Several studies have proven that during this time period, uncircumcised male infants are about 10 times more likely to develop UTIs than are circumcised infants. These infant UTIs lead to high fever, generalized symptoms, and occasionally to disseminated infection (sepsis, meningitis). Tubular sodium loss can lead to high aldosterone levels. Follow-up studies often find evidence of renal scarring. As with HIV, the mechanism has been described. Uropathic bacteria, usually fimbriated Escherichia coli, stick to the moist foreskin (though not to the glans) and ascend up the urinary tract to cause renal infection.

Genital cancer is more common in uncircumcised men and the female partners of uncircumcised men. Penile cancer is seen almost exclusively in uncircumcised men.7 Although it is an uncommon disease (about 1200 cases in the United States annually), it is a devastating, invasive disorder, usually requiring penectomy. Cervical cancer has long been known to be less common in ethnic groups that perform circumcision (Jews and Muslims). Having multiple uncircumcised sexual partners beginning at an early age is a strong risk factor for cervical cancer. It has been shown that human papillomavirus is the causative agent for both penile and cervical cancer, and, as noted, this virus is more commonly carried by uncircumcised men.4

Anecdotally, some have claimed that the foreskin is important for normal sexual activity and improves sexual sensitivity. Objective published studies over the past decade have shown no substantial difference in sexual function between circumcised and uncircumcised men.8 Indeed, circumcised men were found to have more varied sexual activity, and a study in Middle America showed that women preferred circumcised penises, mainly for reasons of improved hygiene.9

Age at circumcision

The ideal time for circumcision-the window of opportunity-is when a child is first born. Newborns are extremely resilient and are programmed for stress, having just experienced the trauma of birth. They have high levels of corticosteroids, epinephrine, androgens, thyroxine, and endorphins. They heal quickly, and, when clamps are used (Gomco, Mogen, or Plastibell), the thin foreskin precludes the need for sutures. In the hands of an experienced physician, the complication rate is lower than 0.5%, and complications are usually minor. Local anesthesia should always be used. At older ages circumcision is riskier, more complicated, and about 10 times more expensive.

It is time for the medical establishment to recognize the compelling evidence favouring newborn circumcision10 and catch up to the public (80% of American males are circumcised).


CLOSING ARGUMENTS

* Circumcision results in several important health advantages over the lifetime.
* Benefits include protection against HIV and AIDS, human papillomavirus, other sexually transmitted infections, genital cancer, and severe infant urinary tract infections.
* The many advantages of circumcision far outweigh the surgical risks, which are low (about 0.5%) and usually minor.
* The newborn period is the ideal time because of ease of surgery, high levels of stress- and pain-controlling hormones, and rapid healing. Local anesthesia should always be used.


Footnotes
Competing interests
None declared

The parties in this debate will have the opportunity to refute each other's arguments in Rebuttals to be published in an upcoming issue.

References

1. Schoen EJ. Ed Schoen, MD, on circumcision: timely information for parents and professionals from America's #1 expert on circumcision. Berkeley, CA: RDR Books; 2005.
2. Newell ML, Barnighausen T. Male circumcision to cut HIV risk in the general population. Lancet 2007;369:617-9.[Medline]
3. 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;82:101-10.[Abstract/Free Full Text]
4. Castellsagué X, Bosch FX, Muños N, Meijer CJ, Shah KV, de Sanjosé S, et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med 2002;346:1105-12.[Abstract/Free Full Text]
5. Wiswell TE, John K. Lattimer Lecture. Prepuce presence portends prevalence of potentially perilous periurethral pathogens. J Urol 1992;148:739-42.[Medline]
6. Schoen EJ, Colby CJ, Ray GT. Newborn circumcision decreases incidence and costs of urinary tract infections during the first year of life. Pediatrics 2000;105:789-93.[Abstract/Free Full Text]
7. Schoen EJ, Oehrli M, Colby CJ, Machin G. The highly protective effect of newborn circumcision against invasive penile cancer. Pediatrics 2000;105:e36. Available from: http://pediatrics.aappublications.org/cgi/reprint/105/3/e36. Accessed 2007 October 22.[Abstract/Free Full Text]
8. Senkul T, Iseri C, Sen B, Karademir K, Saracoglu F, Erden D. Circumcision in adults: effects on sexual function. Urology 2004;63:155-8.[Medline]
9. Williamson ML, Williamson PS. Women's preference for penile circumcision in sexual partners. J Sex Educ 1988;14:8-12.[Medline]
10. Schoen EJ. Ignoring evidence of circumcision benefits. Pediatrics 2006;118:385-7.[Free Full Text]