Debates about circumcision aren’t only found among parents and pediatricians.  Research on circumcision is highly charged and there are plenty of peer reviewed articles that offer contradictory claims as to the benefits and harms of circumcision.

Since the early 2000s American researchers have been exporting circumcision as part of their work in Africa on HIV prevention.  As part ofpaper this research they have been circumcising men and looking at the impact of circumcision on risk of HIV and other STIs.


  Like many others, I have concerns about the lack of context and colonial look and feel of much of the research on circumcision and HIV in Africa.  

From the researchers themselves, and the mainstream media coverage of this work, we mostly hear numbers:  their studies show a reduction in risk of HIV infection in men by 50-60%.  They show a reduction in risk of HPV and herpes infection.  The findings were so strong in one study that they felt they ethically had to stop the study and circumcise all the men.

Of course not every study demonstrates these findings.  Research that compares circumcised and uncircumcised men in the west doesn't come close to this (you'll not that research in the west doesn't include actually circumcising men for research purposes, an intervention that would likely be considered far too extreme to pass ethics review here).

And this is what concerns me most about this research.  Regardless of the outcome, circumcision isn't a minor intervention.  I haven't heard anyone respond to the question of whether or not such an invasive procedure is justified given how little is known about why the research studies delivered the results they did.

What if the effects aren't from the circumcision at all, but some other part of the study?  They say, of course, that they "control" for such things.  But in real life it's not possible to control for everything.
It seems to me one thing we need to know is more about why such a dramatic protective effect has been found in these studies in Africa.

Which is why I was so pleased to read a study published in the open access journal mBio, that is trying to look at just that.

Researchers took swabs from the penises of men in one of the circumcision studies in Uganda, both before and after they were circumcised.  What they were looking at was how circumcision changes what they call the "penis microbiome" which is a term that describes the microbial stuff that is present on the penis, particularly around and under the foreskin.  They found, not surprisingly, that when you remove the foreskin and the head of the penis is constantly exposed, some microbes die off and others grow more.  Their next step is to consider how those changes may be linked to HIV transmission or HIV protection.

Here's how Lance Price, one of the authors of the study, explains it:

"From an ecological perspective, it's like rolling back a rock and seeing the ecosystem change. You remove the foreskin and you're increasing the amount of oxygen, decreasing the moisture - we're changing the ecosystem."

While I continue to find the original research claiming circumcision as a prevention tool to be troubling, this penis microbiome stuff is fascinating.  What's more, it may actually lead to fewer circumcisions.

In a prepared release Price reveals a surprise twist for all those who only see this topic as the most recent front in their war either for or against circumcision.  As it turns out, he is interested in researching circumcisions positive impact on health as a way to prevent the need for circumcision in the first place.  From the release:

To Price, this study has implications beyond circumcision. Understanding the changes in the microbiome following surgery could eventually lead to interventions that don't require a surgical procedure. "The work that we're doing, by potentially revealing the underlying biological mechanisms, could reveal alternatives to circumcision that would have the same biological impact. In other words, if we find that it's a group of anaerobes that are increasing the risk for HIV, we can find alternative ways to bring down those anaerobes," and prevent HIV infection in all sexually active men, says Price.

So the same research that is supposedly proving the utility of circumcision may also provide evidence that makes the procedure unnecessary.