CIRCUMCISION STATUS OF THE MAN

hpv-kling2ALAN KLING, M.D

Dr. Kling is a recognized expert in the field of HPV treatment, Dr. Kling has lectured on HPV at Columbia, Cornell, Mount Sinai, NYU, Yale and many other medical centers, as well as at numerous national meetings. He is up-to-date on the latest advances in the diagnosis and treatment of HPV. Dr. Kling is the recognized go-to-person for HPV-related diagnoses in the metropolitan NYC area.
Dr. Kling’s private practice offices are located on the Upper East Side in Manhattan and in Park Slope, Brooklyn. The offices are comfortable, stylish, elegantly decorated and impeccably clean. You can feel reassured that your consultation and treatment will be performed by an accomplished, experienced, and well-respected board-certified physician.

Q: What is circumcision?
A: Circumcision is when the naturally-occurring skin that covers the penis is removed. The prepuce refers to the part of the foreskin which covers the tip of the penis.

Q: What is the role of circumcision the prevention of HPV?
A: The prevalence of both high risk and low risk HPV strains or types among circumcised men is significantly lower than in uncircumcised men. Circumcised men do not develop genital warts or condyloma as frequently as uncircumcised men, and their partners have a lower chance of contracting an infection from them. Genital warts in uncircumcised men also recur more frequently than in circumcised men.

Q: How does the circumcision status of the man affect the woman’s chance of getting cancer of the cervix?
A: There is a higher chance of a woman getting cancer of the cervix after sexual contact with a man who is uncircumcised compared to a man who is circumcised.

Q: How much less frequently do the different HPV strains occur in men who are circumcised?
A: Both high-risk and low-risk HPV types occur 20%-70% less in circumcised men compared to uncircumcised men.

Q: Why is there an increased chance of a woman getting cancer of the cervix from an uncircumcised man?
A: The uncircumcised man is more likely than the circumcised man to be harboring the high risk strains of HPV.

Q: Why is an uncircumcised man more contagious than a circumcised man?
A: The foreskin that is present in an uncircumcised man gets easily traumatized. Multiple small breaks occur on the foreskin, HPV gets under the skin through these breaks and an infection is established.

Q: Why is the foreskin so easily infected?
A: The foreskin provides an increased surface area that the HPV virus can infect. Infections on the foreskin are much more resistant to treatment and are associated with increased recurrences after treatment compared to treatment in circumcised men.

Q: What happens when the foreskin is removed?
A: When the foreskin is removed the area of the skin that was previously more prone to get traumatized and infected is no longer present after a circumcision. Circumcised men have a lower chance of being carriers for HPV and of transmitting the infection compared to uncircumcised men.

Q: What happens to the penis after the foreskin is removed?
A: The skin on the penis gets thicker after the foreskin is removed. The thicker skin is a more effective barrier against HPV, as well as other infections. Chlamydia, for example, which is a co-factor that promotes the chance of a man getting an HPV infection, is also less likely to occur in the circumcised man.

Q: Are there any other benefits to circumcision?
A: The malodorous accumulation of the cheesy material under the foreskin known as smegma does not occur in men who are circumcised. There is less odor in the genital area when the man is circumcised because is easier to keep the area around the penis clean. Men who are uncircumcised complain that it can be virtually impossible to maintain good penile hygiene regardless of how often they wash themselves during the day. This odor is not infrequently an issue for both the men and their partner(s).

Q: What would you expect to occur after a man is circumcised?
A: The circumcised man will have a lower chance of getting or transmitting an infection with both the high and low risk HPV strains.

Q: How are the chances of a woman getting an HPV infection affected by the circumcision status of her male partner?
A: Women who are exposed to men who are carriers of high-risk HPV viruses are less likely to acquire infection if their male partner is circumcised.

Q: Why are men who are not circumcised more likely to get an HPV infection than men who are circumcised?
A: Men who are not circumcised are more likely to get an HPV infection than men who are circumcised because more breaks occur on the fragile foreskin through which the HPV virus can establish an infection. The heat and moisture under the foreskin also creates a more hospitable environment in which the HPV virus can grow and thrive.

Q: Are HPV infections in uncircumcised men more difficult to treat?
A: HPV infections in uncircumcised men are more difficult to treat, have higher recurrence rates and are more likely to infect a partner than are infections in circumcised men.

Q: What is the status of male circumcision in the United States today?
A: The number of uncircumcised males in the United States is increasing. The initial trend after World War II was to circumcise males shortly after birth because it was believed that this would result in better hygiene and better health. Although the role of circumcision in preventing infections and certain unwanted medical conditions is acknowledged, the views encouraging circumcision are not as adamant as they had once been.. As a consequence, more parents are now choosing not to circumcise their sons.

Q: Are there any other reasons why the number of uncircumcised men in the United States is increasing?
A: Over the last several decades there has been increased immigration from Asian and Hispanic countries, where circumcision is not routinely practiced and it is not part of the culture. These groups tend to carry on the family tradition of not getting circumcised. Whereas before there used to be firm healthcare guidelines unequivocally encouraging parents to circumcised their sons, the Department of Health has taken and is now offering a more watchful waiting and active surveillance approach.

Q: How will the increasing numbers of uncircumcised men in the United States affect the prevalence of HPV infections?
A: There will most likely be an increased incidence and spread of HPV amongst the female and male population exposed to men who are not circumcised. HPV infections in uncircumcised men have been associated with a greater number of lesions, more extensive involvement and higher rates of recurrence compared to infections in men who are circumcised.

Q: How often do men decide to get circumcised as adults in order to get an HPV infection under control?
A: The rate of circumcision in adult men is very low. Adult men who decide to get circumcised usually have other additional issues which make circumcision advisable. Adult men who decide to get circumcised in order to manage especially resistant and recurrent HPV infection s are rare.

Q: What can a man who is not circumcised and/or his partner do in order to minimize their chances of getting an HPV infection?
A: The HPV vaccine would be an especially helpful and valuable approach to minimize the chance of an HPV infection in men who are not circumcised and in their partners.

Q: Will the HPV vaccine help treat an uncircumcised man and/or his partner who are already infected with HPV
A: The HPV vaccine works well to protect a person against those strains of the virus which are in the vaccine to which they have not been previously exposed, but will not give increased immunity against those strains of the virus with which they have already been infected. The vaccine is preventive and not therapeutic. The vaccine will not help a current infection that has already been established.

Q: What percentage of men in the United States are circumcised?
A: According to the CDC (Center for Disease Control), the circumcision rate for newborn infant males in the United States has experienced a significant decrease over the last several decades. 32% of male infants born in the United States in 2009 were circumcised, compared to a 56% circumcision rate in 2006 and a rate that was over 80% in the 1970’s and the 1980’s.

Q: What were the previous circumcision rates in the United States for infant boys?
A: The circumcision rate in infant boys in the United States peaked in the 1970’s and 1980’s when over 80% of newborn male infants were circumcised.

Q: Are there regional differences throughout the United States?
A: There are regional variation in circumcision rates. The western Untied States has the lowest rate of infant circumcision, ar below the national average of 32% in 2009. Circumcision rates tend to be high in areas with significant Jewish and Muslim populations, where circumcision is traditionally associated as part of the religious and cultural practices of these groups.

Q: Is the percentage of circumcised males in the United States going up or going down?
A: The percentage of males in the United States continues to decline.

Q: What is the medical profession’s recommendation on circumcision?
A: The American Academy of Pediatrics (AAP) released a statement (August 27, 2012) that states that new scientific evidence shows the health benefits of newborn male circumcision outweigh the risks of the procedure, but the benefits are not great enough to recommend routine circumcision for all newborn boys.

Q: What are the scientific research show?
A: Scientific research shows that circumcision offers clear health benefits that includes lower risk of acquiring HIV, genital herpes, human papillomavirus and syphilis. Circumcision also lowers the risk of penile cancer over a lifetime, reduces the risk of cervical cancer in sexual partners, and lowers the risk or urinary tract infections in the first year of life.

Q: Would you expect a position more strongly favoring circumcision by the American Academy of Pediatrics based on this data?
A: The scientific evidence and medical advantages of circumcision are clear. Circumcision is an emotional decision for many parents. No turnaround in the circumcision rate will occur unless a prestigious and respected organization like the American Academy of Pediatrics or a federal agency or organization takes a firm and clear position on the issue based on health considerations. The American Academy of Pediatricians has punted and taken the politically-guided noncommittal position that the decision should be made by the parents in the context of their religious, ethical and cultural beliefs.

Q: How does the circumcision status of the man affect his chances of getting an HPV infection?
A: Uncircumcised men have a greater chance of contracting an HPV infection.

Q: How does the circumcision status of the man affect his female partner’s chances of getting an HPV infection?
A: A woman has a higher chance of getting an HPV infection from a man who is uncircumcised than from a man who is circumcised. The circumcision status of the man is one of the important co-factors in the male partner that affects a woman’s chance of developing HPV infections and cancer.

Q: How do the treatment results compare in men who are circumcised compared to those who are uncircumcised?
A: Men who are not circumcised have a higher chance of getting recurrent HPV infections after treatment compared to men who are circumcised.

Q: Does the circumcision status of the man affect the number of treatments the man will need in order to get their infection under control?
A: Men who are uncircumcised usually require a greater number of treatments in order to get their HPV infection under control compared to men who are circumcised.

Q: How does the rate of transmission of HPV to their partner(s) compare in men who are circumcised compared to men who are not uncircumcised?
A: The rate of HPV transmission is decreased in men who are circumcised.

Q: Should men who are uncircumcised who have HPV infections get a circumcision?
A: Men who are uncircumcised should not be routinely advised to get a circumcision . The infection can be managed and contained with traditional treatments and diligent follow up evaluations. Circumcision should be reserved as an option only for the most extreme of cases.

Q: How does a man’s circumcision state affect the chances of him getting an HPV infection?
A: Men who are not circumcised have up to a 30% increased chance of getting an HPV infection.

Q: Is there any difference in the man’s response to treatment if he is circumcised compared to if he is not circumcised?
A: There is a 30% increased persistence rate of HPV infections in men who are not circumcised compared to men who are circumcised.

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