Research shows circumcision has little effect on spread of disease

Circumcision, once advocated as a means of reducing the spread of venereal diseases, has very little impact on their transmission, but it does seem to improve sexual pleasure for some men, contends a new study led by Edward Laumann, the George Herbert Mead Distinguished Service Professor in Sociology.

The report, "Circumcision in the U.S.: Prevalence, Prophylactic Effects, and Sexual Practice," published April 2 in the Journal of the American Medical Association, found that circumcised men are slightly more likely to have had both a bacterial and a viral sexually transmitted disease in their lifetime.

In most cases, the differences reported between circumcised and uncircumcised men in contracting sexually transmitted diseases are statistically insignificant, with the exception of the disease chlamydia, in which 26 of the circumcised men in the sample and none of the uncircumcised men had the disease, said Laumann. Co-authors of the study are Christopher Masi, M.D., who is a Ph.D. candidate in the School of Social Service Administration, and Ezra Zuckerman, a graduate student in sociology at the University.

The paper, based on the path-breaking 1992 National Health and Social Life Survey conducted by the National Opinion Research Center, is the first systematic examination of the consequences of circumcision for disease and sexual practice.

The National Health and Social Life Survey was based on a randomly selected sample of 1,410 men between the ages of 18 to 59. Circumcision was widely practiced in the United States between 1933 and 1974, when the men in the study were born. Doctors encouraged the procedure for newborn boys after studies during World War II claimed that circumcision reduced the spread of disease.

Physicians had contended that circumcision improved men's hygiene, but have found that other practices, such as thorough washing, are equally effective, Laumann said. Doctors now advise parents to weigh the risks and benefits of circumcision, but the practice has become only somewhat less common.

According to the research team, white, well-educated men are more likely to have been circumcised. The researchers found that, according to their sample, 81 percent of white men, 65 percent of black men and 54 percent of Hispanic men have had circumcisions.

Although the study found little connection between sexually transmitted diseases and circumcision, it did find important socially based differences among men who are circumcised and those who are not. Circumcised men engage in a wider variety of sexual practices than do uncircumcised men, and they also report less sexual dysfunction as they age, regardless of their social and economic status.

According to the study, "When all age groups are considered, almost every dysfunction is slightly more common among men who have not been circumcised. In particular, the likelihood of having difficulty achieving or maintaining an erection is significantly lower for circumcised men."

The association between circumcision and sexual performance is highest among men between the ages of 45 and 59, the survey found. "Of the seven sexual dysfunctions considered, uncircumcised older men were more likely to experience every one of these difficulties than were their circumcised peers," the researchers reported.

The odds of circumcised men between the ages of 45 and 59 experiencing anxiety about sexual performance were about half of that experienced by uncircumcised men, the study found.

According to the researchers, circumcised men are also more likely to explore a broader set of sexual practices than uncircumcised men. "For each of the practices examined -- lifetime experience of various forms of oral and anal sex and masturbation frequency in the past year, circumcised men engaged in these behaviors at higher rates.

"For white men, the differences between circumcised and uncircumcised men were quite stark," the researchers wrote. Regardless of their social or economic status, circumcised white men were much more likely to engage in masturbation and oral sex than uncircumcised white men. Black and Hispanic men were less likely to report these practices whether they were circumcised or not.

It is unclear why circumcised white men have broader interests in different sexual practices. It could be that uncircumcised men, in a significant minority among white men, feel a stigma that reduces their willingness to engage in a variety of sexual acts, Laumann said.

The National Health and Social Life Survey was conducted in 1992. It consisted of 90-minute face to face interviews with 3,432 randomly selected men and women. It is the nation's first comprehensive, scientifically accurate survey on American sexual behavior. Laumann is co-author of two books produced from the survey, The Social Organization of Sexuality and Sex in America.

-- William Harms