In 2007 The World Health Organization and United Nations organization, UNAIDS, wrote guidelines recommending countries to institute male circumcision programs [1] as apart of a comprehensive HIV and STD prevention program, many surveys and studies have been conducted in various countries to see the public’s opinion on circumcision.

United States:

[2]American General Public: The CDC conducted a study in 2011 which involved sending a questionnaire in regards to circumcision to Americans along with up-to-date information on the risks/benefits of circumcision. Over 95% of circumcised men responded that they planned on pursuing circumcision for their son if they had one, and 70% of uncircumcised men responded that they planned on pursuing circumcision for their son if they had one. Over 50% of respondents said that information on circumcision’s ability to protect from HIV and other STD’s as well as protect from penile cancer and urinary track infections increased the likelihood of pursuing circumcision for their son. Almost all respondents that responded saying they believed in circumcisions ability to reduce STD’s and that circumcision was a low risk procedure said they would pursue circumcision for their son. In total, only 12% of respondents said they would probably not pursue circumcision if they had a son.

[3] Hispanic Immigrants in Miami: A study conducted among Hispanic immigrants in Miami briefed the participants on the benefits of circumcision (Less chance of contracting HIV and some other STD’s, virtual elimination of the risk of getting penile cancer, and reduced risk of urinary track infections) as well as the risk associated with circumcision. Approximately 1/3 of the Hispanic men involved were homosexual, and the prevalence of circumcision among these men was under 20%. 50% of uncircumcised men expressed willingness to undergo circumcision. The men reported the main reason being improved hygiene followed by reduced risk of contracting HIV. The other half of the uncircumcised men felt the change involved with undergoing circumcision would be to great for them. 45% of the women stated they preferred circumcised men, 35% had no preference, and 15% preferred uncircumcised. Over 80% of men and women said they wanted their son to be circumcised after receiving information on circumcision.

Jamaica:

[4] A study conducted in 2012 by Jamaican epidemiologist and doctors tried to assess how the Jamaican public views circumcision and if it is feasible to implement circumcision as an HIV prevention strategy. The study included 549 men ages 19-54 from Western Jamaica. The overall prevalence of circumcision was 14% in this population a table representing men’s acceptance of circumcision before and after being well informed of up-to-date information on the risk and benefits of circumcision is below:jamaica-acceptance

 

 

 

 

 

 

 

 

 

As the table indicates, both circumcised and uncircumcised men have a very high view of circumcision after being well informed on circumcision. Of the men that still reported not being willing to accept circumcision for himself or his son, almost all of them responded saying either ‘you should not change the way God made you’ or ‘circumcision may damage the penis’.

South Korea:

A study [5] from 2014 in South Korea found the circumcision rates comparable to the circumcision rates of whites and blacks in the United States born after 1950 (90%-95% prevalence). The study looked at 150 consecutive patients ages 17-70 to present at an STD clinic. 90.2% of men were circumcised, with a lower circumcision rate among older men. The study may under estimate the circumcision rate since uncircumcised men are more likely to get certain STD’s, and it may also over estimate the circumcision rate since wealthier men are more likely to be circumcised and also seek help at an STD clinic for treatment. Unlike North America though, most men undergo circumcisions in their teenage years or in their 20’s.

[6] A 2006 study in South Korea aimed at gauging doctor’s views of circumcision found the vast majority of urologist and other doctors are in favor of circumcision as presented in the pie chart below:

korea-doctors-view

[7] A large survey involving 2,700 young men in South Korea (around age 20) ask them about their beliefs about circumcision. 75% believed the circumcision was necessary, with most of the men citing that superior penile hygiene was the main reason that made it necessary. 3% of men did not feel that it was necessary. The circumcision rate was found to be 78% with 11.5% of men planning on undergoing circumcision in the near future. This study came without up to date information on the risk/benefits of circumcision, which studies in the USA, Jamaica, China, South Africa, and the Dominican Republic has been found to increase the likelihood of men wanting to undergo circumcision for themselves and their sons in over 50% of men [2, 4, 9, 10].

 

China:

[8] Upon receiving information on the risk/benefits of circumcision from Chinese doctors, 50 out of 67 (74.6%) of Chinese men in Changsha, China between the ages of 18-30 said they would like to undergo circumcision. Again, in this study, almost all men in the 18-30 age group who believed that circumcision was able to reduce the risk of contracting HIV and other STD’s wanted to undergo circumcision.

[9] 3,600 schoolboys ages 6 to 15 were surveyed in Urumqi, China along with their parents to determine the prevalence and views of circumcision in this demographic. Although just around 10% of Chinese adults are circumcised, 46.2% of the schoolboys were circumcised, with the average age of circumcision being 8.3 years old. After receiving information from Chinese doctors on circumcision, over 50% of parents with uncircumcised sons said they would like their sons to undergo circumcision.

Dominican Republic:

[10] A study among 238 uncircumcised men in the Dominican Republic was conducted to see the willingness for these men to undergo circumcision. Previous studies cited in the article indicated that just 14% of men from the Dominican Republic were circumcised. Prior to an information session on the risk/benefits of circumcision, 29% of men said that they would like to undergo circumcision, but after the information session that number increased to 67%. Also, 74% of men reported that they would want their son circumcised after hearing information on the risks/benefits of circumcision.

[11] A similar survey to the one described above was also carried out in the Dominican Republic among doctors. Their beliefs about circumcision are presented in the following table:dr

As shown, 93% of health care providers believes that circumcision had medical benefits. After a briefing on three randomized control trials that showed circumcision reduced the risk of contracting HIV by around 60%, almost all healthcare providers held the belief that circumcision reduced the risk of getting HIV.

India:

[12] a survey conducted among 800 Mothers with sons in Mysore, India was conducted to see their views on circumcision. After receiving information on the risks/benefits of circumcision from an Indian doctor, 81% of mothers with uncircumcised son(s) said they would defiantly want their son to be circumcised if it was available in a hospital setting and free of charge, 7% of mothers said they would probably want their son(s) to be circumcised, 9% were unsure, and just 1% of mothers said they probably would not/definitely would not consider circumcision for their son(s)

South Africa:

[13] A survey conducted in South Africa found that the circumcision rate for men of age 18-19 increased from 61.2% in 2010 to 87.5% in 2015. In addition, 85% of uncircumcised men ages 18-49 said that they wished to be circumcised.

[14] A study in 2014 was conducted among 1778 pregnant mothers to asses the acceptability of newborn male circumcision. Nurses and counsellors who were trained to provided infant circumcision counseling as well as carry out the procedure briefed the mothers on the risks and benefits on circumcision. the study found 83% of mothers wanted their son to be circumcised after the counseling, 41.3% who did not agree to circumcising their son said they needed to discuss circumcision further with other family members, and 15.9% who did not agree to circumcise their newborn son wanted their son’s circumcision to take place in a more religious and culturally appropriate setting. In total, less than 10% of mothers did not want their newborn son circumcised.

Canada:

[15] A survey was conducted among parents in Saskatchewan, Canada at a parenting class in 2013. The parents views on circumcision are presented in the following table:

saskatchewan

As shown, 86 (90.5%) of parents planned on having their child circumcision if it was a son, and just 5 (5.3%) planned on not having their child circumcised it was a son. This study came without any briefing on the risks/benefits of circumcision (60% reduction in contracting HIV, less likely to contract some other STD’s, virtual elimination of the risk of penile cancer, and much less likely in contracting a urinary track infection) which in others studies in the USA, China, Dominican Republic, Haiti, and South Africa found more than 50% of people were more inclined to undergo circumcision for themselves and their sons after receiving information on the risks/benefits of circumcision.

Discussion:

Nearly all circumcised men (around 95%) and women from cultures that practice circumcision hold a positive enough view of circumcision to want their son to get circumcised. Essentially all circumcised men hold a positive or neutral view on circumcision. In addition, a high amount (usually around 70-85%) of uncircumcised men held a positive enough view on circumcision to want their son to undergo circumcision, most young men wanted to undergo circumcision for themselves when hearing of the risks and benefits of circumcision (typically around 70%, even higher for men who believed the World Health Organization’s statement that circumcision reduces the risk of contracting HIV from heterosexual sex), and most women (75-90%) in historically non-circumcising communities hold a high enough view on circumcision that they  wanted their son to undergo circumcision after hearing about the risks and benefits of circumcision. Overall nearly all of the surveyed populations, which represent a wide range of cultures, held a positive or presumably neutral view on male circumcision.

Opposition to Circumcision:

As noted in the discussion, an extremely high number of circumcised men and women in cultures that practice circumcision have a positive opinion of circumcision, and circumcision is universally held in a positive or neutral view among circumcised men. In addition, a very high number of uncircumcised men and women in non circumcising cultures hold a positive view on circumcision. In spite of this, there is some opposition to circumcision. In a study focused around an anti circumcision group in the USA whose many focus was ‘regrowing foreskin’, the researches found that the group consisted of all men, 65% of whom were uncircumcised (in a country where 90%+ of whites and blacks are circumcised) [16]. The group, the largest of its kind in the USA, consisted of a little more than 1,000 members with the number of uncircumcised men in the group almost 50 standard deviation over the norm. Other anti circumcision groups have an even larger disparity between uncircumcised and circumcised. In addition, only 10% of the men in the group did not identify themselves as being homosexual. A psychoanalysis of 8 circumcised members of the group took place and found that all 8 exhibited the following traits: exhibitionism, obsession with body image, and narcissism. From this though it can clearly be seen that the anti circumcision groups are largely driven by a homosexual fetishization of foreskin by some uncircumcised men. Under 5% of articles on PubMed on the subject of male circumcision are against circumcision, with 90% of papers opposing circumcision written by the same 5 or 6 authors, two of them being Dr. Frisch and Mr. Darby (not associated with any university but a self described ‘scholar on circumcision’). Both of these men have sited sexually explicit homosexual fetish websites involving foreskin as a reason to be against circumcision, furthering the notion that anti circumcision sentiments stems from a homosexual foreskin fetish among some uncircumcised men. This fetish group is small though even in the gay community. Study [3] took place in the USA among uncircumcised immigrant Hispanic men found that over 50% of men wanted to undergo circumcision for themselves after receiving information on the risks and benefits of circumcision, and 85% of the men would want their son circumcised if they had in spite of the fact that gay men made up over 1/3 of this group. Another study in the USA found over 50% of gay men wished to undergo circumcision after being given up to date information on the risks/benefits of circumcision [17].

Conclusion:

In spite of some people calling circumcision ‘controversial’, these studies find that circumcision is looked well upon by a very large majority of the world’s population, and anti circumcision sentiment stems from a small subgroup of uncircumcised gay men who fetishize foreskin. A previous study in Korea [6] noted that 97% of Korean websites are in favor of circumcision. In Korea, circumcision occurs during the teenage years and as such, the average person would be compelled, and so 97% of websites being in favor of circumcision accurately reflects the publics views on circumcision.

 

[1] World Health Organization and UNIADS: New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications   http://apps.who.int/iris/bitstream/10665/43751/1/9789241595988_eng.pdf

http://www.who.int/hiv/pub/malecircumcision/research_implications/en/

[2]Acceptability of Newborn Circumcision to Prevent HIV Infection in the United States. Gust et al.    https://www.ncbi.nlm.nih.gov/pubmed/21217414

[3] Acceptability of Circumcision Among Hispanics. Castro et al.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141694/

[4] Factors Associated with the Acceptability of Male Circumcision among Men in Jamaica. Aung et al.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3774608/

[5]Prevalence and Determinants of High-Risk Human Papillomavirus Infections in Male Genital Warts. Park et al. (table 1 contains the circumcision rate)  http://www.icurology.org/search.php?where=aview&id=10.4111/kju.2014.55.3.207&code=0020KJU&vmode=PUBREADER#!po=63.3333

[6]What are Doctors’ Clinical Opinions Regarding Circumcision. Lee et al. https://synapse.koreamed.org/DOIx.php?id=10.4111/kju.2006.47.1.91&vmode=PUBREADER#!po=25.0000

[7]Circumcision Practice Patterns in South Korea: A Community Based Survey. Ku et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1744613/

[8] Factors Associated with Knowledge of and Willingness for Adult Male Circumcision in Changsha, China. Zeng et al.       https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4747502/

[9] Parental Factors Affecting the Circumcision of Non-Muslim Chinese Boys Include Education and Family History. Yan et al.   https://www.ncbi.nlm.nih.gov/pubmed/26215895

[10] Acceptability of Male Circumcision for the Prevention of HIV/AIDS in the Dominican Republic. Brito et al.                        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2765614/

[11] The Feasibility and Acceptability of Male Circumcision Among Men, Women, and Health Providers of the Altagracia Province, Dominican Republic. Brito et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677077/

[12] Acceptability of Male Circumcision Among Mothers with Male Children in Mysore, India. Madhivanan et al.                                  https://www.ncbi.nlm.nih.gov/pubmed/18453858

[13] Sequential Cross-Sectional Surveys in Orange Farm, a Township in South Africa. Marshall et al.       https://www.ncbi.nlm.nih.gov/pubmed/27427957

[14] Acceptability of Neonatal Circumcision by Pregnant Women in South Africa. Phili et al.     https://www.ncbi.nlm.nih.gov/pubmed/26018569

[15] Parents’ Rational for Male Circumcision. Rediger et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576965/

[16] (The study is referenced in the second to last section in this study, as well as supplying a link to the original study. The original study is behind a pay wall though) Critical Evaluation of unscientific Arguments Disparaging Male Circumcision Policies.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978617/#B116

[17] Willingness of Men who Have Sex with Men in the United States to be Circumcised as Adults to Reduce the Risk of Infection. Begley et al.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2443289/

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