[return to first circumcision page]
The operation itself – removing the foreskin – may cause “complications” or “adverse events.” Many adverse events are easy to see, such as excessive bleeding, local infections that lead to pain and swelling.
A review of more than 1,000 circumcisions performed on boys and young men in Kenya in 2004 found that 17.7% of those circumcised in clinics and 35.2% of those circumcised in traditional settings had one or more adverse events. “Bleeding and infection were the most common adverse effects, with excessive pain, lacerations, torsion and erectile dysfunction also observed” (quoted from page 669 of this link). Another report from the same study provides several pictures of men’s genitals after botched circumcisions. Curiously, the lead author for this study has been a vocal advocate for mass male circumcision in Africa.
Is circumcision so dangerous? Many later studies in Africa have reported much lower percentages of adverse events. On the other hand, surveys of clinics and hospitals in 6 of the 13 countries targeted for mass circumcision report that 17% to 83% of facilities did not have equipment to sterilize instruments.
Some important adverse events – infections of HIV, hepatitis B virus, and hepatitis C virus – cause no local or immediate symptoms, and can go unrecognized for years. Nevertheless, a lot of evidence suggests that some boys and men in Africa have gotten HIV from their circumcision procedures.
In Kenya, Lesotho, and Tanzania many men are circumcised during puberty or later. In these countries, from 1.4% to 2.3% of circumcised virgin men aged 15-17 years are HIV-positive compared to only 0%-0.6% of intact virgin men aged 15-17 years. In Mozambique, among boys and young men aged 0-19 years, 3.0% of those who have been circumcised are HIV-positive compared to only 1.1% of those who are intact. In Mozambique, circumcised boys and men are at higher risk for HIV whether they are virgins or sexually experienced.
Finally here’s evidence of risk, as well as lack of commitment to protect African men: A study in Kenya that circumcised men to see if it reduced their risk for HIV found 4 men with new HIV infections one month after they had been circumcised in the study clinic.[i] Three of these 4 men reported no sex partners during the month (which is believable, considering they had just been circumcised). Were they already infected when they were circumcised? Sensitive tests could not find HIV in blood collected at that time. Were they infected during circumcision? According to ethical principles and regulations, the study team should have reported these unexpected infections as adverse events and then investigated them, to see if they came from the study clinic. The study team did not do so – leaving an unsolved mystery and unknown risks for African men accepting to be circumcised.
Table: Evidence that circumcision infected boys with HIV[ii]
|Country, year, boys’ ages
||% of boys that are HIV+
||Relative risk for HIV in circ’d vs intact boys
|Kenyan, 2003, virgin boys aged 15-17 years
||∞ (infinite; >>1)
|Lesotho, 2004, virgin boys aged 15-17 years
|Tanzania, 2003-04, virgin boys aged 15-17 years
| All boys 0-19 years
| Virgin boys
| Non-virgin boys
[i] Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 2007; 369: 643-656.
[ii] Data for Kenya, Lesotho, and Tanzania from: Brewer DD, Potterat JJ, Roberts JM, Brody S. Male and female circumcision associated with prevalent HIV infection in virgins and adolescents in Kenya, Lesotho, and Tanzania. Ann Epidemiol 2007; 17: 217-226. Data for Mozambique are from: Brewer DD. Scarification and male circumcision associated with HIV infection in Mozambican children and youth. WebmedCentral Epidemiology 2011;2(9):WMC002206. Available at: http://www.webmedcentral.com/article_view/2206 (accessed 16 January 2012).