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The newly revealed health benefits of circumcision

[additional-authors]
December 10, 2014

Since Abraham’s circumcision at the ripe age of 99 (Genesis 17:7), Jews have maintained the holy covenant by circumcising their infant boys. Beyond the traditional aspect, circumcision has a solid moral purpose: it serves as a physical reminder of Jewish responsibility and our sacred task to heal the world as partners with G-d; our spiritual and moral endeavors require human effort. The very human organ that is the source of life was chosen to be sanctified by circumcision teaching us that every human desire has a holy purpose.

The rabbis taught that the mitzvot enable one to thrive. Generally the message is moral and spiritual; however, in some rare cases, the utility can be understood as intellectually, emotionally, or physically enhancing. With circumcision (brit milah), Jews have known that there is a health benefit, but we may not have known how serious that benefit was.

The Centers for Disease Control and Prevention (CDC) recently issued generally favorable recommendations for health care providers when counseling adult males and parents before the birth of their male children about circumcision, when performed by medical providers. Using randomized clinical trial data, the CDC noted that adult circumcised men had a 50-60 percent lower risk of contracting HIV, and a 30 percent lower risk of contracting sexually transmitted infections (STIs) such as herpes simplex and the human papillomavirus (HPV) that has been tied to penile and anogenital cancer. In their findings, neonatal circumcision may result in a reduction of prostate cancer by 15 percent.

The theory behind this benefit is simple. In an uncircumcised male, matter (smegma) collects between the penis and foreskin, leading to infection that can lodge here, causing inflammation. In turn, HIV is more likely to be contracted within this inflamed tissue. In a circumcised male, the foreskin is removed, so there is a lower risk for HIV infection.

These findings should be seen in context.

1) Reduced risk may only affect a few people. For example, a reduced risk of 90 percent for penile cancer after circumcision sounds dramatic, but the numbers affected are few, as the lifetime risk of penile cancer overall is only about 1 in 1,400.  Similarly, a reduction of 80 percent in infant urinary tract infections (UTIs) for those circumcised is a reduction based on an annual rate of 1 in 14 infants getting a UTI.

2) The reduction in risk for HIV is a more serious problem in sub-Saharan Africa than America, and applies only to penile-vaginal sex, not oral or anal, and thus does not apply to exclusively gay men. It also does not lower the risk of infection for women who engage in sex with men.

However, for the first time, the CDC has seen a greater benefit versus risk for circumcision. The recommendations reinforce the view that there are health benefits to circumcision, especially in contrast to the low rate of adverse events (less than 0.5 percent among infants, and 2 to 4 percent among adults) associated with medically provided circumcision, with virtually no cases of serious adverse events. On the other hand, while not the major cause, female-to-male sex transmission results in about 10 percent of new U.S. HIV cases, and circumcision would lower this rate. In other cases, circumcised males have consistently lower rates of infection and relevant cancers versus uncircumcised males, which has led the American Academy of Pediatrics and American Academy of Family Physicians to endorse infant circumcision, and the American Urological Association to endorse adult circumcision.

Just three months ago, I watched my new son undergo his brit milah. Frankly, it was mildly traumatic to watch since my wife and I are protecting him with all of our energy. But we are committed both by our faith and reason that this will enable our son to thrive. The circumcision serves as a reminder of our higher calling and that we are imperfect thus needing knowledge and wisdom to flourish. That there are enormous health benefits demonstrates the miraculous foresight of the tradition.

The Shulkhan Arukh says that “this commandment (milah) is greater than (all the) other positive commandments,” (Yoreh De’ah 260). Perhaps there was a sense that health benefits might be revealed; pikuach nefesh (saving life) is one of the highest of all Jewish values. While under half of American male Jews have undergone brit milah, over half have been circumcised (if not with a mohel then in a hospital). Countless around the globe, still remain unprotected. This is a mitzvah that we should encourage fidelity to, in and out of, the Jewish community.

Rabbi Dr. Shmuly Yanklowitz is the Executive Director of the Valley Beit Midrash, the Founder & President of Uri L’Tzedek, the Founder and CEO of The Shamayim V’Aretz Institute and the author of six books on Jewish ethics.  Newsweek named Rav Shmuly one of the top 50 rabbis in America.”

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