ZIMBABWE: Editorial explains doubts over circumcision and HIV link

Independent researcher Laurie Milner, citing a number of studies, explains that malaria and so-called “dry sex” are greater threats to public health and the spread of HIV in Africa than the presence of the human foreskin.

Milner echoes Dr. Joseph Matare’s conclusions in a previous article that other already proven methods of HIV prevention are less costly, less invasive, and far more efficacious than circumcision.

Complete text of the article after the jump.

Circumcision is not a ‘cure’ for HIV

Having recently read Male Circumcision and HIV Prevention – The Great Controversy by Dr. Joseph Matare, the HIV/AIDS Medical Officer for Namibia published on the 29th Jan 2007, I have to endorse his sentiments that circumcision is being heralded around the world as the ‘cure’ for HIV without sufficient thought being given to other factors some of which I will outline.

The fact that Malaria increases the HIV viral load never gets a mention in the popular media. The interaction between Malaria and HIV, the co-infection factor, is widely written about and many sources such as UNICEF, WHO, and articles in the Lancet and other professional medical journals support the thesis that there is an increase in the HIV viral load in people infected with Malaria.

Dry Sex

Beksinska et al, Sex Transm, Inf. 1999;75;178-180, indicated that dry sex is practised by 61% of men and 40% of women in the Gauteng Province of South Africa, the very area where Auvert conducted his research and made the first claim that circumcision reduced the incidence of transmission by 61%.

Having studied his research paper – PLOS Medicine, Vol. 2 Issue, 11 Nov. 2005 – I cannot see any evidence that he took dry sex into account in his analysis.

As dry sex removes all or most of the lubrication between the penis, especially the glans penis, and the vaginal wall, there is an increase in the abrasion, raw friction, discomfort, soreness, and probably tiny tears in the vaginal wall which represent entry points for the HIV virus to enter the blood stream. The penis is likely to be similarly affected.

There is a wide range of research and articles in the Medical Journals that say the same sort of thing. One example is Baleta et al., ‘Concern over “dry sex” practices is South Africa’ – The Lancet, Vol. 352, P1292, Oct 17 1999.

Circumcised Sex

The foreskin contains between 10,000 and 20,000 nerves that are specifically designed to give pleasure to the male during sexual activity. These nerves are removed along with the foreskin during circumcision, leaving only the nerves in the glans penis which are much sparser than the ones in the foreskin and nowhere as sensitive.

The outcome is that a circumcised man is left with a relative blunt instrument with reduced sensation, and the more years that pass, the duller the glans becomes because without the foreskin to cover and protect it, it becomes dulled and toughened (keratanized) as do the soles of the feet when a man walks about barefooted.

The foreskin also plays a role in stimulating the glans and so its loss coupled with the loss of the thousands of fine receptors leave a circumcised man unable to feel the intense feelings from the wide range of gentle movements possible in the act of intercourse. Although he may well be able to prolong intercourse for longer than a natural man he is unlikely to experience the range and intensity of feelings until just before and during orgasm, something which makes orgasm control difficult.

As age takes its toll, he will feel even less and will find more and more difficulty in achieving orgasm at all. Furthermore, circumcision frequently removes some of the shaft skin as well as the foreskin which causes the skin on the shaft of an erect penis to be at worst tight like a drum skin or at best lacking in lose mobile skin compared to one with a foreskin.

From a mechanical point of view, a penis modified in this way becomes akin to a piston which ‘pumps’ vaginal fluids out of the vagina creating the conditions that cause abrasion and soreness to both the man and woman.

On the outstroke, the shaft exits the vagina and takes with it vaginal fluids which evaporate while the rim of the glans acts in a similar way to a washer in a water pump – removing even more vaginal fluids, fluids that nature put there for good reason.

All in all a man who has lost his fine sensory receptors has to engage in harder and more vigorous thrusting in order to achieve orgasm and in so doing accelerates vaginal dryness and causes abrasions to the vaginal wall through which the HIV virus can pass into the blood stream.

The combined affect of circumcision and dry sex is going to cause even more abrasion to the vaginal walls than either dry sex or circumcised sex alone and thus increase transmission of the HIV virus. It is also less pleasurable for the women.

Furthermore, it may not be generally known but in approximately 96% of children up to the age about 4 years, the foreskin is joined to the glans in much the same way as a fingernail is joined to the finger. Its removal at an early age means that it has to be torn away from the glans which leaves the surface of the glans red and raw. The process is rather like pulling a fingernail off a finger. This sounds horrendous but is true and can be checked out in the medical literature.

The resulting raw surface of the glans is of course prone to infection and all sorts of complications, even when done in a UK hospital. What is more, no one knows what neurological damage this does or whether the tissue that grows over the glans in the healing process is the same or different to the natural surface that was removed during circumcision.

Uncircumcised Sex

A penis with a foreskin has movable skin which pulls back into its own sheath on the out-stroke in the same way as the neck and head of a turtle or tortoise moves back into the surplus movable skin on its neck.

This surplus movable skin is gripped by the pubococcygeal (PC) muscles which are just inside the vagina and is more or less held in place there as the body of the penis moves back into it on the out-stroke, thus the part of the penis within the vagina doesn’t actually pull out during intercourse and so doesn’t remove vaginal secretions.

Intercourse with a foreskin is a much more variable, sensuous and pleasurable experience for both the man and the woman, and doesn’t cause damage to the vagina and therefore doesn’t increase the risk of transmission of the HIV virus.

Conclusion

It is said that Langerhans cells in the foreskin are susceptible to the HIV virus and that is the reason for advocating circumcision. Langerhans cells are infact on other parts of the penis as well as on other parts of the body and as such are part of the human immune system.

It is also said that removing them along with the foreskin reduces the risk of HIV transmission by 60% which means that the risk of getting infected is 4 times out of ten; not really a good insurance policy for highly charged sexually active young men! Furthermore, human nature is such that men will soon start to think that they are protected against AIDS if they are circumcised, which definitely isn’t the case.

Nature put the Langerhan’s cells there for reasons of her own and my instinct says that nature knows best; we may not yet understand why they are there or what other functions they may have, but nature doesn’t seem to have got anything else wrong! Discounting this thought, it is surely a case of weighing up the advantages of the foreskin. It is my opinion that outwardly generated pressure to circumcise Africa will cause an increase in HIV/AIDS in the long term rather than a reduction. I feel it would be better to work towards eliminating Malaria, and all the other indigenous diseases that lower the immune system.

Surely it would be advantageous to cut out promiscuity and to educate against dry sex which is already being abandoned by the younger and more educated members of African society.

Multiple partners and inheriting the brother’s wife, who may well have died from AIDS, are obviously traditions that help rather than hinder the epidemic.

I also agree with Dr. Joseph Matare that microbicides may well have an important role to play if people can be persuaded to use them. Fine words, however, are one thing but changing attitudes is another.

One also needs to look at the United States which has both the highest rate of HIV transmission in the Western World and the highest percentage (90%) of sexually active circumcised men. If circumcision really does prevent HIV/AIDS than why does America not have the lowest rates in the world?

There is strong rumour and much on the internet claiming that the biotech industries in the United States harvest foreskins which they use in the production of off the shelf skin grafts.

Typing ‘foreskins for sale’ in Google or any other search engine certainly brings up some interesting reading. How much truth there is in these claims I am not in a position to say.

Finally, I am one of the few researchers who is qualified to talk about the differences between circumcised and uncircumcised sex as I was circumcised at 3 years of age and remained so until my fifties.

[Foreskin restoration] is easy to do and makes use of standard skin expansion techniques as used on a daily basis in hospitals around the world and doesn’t involve surgery. If anyone is interested in this then simply type the words, ‘foreskin restoration’ into Google or any other search engine on your computer.

The cost of restoring is virtually nothing, doesn’t require medical supervision and no one need know that you’re doing it.  It is, however, a slow process that takes from 3 to 6 years to complete.

Laurie Milner, (UK). Independent Researcher of the role, function and health of the foreskin.

Reference

Milner, Laurie. Circumcision is not a ‘cure’ for HIV. Zimdaily Weekender. February 3, 2007.

http://zimdaily.com/news/117/ARTICLE/1291/2007-02-03.html

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