Why Women Should Favor Circumcision: To Prevent HPV Infection

To snip or not? Any parent of an infant son faces this circumcision question; for some, like me, it's a no-brainer. I had my two sons circumcised in accordance with my Jewish faith. Others, though, would like to know if there are any health reasons in favor of circumcision. Well, a study of 5,000 initially uncircumcised Ugandan men in this week's New England Journal of Medicine found that once the men underwent circumcision, their rate acquiring herpes virus infection plunged by 28 percent and they were 35 percent less likely to get infected with human papillomavirus (HPV), which is responsible for genital warts and, in women, cervical cancer.

Previous research has shown that circumcision reduces infection with the HIV virus by 60 percent—although other studies have shown no difference in rates of certain sexually transmitted diseases between circumcised and uncircumcised men.

Why, though, am I talking about this in my On Women blog? The quick answer: I was intrigued by the finding that there was something men could do, beyond wearing a condom, to prevent infecting women with HPV. After all, the Gardasil vaccine against HPV still isn't approved for use in boys or men—though Merck recently submitted paperwork to the Food and Drug Administration seeking approval to sell the vaccine for use in males.

Will the approval of Gardasil in men truly stop the transmission of HPV to women? I pose this question to Diane Harper, a professor of obstetrics-gynecology at the University of Missouri in Kansas City who previously conducted Merck-funded clinical trials of Gardasil. "From the studies I've seen, the vaccine works well to protect men, ages 16 to 26, from genital warts," she tells me, "but there's not enough data to show that it protects them against anal, esophageal or penile cancers caused by HPV." In one trial, Harper says, only two cases of precancerous cells on the penis were detected in the unvaccinated group. While none were detected in the vaccine group, that number of cases isn't enough to draw statistically reliable conclusions.

Furthermore, Harper adds, there's no way of knowing whether the vaccine will actually keep men from infecting women with HPV because the clinical trials didn't examine that. She points out that some vaccines do work better in certain genders: An experimental vaccine for herpes, for example, worked well at protecting women from the virus but didn't protect men. It's too early to tell whether Gardasil will be worthy of a public health campaign directed at men, she says. It may not be, if it protects only against the virus strains that cause genital warts and not those that cause cancer.

In the meantime, parents reluctant to circumcise may want to reconsider. This new study looks pretty compelling, and someday your son's wife may thank you.

More tomorrow on my interview with Harper. She tells me the real reason Gardasil is given to 11-year-olds and what she thinks about the paralysis cases that might be associated with Gardasil.