How medical male circumcision reduces HIV/Aids risk

How medical male circumcision reduces HIV/Aids risk

JANE NAFULA

Three studies that were done in Uganda, Kenya and South African confirmed that Medical Male Circumcision reduces the risks of a man who is circumcised to acquire HIV virus from a woman or partner who is HIV positive by at least 60 percent. But many of us have been wondering how this works.

The Assistant Commissioner Health Services (National Disease Control) in the Ministry of Health , Dr Alex Opio explained that the inside part of the uncircumcised penis is rich in cells known as Langerhans cells which are normally targeted by the HIV virus.

The removal of the foreskin through medical circumcision, reduces on the number of these cells and the only place where they can be found in the meatus(opening of the penis)

Dr Apio also says the removal of the foreskin exposes the tip of the penis to the underwear and fresh air. When the tip of the penis is exposed, it becomes thicker than the one which is covered by the foreskin.

When it is thicker, it becomes less susceptible to bruises that a penis may sustain during sexual intercourse and ease the transmission of the virus. In medical language, the thickening of the penis is called Keratinization.

He further explains that when a man is not circumcised, a large surface area of the penis tends to be exposed to the vagina during sexual intercourse because the foreskin is over pulled back and incase the woman is infected, the chances of a man contracting HIV would be high because during sexual intercourse, the fiction between the vagina and the penis may create tiny tearing which can only be seen through a microscope thereby exposing the man to infection. However, the risks would be minimal if a man is circumcised since a smaller surface of the penis would be exposed to the vagina.

An uncircumcised man is also said to be more susceptible to sexually transmitted diseases especially those that cause sores in the private parts (genital ulcers). Examples of such diseases include syphilis and Herpes Virus. The wounds ease the penetration of the virus into someone’s body. Dr Opio also explains that circumcision doesn’t prevent HIV transmission 100 per cent.

Other benefits of circumcision

* A circumcised penis is easier to clean and is normally free of smegma that may cause the cancer of the penis, says Dr Alex Opio. Smegma is a sticky white thick secretion that is accumulated under the foreskin of a penis of an uncircumcised man. Many older men, who have bladder or prostate gland problems, also develop difficulties with their foreskins due to their surgeon’s handling, cleaning and using instruments. Some of these patients will need circumcising. Afterwards it is often astonishing to find some who have never ever seen their glans (knob) exposed before.

* If man continues injecting smegma in a woman, her risks of her getting cancer of the cervix are increased, Dr Opio adds. Cancer of the cervix in women is due to the Human Papilloma Virus. It thrives under and on the foreskin from where it can be transmitted during intercourse. An article in the British Medical Journal in April 2002 suggested that at least 20 per cent of cancer of the cervix would be avoided if all men were circumcised.


* Lots of men, and their partners, prefer the appearance of their penis after circumcision, It is odour-free, it feels cleaner, and they enjoy better sex. Awareness of a good body image is a very important factor in building self confidence. Sexual function is not adversely affected by circumcision. On the contrary, published evidence shows that circumcised men have a wider variety of sexual activity, and women prefer circumcised men, mainly because of better genital hygiene.


* Balanitis is an unpleasant, often recurring, inflammation of the glans. It is quite common and can be prevented by circumcision.
* Urinary tract infections sometimes occur in babies and can be quite serious. Circumcision in infancy makes it 10 times less likely.

Gender Selection – Are you male or female?


(hhmmm the debate continues on embryonic development, female by default?)

Eulalee Thompson – BE WELL

It is generally believed that the embryo by default is female. Females carry two X chromosomes (XX) among the 23 pairs of chromosomes in each cell. In about the seventh week, the embryonic presence of the Y chromosome (XY) provides instructions for the development of male characteristics. The hormone, testosterone is produced and the structures become male.

However, as Dr Leslie Gabay, Kingston-based paediatric endocrinologist, points out, many things can go wrong in the change process.

“On the Y chromosome, there is a code that converts the primitive gonad to testicles. The testicles then produce testosterone then change (the embryo) to male,” he said. “(But) we could have XY but don’t get the code across so stay female … or hormones are like keys that (have to) fit in a lock so that we can get the effect of the hormones. So we could have normal testicles, testosterone but don’t have the lock to fit in, so don’t get the conversion to male. This is called androgen insensitivity syndrome,” he added.

The literature points to many chromosomal conditions of the sex chromosomes that affect sex deter-mination (that is the display of sexual characteristics of male or female), sexual development and fertility. Some of the conditions are mild, others severe and can be associated with either structural changes in the chromosomes, missing a copy of the chromosome, or having extra copies.

Sex verification tests

This topic of what makes us male or female would be an ongoing interest of genetic scientists, but has become an issue of public discussion after the International Association of Athletics Federation (IAAF) announced that South African Caster Semenya, the 800m women world champion, was undergoing sex-verification tests. The athlete looks male but, in various published interviews, her father and other relatives indicate that she is in fact female and considers herself female.

“What makes us male or female? That is like saying, ‘Who is God?’ Or, ‘Who am I?’ As I say to people, you have to look at what the purpose of your sex is. If the purpose of chromosomes is to transfer genetic material from one generation to the next, then you will take a particular perspective,” Gabay opines.

He believes that at the end of the day, socially, it is one’s body type (how we look) and genitals which are important in determining sex. A recent issue of The New Scientist reports the case of a unnamed seven-year-old girl with a Y chromosome, accidentally discovered when she was genetically tested before birth. The report indicates that the child “doesn’t have ambiguous gonads, shrivelled testes or other developmental defects. She instead has a normal vagina, cervix and set of ovaries”. A team led by Anna Biason-Lauber of University Children’s Hospital in Zurich, Switzerland, thinks the patient’s normalcy is due to mutations in a poorly understood gene on chromosome 17 called CBX2.

Sex vs gender

Any good student of sociology knows that sex, the biological designation of male or female characteristics, is different from gender, a social construct ascribing roles, behaviour and relations between men and women. Gabay believes that superimposing the issue of gender on sex further complicates the question of what makes us male or female.

“We now have gender, and that is how we see ourselves. I may be in a male body but my psychology is female and how I see myself is female. And a lot of people will want to make the link between this topic and homosexuality, but it is not the same thing,” he said.

Jamaica has its fair share of unclear sex-identification issues. Gabay indicates that between four to six cases of ambiguous genitalia (which is where the clinician is unable to clearly define the sex of the child) are identified here each year. The diagnosis of androgen insensitivity syndrome is less common and is only seen about once every five years.

Eulalee Thompson is health editor and a professional counsellor. Email: eulalee.thompson@gleanerjm.com.