An article in press in Fertility and Sterility is getting a lot of media attention. The study connected men seeking infertility care to a cancer registry in the State where the clinic was located. The researchers found that men with infertility had almost twice the chance of getting cancer and almost three times the chance if the man had no sperm in his ejaculate.
The authors of the study have a few theories about why cancer and male infertility may be connected. Cells need to divide just right to make sperm in the testes, and problems with division could lead to both problems with making sperm and the kind of bad division that makes cancer. It could also be that toxic substances in the environment may lead to both infertility and cancer.
Whatever the reason, we’re beginning to understand that problems with male fertility are just a tip of a much bigger iceberg that involves health in general. It’s more than just about the testicles.
The news is heating up lately over one San Franciscan’s attempts to ban circumcision in his city. Is circumcision so bad that it’s worth banning? Studies support health benefits of circumcision, including reducing the risk of human papilloma virus in men and cancer of the cervix in their female partners and lessening the chance of urinary tract infections in boys. Three large studies in Africa (Auvert, Gray and Bailey) all show that circumcision cuts by half the risk of transmission of HIV from a woman to a man.
Foreskin contains nerve endings lost during circumcision, but removing it can’t be seriously equated to clitorectomy, the practice in some cultures of removing a girl’s clitoris at birth. The equivalent of clitoretomy in the male would be to remove the entire glans penis, which would obviously have profound consequences on sexual sensation. The question is, does removing the foreskin inflict such harm to a young boy that it ought to be prohibited? LIke all medical questions, the answer comes from weighing the risks against the benefits.
The majority of circumcised men would tell you that their penises work fine without the foreskin, and so the risk of circumcision, while there, is small. The benefits, lessening the chance of infection and cancer, are real. It seems to me that parents choosing to circumcise their newborn boys are balancing the benefits against the risks and making a sensible choice. If the voters in San Francisco do get a chance to vote on a ban on circumcision, I hope that they preserve that choice for parents.