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Does His Circumcision Lower Her Risk for Cervical Cancer?

Male circumcision may reduce both HPV risk in men and cervical cancer risk in their sexual partners.

Limited data address the effect of male circumcision on the risk for genital human papillomavirus (HPV) infection in men or on the risk for cervical cancer in their female partners. These authors examined data collected between 1985 and 1993 on couples enrolled in 7 case-control studies of cervical neoplasia in Europe, South America, and Asia.

A total of 1329 women with recently diagnosed in situ or invasive cervical cancer and 1471 age-matched controls reported having a stable relationship with a male partner (i.e., the same sexual partner for at least 6 months); 74% of male case partners and 64% of male control partners were interviewed. The overall prevalence of circumcision was 19.3%, but the prevalence varied widely among male partners in different countries (1.5% to 91%). Compared with their noncircumcised counterparts, circumcised men were more educated, washed their genitals less frequently after sex, and, as assessed by a physician, had better genital hygiene.

Of the 1921 male partners interviewed, 1139 provided genital specimens (taken from the distal urethra and from external surfaces of the glans/coronal sulcus) that were adequate for HPV analysis. Of these men, 182 (16%) were HPV positive. HPV was found in 19.6% of uncircumcised men and 5.5% of circumcised men. After adjustment, the overall odds ratio for penile HPV infection associated with circumcision was 0.37 (95% CI, 0.16-0.85).

Overall, a moderate decrease in the risk for cervical cancer was associated with circumcision (OR, 0.72; P>0.05). In an analysis limited to women who reported having only 1 male partner, male partners were stratified by sexual behavior-based risk categories for HPV exposure. In this subgroup analysis, the inverse relation between circumcision and risk for cervical cancer was more robust: In women whose partners were at highest risk for HPV, circumcision was associated with a markedly reduced risk for cervical cancer (OR, 0.18).

Comment: These findings show that circumcision is associated with a lowered risk for penile HPV infection. In addition, among male partners who engaged in high-risk sexual behavior -- including sex with multiple partners -- circumcision was associated with a substantial reduction in cervical cancer risk among their female partners. The investigators speculated that 2 factors related to circumcision may result in fewer HPV infections: (1) circumcision increases the likelihood of good genital hygiene, and (2) the mucosal lining of the prepuce (a structure removed during circumcision) is not keratinized, possibly providing vaginal virions more opportunity to infect the male during intercourse. Given the global importance of genital HPV infections, future studies should assess whether routine circumcision can reduce transmission of HPV and other sexually transmitted infections.

— Andrew M. Kaunitz, MD

Published in Journal Watch Women's Health June 5, 2002

Citation(s):

Castellsagué X et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med 2002 Apr 11; 346:1105-12.

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