The article on non-medical male circumcision was well researched (the guardian.com, 20 July). But health researchers with knowledge of epidemiology might take exception to the use of the Danish cross-sectional survey by Frisch et al (2011) when arguing for an association between circumcision and sexual problems.
The first author of the study, Morten Frisch from the Danish State Serum Institute, is an intactivist, who has been heading a campaign against non-medical circumcision in Denmark. In the study, the vast majority of the circumcised participants listed their religious affiliation as Lutheran, and thus, in Denmark, it is fair to assume these men were circumcised for medical reasons. The causes for medical circumcision are well-known risk factors for sexual dysfunction. It is no surprise, therefore, that male circumcision in this study was associated with increased risk of sexual problems. But this is the result of disease that existed prior to circumcision. Therefore, the study is of little or no relevance regarding circumcision of healthy males.
Rather than basing statements on a single study, systematic reviews of existing scientific studies are the gold standard for assessment of causality. Five recent reviews have shown no association between non-medical male circumcision and experienced sexual function (eg Shabanzadeh et al, 2016; Friedberg et al, 2016; Yang et al, 2017).
Despite the lack of scientific evidence, intactivists promote the notion that male circumcision results in sexual dysfunction. This fake health science portrays circumcised men as sexually dysfunctional and traumatised. In fact, the stigma associated with this portrayal is likely to cause more health-related problems than non-medical male circumcision, especially in European countries where most non-medically circumcised men belong to the Muslim and Jewish minority groups.
Dan Meyrowitsch
Epidemiologist, University of Copenhagen, Denmark
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