What Are the Advantages of Male Circumcision for Women?

Wives, girlfriends, and mothers hold divergent views on the implications of large-scale male circumcision campaigns aimed at preventing HIV transmission. While the voices of women have often been sidelined in discussions about male circumcision as an HIV prevention strategy, informal conversations reveal a range of concerns, preferences, and insights that researchers and governments must consider before advancing national programs. A non-scientific survey conducted by IRIN/PlusNews among numerous women underscores this division, highlighting how such initiatives could reshape sexual dynamics, power imbalances, and health outcomes in intimate relationships. "This will be a boon for married women who are cheated on by their husbands," opined Carol Masombuka, a 19-year-old Sesotho woman from South Africa's Mpumalanga province. She emphasized that even partial protection from circumcision could empower women who lack the authority to insist on condom use, thereby reducing their vulnerability to HIV and other sexually transmitted infections (STIs). Indeed, beyond HIV, studies have shown that women with circumcised partners experience lower risks of conditions like bacterial vaginosis, trichomoniasis, and human papillomavirus (HPV) infections, which can lead to cervical cancer—a leading cause of death among women in sub-Saharan Africa. However, skepticism abounds. Some women fear that circumcision might provide men with yet another pretext to forgo condoms, exacerbating existing gender inequalities in sexual decision-making. "Most women become shy when it comes to matters of sex—it's always the man who knows best, so he'll decide when we make love and whether to use a condom or not; whatever he says will be followed, allowing him to dominate even more women," shared Kgaulelo Khotu, a 20-year-old student from South Africa's Limpopo province. This concern is rooted in broader societal patterns where women often cede control in intimate encounters, potentially amplifying risks if men misinterpret circumcision as full immunity. For Masombuka, education is key: "Women should be informed so they don't get tricked by men, because some girls might be told they won't get infected since the man is circumcised." This underscores the need for comprehensive awareness campaigns to prevent misinformation and ensure women can advocate for their health. Gloria Mphekgwana, a 44-year-old receptionist and single mother of two from a Johannesburg suburb, who has witnessed family members succumb to HIV/AIDS and related infections, strongly advocates for male circumcision. "Women should fight for this," she asserted. "They can refuse sex until their man is circumcised." Her stance reflects a growing body of evidence suggesting that women not only support but often exhibit higher acceptance rates for male circumcision than men, viewing it as a proactive step toward family health and stability. **Evidence, or a Lack Thereof?** Research indicates higher acceptability of male circumcision among women than men, despite uncertainties about its direct impact on female partners in large-scale campaigns. Three landmark clinical trials demonstrated that circumcision reduces a man's risk of HIV acquisition during heterosexual intercourse by approximately 60%. This reduction could translate into fewer infections overall, indirectly lowering HIV rates among women through decreased community prevalence. The mechanism involves removing the foreskin, which contains cells highly susceptible to HIV entry, thereby diminishing viral vulnerability during exposure. At a population level, widespread voluntary medical male circumcision (VMMC) in high-prevalence regions like Eastern and Southern Africa has been modeled to avert millions of infections, benefiting women by reducing their exposure to infected partners over time. Moreover, circumcised men are less likely to harbor HPV, the virus responsible for cervical cancer, providing a direct protective effect for women. Systematic reviews have confirmed consistent evidence of reduced risks for cervical dysplasia, syphilis, chlamydia, and herpes simplex virus type 2 in female partners, with medium evidence for HPV protection and variable findings for other STIs like gonorrhea and HIV. Yet, guidelines from the World Health Organization (WHO) and UNAIDS, issued in March 2007 and updated since, clarify that there is no direct evidence that male circumcision reduces HIV transmission from men to women. Preliminary data from an ongoing Ugandan study suggest that HIV-positive men resuming sexual activity before full wound healing post-circumcision may significantly increase transmission risks to female partners. While these findings are not yet conclusive, they highlight the critical need for education on healing timelines, condom use, and mutual risk awareness. The greatest peril lies in behavioral risk compensation: circumcised men might overestimate their protection and abandon safer practices like condom use. Quantifying this risk remains challenging, but it could be mitigated through targeted education and counseling, ensuring that circumcision complements—rather than replaces—other prevention strategies. **A Greater Sense of Masculinity?** African women's experiences with male circumcision often stem from traditional rites of passage for their sons, brothers, and male friends within certain ethnic groups. Women are typically barred from these rituals, and men are discouraged from discussing them, with folklore warning that such revelations could drive women mad, as Masombuka noted. Several women interviewed by IRIN/PlusNews observed positive behavioral shifts in men who underwent traditional circumcision schools. "Most men who attend this school know how to respect women and elders; those who don't come from the circumcision school are very rude and use force," said Mphekgwana, from Limpopo where the practice is common. Masombuka added, "They teach them to be faithful to one girl, to marry her, and not to 'go elsewhere.'" These observations suggest that circumcision, when embedded in cultural education, fosters responsibility and fidelity. Rachel Jewkes, director of the Gender and Health Unit at South Africa's Medical Research Council, advocates framing male circumcision for HIV prevention as a "process of change" akin to traditional approaches. "It would be a mistake to see circumcision solely as a medical intervention; it's a social one," she explained. "Culture is flexible, and since circumcision has been linked to virility, it holds immense potential to be tied to improved masculine maturity." By this, Jewkes means promoting sexual responsibility and gender equality, using circumcision programs as platforms for dialogues on safer sex and equitable relationships. "The only critique is that men's engagement in HIV prevention shouldn't end with the scalpel; programs must drive a gender-transformative approach to VIH prevention," she urged. This perspective aligns with broader efforts to redefine masculinity in ways that reduce violence and promote mutual respect, potentially amplifying the long-term societal benefits of VMMC. **What Role for Women?** Public health experts intend to involve women in expanding national male circumcision programs, though the exact form of this engagement remains undefined. Dr. Yassa Pierre, a virologist treating HIV patients at Lusaka University Hospital in Zambia, believes women could motivate their husbands to undergo the procedure. He speculated that circumcised men might experience reduced sensation during sex—potentially prolonging intercourse, which some women view as advantageous—though recent research refutes significant sensitivity loss. Pierre noted, "Some women prefer circumcised men because they last longer." More commonly, women cited hygiene as a preference. "I prefer a man who is circumcised. I believe it's safer and cleaner," said Kgaugelo Khuto, the Limpopo student. "But I wouldn't dare ask him to do it." This highlights persistent taboos around discussing sexual health. Mothers, in particular, favor medical over traditional circumcision due to safety concerns. Mphekgwana resists her husband's pressure to send their son to a traditional school, citing reports of botched procedures and fatalities from unsanitary tools. "No one wants to send their son there anymore because they don't use clean utensils; they use just one blade. I want to take him to the hospital for circumcision," she said. At Lusaka University Hospital's circumcision clinic, where about 80 procedures occur monthly, nearly half involve young boys brought by mothers. "Studies show high acceptance among women for these interventions," said clinic director Dr. Kasonde Bowa. "I think they're very enthusiastic about anything healthy for their sons and husbands." This maternal advocacy could be leveraged to boost program uptake, integrating women's roles in decision-making and promotion to ensure equitable, community-driven HIV prevention.