No Clear Relationship Found between Circumcision and Age at Sexual Debut among Men in Sub-Saharan Africa

for circumcision status, its focus on only one potential manifestation of risk compensation and its inability to differentiate between medical and traditional circumcision. Moreover, the cross-sectional nature of the study precludes assumptions of causal relationships. However, the researchers note that the findings do suggest that the association between circumcision and age at sexual debut “is historically specific and varies across countries.” Thus, risk compensation may be a concern in some contexts but not in others. For example, circumcision was associated with earlier sexual debut in the three countries that have recently initiated mass medical circumcision programs, which may reflect perceptions that circumcision makes men “immune from sexually transmitted diseases” or that it is a “rite of passage” that “confers seniority, virility and the permission to have sex.” The authors recommend that countries that introduce or expand circumcision programs consider the “context-specific factors” that may influence the behavioral impact of the procedure, and that policy regarding such programs should be “informed by a grounded understanding of the social history of [circumcision]” in relevant areas.—P. Doskoch