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			{{Short description|Removal of the human foreskin}}
	{{POV-section|date=December 2009}}
			{{Distinguish|female circumcision}}
	{{About|male circumcision|female circumcision|Female genital cutting|Islam's circumcision ritual|Khitan (Circumcision)|Judaism's circumcision ritual|Brit milah|the controversy in early Christianity|Circumcision controversy in early Christianity}}
			{{For|the paintings|The Circumcision (disambiguation){{!}}''The Circumcision''}}
	],) c. 1865-1872. Restored ].]]
			{{pp-vandalism|small=yes}}
	Male '''circumcision''' is the removal of some or all of the ] (prepuce) from the ].<ref>Dictionary definitions of circumcision:
			<!-- Definition, technique, and reasons -->
	*"The act of cutting off the prepuce or foreskin of males, or the internal labia of females." Webster's Revised Unabridged Dictionary (1913)
			{{Use dmy dates|date=February 2022}}
	* "to remove the foreskin of (males) sometimes as a religious rite." The Macquarie Dictionary (2nd Edition, 1991)
			{{cs1 config|name-list-style=vanc|display-authors=6}}
	*"Cut off foreskin of (as Jewish or Mohammedan rite, or surgically), Concise Oxford Dictionary, 5th Edition, 1964
			{{Infobox medical intervention
	Circumcision defined in a medical context:
			| Name = Circumcision
	*"Male circumcision is the surgical removal of all or part of the foreskin of the penis." , ]
			| Image = Circumcision illustration.jpg
	*"Circumcision, surgical removal of all or part of the foreskin of the human male...", "Circumcision", ], 2007.
			| Caption = Circumcision surgery with hemostats and scissors
	*"Male circumcision is an elective surgery to remove the foreskin..." , ] Health Guide, June 2, 2006. Retrieved July 18, 2007.
			| ICD10 = Z41.2
	*"Circumcision is surgery..." , ] Health System, February 2007. Retrieved July 18, 2007.
			| ICD9 = {{ICD9|V50.2}}
	*" Circumcision is cutting away part of the foreskin... When this surgery is performed..." , ] website. Retrieved July 18, 2007.</ref> The word "circumcision" comes from ] ''{{lang|la|circum}}'' (meaning "around") and ''{{lang|la|cædere}}'' (meaning "to cut").
			| ICD9_mult =
	Early depictions of circumcision are found in ]s and ]ian ]s, though some pictures are open to interpretation.<ref>{{cite journal |last=Hodges |first=F.M. |authorlink= |coauthors= |year=2001 |month=Fall |title=The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme. |journal=The Bulletin of the History of Medicine |volume=75 |issue=3 |pages=375–405 |pmid= 11568485 |url= |accessdate= |quote= |doi=10.1353/bhm.2001.0119 }}</ref><ref>{{cite journal
			| MeshID = D002944
	|last = Wrana
			| OPS301 = {{OPS301|5–640}}.2
	|first = P.
			| OtherCodes =
	|year = 1939
			| MedlinePlus = 002998
	|title = Historical review: Circumcision
			| eMedicine = 1015820
	| journal = Archives of Pediatrics
	| volume = 56
	| issue =
	| pages = 385&ndash;392
	}} as quoted in: {{cite journal | last = Zoske | first = Joseph | month = Winter | year = 1998 | title = Male Circumcision: A Gender Perspective | journal = ] | volume = 6 | issue = 2 | pages = 189&ndash;208 | url = http://www.noharmm.org/zoske.htm|accessdate = 2006-06-14}}</ref><ref name = "Gollaher">{{cite book
	| last = Gollaher
	| first = David L.
	| title = Circumcision: a history of the world’s most controversial surgery
	| year = 2000
	| month = February
	| publisher = ]
	| location = ]
	| language =
	| isbn = 978-0-465-04397-2 {{LCCN|99|0|40015}}
	| doi =
	| pages = 53&ndash;72
	| chapter =
	| chapterurl =
	| quote =
	}}		}}
	</ref> ] is considered a ] in ].<ref>{{cite web
	| url = http://www.jewishvirtuallibrary.org/jsource/Judaism/circumcision.html
	| title = Circumcision
	| accessdate = 2006-10-03
	| publisher = ]
	}}
	</ref> In ], though not discussed in the ], circumcision is widely practiced and most often considered to be a ].<ref>{{cite journal
	| last = S.A.H Rizvi, S.A A Naqvi, M Hussain, A.S Hasan
	| year = 1999
	| title = Religious circumcision: a Muslim view
	| journal = BJU International
	| volume = 83
	| issue = s1
	| pages = 13&ndash;16
	| doi = 10.1046/j.1464-410x.1999.0830s1013.x
	| url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1013.x
	| format = PDF
	}}
	</ref> It is also customary in some Christian churches in Africa, including some ] Churches.<ref name=Christian><small>Customary in some Coptic and other churches:
	*"The Coptic Christians in Egypt and the Ethiopian Orthodox Christians —two of the oldest surviving forms of Christianity— retain many of the features of early Christianity, including male circumcision. Circumcision is not prescribed in other forms of Christianity.…Some Christian churches in South Africa oppose the practice, viewing it as a pagan ritual, while others, including the Nomiya church in Kenya, require circumcision for membership and participants in focus group discussions in Zambia and Malawi mentioned similar beliefs that Christians should practice circumcision since Jesus was circumcised and the Bible teaches the practice." , ], February 26, 2007.
	*"The decision that Christians need not practice circumcision is recorded in Acts 15; there was never, however, a prohibition of circumcision, and it is practiced by Coptic Christians." , The Columbia Encyclopedia, Sixth Edition, 2001-05.</small></ref>
	According to the ] (WHO), global estimates suggest that 30% of males are circumcised, of whom 68% are Muslim.<ref name="WHO-GTPDSA">{{cite web
	| url = http://whqlibdoc.who.int/publications/2007/9789241596169_eng.pdf
	| title = Male circumcision: Global trends and determinants of prevalence, safety and acceptability
	| accessdate = 2009-03-04
	| year = 2007
	| publisher = ]
	|format=PDF}}
	</ref> The prevalence of circumcision varies mostly with religious affiliation, and sometimes culture. Most circumcisions are performed during adolescence for cultural or religious reasons;<ref>{{cite journal | year = 2008 | title = Adolescent boys: who cares? | journal = Bulletin of the World Health Organization | volume = 86 | issue = 9 | pages = 659 | doi = 10.2471/BLT.08.057752 | url = http://www.who.int/entity/bulletin/volumes/86/9/08-057752.pdf |format=PDF| author = Schmid GP, Dick B.}}</ref> in some countries they are more commonly performed during infancy.<ref name="WHO-GTPDSA"/>
			<!-- Note to editors: This article has a long history of intense debates, particularly over the wording of the lead, sexual function section, and describing the positions of major medical organizations. Please review the talk page before making changes to lines to see if there is a previous established consensus or compromise. Thank you. -->
	There is ]. Advocates of circumcision argue, for example, that it provides important health advantages which outweigh the risks, has no substantial effects on sexual function, and has a low complication rate when carried out by an experienced physician.<ref name="Schoen">{{cite journal
			'''Circumcision''' is a ] that removes the ] from the ]. In the most common form of the operation, the foreskin is extended with ], then a circumcision device may be placed, after which the foreskin is ]. Topical or locally injected ] is generally used to reduce pain and ].<ref name=AAP_2012 /> Circumcision is generally ], most commonly done as a form of ], as a ], or as a ].<ref name=WHO_2007_GTDPSA /> It is also an option for cases of ], other ] that do not resolve with other treatments, and chronic ]s (UTIs).<ref name="lissauer_2012" /><ref name=hay_2012/> The procedure is ] in cases of certain genital structure abnormalities or poor general health.<ref name="hay_2012" /><ref name=rudolph_2011 />
	| last = Schoen
	| first = Edgar J
	| date = December 1, 2007 | title = Should newborns be circumcised? Yes
	| journal = Can Fam Physician
	| volume = 53
	| issue = 12
	| pages = 2096&ndash;8, 2100&ndash;2
	| pmid = 18077736
	| url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18077736
	| accessdate = 2008-05-02
	}}
	</ref> Opponents of circumcision argue, for example, that it adversely affects normal sexual pleasure and performance, is justified by medical myths, and is effectively comparable to ].<ref name = "Milos">{{cite journal
	| last = Milos
	| first = Marilyn Fayre
	| coauthors = Donna Macris
	| year = 1992
	| month = March&ndash;April
	| title = Circumcision: A medical or a human rights issue?
	| journal = Journal of Nurse-Midwifery
	| volume = 37
	| issue = 2 S1
	| pages = S87–S96
	| pmid = 1573462
	| doi = 10.1016/0091-2182(92)90012-R
	| url = http://www.cirp.org/library/ethics/milos-macris/
	| accessdate = 2007-04-06
	}}
	</ref>
			<!-- Evidence, side effects, and positions -->
	The ] stated in 1999: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."<ref name = "CSA:I-99">{{cite web
			The procedure is associated with reduced rates of ]s<ref name="yuan" /> and ]s.<ref name="AAP_2012" /><ref name="rehmeyer_2011" /><ref name="larke_HPV_2011" /> This includes reducing the incidence of ] forms of ] (HPV) and significantly reducing ] among ] in high-risk populations;<ref name="Chikutsa-2015" /> its prophylactic efficacy against HIV transmission in the ] or among ] is debated.<ref name="WHO-2010b" /><ref name="siegfried_Cochrane_2009" /><ref name="Merson-2017" /> Neonatal circumcision decreases the risk of ].<ref name="Thomas_2021" /> Complication rates increase significantly with age.<ref name="weiss_2010_complications" /> Bleeding, infection, and the removal of either too much or too little foreskin are the most common acute complications, while ] is the most common long-term.<ref name="Selekman-2020" /> There are various ], and ] views on circumcision. Major medical organizations hold variant views on the strength of circumcision's prophylactic efficacy in developed countries. Some medical organizations take the position that it carries prophylactic health benefits which outweigh the risks, while other medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk.<ref name="Gable-2007" /><ref name="WHO-2010a" /><ref name="Bolnick_2012_ch1" /><ref name="caga-anan_2011" /> <!-- Epidemiology, history, and culture -->
	| year = 1999
	| month = December
			Circumcision is one of the world's most common and oldest medical procedures.<ref name="WHO_2007_GTDPSA" /> Prophylactic usage originated in ] during the 1850s and subsequently widely spread, becoming predominately established as a way to prevent sexually transmitted infections.<ref name="Al-Salem-2016" /><ref name = "Afshar_2018" /> Beyond use as a prophylactic or treatment option in healthcare, circumcision plays a major role in many of the world's cultures and religions, most prominently ] and ]. Circumcision is among the ].<ref name="Mark-2003a" /><ref name="Hamilton-1990" /> In some ] and ] male circumcision is an established practice, and require that their male members undergo circumcision.<ref name="N. Stearns 2008 179" /><ref>{{cite book|title=Cultural Encyclopedia of the Body |first=Victoria |last=Pitts-Taylor|year= 2008| isbn= 9781567206913| page =394|publisher=ABC-CLIO|quote=For most part, Christianity does not require circumcision of its followers. Yet, some Orthodox and African Christian groups do require circumcision. These circumcisions take place at any point between birth and puberty.}}</ref> It is widespread in Australia, Canada, the United States, South Korea, most of Africa, and parts of Asia.<ref name="WHO_2007_GTDPSA" /> It is relatively rare for non-religious reasons in parts of Southern Africa, Latin America, Europe, and parts of Asia.<ref name="WHO_2007_GTDPSA" /> The origin of circumcision is not known with certainty, but the oldest documentation comes from ].<ref name="WHO_2007_GTDPSA" /><ref name="Doy2005" /><ref name="alanis_2004" />
	| url = http://www.ama-assn.org/ama/no-index/about-ama/13585.shtml
	| title = Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision
			{{TOC limit}}
	| format =
	| work = 1999 AMA Interim Meeting: Summaries and Recommendations of Council on Scientific Affairs Reports
	| pages = 17		== Uses ==
	| publisher = ]
			=== Elective ===
	| accessdate = 2006-06-13
			Around half of all circumcisions worldwide are performed for reasons of prophylactic healthcare.<ref name="hay_2012" />
	}}
	</ref>
			==== Prophylactic usage in high-risk populations ====
			] became the 1 millionth ] in the ] of ], South Africa.<ref>{{Cite web | vauthors = Seeth A |date=June 1, 2018 |title='It's hassle-free,' says actor Melusi Yeni about his medical circumcision |url=https://www.news24.com/citypress/news/its-hassle-free-says-actor-melusi-yeni-about-his-medical-circumcision-20180601 |access-date=May 5, 2022 |website=] |language=en-US |quote=Actor Melusi Yeni was the millionth man to undergo voluntary male medical circumcision at the Sivananda Clinic in KwaZulu-Natal. |archive-date=5 May 2022 |archive-url=https://web.archive.org/web/20220505072202/https://www.news24.com/citypress/news/its-hassle-free-says-actor-melusi-yeni-about-his-medical-circumcision-20180601 |url-status=live }}</ref>]]
			There is a consensus among the world's major medical organizations and in the academic literature that circumcision is an efficacious intervention for HIV prevention in high-risk populations if carried out by medical professionals under safe conditions.<ref name="WHO-PrevHIV">{{cite web |year=2020 |title=Preventing HIV Through Safe Voluntary Medical Male Circumcision For Adolescent Boys And Men In Generalized HIV Epidemics |url=https://www.who.int/publications/i/item/978-92-4-000854-0 |url-status=live |archive-url=https://web.archive.org/web/20211122140037/https://www.who.int/publications/i/item/978-92-4-000854-0 |archive-date=22 November 2021 |access-date=24 May 2021 |publisher=]}}</ref><ref name="siegfried_Cochrane_2009" /><ref name="Chikutsa-2015">For sources on this, see:
			* {{cite journal | vauthors = Chikutsa A, Maharaj P | title = Social representations of male circumcision as prophylaxis against HIV/AIDS in Zimbabwe | journal = BMC Public Health | volume = 15 | issue = 1 | pages = 603 | date = July 2015 | pmid = 26133368 | pmc = 4489047 | doi = 10.1186/s12889-015-1967-z | quote = It is now generally accepted in public health spheres that medical male circumcision is efficacious in the prevention of HIV infection. | doi-access = free | issn = 1471-2458}}
			*{{Cite book | vauthors = Bell K |title=Health and Other Unassailable Values: Reconfigurations of Health, Evidence and Ethics |publisher=Taylor & Francis |year=2016 |isbn=978-1-317-48203-1 |pages=106 |quote=...defending the casual relation between male circumcision and reduced HIV transmission has become essentially hegemonic in the academic literature.}}
			*{{Cite book | vauthors = Merson M, Inrig S |title=The AIDS Pandemic: Searching for a Global Response |publisher=] |year=2017 |isbn=978-3-319-47133-4 |pages=379}}</ref>
			In 2007, the WHO and the ] (UNAIDS) stated that they recommended adolescent and adult circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV, as long as the program includes "], ], and absence of ]" — known as voluntary medical male circumcision, or VMMC.<ref name="WHO-PrevHIV" /> In 2010, this was expanded to routine neonatal circumcision, as long as those undergoing the procedure received assent from their parents.<ref name="WHO-2010a" /> In 2020, the World Health Organization again concluded that male circumcision is an efficacious intervention for HIV prevention and that the promotion of male circumcision is an essential strategy, in addition to other preventive measures, for the prevention of heterosexually acquired HIV infection in men. Eastern and southern Africa had a particularly low prevalence of circumcised males. This region has a disproportionately high HIV infection rate, with a significant number of those infections stemming from heterosexual transmission. As a result, the promotion of prophylactic circumcision has been a priority intervention in that region since the WHO's 2007 recommendations.<ref name="WHO-PrevHIV" /><ref name="WHO-2010a" /> The International Antiviral Society–USA also suggests circumcision be discussed with ], especially in regions where HIV is common.<ref name="Marrazzo et al. 2014" /> There is evidence that circumcision is associated with a reduced risk of HIV infection for such men, particularly in low-income countries.<ref name="yuan">{{cite journal | vauthors = Yuan T, Fitzpatrick T, Ko NY, Cai Y, Chen Y, Zhao J, Li L, Xu J, Gu J, Li J, Hao C, Yang Z, Cai W, Cheng CY, Luo Z, Zhang K, Wu G, Meng X, Grulich AE, Hao Y, Zou H | title = Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data | journal = The Lancet. Global Health | volume = 7 | issue = 4 | pages = e436–e447 | date = April 2019 | pmid = 30879508 | pmc = 7779827 | doi = 10.1016/S2214-109X(18)30567-9 | type = Mata-analysis }}</ref>
			The finding that circumcision significantly reduces female-to-male HIV transmission has prompted medical organizations serving communities affected by endemic HIV/AIDS to promote circumcision as an additional method of controlling the spread of HIV.<ref name="Bolnick_2012_ch1" />
			==== Prophylactic usage in developed countries ====
			Major medical organizations hold varying positions on the ] of the elective circumcision of minors in the context of ].<ref name="Bolnick_2012_ch1" /> Literature on the matter is polarized, with the cost-benefit analysis being highly dependent on the kinds and frequencies of health problems in the population under discussion and how circumcision affects them.<ref name="caga-anan_2011" /><ref name="pinto_2012" /><ref name="Wapner-2015">{{Cite web| vauthors = Wapner J |date=24 February 2015|title=The Troubled History of Foreskin|url=https://mosaicscience.com/story/troubled-history-foreskin/|website=Mosaic Science|quote=In the decades since, medical practice has come to rely increasingly on evidence from large research studies, which, as many American doctors see it, have supported the existing rationale... How can experts who have undergone similar training evaluate the same studies and come to opposing conclusions? I've spent months scrutinising the medical literature in an attempt to decide which side is right. The task turned out to be nearly impossible. That's partly because there is so much confused thinking around the risks and benefits of circumcision, even among trained practitioners.|access-date=3 February 2022|archive-date=26 December 2021|archive-url=https://web.archive.org/web/20211226154538/https://mosaicscience.com/story/troubled-history-foreskin/|url-status=live}}</ref>
			The ] (WHO), ], and American medical organizations take the position that it carries prophylactic health benefits which outweigh the risks, while European medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk.<ref name="Gable-2007" /><ref name="WHO-2010a" /><ref name="Bolnick_2012_ch1" /><ref name="caga-anan_2011" /> Advocates of circumcision consider it to have a net health benefit, and therefore feel that increasing the circumcision rate is "imperative".<ref>{{cite journal | vauthors = Morris BJ | title = Why circumcision is a biomedical imperative for the 21(st) century | journal = BioEssays | volume = 29 | issue = 11 | pages = 1147–1158 | date = November 2007 | pmid = 17935209 | doi = 10.1002/bies.20654 | url = https://pubmed.ncbi.nlm.nih.gov/17935209/ | access-date = 26 December 2021 | url-status = live | archive-url = https://web.archive.org/web/20211226154518/https://pubmed.ncbi.nlm.nih.gov/17935209/ | archive-date = 26 December 2021 }}</ref> They recommend performing it during the neonatal period when it is less expensive and has a lower risk of complications.<ref name="pinto_2012">{{cite journal | vauthors = Pinto K | title = Circumcision controversies | journal = Pediatric Clinics of North America | volume = 59 | issue = 4 | pages = 977–986 | date = August 2012 | pmid = 22857844 | doi = 10.1016/j.pcl.2012.05.015 }}</ref> The ] and ] stated that the potential benefits of circumcision outweigh the risks.<ref name="AAP_2012" /><ref>{{Cite web |title=Background, Methods, and Synthesis of Scientific Information Used to Inform "Information for Providers to Share with Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV Infection, Sexually Transmitted Infections, and other Health Outcomes" |url=https://stacks.cdc.gov/view/cdc/58457 |access-date=2023-10-12 |website=stacks.cdc.gov |archive-date=22 October 2023 |archive-url=https://web.archive.org/web/20231022115215/https://stacks.cdc.gov/view/cdc/58457 |url-status=live }}</ref>
			The World Health Organization in 2010 stated:<ref name="WHO-2010a" />
			{{Blockquote|There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men.<ref name="WHO-2010a" /> }}
			=== Pathologies ===
			Circumcision is also used to treat various pathologies. These include pathological ], refractory ] and chronic or recurrent ]s (UTIs).<ref name="lissauer_2012" /><ref name="hay_2012" />
			== Contraindications ==
			Circumcision is ] in certain cases.<ref name="rudolph_2011" /><ref name="hay_2012" /><ref name="Jhpiego-2009" />
			These include infants with certain ] structure abnormalities, such as a misplaced ] (as in ] and ]), curvature of the head of the penis (]), or ], because the foreskin may be needed for reconstructive surgery. Circumcision is contraindicated in ] infants and those who are not clinically stable and in good health.<ref name="rudolph_2011" /><ref name="hay_2012" /><ref name="Jhpiego-2009" /> If an individual is known to have or has a family history of serious bleeding disorders such as ], it is recommended that the blood be checked for normal ] properties before the procedure is attempted.<ref name="hay_2012" /><ref name="Jhpiego-2009" />
			==Technique==
			{{Main|Circumcision surgical procedure}}
			]. After the operation, the ] is exposed even when the penis is ].]]
			The ] is the double-layered fold of tissue at the distal end of the ] that covers the ] and the ].<ref name=WHO_2007_GTDPSA/> For adult medical circumcision, superficial wound healing takes up to a week, and complete healing 4 to 6 months. For infants, healing is usually complete within one week.<ref name="Jhpiego-2009">{{cite web | author1 =World Health Organization | author2 = UNAIDS | author3 = Jhpiego (Johns Hopkins Program for International Education in Gynecology and Obstetrics) |date=December 2009 |title=Manual for Male Circumcision Under Local Anaesthesia |url=https://www.who.int/hiv/pub/malecircumcision/who_mc_local_anaesthesia.pdf |archive-url=https://web.archive.org/web/20120115175057/http://www.who.int/hiv/pub/malecircumcision/who_mc_local_anaesthesia.pdf |archive-date=January 15, 2012 |publisher= |quote=...there are many myths about male circumcision that circulate. For example, some people think that circumcision can cause impotence (failure of erection) or reduce sexual pleasure. Others think that circumcision will cure impotence. Let me assure you that none of these is true. |author1-link=World Health Organization |author2-link=UNAIDS |author3-link=Jhpiego }} {{Webarchive|url=https://web.archive.org/web/20230330035156/https://www.scribd.com/document/186396682/Who-Mc-Local-Anaesthesia |date=30 March 2023 }}</ref>
			===Removal of the foreskin===
			For infant circumcision, ] such as the ], ] and ] are commonly used in the USA.<ref name=AAP_2012/> These follow the same basic procedure. First, the amount of foreskin to be removed is estimated. The practitioner opens the foreskin via the preputial ] to reveal the glans underneath and ensures it is normal before bluntly separating the inner lining of the foreskin (]) from its attachment to the glans. The practitioner then places the circumcision device (this sometimes requires a ]), which remains until blood flow has stopped. Finally, the foreskin is ].<ref name=AAP_2012/> For older babies and adults, circumcision is often performed surgically without specialized instruments,<ref name="Jhpiego-2009" /> and alternatives such as ] or the ] are available.<ref name=WHO_adult_devices_2012/>
			===Pain management===
			The circumcision procedure causes pain, and for neonates this pain may interfere with mother-infant interaction or cause other behavioral changes,<ref name=perera_2010/> so the use of ] is advocated.<ref name=AAP_2012/><ref name=CPSBC_2009/> Ordinary procedural pain may be managed in ] and non-pharmacological ways. Pharmacological methods, such as localized or regional pain-blocking injections and topical analgesic creams, are safe and effective.<ref name=AAP_2012/><ref name=lonngvist_2010/><ref name=shockley_2011/> The ] and dorsal penile nerve block (DPNB) are the most effective at reducing pain, and the ring block may be more effective than the DPNB. They are more effective than ] (eutectic mixture of local anesthetics) cream, which is more effective than a ].<ref name=lonngvist_2010/><ref name=shockley_2011/> Topical creams have been found to irritate the skin of ] infants, so penile nerve block techniques are recommended in this group.<ref name=AAP_2012/>
			For infants, non-pharmacological methods such as the use of a comfortable, padded chair and a ] or non-sucrose pacifier are more effective at reducing pain than a placebo,<ref name=shockley_2011/> but the ] (AAP) states that such methods are insufficient alone and should be used to supplement more effective techniques.<ref name=AAP_2012/> A quicker procedure reduces duration of pain; use of the Mogen clamp was found to result in a shorter procedure time and less pain-induced stress than the use of the Gomco clamp or the Plastibell.<ref name=shockley_2011/> The available evidence does not indicate that post-procedure pain management is needed.<ref name=AAP_2012/> For adults, ], ring block, dorsal penile nerve block (DPNB) and ] are all options,<ref name=wolter_2008/> and the procedure requires four to six weeks of abstinence from ] or intercourse to allow the wound to heal.<ref name="Jhpiego-2009" />
			==Effects==
			===Sexually transmitted infections===
			====Human immunodeficiency virus====
			{{See also|Circumcision in Africa#Circumcision to prevent the spread of human immunodeficiency virus in Africa}}
			{{excerpt|Circumcision and HIV|paragraphs=1-2}}
			====Human papillomavirus====
			] (HPV) is the most commonly transmitted ], affecting both men and women. While most infections are ] and are cleared by the ], some types of the virus cause ]s, and other types, if untreated, cause various forms of cancer, including ] and ]. Genital warts and cervical cancer are the two most common problems resulting from HPV.<ref name=CDC_HPV/>
			Circumcision is associated with a reduced ] of ] types of HPV infection, meaning that a randomly selected circumcised man is less likely to be found infected with cancer-causing types of HPV than an uncircumcised man.<ref name=hpv_prevalence_ref_bundle/><ref name=zhu>{{cite journal | vauthors = Zhu YP, Jia ZW, Dai B, Ye DW, Kong YY, Chang K, Wang Y | title = Relationship between circumcision and human papillomavirus infection: a systematic review and meta-analysis | journal = Asian Journal of Andrology | volume = 19 | issue = 1 | pages = 125–131 | date = 8 March 2016 | pmid = 26975489 | pmc = 5227661 | doi = 10.4103/1008-682X.175092 | doi-access = free }}</ref> It also decreases the likelihood of multiple infections.<ref name=rehmeyer_2011/> {{As of|2012}}, there was no strong evidence that it reduces the rate of new HPV infection,<ref name=larke_HPV_2011/><ref name=rehmeyer_2011/><ref name=albero_2012/> but the procedure is associated with increased ] of the virus by the body,<ref name=larke_HPV_2011/><ref name=rehmeyer_2011/> which can account for the finding of reduced prevalence.<ref name=rehmeyer_2011/>
			Although genital warts are caused by a type of HPV, there is no ] between being circumcised and the presence of genital warts.<ref name=larke_HPV_2011/><ref name=zhu/><ref name=albero_2012/>
			====Other infections====
			Studies evaluating the effect of circumcision on the rates of other sexually transmitted infections have, generally, found it to be protective. A 2006 meta-analysis found that circumcision was associated with lower rates of ], ], and possibly genital ].<ref name=weiss_2006_syphilis /> A 2010 review found that circumcision reduced the incidence of ]-2 (herpes simplex virus, type 2) infections by 28%.<ref name=wetmore_2010 /> The researchers found mixed results for protection against ] and ], and no evidence of protection against ] or syphilis.<ref name=wetmore_2010/> It may also possibly protect against syphilis in MSM.<ref name=templeton_2010 />
			===Phimosis, balanitis and balanoposthitis===
			Phimosis is the inability to retract the foreskin over the glans penis.<ref name="hayashi_2011">{{cite journal | vauthors = Hayashi Y, Kojima Y, Mizuno K, Kohri K | title = Prepuce: phimosis, paraphimosis, and circumcision | journal = TheScientificWorldJournal | volume = 11 | pages = 289–301 | date = February 2011 | pmid = 21298220 | pmc = 5719994 | doi = 10.1100/tsw.2011.31 | doi-access = free }}</ref> At birth, the foreskin cannot be retracted due to ] between the foreskin and glans, and this is considered normal (physiological phimosis).<ref name="hayashi_2011"/> Over time the foreskin naturally separates from the glans, and a majority of boys are able to retract the foreskin by age three.<ref name="hayashi_2011"/> Less than one percent are still having problems at age 18.<ref name="hayashi_2011"/> If the inability to do so becomes problematic (pathological phimosis) circumcision is a treatment option.<ref name=lissauer_2012/><ref name=becker_2011/> This pathological phimosis may be due to scarring from the skin disease ] (BXO), repeated episodes of ] or forced retraction of the foreskin.<ref name=":1">{{cite journal | vauthors = Moreno G, Ramirez C, Corbalán J, Peñaloza B, Morel Marambio M, Pantoja T | title = Topical corticosteroids for treating phimosis in boys | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | pages = CD008973 | date = January 2024 | pmid = 38269441 | pmc = 10809033 | doi = 10.1002/14651858.CD008973.pub3 | pmc-embargo-date = January 25, 2025 }}</ref> ] creams are also a reasonable option and may prevent the need for surgery including in those with mild BXO.<ref name=":1" /><ref>{{cite journal | vauthors = Celis S, Reed F, Murphy F, Adams S, Gillick J, Abdelhafeez AH, Lopez PJ | title = Balanitis xerotica obliterans in children and adolescents: a literature review and clinical series | journal = Journal of Pediatric Urology | volume = 10 | issue = 1 | pages = 34–39 | date = February 2014 | pmid = 24295833 | doi = 10.1016/j.jpurol.2013.09.027 | doi-access = free }}</ref> The procedure may also be used to prevent the development of phimosis.<ref name=hay_2012/> Phimosis is also a complication that can result from circumcision.<ref name="Complications of circumcision">{{cite journal | vauthors = Krill AJ, Palmer LS, Palmer JS | title = Complications of circumcision | journal = TheScientificWorldJournal | volume = 11 | pages = 2458–2468 | date = 2011 | pmid = 22235177 | pmc = 3253617 | doi = 10.1100/2011/373829 | doi-access = free }}</ref>
			An inflammation of the glans penis and foreskin is called balanoposthitis, and the condition affecting the glans alone is called ].<ref name=leber_2006/><ref name=osipov_2006/> Most cases of these conditions occur in uncircumcised males,<ref name=aridogan_2011/> affecting 4{{endash}}11% of that group.<ref name=hayashi_2011/> The moist, warm space underneath the foreskin is thought to facilitate the growth of pathogens, particularly when hygiene is poor. Yeasts, especially '']'', are the most common penile infection and are rarely identified in samples taken from circumcised males.<ref name=aridogan_2011/> Both conditions are usually treated with topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams.<ref name=leber_2006/><ref name=osipov_2006/> Circumcision is a treatment option for refractory or recurrent balanoposthitis, but in the twenty-first century the availability of the other treatments has made it less necessary.<ref name=leber_2006/><ref name=osipov_2006/>
			===Urinary tract infections===
			A UTI affects parts of the ] including the ], ], and ]s. There is about a one percent risk of UTIs in boys under two years of age, and the majority of incidents occur in the first year of life. There is good but not ] that circumcision of babies reduces the incidence of UTIs in boys under two years of age, and there is fair evidence that the reduction in incidence is by a factor of 3{{endash}}10 times (100 circumcisions prevents one UTI).<ref name=AAP_2012/><ref name="MorrisWiswell2013">{{cite journal | vauthors = Morris BJ, Wiswell TE | title = Circumcision and lifetime risk of urinary tract infection: a systematic review and meta-analysis | journal = The Journal of Urology | volume = 189 | issue = 6 | pages = 2118–2124 | date = June 2013 | pmid = 23201382 | doi = 10.1016/j.juro.2012.11.114 }}</ref>{{COI source|sure=yes|date=March 2023}}<ref name=jagannath_2012/> Circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects,<ref name=AAP_2012/> and may be used to treat recurrent UTIs.<ref name=lissauer_2012/>
			There is a plausible biological explanation for the reduction in UTI risk after circumcision. The orifice through which urine passes at the tip of the penis (the ]) hosts more urinary system disease-causing bacteria in uncircumcised boys than in circumcised boys, especially in those under six months of age. As these bacteria are a risk factor for UTIs, circumcision may reduce the risk of UTIs through a decrease in the bacterial population.<ref name=AAP_2012/><ref name=jagannath_2012/>
			===Cancers===
			Not being circumcised is the primary ] for ].<ref name=tpc>{{cite book |vauthors=Ottenhof SR, Bleeker MC, Heideman, DA, Snijders PJ, Meijer CJ, Horenblas S |chapter=Etiology of Penile Cancer |year=2016 |veditors=Muneer A, Horenblas S|title=Textbook of Penile Cancer |publisher=Springer |doi=10.1007/978-3-319-33220-8_2 |edition=2nd |pages=11–15 |isbn=978-3-319-33220-8}}</ref><ref>{{cite web |publisher=] |url=https://www.cancer.org/cancer/penile-cancer/causes-risks-prevention/risk-factors.html |title=Risk Factors for Penile Cancer |date=25 June 2018 |access-date=25 January 2023 |archive-date=25 July 2022 |archive-url=https://web.archive.org/web/20220725193031/https://www.cancer.org/cancer/penile-cancer/causes-risks-prevention/risk-factors.html |url-status=live }}</ref> Pre-adolescent circumcision has a strong protective effect against penile cancer in later life.<ref name="Thomas_2021" /> Penile cancer is a rare disease in the ] but much more prevalent in the ].<ref name="Thomas_2021" /> The penile tissue removed during circumcision is a potential origin for penile cancer.<ref>{{cite journal | vauthors = Hakenberg OW, Compérat EM, Minhas S, Necchi A, Protzel C, Watkin N | title = EAU guidelines on penile cancer: 2014 update | journal = European Urology | volume = 67 | issue = 1 | pages = 142–150 | date = January 2015 | pmid = 25457021 | doi = 10.1016/j.eururo.2014.10.017 | type = Practice guideline }}</ref> Risk-benefit considerations around the use of circumcision as a cancer-preventive measure are a source of debate.<ref name="tpc" />
			Penile cancer development can be detected in the carcinoma ''in situ'' (CIS) cancerous precursor stage and at the more advanced invasive squamous cell carcinoma stage.<ref name="AAP_2012" /> There is an association between adult circumcision and an increased risk of invasive penile cancer; this is believed to be from men being circumcised as a treatment for penile cancer or a condition that is a precursor to cancer rather than a consequence of circumcision itself.<ref name="larke_penile_cancer_2011" /> Penile cancer has been observed to be nearly eliminated in populations of males circumcised neonatally.<ref name="hayashi_2011" />
			Important risk factors for penile cancer include phimosis and HPV infection, both of which are mitigated by circumcision.<ref name=larke_penile_cancer_2011/> The mitigating effect circumcision has on the risk factor introduced by the possibility of phimosis is secondary, in that the removal of the foreskin eliminates the possibility of phimosis. This can be inferred from study results that show uncircumcised men with no history of phimosis are equally likely to have penile cancer as circumcised men.<ref name=AAP_2012/><ref name=larke_penile_cancer_2011/> Circumcision is also associated with a reduced prevalence of cancer-causing types of HPV in men<ref name=rehmeyer_2011/> and a reduced risk of cervical cancer (which is caused by a type of HPV) in female partners of men.<ref name=hay_2012/>
			There is some evidence that circumcision is associated with reduced risk of ].<ref name=prost>{{cite journal | vauthors = Morris BJ, Matthews JG, Pabalan N, Moreton S, Krieger JN | title = Male circumcision and prostate cancer: a meta-analysis revisited | journal = The Canadian Journal of Urology | volume = 28 | issue = 4 | pages = 10768–10776 | date = August 2021 | pmid = 34378513 | doi = | type = Meta-analysis }}</ref>
			=== Women's health ===
			A 2017 systematic review found consistent evidence that male circumcision prior to heterosexual contact was associated with a decreased risk of cervical cancer, ], HSV-2, chlamydia, and syphilis among women. The evidence was less consistent in regards to the potential association of circumcision with women's risk of HPV and HIV.<ref>{{cite journal | vauthors = Grund JM, Bryant TS, Jackson I, Curran K, Bock N, Toledo C, Taliano J, Zhou S, Del Campo JM, Yang L, Kivumbi A, Li P, Pals S, Davis SM | title = Association between male circumcision and women's biomedical health outcomes: a systematic review | journal = The Lancet. Global Health | volume = 5 | issue = 11 | pages = e1113–e1122 | date = November 2017 | pmid = 29025633 | pmc = 5728090 | doi = 10.1016/S2214-109X(17)30369-8 }}</ref>
			===Sexual effects===
			The accumulated data show circumcision does not have an adverse physiological effect on sexual pleasure, function, desire, or fertility.<ref name=bless>{{cite journal | vauthors = Bañuelos Marco B, García Heil JL | title = Circumcision in childhood and male sexual function: a blessing or a curse? | journal = International Journal of Impotence Research | volume = 33 | issue = 2 | pages = 139–148 | date = March 2021 | pmid = 32994555 | pmc = 7985026 | doi = 10.1038/s41443-020-00354-y }}</ref><ref name="sexual_function">The American Academy of Pediatrics Task Force on Circumcision "Technical Report" (2012) addresses sexual function, sensitivity and satisfaction without qualification by age of circumcision. Sadeghi-Nejad ''et al.'' "Sexually transmitted diseases and sexual function" (2010) addresses adult circumcision and sexual function. Doyle ''et al.'' "The Impact of Male Circumcision on HIV Transmission" (2010) addresses adult circumcision and sexual function. Perera ''et al.'' "Safety and efficacy of nontherapeutic male circumcision: a systematic review" (2010) addresses adult circumcision and sexual function and satisfaction.
			* {{cite journal | vauthors = Dave S, Afshar K, Braga LH, Anderson P | title = Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version) | journal = Canadian Urological Association Journal | volume = 12 | issue = 2 | pages = E76–E99 | date = February 2018 | pmid = 29381458 | pmc = 5937400 | doi = 10.5489/cuaj.5033 | quote = There is lack of any convincing evidence that neonatal circumcision will impact sexual function or cause a perceptible change in penile sensation in adulthood. }}
			* {{cite journal | vauthors = Shabanzadeh DM, Düring S, Frimodt-Møller C | title = Male circumcision does not result in inferior perceived male sexual function - a systematic review | journal = Danish Medical Journal | volume = 63 | issue = 7 | date = July 2016 | pmid = 27399981 | type = Systematic review }}
			* {{cite journal | vauthors = Friedman B, Khoury J, Petersiel N, Yahalomi T, Paul M, Neuberger A | title = Pros and cons of circumcision: an evidence-based overview | journal = Clinical Microbiology and Infection | volume = 22 | issue = 9 | pages = 768–774 | date = September 2016 | pmid = 27497811 | doi = 10.1016/j.cmi.2016.07.030 | doi-access = free }}
			*{{Cite web |last=Staff |title=Statement on Newborn Male Circumcision |url=https://www.acog.org/en/womens-health/faqs/newborn-male-circumcision |access-date=March 21, 2023 |website=] |language=en |quote=Some parents also may worry that circumcision harms a man's sexual function, sensitivity, or satisfaction. However, current evidence shows that it does not. |archive-date=21 March 2023 |archive-url=https://web.archive.org/web/20230321004554/https://www.acog.org/en/womens-health/faqs/newborn-male-circumcision |url-status=live }}
			* {{cite journal | vauthors = Shezi MH, Tlou B, Naidoo S | title = Knowledge, attitudes and acceptance of voluntary medical male circumcision among males attending high school in Shiselweni region, Eswatini: a cross sectional study | journal = BMC Public Health | volume = 23 | issue = 1 | pages = 349 | date = February 2023 | pmid = 36797696 | pmc = 9933013 | doi = 10.1186/s12889-023-15228-3 | quote = It was interesting to note that the young males in this study had misconceptions about sexual pleasure post male circumcision... | doi-access = free }}
			* {{cite journal | vauthors = Sorokan ST, Finlay JC, Jefferies AL | title = Newborn male circumcision | journal = Paediatrics & Child Health | volume = 20 | issue = 6 | pages = 311–320 | date = September 8, 2015 | pmid = 26435672 | pmc = 4578472 | doi = 10.1093/pch/20.6.311 | quote = ...medical studies do not support circumcision as having a negative impact on sexual function or satisfaction in males or their partners. }}
			* {{cite web |last1=World Health Organization |last2=UNAIDS |last3=Jhpiego |date=December 2009 |title=Manual for Male Circumcision Under Local Anaesthesia |url=https://www.who.int/hiv/pub/malecircumcision/who_mc_local_anaesthesia.pdf |archive-url=https://web.archive.org/web/20120115175057/http://www.who.int/hiv/pub/malecircumcision/who_mc_local_anaesthesia.pdf |archive-date=January 15, 2012 |publisher= |quote=...there are many myths about male circumcision that circulate. For example, some people think that circumcision can cause impotence (failure of erection) or reduce sexual pleasure. Others think that circumcision will cure impotence. Let me assure you that none of these is true. |author1-link=World Health Organization |author2-link=UNAIDS |author3-link=Jhpiego }} {{Webarchive|url=https://web.archive.org/web/20230330035156/https://www.scribd.com/document/186396682/Who-Mc-Local-Anaesthesia |date=30 March 2023 }}</ref> There is some evidence that circumcision has no effect on ], ], ], ] or difficulties with ].<ref name=Tian2013>{{cite journal | vauthors = Tian Y, Liu W, Wang JZ, Wazir R, Yue X, Wang KJ | title = Effects of circumcision on male sexual functions: a systematic review and meta-analysis | journal = Asian Journal of Andrology | volume = 15 | issue = 5 | pages = 662–666 | date = September 2013 | pmid = 23749001 | pmc = 3881635 | doi = 10.1038/aja.2013.47 | type = Systematic review }}</ref>
			According to a 2014 review, the effect of circumcision on sexual partners' experiences is unclear as this has not been well studied.<ref name="bossio_2014" /> According to a policy statement from the ] that was reaffirmed in 2021,<ref>{{Cite web |title=Newborn male circumcision | work = Canadian Paediatric Society |url=https://cps.ca/en/documents/position/circumcision |access-date=2023-04-10 |language=en |archive-date=11 April 2023 |archive-url=https://web.archive.org/web/20230411220045/https://cps.ca/en/documents/position/circumcision |url-status=live }}</ref> "medical studies do not support circumcision as having an impact on sexual function or satisfaction for partners of circumcised individuals".<ref name="sexual_function" />
			There are popular misconceptions that circumcision benefits or adversely impacts the sexual pleasure of the circumcised person.<ref name="sexual_function" />
			==Adverse effects==
			Neonatal circumcision is generally a safe, low-risk procedure when done by an experienced practitioner.<ref>{{cite journal | vauthors = Friedman B, Khoury J, Petersiel N, Yahalomi T, Paul M, Neuberger A | title = Pros and cons of circumcision: an evidence-based overview | journal = Clinical Microbiology and Infection | volume = 22 | issue = 9 | pages = 768–774 | date = September 2016 | pmid = 27497811 | doi = 10.1016/j.cmi.2016.07.030 | doi-access = free }}</ref><ref name=AUA_2007/><ref name="KrillPalmer2011"/>
			The most common acute ] are bleeding, infection and the removal of either too much or too little foreskin.<ref name="AAP_2012" /><ref name="AAFP_2013" /> These complications occur in approximately 0.13% of procedures, with bleeding being the most common acute complication in the United States.<ref name="AAFP_2013" /><!-- Quote = Acute complications can include bleeding (0.8-1.8/1,000), infection (6/10,000), and injury to the penis (4/10,000). --> Minor complications are reported to occur in three percent of procedures.<ref name="AUA_2007" /> Severe complications are rare.<ref name="Complications of circumcision" /> A specific complication rate is difficult to determine due to scant data on complications and inconsistencies in their classification.<ref name="AAP_2012" /> Complication rates are greater when the procedure is performed by an inexperienced operator, in unsterile conditions, or when the child is at an older age.<ref name="weiss_2010_complications" /> Significant acute complications happen rarely,<ref name="AAP_2012" /><ref name="weiss_2010_complications" /> occurring in about 1 in 500 newborn procedures in the United States.<ref name="AAP_2012" /> Severe to catastrophic complications, including death, are so rare that they are reported only as individual case reports.<ref name="AAP_2012" /><ref name="KrillPalmer2011" /> Where a Plastibell device is used, the most common complication is the retention of the device occurring in around 3.5% of procedures.<ref name="Selekman-2020" /> Other possible complications include ], ], phimosis, ]s, urethral fistulas, and ].<ref name="KrillPalmer2011" /> These complications may be partly avoided with proper technique, and are often treatable without requiring surgical revision.<ref name="KrillPalmer2011">{{cite journal | vauthors = Krill AJ, Palmer LS, Palmer JS | title = Complications of circumcision | journal = TheScientificWorldJournal | volume = 11 | pages = 2458–2468 | year = 2011 | pmid = 22235177 | pmc = 3253617 | doi = 10.1100/2011/373829 | doi-access = free }}</ref> The most common long-term complication is meatal stenosis, this is almost exclusively seen in circumcised children, it is thought to be caused by ammonia producing bacteria coming into contact with the meatus in circumcised infants.<ref name="Selekman-2020" /> It can be treated by ].<ref name="Selekman-2020" />
			Effective pain management should be used during the procedure.<ref name="AAP_2012" /> Inadequate pain relief may carry the risks of heightened pain response for newborns.<ref name=perera_2010/> Newborns that experience pain due to being circumcised have different responses to vaccines given afterwards, with higher pain scores observed.<ref>{{cite journal | vauthors = Sorokan ST, Finlay JC, Jefferies AL | title = Newborn male circumcision | journal = Paediatrics & Child Health | volume = 20 | issue = 6 | pages = 311–320 | date = 8 September 2015 | pmid = 26435672 | pmc = 4578472 | doi = 10.1093/pch/20.6.311 | url = http://www.cps.ca/documents/position/circumcision | url-status = live | archive-url = https://web.archive.org/web/20160118224324/http://www.cps.ca/documents/position/circumcision | archive-date = 18 January 2016 }}</ref> For adult men who have been circumcised, there is a risk that the ] may be tender.<ref name="crit">{{cite journal | vauthors = Morris BJ, Moreton S, Krieger JN | title = Critical evaluation of arguments opposing male circumcision: A systematic review | journal = Journal of Evidence-Based Medicine | volume = 12 | issue = 4 | pages = 263–290 | date = November 2019 | pmid = 31496128 | pmc = 6899915 | doi = 10.1111/jebm.12361 | type = Systematic review }}</ref> There is no good evidence that circumcision affects cognitive abilities.<ref name="nhs">{{cite web |date=22 February 2016 |title=Circumcision in men |url=https://www.nhs.uk/conditions/circumcision-in-men/ |publisher=National Health Service |access-date=30 October 2018 |archive-date=29 June 2020 |archive-url=https://web.archive.org/web/20200629155854/https://www.nhs.uk/conditions/circumcision-in-men/ |url-status=live }}</ref>
	The World Health Organization (WHO; 2007), the ] (UNAIDS; 2007), and the ] (CDC; 2008) state that evidence indicates male circumcision significantly reduces the risk of ] acquisition by men during penile-vaginal sex, but also state that circumcision only provides minimal protection and should not replace other interventions to prevent transmission of ].<ref name="WHO-C&R"/><ref name="CDC-2008">{{cite web |title=Male Circumcision and Risk for HIV Transmission and Other Health Conditions: Implications for the United States |publisher=Centers for Disease Control and Prevention |year=2008 |url=http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm}}</ref>
	==History==		==History==
	{{Main|History of male circumcision}}		{{Main|History of circumcision}}
			{{Undue weight section|date=November 2023}}
			]
	===Origins===
			Circumcision is the oldest known surgical procedure.<ref name=":0">{{cite book | vauthors = Cox G, Morris BJ |title=Surgical Guide to Circumcision |publisher=Springer Science & Business Media |year=2012 |isbn=978-1-4471-2858-8 | veditors = Bolnick D, Koyle M, Yosha A |chapter=Why Circumcision? From Prehistory to the Twenty-First Century |pages=243–244}}</ref> Depictions of circumcised penises are found in ],<ref>{{cite journal | vauthors = Angulo JC, García-Díez M | title = Male genital representation in paleolithic art: erection and circumcision before history | journal = Urology | volume = 74 | issue = 1 | pages = 10–14 | date = July 2009 | pmid = 19395004 | doi = 10.1016/j.urology.2009.01.010 | url = https://www.sciencedirect.com/science/article/pii/S0090429509000831 | access-date = 7 February 2024 | url-status = live | hdl-access = free | archive-date = 10 November 2011 | archive-url = https://web.archive.org/web/20111110225228/http://www.sciencedirect.com/science/article/pii/S0090429509000831 | hdl = 10400.26/23819 }}</ref> predating the earliest signs of ].<ref name=":0" /><ref>{{cite journal | vauthors = Faria MA | title = Neolithic trepanation decoded- A unifying hypothesis: Has the mystery as to why primitive surgeons performed cranial surgery been solved? | journal = Surgical Neurology International | volume = 6 | pages = 72 | date = 2015-05-07 | pmid = 25984386 | pmc = 4427816 | doi = 10.4103/2152-7806.156634 | doi-access = free }}</ref>
	] at the ], ], Egypt. ], ], c. 1360 BC.]]
	It has been variously proposed that circumcision began as a religious ], as a ] marking a boy's entrance into adulthood, as a form of ] to ensure virility, as a means of suppressing sexual pleasure or to increase a man's attractiveness to women, or as an aid to ] where regular ] was impractical, among other possibilities. Immerman ''et al.'' suggest that circumcision causes lowered sexual arousal of pubescent males, and hypothesize that this was a competitive advantage to tribes practicing circumcision, leading to its spread regardless of whether the people understood this.<ref>{{cite journal |last=Immerman |first=R.S. |authorlink= |coauthors=W.C. Mackey |year=1997 |month=Fall-Winter |title=A biocultural analysis of circumcision |journal=Social Biology |volume=44 |issue=3-4 |pages=265–275 |pmid=9446966 |url=http://www.cirp.org/library/psych/immerman2/ |accessdate= |quote= |doi=10.1111/j.1467-9744.1976.tb00285.x }}</ref>
	It is possible that circumcision arose independently in different cultures for different reasons.
	The oldest documentary evidence for circumcision comes from ].<ref> Tomb artwork from the ] (2345&ndash;2181 BCE) shows men with circumcised penises, and one ] from this period shows the rite being performed on a standing adult male. The ] for "penis" depicts either a circumcised or an erect organ. The examination of Egyptian mummies has found some with foreskins and others who were circumcised.</ref> Circumcision was common, although not universal, among ancient ] peoples.<ref> The book of Genesis records circumcision as God's covenant/command to Abraham. It was a sign of obedience and was to be performed by the male child's eighth day after birth. The ], written in the sixth century BCE, lists the Egyptians, Jews, ], ]ites, and ] as circumcising cultures. ], writing in the fifth century BCE, would add the ], ]ns, ], and ]ns to that list.</ref> In the aftermath of the conquests of ], however, Greek dislike of circumcision (they regarded a man as truly "naked" only if his prepuce was retracted) led to a decline in its incidence among many peoples that had previously practiced it.<ref>The writer of the ] wrote that under the ]s, many Jewish men attempted to hide or reverse their circumcision so they could exercise in Greek ], where nudity was the norm. First Maccabees also relates that the Seleucids forbade the practice of ] (Jewish circumcision), and punished those who performed it&ndash;as well as the infants who underwent it&ndash;with death.</ref>
			The history of the migration and evolution of circumcision is known mainly from the cultures of two regions. In the lands south and east of the Mediterranean, starting with Central Sahara, Sudan and Ethiopia, the procedure was practiced by the ]ians and the ], and then by the Jews and Muslims. In Oceania, circumcision is practiced by the ] and ].<ref name="gollaher_2001_ch1" /> There is also evidence that circumcision was practiced among the ] and ] civilizations in the Americas,<ref name="WHO_2007_GTDPSA" /> but little is known about that history.<ref name="Doy2005" /><ref name="alanis_2004" />
	Circumcision has ancient roots among several ethnic groups in sub-equatorial Africa, and is still performed on adolescent boys to symbolize their transition to warrior status or adulthood.<ref>{{cite journal |last=Marck |first=J |year=1997 |month= |title=Aspects of male circumcision in sub-equatorial African culture history |journal=Health Transit Review |volume=7 |issue=supplement |pages=337–360 |pmid=10173099 }}</ref>
			It has been speculated that circumcision originated as a substitute for ] of defeated enemies or as a ].<ref name="alanis_2004" /> In many traditions, it acts as a ] marking a boy's entrance into ]hood.<ref name="alanis_2004" />
	===Non-religious circumcision in the English-speaking world===
	Infant circumcision was taken up in the United States, Australia and the English-speaking parts of ], ], ] and to a lesser extent in the ].
	There are several hypotheses to explain why infant circumcision was accepted in the United States about the year 1900. The ] elicited an image of the human body as a conveyance for many dangerous germs, making the public "germ phobic" and suspicious of dirt and bodily secretions. The penis became "dirty" by association with its function, and from this premise circumcision was seen as preventative medicine to be practiced universally.<ref name="Gollaher1994">{{cite journal
	| last = Gollaher
	| first = David
	| coauthors =
	| year = 1994
	| month = Fall
	| title = From ritual to science: the medical transformation of circumcision in America
	| journal = Journal of Social History
	| volume = 28
	| issue = 1
	| pages = 5&ndash;36
	| pmid =
	| doi =
	| url = http://www.cirp.org/library/history/gollaher/
	| accessdate = 2007-12-06
	}}</ref> In the view of many practitioners at the time, circumcision was a method of treating and preventing masturbation.<ref name="Gollaher1994"/> Aggleton wrote that ] viewed male circumcision in this way, and further "advocated an unashamedly punitive approach."<ref>{{cite journal| last = Aggleton| first = P.| title = Roundtable: “Just a Snip”?: A Social History of Male Circumcision. | journal = Reproductive Health Matters| year = 2007| volume = 15| issue = 29| pages = 15–21| url = http://www.hsph.harvard.edu/pihhr/files/RHM/RHM29%20-%20Aggleton.pdf|format=PDF| accessdate = 2008-12-17| doi = 10.1016/S0968-8080(07)29303-6}}</ref> Circumcision was also said to protect against ],<ref>{{cite journal | title=On the influence of circumcision in preventing syphilis | journal=Medical Times and Gazette | volume=NS Vol II | year=1855 | pages=542&ndash;3 | unused_data=Hutchinson J }}</ref> phimosis, paraphimosis, balanitis, and "excessive ]" (which was believed to produce ]).<ref name="Gollaher1994" /> Gollaher states that physicians advocating circumcision in the late nineteenth century expected public scepticism, and refined their arguments to overcome it.<ref name="Gollaher1994" />
			===Middle East, Africa and Europe===
	Although it is difficult to determine historical circumcision rates, one estimate of infant circumcision rates in the United States holds that 32% of newborn American boys were being circumcised in 1933.<ref name=Laumann/> Laumann ''et al.'' reported that the prevalence of circumcision among US-born males was approximately 70%, 80%, 85%, and 77% for those born in 1945, 1955, 1965, and 1971 respectively.<ref name=Laumann/> Xu ''et al.'' reported that the prevalence of circumcision among US-born males was 91% for males born in the 1970s and 84% for those born in the 1980s.<ref>{{cite journal |author=Xu F, Markowitz LE, Sternberg MR, Aral SO |title=Prevalence of circumcision and herpes simplex virus type 2 infection in men in the United States: the National Health and Nutrition Examination Survey (NHANES), 1999-2004 |journal=Sex Transm Dis |volume=34 |issue=7 |pages=479–84 |year=2007 |month=July |pmid=17413536 |doi=10.1097/01.olq.0000253335.41841.04 |url=}}</ref> Between 1981 and 1999, National Hospital Discharge Survey data from the ] demonstrated that the infant circumcision rate remained relatively stable within the 60% range, with a minimum of 60.7% in 1988 and a maximum of 67.8% in 1995.<ref>{{cite web |url=http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions.htm |title=Trends in circumcisions among newborns |accessdate=2008-08-19 |work=National Hospital Discharge Survey |publisher=National Center for Health Statistics |date=January 11, 2007}}</ref> A 1987 study found that the most prominent reasons US parents choose circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns.<ref>{{cite journal |last=Brown |first=M.S. |coauthors=C.A. Brown |year=1987 |month=August |title=Circumcision decision: prominence of social concerns |journal=Pediatrics |volume=80 |issue=2 |pages=215–219 |pmid=3615091 |url= |accessdate= |quote= }}</ref> However, a later study speculated that an increased recognition of the potential benefits of neonatal circumcision may have been responsible for the observed increase in the US rate between 1988 and 2000.<ref>{{cite journal |last=Nelson |first=C.P. |coauthors=R. Dunn, J. Wan, J.T. Wei |year=2005 |month=March |title=The increasing incidence of newborn circumcision: data from the nationwide inpatient sample |journal=Journal of Urology |volume=173 |issue=3 |pages=978–981 |pmid=15711354 |url= |accessdate= |quote= |doi=10.1097/01.ju.0000145758.80937.7d }}</ref> A report by the ] placed the 2005 national circumcision rate at 56%.<ref>{{cite news |first= |last= |title=U.S. circumcision rates vary by region |url=http://www.hcup-us.ahrq.gov/reports/statbriefs/sb45.pdf
			{{Further|Circumcision in Africa}}
	|format=PDF|work= |publisher=Agency for Healthcare Research and Quality |date=January, 2008 |accessdate=2008-08-19 }}</ref>
			At ], in ], engraved rock art with masked bowmen, which feature male circumcision and may be a scene involving ritual, have been dated to earlier than 6000 BP amid the ];<ref name="Campbell">{{cite journal | vauthors = Campbell A, Coulson D |title=Big Hippo Site, Oued Afar, Algeria |journal=Sahara |date=2010 |volume=21 |pages=85, 90–91 |url=https://media.africanrockart.org.s3.amazonaws.com/wp-content/uploads/2018/12/26145300/NG_Ancient-art-of-the-Sahara-June-1999.pdf |issn=1120-5679 |s2cid=191103812 |access-date=27 August 2022 |archive-date=26 October 2022 |archive-url=https://web.archive.org/web/20221026015942/https://media.africanrockart.org.s3.amazonaws.com/wp-content/uploads/2018/12/26145300/NG_Ancient-art-of-the-Sahara-June-1999.pdf |url-status=dead }}</ref> more specifically, while possibly dating much earlier than 10,000 BP, rock art walls from the Bubaline Period have been dated between 9200 BP and 5500 BP.<ref name="Soukopova">{{cite journal | vauthors = Soukopova J |title=Central Saharan rock art: Considering the kettles and cupules |journal=Journal of Arid Environments |date=August 2017 |volume=143 |page=12 |doi=10.1016/j.jaridenv.2016.12.011 |bibcode=2017JArEn.143...10S |s2cid=132225521 |url=https://www.academia.edu/33092285 |access-date=27 August 2022 |archive-date=7 November 2021 |archive-url=https://web.archive.org/web/20211107084913/https://www.academia.edu/33092285 |url-status=live }}</ref> The cultural practice of circumcision may have spread from the Central ], toward the south in ] and toward the east in the region of the ].<ref name="Campbell" /> Based on ] evidence found on walls and evidence from ], circumcision has been dated to at least as early as 6000 BCE in ].<ref name="Al-Salem">{{cite book | vauthors = Al-Salem AH |title=An Illustrated Guide to Pediatric Urology |date=November 8, 2016 |publisher=Springer Cham |isbn=978-3-319-44182-5 |doi=10.1007/978-3-319-44182-5_22 |s2cid=79015190 |page=480 |chapter-url=https://link.springer.com/chapter/10.1007/978-3-319-44182-5_22 |chapter=Male Circumcision |access-date=27 August 2022 |archive-date=23 August 2022 |archive-url=https://web.archive.org/web/20220823235108/https://link.springer.com/chapter/10.1007/978-3-319-44182-5_22 |url-status=live }}</ref> Some ], which have been dated as early as 4000 BCE, show evidence of circumcision.<ref name="gollaher_2001_ch1" />{{rp|2–3}}<ref name="Dobanovački">{{cite journal | vauthors = Dobanovački D, Milovanović L, Slavković A, Tatić M, Mišković-Skeledžija S, Škorić-Jokić S, Pećanac M |title=Surgery Before Common Era (B.C.E.*) |journal=Archive of Oncology |date=2012 |volume=20 |issue=1–2 |page=29 |doi=10.2298/AOO1202028D |s2cid=53008076 |url=http://www.doiserbia.nb.rs/img/doi/0354-7310/2012/0354-73101202028D.pdf |access-date=27 August 2022 |archive-date=12 February 2023 |archive-url=https://web.archive.org/web/20230212202036/http://www.doiserbia.nb.rs/img/doi/0354-7310/2012/0354-73101202028D.pdf |url-status=live }}</ref>
	In 1949, the United Kingdom's newly-formed ] removed infant circumcision from its list of covered services, and circumcision has since been an ] to parents. As a result, prevalence in the UK is age-graded, with 12% of those aged 16–19 years circumcised and 20% of those aged 40–44 years,<ref name="Davis">{{cite journal
	|title=Male circumcision in Britain: findings from a national probability sample survey
	|author=Dave, SS
	|coauthors=''et al.''
	|journal=Sex Transm Infect
	|year=2003
	|volume=79
	|pages=499–500
	|url=http://sti.bmj.com/cgi/content/full/79/6/499
	|doi=10.1136/sti.79.6.499
	}}</ref> and the proportion of newborns circumcised in England and Wales has fallen to less than one percent.
			Evidence suggests that circumcision was practiced in the Middle East by the fourth millennium BCE, when the ]ians and the Semites moved into the area that is modern-day Iraq from the North and West.<ref name=Doy2005/> The earliest historical record of circumcision comes from Egypt, in the form of an image of the circumcision of an adult carved into the tomb of Ankh-Mahor at ], dating to about 2400{{endash}}2300 BCE. Circumcision was possibly done by the Egyptians for hygienic reasons, but also was part of their obsession with purity and was associated with spiritual and intellectual development. No well-accepted theory explains the significance of circumcision to the Egyptians, but it appears to have been endowed with great honor and importance as a ], performed in a public ceremony emphasizing the continuation of family generations and fertility. It may have been a mark of distinction for the elite: the Egyptian '']'' describes the sun god ] as having circumcised himself.<ref name=alanis_2004/><ref name=gollaher_2001_ch1/>
	The circumcision rate has declined sharply in Australia since the 1970s, leading to an age-graded fall in prevalence, with a 2000-01 survey finding 32% of those aged 16–19 years circumcised, 50% for 20–29 years and 64% for those aged 30–39 years.<ref>"In Australia and New Zealand, the circumcision rate has fallen considerably in recent years and it is estimated that currently only 10%-20% of male infants are routinely circumcised." (RACP: 2004)</ref><ref name=richters>{{cite journal
			]; the Greeks abhorred circumcision, making life difficult for circumcised Jews living among the Greeks.]]
	|title=Circumcision in Australia: prevalence and effects on sexual health
	|author=Richters, J
	|coauthors=''et al.''
	|journal=Int J STD AIDS
	|year=2006
	|volume=17
	|pages=547–554
	|pmid=16925903
	|quote=Neonatal circumcision was routine in Australia until the 1970s … In the last generation, Australia has changed from a country where most newborn boys are circumcised to one where circumcision is the minority experience.
	|url=http://www.cirp.org/library/general/richters1/
	|doi=10.1258/095646206778145730
	}}</ref>
			Circumcision is prominent in the ].<ref>{{cite book | vauthors = McNutt PM |title=Reconstructing the Society of Ancient Israel |url=https://archive.org/details/reconstructingso0000mcnu |url-access=registration |page= |quote=Abraham patriarchal known history. |year=1999 |publisher=Westminster John Knox Press |isbn=978-0-664-22265-9 }}</ref> In addition to proposing that circumcision was adopted by the Israelites purely as a religious mandate, scholars have suggested that Judaism's patriarchs and their followers adopted circumcision to make penile hygiene easier in hot, sandy climates; as a rite of passage into adulthood; or as a form of blood sacrifice.<ref name="Doy2005" /><ref name="gollaher_2001_ch1" /><ref name="encyc_judaica_2006" />
	In Canada, Ontario health services delisted circumcision in 1994.<ref>{{cite journal |pmid=9241462 |pmc=2255121 |title=Neonatal male circumcision after delisting in Ontario. Survey of new parents |author=Walton RE, Ostbye T, Campbell MK |journal=Can Fam Physician |year=1997 |volume=43 |pages=1241–7}}</ref>
			Historical campaigns of ] frequently included bans on circumcision as a means of ].<ref name="Antisemitism">For sources, see:
	==Cultures and religions {{Anchor|Cultures and religions}}==
	]]]]]
	::''See also ], ] ("covenant of circumcision" is ritual circumcision in ]) and ] (circumcision as carried out in ]), and ].''
			* {{Cite book | vauthors = Livingston M |title=Dreamworld or Dystopia: The Nordic Model and Its Influence in the 21st Century |publisher=] |year=2021 |isbn=978-1-108-75726-3 |pages=87 |quote=In Jewish history, the banning of circumcision (brit mila) has historically been a first step toward more extreme and violent forms of persecution. |author-link=Michael Livingston}}
	In some cultures, males must be circumcised shortly after birth, during childhood, or around puberty as part of a rite of passage. Circumcision is commonly practised in the ] and ] faiths.
			* {{Cite book | vauthors = Wilson R |title=The Contested Place of Religion in Family Law |publisher=] |year=2018 |isbn=978-1-108-41760-0 |pages=174 |quote=Jews have a long history of suffering punishment at the hands of government authorities for engaging in circumcision. Muslims have also experienced suppression of their identities through suppression of this religious practice.}}
			* {{cite journal | vauthors = Miller GP |date=Spring 2002 |title=Circumcision: Cultural-Legal Analysis |journal=Virginia Journal of Social Policy & the Law |volume=9 |pages=497–585 |doi=10.2139/ssrn.201057 |ssrn=201057 <!-- | format = PDF (free download) -- can't list format or access-date without url--> |quote=Ritual circumcision of boys is a durable tradition. Jews of ancient times refused to abandon the practice despite enormous pressure to do so. In 167 BCE the Seleucid emperor Antiochus IV, as part of a campaign to Hellenise the Jews, condemned to death every Hebrew who allowed a son to be circumcised. The Jews responded with the Maccabean revolt, a campaign of ] which resulted in major victories for the rebels and, eventually, a peace treaty which restored Jewish ritual prerogatives.}}
			* {{Cite book | vauthors = Silverman E |title=From Abraham to America: A History of Jewish Circumcision |publisher=] |year=2006 |isbn=978-0-7425-1669-4 |pages=161–162 |chapter=Circumcision, Anti-Semitism, and Christ's Foreskin |quote=Ancient authors praised Jewish wisdom, courage, temperance, and justice. Still, they always denounced circumcision. The anonymous authors of Historiae Augustae, writing in the late fourth century, ttributed a Jewish revolt against Rome in 132-135, called the Bar Kokhba rebellion, to a ban on circumcision enacted by the emperor Hadrian... The prohibition was part of a broad campaign to "civilize" ethnic groups...}}
			* {{Cite book | vauthors = Rosner F |title=Encyclopedia of Jewish Medical Ethics |publisher=] |year=2003 |isbn=978-1-58330-592-8 |pages=196 |quote=Several eras in subsequent Jewish history were associated with forced conversions and with prohibitions against ritual circumcision... Jews endangered their lives during such times and exerted strenuous efforts to nullify such edicts. When they succeeded, they celebrated by declaring a holiday. Throughout most of history, Jews never doubted their obligation to observe circumcision... voiders of the covenant of Abraham our father, and they have no portion in the World to Come.}}</ref> ] conquered the Middle East in the fourth century BCE, and in the following centuries ancient Greek cultures and values came to the Middle East. The Greeks abhorred circumcision, making life for circumcised Jews living among the Greeks and later the Romans very difficult.<ref name="Antisemitism" /> ] by European governments have occurred several times in world history, including the ] under ] and the ] under ], where it was used as a means of ].<ref name="Antisemitism" /> Antiochus IV's restriction on Jewish circumcision was a major factor in the ].<ref name="Antisemitism" /> ]'s prohibition has also been considered by some to have been a contributing cause of the ].<ref name="Antisemitism" /> According to Silverman (2006), these restrictions were part of a "broad campaign" by the Romans to "civilize" the Jewish people, viewing the practice as repulsive and analogous to ].<ref name="Antisemitism" /> His successor, ], altered the edict to permit {{transliteration|he|Brit Milah}}.<ref name="Antisemitism" /> During this period in history, Jewish circumcision called for the removal of only a part of the prepuce, and ] Jews often attempted to look uncircumcised by stretching the extant parts of their foreskins. This was considered by the Jewish leaders to be a serious problem, and during the second century CE they changed the requirements of Jewish circumcision to call for the complete removal of the foreskin,<ref>{{cite encyclopedia|vauthors=Hirsch EG, Kohler K, Jacobs J, Friedenwald A, Broydé I|date=1906|title=Circumcision|url=http://www.jewishencyclopedia.com/articles/4391-circumcision|encyclopedia=]|quote=In order to prevent the obliteration of the 'seal of the covenant' on the flesh, as circumcision was henceforth called, the Rabbis, probably after the ] (see Yeb. l.c.; Gen. R. xlvi.), instituted the 'peri'ah' (the laying bare of the glans), without which circumcision was declared to be of no value (Shab. xxx. 6).|access-date=8 March 2018|archive-date=4 August 2011|archive-url=https://web.archive.org/web/20110804221009/http://www.jewishencyclopedia.com/view.jsp?artid=514&letter=C&search=circumcision|url-status=live}}</ref> emphasizing the Jewish view of circumcision as intended to be not just the fulfillment of a Biblical commandment but also an essential and permanent mark of membership in a people.<ref name="gollaher_2001_ch1" /><ref name="encyc_judaica_2006" />
			]|left]]A narrative in the Christian ] makes a brief mention of the ], but physical circumcision is not part of the received teachings of Jesus. Circumcision has ] in ] and ]. ] reinterpreted circumcision as a spiritual concept, arguing literal circumcision to be unnecessary for Gentile converts to Christianity. The teaching that circumcision was unnecessary for membership in a divine covenant was instrumental to the separation of Christianity from Judaism.<ref name="Jacobs-2012">{{Cite book | vauthors = Jacobs A |title=Christ Circumcised: A Study in Early Christian History and Difference |publisher=] |year=2012 |isbn=978-0-8122-0651-7 |location=United States |pages=}}</ref><ref name="Bolnick-2012">{{Cite book | vauthors = Bolnick D, Koyle M, Yosha A |title=Surgical Guide to Circumcision |publisher=] |year=2012 |isbn=978-1-4471-2858-8 |location=United Kingdom |pages=290–298 |chapter=Circumcision in the Early Christian Church: The Controversy That Shaped a Continent |quote=In summary, circumcision has played a surprisingly important role in Western history. The circumcision debate forged a Gentile identity to the early Christian church which allowed it to survive the Jewish Diaspora and become the dominant religion of Western Europe. Circumcision continued to have a major cultural presence throughout Christendom even after the practice had all but vanished.... the circumcision of Jesus... celebrated as a religious holiday... examined by many of the greatest scholars and artists of the Western tradition.}}</ref> While the circumcision of Jesus is celebrated as ] in the ] of many ]s.<ref name="Bolnick-2012"/>
	] states that circumcision is a ''']'' ("positive commandment" to perform an act) and is obligatory for Jewish-born males and for non-circumcised Jewish male converts. It is only postponed or abrogated in the case of threat to the life or health of the child.<ref name="GlassJM">{{cite journal
	| last = Glass
	| first = J.M.
	| year = 1999
	| month = January
	| title = Religious circumcision: a Jewish view
	| journal = BJU International
	| volume = 83
	| issue = Supplement 1
	| pages = 17–21
	| doi = 10.1046/j.1464-410x.1999.0830s1017.x
	| pmid = 10766529
	| url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1017.x
	| format = PDF
	| accessdate = 2006-10-18
	}}
	</ref> It is usually performed by a '']'' on the eighth day after birth in a ceremony called a '']'' (or ''Bris milah'', colloquially simply ''bris''), which means "Covenant of circumcision" in ].
	It is considered of such religious importance that the body of an uncircumcised Jewish male will sometimes be circumcised before burial.<ref>{{cite book
	|last = Lamm
	|first = Maurice
	|title = The Jewish Way in Death and Mourning
	|origdate = 1969
	|url = http://www.chabad.org/library/article_cdo/aid/281541/jewish/The-Jewish-Way-in-Death-and-Mourning.htm
	|publisher = Jonathan David
	|location = New York
	|pages = 239&ndash;240
	}}
	</ref>
			Although it is not explicitly mentioned in the ] (early seventh century CE), circumcision is considered essential to Islam, and it is nearly universally performed among Muslims. The practice of circumcision spread across the Middle East, North Africa, and Southern Europe with Islam.<ref name="gollaher_2001_ch2" />
	In ], circumcision is mentioned in some '']'' (it is referred as ]), but not in the ]. Some '']'' scholars state that circumcision is recommended ('']''); others that it is obligatory.<ref>{{cite web
	| url = http://www.islam-qa.com/index.php?ln=eng&ds=qa&lv=browse&QR=9412&dgn=4
	| title = Question #9412: Circumcision: how it is done and the rulings on it
	| accessdate = 2006-07-01
	| last = Al-Munajjid
	| first = Muhammed Salih
	| publisher = Islam Q&A
	}}
	</ref> Some have quoted the ''hadith'' to argue that the requirement of circumcision is based on the ] with ].<ref>{{cite web
	| url = http://www.islam-qa.com/index.php?ln=eng&ds=qa&lv=browse&QR=7073&dgn=3
	| title = Question #7073: The health and religious benefits of circumcision
	| accessdate = 2006-07-01
	| last = Al-Munajjid
	| first = Muhammed Salih
	| publisher = Islam Q&A
	}}
	</ref> While endorsing circumcision for males, Islamic scholars note that it is not a requirement for converting to Islam.<ref>{{cite book
	| last =al-Sabbagh
	| first = Muhammad Lutfi
	| title =Islamic ruling on male and female circumcision
	| publisher = ]
	| year = 1996
	| location = ]
	| isbn =
	| page = 16 }}</ref>
			] and the following Yuan Emperors in China forbade Islamic practices such as ] butchering and circumcision.<ref name="Leslie-1998">{{cite web|url=http://www.islamicpopulation.com/asia/China/China_integration%20of%20religious%20minority.pdf |title=The Integration of Religious Minorities in China: The Case of Chinese Muslims | vauthors = Leslie DD |year=1998 |page=12 |publisher=The Fifty-ninth George Ernest Morrison Lecture in Ethnology |access-date=30 November 2010 |url-status=dead |archive-url=https://web.archive.org/web/20101217112014/http://islamicpopulation.com/asia/China/China_integration%20of%20religious%20minority.pdf |archive-date=17 December 2010 }}</ref><ref name="Elverskog-2010">{{cite book|url=https://archive.org/details/buddhismislamons0000elve|url-access=registration|title=Buddhism and Islam on the Silk Road| vauthors = Johan E |year=2010|publisher=University of Pennsylvania Press|edition=illustrated|pages=|isbn=978-0-8122-4237-9|access-date=28 June 2010}}</ref>
	The Catholic Church condemned the observance of circumcision as a mortal sin and ordered against its practice in the ] in 1442.<ref name = "Florence">{{cite web
	| title = Session 11—4 February 1442 (Bull of union with the Copts)
	| url = http://www.ewtn.com/library/councils/Florence.htm#5
	| work = Eccumenical Council of Florence (1438-1445)
	| publisher = ]
	| accessdate = 2009-05-11
	| quote = <small>Therefore it strictly orders all who glory in the name of Christian, not to practise circumcision either before or after baptism, since whether or not they place their hope in it, it cannot possibly be observed without loss of eternal salvation.</small>
	}}
	</ref>
			The practice of circumcision is thought to have been brought to the Bantu-speaking tribes of Africa by either the Jews after one of their many expulsions from European countries, or by Muslim Moors escaping after the 1492 ] of Spain. In the second half of the first millennium CE, inhabitants from the Northeast of Africa moved south and encountered groups from Arabia, the Middle East, and West Africa. These people moved south and formed what is known today as the Bantu. Bantu tribes were observed to be upholding what was described as Jewish law, including circumcision, in the 16th century. Circumcision and elements of Jewish dietary restrictions are still found among Bantu tribes.<ref name=Doy2005/>
	Circumcision is customary among the ], ], and ] Churches, and also some other African churches.<ref name=Christian/> Some Christian churches in South Africa oppose circumcision, viewing it as a pagan ritual, while others, including the Nomiya church in Kenya,<ref name=Christian/><ref>{{cite journal |last=Mattson |first=C.L. |authorlink= |coauthors=R.C. Bailey, R. Muga, R. Poulussen, T. Onyango |year=2005 |month=February |title=Acceptability of male circumcision and predictors of circumcision preference among men and women in Nyanza Province, Kenya |journal=AIDS Care |volume=17 |issue=2 |pages=182–194 |pmid=15763713 |url= |accessdate= |quote= |doi=10.1080/09540120512331325671 }}</ref> require circumcision for membership. Some Christian churches celebrate the ].<ref>{{cite web|url=http://www.goarch.org/en/chapel/calendar.asp?Y=2007&M=1|title=Greek Orthodox Archdiocese calendar of Holy Days}}</ref><ref>{{cite web|url=http://www.holytrinityorthodox.com/calendar/los/January/01-01.htm|title=Russian Orthodox Church, Patriarchate of Moscow}}</ref> The vast majority of Christians do not practise circumcision as a religious requirement.
			===Indigenous peoples of the Americas and Oceania===
	Circumcision in South Korea is largely the result of American cultural and military influence following the ]. In West Africa infant circumcision may have had tribal significance as a rite of passage or otherwise in the past; today in some non-Muslim ]n societies it is medicalised and is simply a cultural norm.<ref>Ajuwon ''et al.'', "Indigenous surgical practices in rural southwestern Nigeria: Implications for disease," Health Educ. Res..1995; 10: 379&ndash;384 Health Educ. Res..1995; 10: 379&ndash;384 Retrieved 3 October 2006</ref>
			Circumcision is practiced by some groups amongst ] peoples, ], and ].<ref name=WHO_2007_GTDPSA/><ref name="Doy2005"/>
	Circumcision is part of ] in some African, Pacific Islander, and Australian aboriginal ] in areas such as ],<ref>{{cite paper
	| author = Aaron David Samuel Corn
	| title = Ngukurr Crying: Male Youth in a Remote Indigenous Community
	| version = Working Paper Series No. 2
	| publisher = ]
	| year= 2001
	| url = http://www.uow.edu.au/arts/sealcp/wkgpapers/wp2.pdf
	| format = PDF
	| accessdate = 2006-10-18
	}}
	</ref> where the practice was introduced by Makassan traders from ] in the ]n Archipelago.<ref>{{cite web
	| url = http://www.mfgsc.vic.edu.au/greenturtledreaming/EKmigrate.htm
	| title = Migration and Trade
	| accessdate = 2006-10-18
	| publisher = Green Turtle Dreaming
	| quote = In exchange for turtles and trepang the Makassans introduced tobacco, the practice of circumcision and knowledge to build sea-going canoes.
	}}
	</ref> Circumcision ceremonies among certain Australian aboriginal societies are noted for their painful nature: ] is practised amongst some aboriginal peoples in the Western Desert.<ref>{{cite journal
	| last = Jones
	| first = IH
	| year = 1969
	| month = June
	| title = Subincision among Australian western desert Aborigines
	| journal = British Journal of Medical Psychology
	| volume = 42
	| issue = 2
	| pages = 183&ndash;190
	| doi =
	| id = {{ISSN|0007-1129}} PMID 5783777
	}}
	</ref>
	In the Pacific, ritual circumcision is nearly universal in the Melanesian islands of ] and ];<ref>{{cite web
	| url = http://www.aids.net.au/aids-png-project-20060403.htm
	| title = RECENT GUEST SPEAKER
	| accessdate = 2006-07-01
	| year = 2006
	| publisher = Australian AIDS Fund Incorporated
	}}
	</ref> participation in the traditional land diving on ] is reserved for those who have been circumcised.<ref>{{cite web
	| url = http://www.getaway.co.nz/destination.asp?id=34
	| title = Weird & Wonderful
	| accessdate = 2006-07-01
	| publisher = United Travel
	}}
	</ref>
			For Aboriginal Australians and Polynesians, circumcision likely started as a blood sacrifice and a test of bravery and became an initiation rite with attendant instruction in manhood in more recent centuries. Often seashells were used to remove the foreskin, and the bleeding was stopped with ] smoke.<ref name=Doy2005/><ref name=gollaher_2001_ch3/>
	Circumcision is also commonly practiced in the Polynesian islands of ], ], ], and ], where the custom is recorded as a pre-Christian/colonial practice. In Samoa it is accompanied by a celebration.
			] reported circumcision being practiced by Native Americans.<ref name=alanis_2004/> It probably started among South American tribes as a blood sacrifice or ritual to test bravery and endurance, and later evolved into a rite of initiation.<ref name=Doy2005/>
	Among some West African groups, such as the ] and Dowayo, circumcision is taken to represent a removal of "feminine" aspects of the male, turning boys into fully masculine males.<ref>{{cite web
	| url = http://www.necep.net/articles.php?id_soc=12&id_article=84
	| title = Circumcision amongst the Dogon
	| accessdate = 2006-09-03
	| year = 2006
	| publisher = The Non-European Components of European Patrimony (NECEP) Database
	}}
	</ref> Among the Urhobo of southern Nigeria it is symbolic of a boy entering into manhood. The ritual expression, ''Omo te Oshare'' ("the boy is now man"), constitutes a rite of passage from one ] to another.<ref>{{cite journal
	| last = Agberia
	| first = John Tokpabere
	| year = 2006
	| title = Aesthetics and Rituals of the Opha Ceremony among the Urhobo People
	| journal = Journal of Asian and African Studies
	| volume = 41
	| issue = 3
	| pages = 249&ndash;260
	| doi = 10.1177/0021909606063880
	| url = http://jas.sagepub.com/cgi/reprint/41/3/249.pdf
	| format = PDF
	| accessdate = 2006-10-18
	}}
	</ref> For ] peoples, such as the ] and ], circumcision is a rite of passage observed collectively by a number of boys every few years, and boys circumcised at the same time are taken to be members of a single age set.<ref>{{cite web
	| url = http://www.masaikenya.org/
	| title = Masai of Kenya
	| accessdate = 2007-04-06
	| quote = <small>Authority derives from the age-group and the age-set. Prior to circumcision a natural leader or olaiguenani is selected; he leads his age-group through a series of rituals until old age, sharing responsibility with a select few, of whom the ritual expert (oloiboni) is the ultimate authority. Masai youths are not circumcised until they are mature, and a new age-set is initiated together at regular intervals of twelve to fifteen years. The young warriors (ilmurran) remain initiates for some time, using blunt arrows to hunt small birds which are stuffed and tied to a frame to form a head-dress.</small>
	}}
	</ref>
			=== Prophylactic circumcision ===
	==Prevalence==
	{{Main|Prevalence of circumcision}}
	]/]) showing percentage of males who have been circumcised, at a country level. Data was provided by ] and other sources. ]]
	Estimates of the proportion of males that are circumcised worldwide vary from one-sixth<ref name="WillKap">{{cite journal
	| last = Williams
	| first = N
	| coauthors = L. Kapila
	| year = 1993
	| month = October
	| title = Complications of circumcision
	| journal = British Journal of Surgery
	| volume = 80
	| issue = 10
	| pages = 1231&ndash;1236
	| doi = 10.1002/bjs.1800801005
	| url = http://www.cirp.org/library/complications/williams-kapila/
	| accessdate = 2006-07-11
	}}</ref> to a third.<ref name="crawford2002">{{cite journal |last=Crawford |first=DA |title=Circumcision: a consideration of some of the controversy |journal=J Child Health Care. |year=2002 |month=December |volume=6 |issue=4 |pages=259–270 |url= http://chc.sagepub.com/cgi/content/abstract/6/4/259 |pmid = 12503896 |doi=10.1177/136749350200600403}}</ref> The WHO has estimated that 664,500,000 males aged 15 and over are circumcised (30% global prevalence), with almost 70% of these being Muslim.<ref name="WHO-GTPDSA" /> Circumcision is most prevalent in the ], parts of ], Africa, the United States, ], ], and South Korea. It is relatively rare in Europe, ], parts of ], and most of Asia and ]. Prevalence is near-universal in the Middle East and Central Asia.<ref name="WHO-GTPDSA"/> The WHO states that "there is generally little non-religious circumcision in Asia, with the exceptions of the Republic of Korea and the Philippines".<ref name="WHO-GTPDSA"/> The WHO presents a map of estimated prevalence in which the level is generally low (< 20%) across Europe,<ref name="WHO-GTPDSA"/> and Klavs ''et al'' report findings that "support the notion that the prevalence is low in Europe".<ref name="KlavsHamers">{{cite journal
	|author=Klavs I, Hamers FF
	|title=Male circumcision in Slovenia: results from a national probability sample survey
	|journal=Sex Transm Infect
	|volume=84
	|issue=1
	|pages=49–50
	|year=2008
	|month=February
	|pmid=17881413
	|doi=10.1136/sti.2007.027524
	}}</ref> In Latin America, prevalence is universally low.<ref name="Drain">{{cite journal
	|last=Drain
	|first=PK
	|coauthors= ''et al.''
	|year=2006
	|month=November
	|title=Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries
	|journal=BMC Infect Dis
	|volume=30
	|issue=6 |pages=172
	|doi=10.1186/1471-2334-6-172
	|pmid=17137513
	|url=http://www.biomedcentral.com/1471-2334/6/172
	|accessdate=2008-04-25
	}}</ref> Estimates for individual countries include Spain<ref name="castellsague" />, ]<ref name="castellsague">{{cite journal
	|title=Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners
	|author=Castellsagué, X |coauthors=''et al.''
	|journal= N Engl J Med
	|year=2002
	|volume=346
	|issue=15
	|pages=1105–12
	|pmid=11948269
	|doi=10.1056/NEJMoa011688
	|url =http://content.nejm.org/cgi/content/full/346/15/1105
	}}</ref> and Denmark<ref>{{cite journal
	|title=Falling incidence of penis cancer in an uncircumcised population (Denmark 1943-90)
	|author=Frisch, M |coauthors=''et al.''
	|journal=BMJ |date= December 2, 1995 |volume=311
	|pages=1471
	|url=http://bmj.bmjjournals.com/cgi/content/full/311/7018/1471
	|pmid=8520335
	|issue=7018
	}}</ref> less than 2%, Finland<ref>{{cite journal
	|title=Cost analysis of neonatal circumcision in a large health maintenance organization
	|author=Schoen, E J
	|coauthors=Colby, C J; Trinh, T To
	|journal=J Urol
	|volume=175
	|pages=1111–1115
	|doi=10.1016/S0022-5347(05)00399-X
	|year=2006}}</ref> and ]<ref name="castellsague" /> 7%, ]<ref>{{cite journal
	|last=Ko
	|first=MC
	|coauthors=''et al.''
	|year=2007
	|month=April
	|title=Age-specific prevalence rates of phimosis and circumcision in Taiwanese boys
	|journal=J Formos Med Assoc
	|volume=106
	|issue=4
	|pages=302–7
	|pmid=17475607
	|quote=… the prevalence of circumcision slightly increased with age from 7.2% (95% CI, 5.3-10.8%) for boys aged 7 years to 8.7% (95% CI, 6.5-13.3%) for boys aged 13 years.
	}}</ref> 9%, ]<ref name="castellsague" /> 13% and Australia<ref name=richters/> 58.7%.
			==== Anglophonic adoption (1855–1918) ====
	The WHO estimates prevalence in the United States and Canada at 75% and 30%, respectively.<ref name="WHO-GTPDSA" /> Prevalence in Africa varies from less than 20% in some southern African countries to near universal in North and West Africa.<ref name="Drain" />
			] physician ] in 1855. By the late 19th century, the belief that circumcision acted as an effective prophylactic against disease was held by a majority of the ]'s medical communities and doctors, such as the prominent ], president of the ], subsequently leading to its widespread adoption.<ref name="Al-Salem-2016">{{Cite book | vauthors = Al-Salem A |title=An Illustrated Guide to Pediatric Urology |publisher=] |year=2016 |isbn=978-3-319-44182-5 |pages=481}}</ref>]]
			Circumcision began to be advocated as a means of ''prophylaxis'' in 1855, primarily as a means of preventing the transmission of sexually transmitted infections. At this time, ] physician ] published his findings that, among his venereal disease patients, Jews had a lower prevalence of ].<ref name="darby_2005" /><ref name="Hutchinson1855">{{cite journal | vauthors = Hutchinson J |title=On the influence of circumcision in preventing syphilis |journal=Medical Times and Gazette |date=1855 |volume=32 |pages=542–543}}</ref> Hutchinson suggested that circumcision lowers the risk of contracting syphilis.<ref name="Hutchinson1855"/> Pursuing a successful career as a general practitioner, Hutchinson went on to advocate circumcision for health reasons for the next fifty years,<ref name="darby_2005" /> eventually earned a ] for his contributions to medicine. His viewpoint that circumcision was prophylactic against disease was adopted by other medical professionals.<ref name="matthew_2004" />
			In 1870, orthopedic surgeon ], a founder of the ], introduced circumcision in the United States as a purported cure for several cases of young boys presenting with paralysis and other significant gross motor problems. He thought the procedure ameliorated such problems based on the then prominent "reflex neurosis" theory of disease, thinking that a tight foreskin inflamed the nerves and caused systemic problems.<ref name="Chubak-2013">{{Cite journal | vauthors = Chubak B |date=2013-04-01 |title=1101 the orthopedic origin of popular male circumcision in america |url= |journal=Journal of Urology |volume=189 |issue=4S |pages=e451 |doi=10.1016/j.juro.2013.02.693 |quote=Male circumcision was first popularized in late 19th-century America by Lewis Sayre, a renowned orthopedic surgeon, public-health activist, and creator of the Journal of the American Medical Association. On the basis of a few orthopedic case reports, Sayre used his influence to promote male circumcision as systemic therapy, rather than a local anatomic alteration. This redefinition was consistent with the contemporary reflex neurosis theory of disease, as well as the historic humoral-mechanical understanding of the human body.}}</ref> The use of circumcision to promote good health also fit the ], which saw validation during the same period: the foreskin was thought to harbor infection-causing ].<ref name="gollaher_2001_ch4"/>{{rp|106}} Sayre published works on the subject and promoted it in speeches.<ref name="Chubak-2013" /> Although later discredited, many contemporary physicians believed it could cure, reduce, or otherwise prevent a wide-ranging array of perceived medical problems and social ills, including that of ], ], ], ], ], ] and ]. Its popularity spread with publications such as Peter Charles Remondino's ''History of Circumcision''.<ref name="gollaher_2001_ch4" /><ref name="darby_2003" /><ref>{{cite journal | vauthors = Laumann EO, Masi CM, Zuckerman EW | title = Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice | journal = JAMA | volume = 277 | issue = 13 | pages = 1052–1057 | date = April 1997 | pmid = 9091693 | doi = 10.1001/jama.1997.03540370042034 | url = https://pubmed.ncbi.nlm.nih.gov/9091693 | access-date = 19 December 2021 | url-status = live | archive-url = https://web.archive.org/web/20211219170126/https://pubmed.ncbi.nlm.nih.gov/9091693/ | archive-date = 19 December 2021 }}</ref> By the late 19th century, circumcision had become common throughout the ]—Australia, Canada, the United States, and the United Kingdom—as well as the ]. In the United Kingdom and United States, it was universally recommended.<ref name="Al-Salem-2016" /><ref name="gollaher_2001_ch4" />
	==Modern circumcision procedures==
	For infant circumcision, devices such as the ], ], and Mogen clamp are commonly used.<ref>{{cite journal
	| last = Holman
	| first = John R.
	| coauthors = Evelyn L. Lewis, Robert L. Ringler
	| year = 1995
	| month = August
	| title = Neonatal circumcision techniques &ndash; includes patient information sheet
	| journal = American Family Physician
	| volume = 52
	| issue = 2
	| pages = 511&ndash;520
	| id = {{ISSN|0002-838X}} PMID 7625325
	| url = http://www.findarticles.com/p/articles/mi_m3225/is_n2_v52/ai_17281985
	| accessdate = 2006-06-29
	| format = {{Dead link|date=April 2009}} &ndash; <sup></sup>
	}}
	</ref>
			Historian ] proposes that "Americans found circumcision appealing not merely on medical grounds, but also for its connotations of science, health, and cleanliness—newly important class distinctions" in a country where 17 million immigrants arrived between 1890 and 1914.<ref name="gollaher_2001_ch4"/>{{rp|106}}
	With all these devices the same basic procedure is followed. First, the amount of foreskin to be removed is estimated. The foreskin is then opened via the preputial orifice to reveal the ] underneath and ensure it is normal. The inner lining of the foreskin (preputial epithelium) is then bluntly separated from its attachment to the glans. The device is then placed (this sometimes requires a dorsal slit) and remains there until blood flow has stopped. Finally, the foreskin is amputated.<ref name = "AAP1999"/> Sometimes, the ] band may need to be broken or crushed and cut from the corona near the urethra to ensure that the glans can be freely and completely exposed.<ref>{{cite web |title=Neonatal Circumcision: An Audiovisual Primer |publisher=Stanford School of Medicine |url=http://newborns.stanford.edu/Circumcision.html}}</ref>
	* With the Plastibell, once the glans is freed the Plastibell is placed over the glans, and the foreskin is placed over the Plastibell. A ] is then tied firmly around the foreskin and tightened into a groove in the Plastibell to achieve hemostasis. Foreskin distal to the ligature is excised and the handle is snapped off the Plastibell device. The Plastibell falls from the penis after the wound has healed, typically in four to six days.<ref>{{cite journal
	| last = Herbert
	| first = Barrie
	| coauthors = ''et al.''
	| title = The Plastibell Technique for Circumcision
	| journal = Br Med J
	| volume = 2
	| issue = 5456
	| pages = 273–275
	| year = 1965
	| url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1845746
	| pmid = 14310205
	| doi = 10.1136/bmj.2.5456.273}}</ref>
	* With a Gomco clamp, a section of skin is dorsally crushed with a ] and then slit with scissors. The foreskin is drawn over the bell shaped portion of the clamp and inserted through a hole in the base of the clamp. The clamp is tightened, "crushing the foreskin between the bell and the base plate." The crushed blood vessels provide hemostasis. The flared bottom of the bell fits tightly against the hole of the base plate, so the foreskin may be cut away with a scalpel from above the base plate.<ref>{{cite journal
	| last = Peleg
	| first = David
	| coauthors = Ann Steiner
	| year = 1998
	| month = September 15,
	| title = The Gomco Circumcision: Common Problems and Solutions
	| journal = American Family Physician
	| volume = 58
	| issue = 4
	| pages = 891&ndash;898
	| id = {{ISSN|0002-838X}} PMID 9767725
	| url = http://www.aafp.org/afp/980915ap/peleg.html
	| accessdate = 2006-06-29
	}}
	</ref>
	* With a Mogen clamp, the foreskin is pulled dorsally with a straight hemostat, and lifted. The Mogen clamp is then slid between the glans and hemostat, following the angle of the corona to "avoid removing excess skin ventrally and to obtain a superior cosmetic result" to Gomco or Plastibell circumcisions. The clamp is locked, and a scalpel is used to cut the skin from the flat (upper) side of the clamp.<ref name="Pfenninger">{{cite book
	| last = Pfenninger
	| first = John L.
	| coauthors = Grant C. Fowler
	| title = Procedures for primary care
	| origyear = 1994
	| origmonth =
	| url =
	| format =
	| accessdate =
	| edition = 2nd
	| date = July 21, 2003
	| year =
	| month =
	| publisher = Mosby
	| location =
	| language =
	| isbn = 978-0-323-00506-7 {{LCCN|2003|0|56227}}
	| doi =
	| pages =
	| chapter =
	| chapterurl =
	| quote =
	}}
	</ref><ref name="Reynolds">{{cite journal
	| last = Reynolds
	| first = RD
	| year = 1996
	| month = July
	| title = Use of the Mogen clamp for neonatal circumcision
	| journal = American Family Physician
	| volume = 54
	| issue = 1
	| pages = 177&ndash;182
	| doi =
	| pmid = 8677833
	| url =
	| format = Abstract
	| accessdate = 2006-07-18
	}}
	</ref>
			==== Interwar period and World War II (1918–1945) ====
	Adult circumcisions are often performed without clamps and require 4 to 6 weeks of abstinence from ] or intercourse after the operation to allow the wound to heal.<ref>{{cite journal |last=Holman |first=J.R. |authorlink= |coauthors=K.A. Stuessi |year=1999 |month=March |title=Adult circumcision |journal=American Family Physician |volume=59 |issue=6 |pages=1514–1518 |pmid=10193593 |url=http://www.aafp.org/afp/990315ap/1514.html |accessdate= |quote= }}</ref> In some African countries, male circumcision is often performed by non-medical personnel under unsterile conditions.<ref>{{cite web |url=http://www.iht.com/articles/2007/02/27/news/health.php |title=In Africa, a problem with circumcision and AIDS}}</ref> After hospital circumcision, the foreskin may be used in biomedical research,<ref>{{cite journal |last=Hovatta |first=O. |coauthors=M. Mikkola1, K. Gertow, A.-M. Strömberg, J. Inzunza1, J. Hreinsson1, B. Rozell, E. Elisabeth Blennow, M. Andäng, L. Ährlund-Richter |year=2003 |month=July |title=A culture system using human foreskin fibroblasts as feeder cells allows production of human embryonic stem cells |journal=Human Reproduction |volume=18 |issue=7 |pages=1404–1409 |pmid=12832363 |url= |doi=10.1093/humrep/deg290 }}</ref> consumer skin-care products,<ref>{{cite web |url=http://www.nbc10.com/health/1808693/detail.html |title=The Skinny On 'Miracle' Wrinkle Cream|year=2002|month=November|publisher=NBC Universal, Inc|work=NBC10.com|accessdate=2008-08-20}}</ref> skin grafts,<ref>{{cite web|url=http://www.wired.com/science/discoveries/news/1999/02/17912|title=High-Tech Skinny on Skin Grafts|date=02.16.99|publisher=CondéNet, Inc|work=www.wired.com:science:discoveries|accessdate=2008-08-20}}</ref><ref>{{cite web|url=http://www.emedicine.com/derm/TOPIC867.HTM|title=Skin Grafting|publisher=WebMD|work=www.emedicine.com|accessdate=2008-08-20}}</ref><ref>{{cite web|first=Catherine|last=Amst|coauthors=Carey, John|url=http://www.businessweek.com/1998/30/b3588001.htm|title=Biotech Bodies|date=July 27, 1998|publisher=The McGraw-Hill Companies Inc|work=www.businessweek.com|accessdate=2008-08-20}}</ref> or ]-based drugs.<ref>{{cite web |author=Cowan, Alison Leigh|url=http://query.nytimes.com/gst/fullpage.html?res=9E0CE6D81E38F93AA25757C0A964958260&partner |title=Wall Street; A Swiss Firm Makes Babies Its Bet|date=April 19, 1992|publisher=New York Times|work=New York Times:Business|accessdate=2008-08-20}}</ref> In parts of Africa, the foreskin may be dipped in brandy and eaten by the patient, eaten by the circumciser, or fed to animals.<ref>{{cite journal | last = Anonymous (editorial)| title = A ritual operation| journal = British Medical Journal| volume = 2| pages = 1458–1459| date = 1949-12-24| pmc = 2051965 |quote=<small>"...in parts of West Africa, where the operation is performed at about 8 years of age, the prepuce is dipped in brandy and eaten by the patient; in other districts the operator is enjoined to consume the fruits of his handiwork, and yet a further practice, in Madagascar, is to wrap the operation specifically in a banana leaf and feed it to a calf."</small>| accessdate = 2008-09-26}}</ref> According to ], after a '']'', the foreskin should be buried.<ref>'']'', '']'', 265:10</ref>
			During the ], medical organizations and doctors in ] experimented with the idea of routine circumcision for prophylactic reasons as well, alongside developments in the Anglophonic world. In France, the medical profession went so far as to recommend universal routine circumcision. However, prevalence in France and mainland Europe remained low.<ref name="Bolnick_2012_ch1" /> There is a lack of consensus in the academic literature on why this occurred.<ref name="Bolnick_2012_ch1" />
			''Yosha & Bolnick & Koyle'' (2012) have suggested that a factor in its Anglophonic adoption and dismissal in mainland Europe relates to attitudes towards Judaism and Jewish practices. While many of these Anglophonic polities would not be considered tolerant by modern standards: the United Kingdom had ]—a Jew—as ]; ] were prominent and generally well-respected; while in Australia "the racial issues of the time ], and Jews were essentially below the radar". They argue that once "a substantial proportion of the male population circumcised, the idea that it a Jewish practice no longer relevant. In Britain this was aided by the fact that circumcision was well known to be as much a practice of the nobility as a Jewish religious rite, so that the racial-religious nexus was broken." These factors were absent in ].<ref name="Bolnick_2012_ch1" />
	==Ethical, psychological, and legal considerations==
	===Ethical issues===
	Ethical questions have been raised over removing healthy, functioning genital tissue from a minor. Opponents of circumcision state that infant circumcision infringes upon individual autonomy and represents a ].<ref name = "Somerville">{{cite book
	| last = Somerville
	| first = Margaret
	| title = The ethical canary: science, society, and the human spirit
	| url =
	| accessdate = 2007-02-12
	| year = 2000
	| month = November
	| publisher = ]
	| location = ]
	| isbn = 0670893021
	| id = {{LCCN|2001||369341}}
	| pages = 202–219
	| chapter = Altering Baby Boys’ Bodies: The Ethics of Infant Male Circumcision
	| chapterurl = http://www.intact.ca/canary.htm
	| quote =
	}}
	</ref><ref name = "VanHoweLegal">{{cite journal
	| last = Van Howe
	| first = R.S.
	| coauthors = J.S. Svoboda, J.G. Dwyer, and C.P. Price
	| year = 1999
	| month = January
	| title = Involuntary circumcision: the legal issues
	| journal = BJU International
	| volume = 83
	| issue = Supp1
	| pages = 63–73
	| pmid = 10349416
	| doi = 10.1046/j.1464-410x.1999.0830s1063.x
	| id =
	| url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1063.x
	| language =
	| format = PDF
	| accessdate = 2007-02-12
	}}
	</ref><ref name=BMJMGM2005>{{cite journal |last=Tanne |first=Janice Hopkins |authorlink= |coauthors= |year=2005 |month=August |title=US group lobbies UN to outlaw male circumcision |journal=British Medical Journal |volume= |issue=331(7514) |pages=422 |id=PMC1188135 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1188135 |accessdate= |quote= }}</ref> Rennie ''et al.'' note that using circumcision as a way of preventing HIV in high prevalence, low-income countries in ], is controversial, but argue that "it would be unethical to not seriously consider one of the most promising new approaches to HIV-prevention in the 25-year history of the epidemic".<ref name="rennie">{{cite journal |last=Rennie |first=Stuart |authorlink= |coauthors=Adamson S Muula, Daniel Westreich |year=2007 |month=June |title=Male circumcision and HIV prevention: ethical, medical and public health tradeoffs in low-income countries |journal=Journal of Medical Ethics |volume=33 |issue=6 |pages=357–361 |pmid=17526688 |url=http://jme.bmj.com/cgi/content/full/33/6/357 |accessdate= |quote= |doi=10.1136/jme.2006.019901}}</ref>
			Rates in the Anglophonic world began to sharply diverge after 1945.<ref name="alanis_2004" /> ] recommended circumcision in his influential work '']'', one of the best-selling books of the twentieth century.<ref name="Paige 2021 263">{{Cite book | vauthors = Paige J, Paige K |title=The Politics of Reproductive Ritual |publisher=] |year=2021 |isbn=978-0-520-30674-5 |pages=263 |chapter=Summary and Implications for Complex Societies}}</ref> ]]
	====Consent====
	]
			==== Mid-20th century (1945–1985) ====
			After the end of ], Britain implemented a ]. ]'s 1949 article "The Fate of the Foreskin" argued that the evidence showed that the risks outweighed the benefits, leading to a significant reduction in circumcision incidence within the United Kingdom.<ref>{{cite journal | vauthors = Gairdner D | title = The fate of the foreskin, a study of circumcision | journal = British Medical Journal | volume = 2 | issue = 4642 | pages = 1433–7, illust | date = December 1949 | pmid = 15408299 | pmc = 2051968 | doi = 10.1136/bmj.2.4642.1433 }}</ref>
			In contrast to Gairdner, American pediatrician ] argued in favor of circumcision in his popular '']'' which led to rates in the United States significantly rising. In the 1970s, national medical associations in Australia and Canada issued recommendations against routine infant circumcision, leading to drops in the rates of both of those countries. The United States made similar statements in the 1970s but stopped short of recommending against it.<ref name="alanis_2004" />
			==== Modernity (since 1985) ====
			An association between circumcision and reduced heterosexual HIV infection rates was first suggested in 1986.<ref name="alanis_2004" />
			Experimental evidence was needed to establish a causal relationship, so three ]s were commissioned to exclude other ].<ref name="siegfried_Cochrane_2009" /> Trials took place in South Africa, Kenya and Uganda.<ref name="siegfried_Cochrane_2009" /> All three trials were stopped early by their monitoring boards because those in the circumcised group had a substantially lower rate of HIV contraction than the control group, so it was considered unethical to withhold the procedure, in light of strong evidence of prophylactic efficacy.<ref name="siegfried_Cochrane_2009" /><ref>{{cite journal | vauthors = Hankins C, Forsythe S, Njeuhmeli E | title = Voluntary medical male circumcision: an introduction to the cost, impact, and challenges of accelerated scaling up | journal = PLOS Medicine | volume = 8 | issue = 11 | pages = e1001127 | date = November 2011 | pmid = 22140362 | pmc = 3226452 | doi = 10.1371/journal.pmed.1001127 | doi-access = free }}</ref> WHO assessed these as "gold standard" studies and found "strong and consistent" evidence from later studies that confirmed the results of the studies.<ref name="WHO-PrevHIV" /> A scientific consensus subsequently developed that circumcision reduces heterosexual HIV infection rates in high-risk populations;<ref name="Merson-2017" /><ref name="Chikutsa-2015" /><ref name="Bell-2016">{{Cite book | vauthors = Bell K |title=Health and Other Unassailable Values: Reconfigurations of Health, Evidence and Ethics |publisher=Taylor & Francis |year=2016 |isbn=978-1-317-48203-1 |pages=106 |quote=...defending the casual relation between male circumcision and reduced HIV transmission has become essentially hegemonic in the academic literature.}}</ref> the WHO, along with other major medical organizations, have since promoted circumcision of high-risk populations as part of the program to reduce the spread of HIV.<ref name="WHO-PrevHIV" /> The ''Male Circumcision Clearinghouse'' website was created in 2009 by WHO, UNAIDS, FHI and AVAC to provide evidence-based guidance, information, and resources to support the delivery of safe male circumcision services in countries that choose to scale up the procedure as one component of comprehensive HIV prevention services.<ref name="NYTimes_2009" /><ref name="AVAC_2015" />
			==Society and culture==
			]
			The word ] is from Latin {{Lang|la|circumcidere}}, meaning "to cut around".<ref name="WHO_2007_GTDPSA" />
			===Cultures and religions {{Anchor|Cultures and religions}}===
			{{See also|Cultural views on circumcision|Religious male circumcision}}
			{{Undue weight section|date=November 2023}}
			Many societies hold ], with perspectives ranging widely. In some cultures, males are generally required to be circumcised shortly after birth, during childhood or around puberty as part of a rite of passage. Circumcision is commonly practiced in the Jewish and Islamic and ] faiths and in ] and the ] and the ].<ref name="Bolnick_2012_ch1" /><ref name="glass_1999">{{cite journal | vauthors = Glass JM | title = Religious circumcision: a Jewish view | journal = BJU International | volume = 83 | issue = Suppl 1 | pages = 17–21 | date = January 1999 | pmid = 10349410 | doi = 10.1046/j.1464-410x.1999.0830s1017.x | s2cid = 2888024 }}</ref><ref name="Columbia_encyc_2011_circ">{{cite encyclopedia |year=2011 |title=Circumcision |encyclopedia=Columbia Encyclopedia |publisher=Columbia University Press |url=http://www.infoplease.com/encyclopedia/science/circumcision.html |archive-url=https://web.archive.org/web/20150924051012/http://www.infoplease.com/encyclopedia/science/circumcision.html |archive-date=24 September 2015 |url-status=live}}</ref><ref name="clark_2011">{{cite book |author=Clark M |url=https://books.google.com/books?id=zPXu561ZpvgC&pg=PA178 |title=Islam For Dummies |date=10 March 2011 |publisher=John Wiley & Sons |isbn=978-1-118-05396-6 |page=170 |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=zPXu561ZpvgC&pg=PA178 |archive-date=18 January 2016 |url-status=live}}</ref><ref name="alsabbagh_1996" /><ref name="encyc_religion_2005" /><ref name="riggs_2006" /> In contrast, some religions, such as ] and ] and ], strongly prohibit the practice of routine circumcision.<ref name="Drower" /><ref name = "Clarence-Smith_2008" /><ref name="Cherry-2013" />
			====Judaism====
			{{Main|Brit milah}}Circumcision is near-universal among Jews.<ref name="Cohen-Almagor-2020">{{Cite journal | vauthors = Cohen-Almagor R |date=9 November 2020 |title=Should liberal government regulate male circumcision performed in the name of Jewish tradition? |journal=SN Social Sciences |language=en |volume=1 |issue=1 |pages=8 |doi=10.1007/s43545-020-00011-7 |issn=2662-9283 |quote=Protagonists and critics of male circumcision agree on some things and disagree on many others... They also do not underestimate the importance of male circumcision for the relevant communities.... Even the most critical voices of male circumcision do not suggest putting a blanket ban on the practice as they understand that such a ban, very much like the 1920–1933 prohibition laws in the United States, would not be effective... Protagonists and critics of male circumcision debate whether the practice is morally acceptable... They assign different weights to harm as well as to medical risks and to non-medical benefits. The different weights to risks and benefits conform to their underlying views about the practices... Protagonists and critics disagree about the significance of medical reasons for circumcision... |s2cid=228911544|doi-access=free }}</ref> The '']'' of circumcision on the eighth day of life is considered among the ]. Barring extraordinary circumstances, failure to undergo the rite is seen by followers of ] as leading to a state of '']'': the extinction of the ] and denial of a share in the ].<ref name="Mark-2003a" /><ref name="Hamilton-1990" /><ref name="Antisemitism" /> Reasons for biblical circumcision include to show off "patrilineal descent, sexual fertility, male initiation, cleansing of birth impurity, and dedication to God".<ref name=":92">{{Cite book |last=Hendel |first=Ronald |url=https://academic.oup.com/book/10720/chapter/158788296?login=true#313433798 |title=Remembering Abraham: Culture, Memory, and History in the Hebrew Bible |date=2005 |publisher=Oxford University Press |isbn=9780199784622 |pages=3–30}}</ref>
			]
			The basis for its observance is found in the ] of the Hebrew Bible, in ], in which a covenant of circumcision is made with Abraham and his descendants. Jewish circumcision is part of the {{transliteration|he|]}} ritual, to be performed by a specialist ritual circumciser, a {{transliteration|he|]}}, on the eighth day of a newborn son's life, with certain exceptions for poor health. Jewish law requires that the circumcision leaves the glans bare when the penis is flaccid. Converts to Conservative and Orthodox Judaism must also be circumcised; those who are already circumcised undergo a symbolic circumcision ritual. Circumcision is not required by Judaism for one to be considered Jewish, but mainstream Judaism foresees serious negative spiritual consequences if it is neglected.<ref name="glass_1999" /><ref name="Bolnick_2012_ch23" /> Circumcision is not considered a ] within Judaism. Rather, the commandment to circumcise is seen as only applying to Jewish people. Those who are Gentiles are believed to have a portion in the "World to Come" as long as they follow the tenets of the ].<ref>{{Cite journal |vauthors = Oliver IW |date=2013-05-14 |title=Forming Jewish Identity by Formulating Legislation for Gentiles |url=http://dx.doi.org/10.30965/21967954-00401005 |journal=Journal of Ancient Judaism |volume=4 |issue=1 |pages=105–132 |doi=10.30965/21967954-00401005 |issn=1869-3296 |access-date=22 December 2022 |archive-date=14 September 2023 |archive-url=https://web.archive.org/web/20230914230852/https://brill.com/view/journals/jaj/4/1/article-p105_5.xml |url-status=live }}</ref> There are also certain exceptions for Jews with poor health.<ref>{{Cite book | vauthors = Levine A, Zvi Brettler M |title=The Jewish Annotated New Testament |publisher=] |year=2017 |pages=673 |quote=With rare exceptions (e.g. matters of health), Judaism requires circumcision for all male children on their eighth day of birth. |author-link=Amy-Jill Levine |author-link2=Marc Zvi Brettler}}</ref>
			According to traditional Jewish law, in the absence of an adult free Jewish male expert, a woman, a slave, or a child who has the required skills is also authorized to perform the circumcision, provided that they are Jewish.<ref>Talmud Avodah Zarah 26b; Menachot 42a; Maimonides' Mishneh Torah, Milah, ii. 1; ], Yoreh De'ah, l.c.</ref> However, most streams of non-Orthodox Judaism allow female {{transliteration|he|mohels}}, called {{transliteration|he|mohalot}} ({{langx|he|מוֹהֲלוֹת}}, the plural of {{lang|he|מוֹהֶלֶת}} {{transliteration|he|mohelet}}, feminine of {{transliteration|he|mohel}}), without restriction. In 1984 Deborah Cohen became the first certified Reform {{transliteration|he|mohelet}}; she was certified by the Berit Mila program of Reform Judaism.<ref>{{Cite web|date=2013-10-07|title=Berit Mila Program of Reform Judaism|url=http://beritmila.org/|access-date=2022-07-20|archive-url=https://web.archive.org/web/20131007073323/http://beritmila.org/ |archive-date=7 October 2013 }}</ref> An increasing number of Jews in the United States have chosen not to circumcise their sons.<ref>{{cite news |url= https://www.reuters.com/article/domesticNews/idUSN22970720071003?pageNumber=1 |title= Jewish "intactivists" in U.S. stop circumcising |access-date= 3 November 2007 | vauthors = Chernikoff H |date= 3 October 2007 |newspaper= Reuters |url-status= live |archive-url= https://web.archive.org/web/20081227025338/http://www.reuters.com/article/domesticNews/idUSN22970720071003?pageNumber=1 |archive-date= 27 December 2008 }}</ref>
			All major rabbinical organizations make the recommendation that male infants should be circumcised. The issue of converts remains controversial in Reform and Reconstructionist Judaism;<ref>{{cite web| url = http://www.reformjudaism.org/learning/torah-study/lech-lcha/brit-milah-jewish-answer-modernity| title = B'rit Milah: A Jewish Answer to Modernity| access-date = 11 March 2017| vauthors = Glickman M | date = 12 November 2005| publisher = ]| url-status = live| archive-url = https://web.archive.org/web/20170312052827/http://www.reformjudaism.org/learning/torah-study/lech-lcha/brit-milah-jewish-answer-modernity| archive-date = 12 March 2017}}</ref><ref>{{cite web|url=http://www4.jrf.org/showdt&rid=322&pid=15 |title=Bo: Defining Boundaries |access-date=3 November 2007 | vauthors = Cohen H |date=20 May 2002 |publisher=Jewish Reconstructionist Federation |url-status=dead |archive-url=https://web.archive.org/web/20071009173021/http://www4.jrf.org/showdt%26rid%3D322%26pid%3D15 |archive-date=9 October 2007 }}</ref> circumcision of converts is not mandatory in either.<ref>{{cite web|url=http://www.jewishcalgary.org/page.html?ArticleID=63645 |title=The Conversion Process |access-date=3 November 2007 | vauthors = Epstein L |year=2007 |publisher=Calgary Jewish Community Council |url-status=dead |archive-url=https://web.archive.org/web/20081227065531/http://www.jewishcalgary.org/page.html?ArticleID=63645 |archive-date=27 December 2008 }}</ref>
			====Islam====
			{{Main|Khitan (circumcision)}}
			]
			] market, just after circumcision, Mali, 1990]]
			Islamic scholars have diverse opinions on the obligatory nature of male circumcision, with some considering it mandatory ('']''), while others view it as only being recommended (''sunnah'').<ref name="pmid36006531">{{cite journal | vauthors = Dabbagh H | title = Is Circumcision "Necessary" in Islam? A Philosophical Argument Based on Peer Disagreement | journal = Journal of Religion and Health | volume = 61 | issue = 6 | pages = 4871–4886 | date = December 2022 | pmid = 36006531 | pmc = 9569283 | doi = 10.1007/s10943-022-01635-0 }}</ref> According to ] and scholars of ], the Islamic tradition of circumcision was derived from the ] of ].<ref>{{cite journal | vauthors = Abu-Sahlieh SA | title = To mutilate in the name of Jehovah or Allah: legitimization of male and female circumcision | journal = Medicine and Law | volume = 13 | issue = 7–8 | pages = 575–622 | date = 1994 | pmid = 7731348 | publisher = ] | author-link = Sami Aldeeb }}; {{cite journal | vauthors = Aldeeb Abu-Sahlieh SA |date=1995 |url=https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1036&context=twls |title=Islamic Law and the Issue of Male and Female Circumcision |journal=Third World Legal Studies |volume=13 |pages=73–101 |publisher=] |access-date=13 February 2020 |archive-url=https://web.archive.org/web/20191112162823/https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1036&context=twls |archive-date=12 November 2019 |url-status=live }}</ref> Although there is some debate within Islam over whether it is a religious requirement or mere recommendation, circumcision (called ''khitan'') is practiced nearly universally by Muslim males. Islam bases its practice of circumcision on the Genesis 17 narrative, the same Biblical chapter referred to by Jews. The procedure is not explicitly mentioned in the Quran, however, it is a tradition established by Islam's prophet ] directly (following Abraham), and so its practice is considered a '']'' (prophet's tradition) and is very important in Islam. For Muslims, circumcision is also a matter of cleanliness, purification and control over one's baser self ('']'').<ref name=clark_2011/><ref name=alsabbagh_1996/><ref name=Bolnick_2012_ch24/>
			There is no agreement across the many Islamic communities about the age at which circumcision should be performed. It may be done from soon after birth up to about age 15; most often it is performed at around six to seven years of age. The timing can correspond with the boy's completion of his recitation of the whole Quran, with a coming-of-age event such as taking on the responsibility of daily prayer or betrothal. Circumcision may be celebrated with an associated family or community event. Circumcision is recommended for, but is not required of, converts to Islam.<ref name=clark_2011/><ref name=alsabbagh_1996/><ref name=Bolnick_2012_ch24/>
			====Christianity====
			{{Main|Religious male circumcision#In Christianity}}
			Traditionally, circumcision has not been practiced by Christians for religious reasons, with the practice being viewed as succeeded by ], with the ] chapter ] recording that Christianity did not require circumcision from new converts.<ref>{{Cite book | vauthors = Mark E |title=The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite |publisher=] |year=2003 |isbn=978-1-58465-307-3 |pages=xxiii}}</ref> Christian denominations generally hold a neutral position on circumcision for prophylactic, cultural, and social reasons, while strongly opposing it for religious reasons. This includes the ], which explicitly banned the practice of religious circumcision in the ],<ref name = "CoF">{{cite book| author = Pope Eugenius IV| author-link = Pope Eugene IV| veditors = Tanner NP | title = Decrees of the ecumenical councils| orig-date = 1442| access-date = 25 April 2007| series = 2 volumes| year = 1990| publisher = ]| location = ]| isbn = 978-0-87840-490-2| language = el, la| chapter = Ecumenical Council of Florence (1438–1445): Session 11—4 February 1442; Bull of union with the Copts| chapter-url = http://www.ewtn.com/library/COUNCILS/FLORENCE.HTM#5| quote = it denounces all who after that time observe circumcision| lccn = 90003209| archive-date = 25 April 2009| archive-url = https://web.archive.org/web/20090425150516/http://www.ewtn.com/library/COUNCILS/FLORENCE.HTM#5| url-status = live}}</ref> and maintains a neutral position on the practice of circumcision for other reasons.<ref name=Slosar>{{cite journal | vauthors = Slosar JP, O'Brien D | title = The ethics of neonatal male circumcision: a Catholic perspective | journal = The American Journal of Bioethics | volume = 3 | issue = 2 | pages = 62–64 | year = 2003 | pmid = 12859824 | doi = 10.1162/152651603766436306 | s2cid = 38064474 }}</ref> A majority of other ] take a similar position on circumcision, prohibiting it for religious observance, but neither explicitly supporting or forbidding it for other reasons.<ref name=Slosar/>
			] Children wearing traditional circumcision costumes]]
			Thus, circumcision rates of Christians are predominately determined by the surrounding cultures which they live in. In some ] and ] circumcision is an established practice,<ref name="N. Stearns 2008 179">{{Cite book | vauthors = Stearns PN |title=The Oxford Encyclopedia of the Modern World |publisher=] |year=2008 |isbn=978-0-19-517632-2 |pages=179 |quote=Uniformly practiced by Jews, Muslims, and the members of Coptic, Ethiopian, and Eritrean Orthodox Churches, male circumcision remains prevalent in many regions of the world, particularly Africa, South and East Asia, Oceania, and Anglosphere countries.}}</ref><ref>{{cite book|title=Cultural Encyclopedia of the Body | vauthors = Pitts-Taylor V |year= 2008| isbn= 978-1-56720-691-3| page =394|publisher=ABC-CLIO|quote=For most part, Christianity does not require circumcision of its followers. Yet, some Orthodox and African Christian groups do require circumcision. These circumcisions take place at any point between birth and puberty.}}</ref> and generally boys undergo circumcision shortly after birth as part of a ].<ref name="N. Stearns 2008 179" /> Circumcision is near-universal among ],<ref>{{cite book|title= American Evangelicals in Egypt: Missionary Encounters in an Age of Empire| vauthors = Sharkey HJ |year= 2015| isbn=978-0-691-16810-4 | page =30|publisher=Princeton University Press}}</ref> and they practice circumcision as a rite of passage.<ref name=WHO_2007_GTDPSA/><ref name=Columbia_encyc_2011_circ/><ref name=riggs_2006/><ref name=Bolnick_2012_ch26/> The ] calls for circumcision, with near-universal prevalence among Orthodox men in Ethiopia.<ref name=WHO_2007_GTDPSA/> ] practice circumcision as a rite of passage, and they circumcise their sons "anywhere from the first week of life to the first few year".<ref>{{Cite book| vauthors = DeMello M |title=Encyclopedia of Body Adornment|publisher=]|year=2007|isbn=978-0-313-33695-9 |pages=66|quote=Coptic Christians, Ethiopian Orthodox, and Eritrean Orthodox churches on the other hand, do observe the ordainment, and circumcise their sons anywhere from the first week of life to the first few years.}}</ref> Some Christian churches in South Africa disapprove of the practice, while others require it of their members.<ref name=WHO_2007_GTDPSA/>
			Circumcision is practiced in many predominantly ] and Christian communities.<ref name="Gruenbaum 2015 61">{{cite book | vauthors = Gruenbaum E |title=The Female Circumcision Controversy: An Anthropological Perspective |publisher=University of Pennsylvania Press |year=2015 |isbn=978-0-8122-9251-0 |page=61 |quote=Christian theology generally interprets male circumcision to be an Old Testament rule that is no longer an obligation ... though in many countries (especially the United States and Sub-Saharan Africa, but not so much in Europe) it is widely practiced among Christians}}</ref><ref>{{cite book|title=Essential Case Studies in Public Health: Putting Public Health Into Practice| vauthors = Hunting K |year= 2012| isbn=978-1-4496-4875-6| pages =23–24 |publisher=Jones & Bartlett Publishers|quote= Neonatal circumcision is the general practice among Jews, Christians, and many, but not all Muslims.}}</ref><ref name="R. Wylie 2015 101">{{cite book | vauthors = Wylie KR |title=ABC of Sexual Health |publisher=John Wiley & Sons |year=2015 |isbn=978-1-118-66569-5 |page=101 |quote=Although it is mostly common and required in male newborns with Moslem or Jewish backgrounds, certain Christian-dominant countries such as the United States also practice it commonly.}}</ref> ] in ],<ref>{{cite book | vauthors = Creighton S, Liao LM |title=Female Genital Cosmetic Surgery: Solution to What Problem? |date=2019 |publisher=Cambridge University Press|isbn=978-1-108-43552-9 |page=63 |language=English |quote=Christians in Africa, for instance, often practise infant male circumcision.}}</ref><ref>{{cite web |first =Armelle |last =Nga |url =https://www.africanews.com/2019/12/30/the-ritual-of-circumcision-in-africa-the-case-of-south-africa/ |title =The Ritual of Circumcision in Africa: The Case of South Africa |date =30 December 2019 |publisher =Africanews |quote =This practice is old and widespread among African Christians with very close links to their beliefs. It can be executed traditionally or in hospital. |access-date =8 November 2022 |archive-date =6 December 2022 |archive-url =https://web.archive.org/web/20221206235611/http://www.africanews.com/2019/12/30/the-ritual-of-circumcision-in-africa-the-case-of-south-africa/ |url-status =live }}</ref> some ], the Philippines, the Middle East,<ref>{{cite book | vauthors = Bakos GT |title=On Faith, Rationality, and the Other in the Late Middle Ages:: A Study of Nicholas of Cusa's Manuductive Approach to Islam |date=2011 |publisher=Wipf and Stock Publishers|isbn= 978-1-60608-342-0|page=228 |language=English |quote=Although it is stated that circumcision is not a sacrament necessary for salvation, this rite is accepted for the Ethiopian Jacobites and other Middle Eastern Christians.}}</ref><ref>{{cite book | vauthors =Sharkey HJ |title=A History of Muslims, Christians, and Jews in the Middle East|date=2017 |publisher=Cambridge University Press|isbn=978-0-521-76937-2|page=63 |language=English |quote= On the Coptic Christian practice of male circumcision in Egypt, and on its practice by other Christians in western Asia.}}</ref> South Korea and ] have high circumcision rates,<ref name="Associated Press">{{cite web |date=March 30, 2008 |title=Circumcision protest brought to Florence |url=https://apnews.com/article/19456997e17c4a12a24abb9d11c01dba |publisher=] |quote=However, the practice is still common among Christians in the United States, Oceania, South Korea, the Philippines, the Middle East and Africa. Some Middle Eastern Christians actually view the procedure as a rite of passage. |access-date=2 August 2022 |archive-date=26 March 2023 |archive-url=https://web.archive.org/web/20230326234939/https://apnews.com/article/19456997e17c4a12a24abb9d11c01dba |url-status=live }}</ref><ref>{{cite book |title= Religion and Violence: An Encyclopedia of Faith and Conflict from Antiquity to the Present | vauthors = Ross JI |year= 2015| isbn=978-1-317-46109-8| page =169|publisher=Routledge|quote=For instance, the majority of South Koreans, Americans, and Filipinos, as well as African Christians, practice circumcision.}}</ref> while Christian communities in ] and ] have low circumcision rates, although none of these are performed out of perceived religious obligation.<ref name="N. Stearns 2008 179" /><ref name="R. Peteet 2017 97–101">{{cite book | vauthors = Peteet JR |title=Spirituality and Religion Within the Culture of Medicine: From Evidence to Practice |publisher=Oxford University Press |year=2017 |isbn=978-0-19-027243-2 |pages=97–101 |quote=male circumcision is still observed among Ethiopian and Coptic Christians, and circumcision rates are also high today in the Philippines and the US.}}</ref> Scholar Heather L. Armstrong writes that, {{as of|lc=y|2021|post=,}} about half of Christian males worldwide are circumcised, with most of them being located in Africa, Anglosphere countries, and the Philippines.<ref name="Armstrong">{{cite book | vauthors = Armstrong HL |title=Encyclopedia of Sex and Sexuality: Understanding Biology, Psychology, and Culture |publisher=ABC-CLIO |year=2021 |isbn=978-1-61069-875-7 |pages=115–117}}</ref>
			====Druze faith====
			] child]]
			Circumcision is widely practiced by the ];<ref name="Ubayd-2006a">{{cite book|title=The Druze and Their Faith in Tawhid| vauthors = Ubayd A |year= 2006| isbn=978-0-8156-3097-5| page =150|publisher=Syracuse University Press|quote=Male circumcision is standard practice, by tradition, among the Druze}}</ref> Druze practice Druzism, an ],<ref name="BritishLibrary">{{cite web | vauthors = Abulafia AS |author-link=Anna Abulafia |date=23 September 2019 |url=https://www.bl.uk/sacred-texts/articles/the-abrahamic-religions |title=The Abrahamic religions |website=www.bl.uk |publisher=] |location=] |access-date=9 March 2021 |url-status=live |archive-url=https://web.archive.org/web/20200712150432/https://www.bl.uk/sacred-texts/articles/the-abrahamic-religions |archive-date=12 July 2020}}</ref><ref name="TheDruze">{{cite book| vauthors = Obeid A |title=The Druze & Their Faith in Tawhid|url=https://books.google.com/books?id=FejqBQAAQBAJ&pg=PT1|year=2006|publisher=Syracuse University Press|isbn=978-0-8156-5257-1|page=1}}</ref> ], ], and ]. The procedure is practiced as a cultural tradition, and has no religious significance in the Druze faith.<ref>{{cite book|title=Israel and the Palestinian Territories: The Rough Guide| vauthors = Jacobs D |year= 1998| isbn=978-1-85828-248-0| page =147|publisher=Rough Guides|quote=Circumcision is not compulsory and has no religious significance.}}</ref><ref>{{cite book|title=The History of Galilee, 1538–1949: Mysticism, Modernization, and War| vauthors = Silver MM |year= 2022| isbn= 978-1-7936-4943-0 | page =97|publisher=Rowman & Littlefield|quote=Muslim men are circumcised, whereas this is not a religious obligation among the Druze}}</ref> There is no special date for this act in the ]: male Druze infants are usually circumcised shortly after birth,<ref name = "Dana_2003" /> however some remain uncircumcised until the age of ten or older.<ref name = "Dana_2003" />
			Some Druses do not circumcise their male children and refuse to observe this "common Muslim practice".<ref>{{cite book|title=The Sunni-Shi'a Divide: Islam's Internal Divisions and Their Global Consequences | vauthors = Brenton RB |year= 2013| isbn=978-1-61234-523-9| page =56|publisher=Potomac Books, Inc.|quote=There are many references to the Druze refusal to observe this common Muslim practice, one of the earliest being the rediscoverer of the ruins of Petra, John Burckhardt. "The Druses do not circumcise their children}}</ref>
			====Samaritanism====
			Like Judaism, the religion of ] requires ritual circumcision on the eighth day of life.<ref name="Mark-2003">{{Cite book | vauthors = Mark E |title=The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite |publisher=] |year=2003 |isbn=978-1-58465-307-3 |pages=94–95}}</ref>
			====Mandaeism====
			Circumcision is forbidden in ],<ref name="Drower">{{cite book| vauthors = Drower ES |title=The Mandaeans of Iraq and Iran|publisher=Oxford At The Clarendon Press|year=1937}}</ref><ref>{{cite book| vauthors = Lupieri E |title=The Mandaeans: The Last Gnostics|date=2001|publisher=Wm. B. Eerdmans Publishing|isbn=978-0-8028-3350-1 |url=https://books.google.com/books?id=zJ73YfrZ2T4C&q=Nicolas%20Siouffi%20christian&pg=PA12|page=60|access-date=6 August 2022|archive-date=14 September 2023|archive-url=https://web.archive.org/web/20230914230849/https://books.google.com/books?id=zJ73YfrZ2T4C&q=Nicolas%20Siouffi%20christian&pg=PA12|url-status=live}}</ref> and the sign of the Jews given to ] by God, circumcision, is considered abhorrent by the ].<ref>{{cite book|title=Beyond ISIS: History and Future of Religious Minorities in Iraq| vauthors = Schmidinger T |year= 2019| isbn=978-1-912997-15-2| page =82|publisher=Transnational Press London|quote=}}</ref> According to Mandaean doctrine, a circumcised man cannot serve as a ].<ref>{{cite book|title=Guardians of the Gate: Angelic Vice-regency in the Late Antiquity| vauthors = Deutsch N |year= 1999| isbn=978-90-04-10909-4| page =105|publisher=BRILL|quote=}}</ref>
			====Yazidism====
			Circumcision is not required in ], but is practised by some ] due to regional customs.<ref>{{cite web | vauthors = Parry OH |title=Six months in a Syrian monastery; being the record of a visit to the head quarters of the Syrian church in Mesopotamia, with some account of the Yazidis or devil worshippers of Mosul and El Jilwah, their sacred book |url=https://archive.org/stream/sixmonthsinasyr00parrgoog/sixmonthsinasyr00parrgoog_djvu.txt |publisher=London : H. Cox |date=1895}}</ref> The ritual is usually performed soon after birth, it takes place on the knees of the kerîf (approximately "godfather"), with whom the child will have a life-long formal relationship.<ref>{{Cite book| vauthors = Kreyenbroek PG |title=Yezidism in Europe: Different Generations Speak about Their Religion|date=2009|publisher=Otto Harrassowitz Verlag|isbn=978-3-447-06060-8|language=en}}</ref>
			====Sikhism====
			] does not require the elective circumcision of its followers and strongly criticizes the practice.<ref name="Cherry-2013">{{Cite book| vauthors = Cherry M |title=Religious Perspectives on Bioethics|publisher=]|year=2013|isbn=978-90-265-1967-3|pages=213}}</ref><ref>{{cite book | vauthors = Cole WO, Sambhi PS |date=1995 |title=The Sikhs: Their Religious Beliefs and Practices |publisher=Sussex Academic Press |isbn=978-1-898723-13-4 |pages=155–156}}</ref>
			For example, ] criticizes the practise of circumcision in the hymn of ].<ref>{{Cite web|url=http://www.srigranth.org/servlet/gurbani.gurbani?Action=Page&Param=477|title=Sri Granth: Sri Guru Granth Sahib|website=www.srigranth.org}}</ref>
			====African cultures====
			{{excerpt|Circumcision in Africa|paragraphs=1}}
			====Australian cultures====
			Some ] use circumcision as a test of bravery and self-control as a part of a rite of passage into manhood, which results in full societal and ceremonial membership. It may be accompanied by body ] and the removal of teeth, and may be followed later by ]. Circumcision is one of many trials and ceremonies required before a youth is considered to have become knowledgeable enough to maintain and pass on the cultural traditions. During these trials, the maturing youth bonds in solidarity with the men. Circumcision is also strongly associated with a man's family, and it is part of the process required to prepare a man to take a wife and produce his own family.<ref name=encyc_religion_2005/>
			====Filipino culture====
			{{Main|Tuli (rite)}}
			In the Philippines, circumcision is known as "tuli" and is generally viewed as a rite of passage.<ref name=Tuli2011/> An overwhelming majority of Filipino men are circumcised.<ref name="Tuli2011">{{cite web|title=Tuli a rite of passage for Filipino boys|url=http://www.gmanetwork.com/news/story/219779/news/nation/tuli-a-rite-of-passage-for-filipino-boys|access-date=6 December 2015|date=6 May 2011|url-status=live|archive-url=https://web.archive.org/web/20151208183045/http://www.gmanetwork.com/news/story/219779/news/nation/tuli-a-rite-of-passage-for-filipino-boys|archive-date=8 December 2015}}</ref>{{efn| The most commonly-done procedure is in actuality not a ''circumcision'' but a ], where no foreskin is actually removed. When the foreskin is removed, it is commonly known locally as a "German cut" in reference to the introduction of the modern surgical technique by the founder of plastic and reconstructive surgery, ].<ref> {{Webarchive|url=https://web.archive.org/web/20220902032825/https://books.google.com/books?id=hpNlnylhRKsC&pg=PA435 |date=2022-09-02 }} (vgl. Schumpelick u.&nbsp;a., S. 434 ff.)</ref>}} Often this occurs, in April and May, when Filipino boys are taken by their parents. The practice dates back to the arrival of ] in 1450. Pressure to be circumcised is even in the language: one ] for 'uncircumcised' is ''supot'', meaning 'coward' literally. A circumcised eight or ten year-old is no longer considered a boy and is given more adult roles in the family and society.<ref>{{cite news |title='Circumcision season': Philippine rite puts boys under pressure |url=https://www.channelnewsasia.com/news/asia/-circumcision-season---philippine-rite-puts-boys-under-pressure--11640442 |access-date=20 June 2019 |work=Channel News Asia |agency=Agence France-Presse |date=19 June 2019 |archive-date=20 June 2019 |archive-url=https://web.archive.org/web/20190620140705/https://www.channelnewsasia.com/news/asia/-circumcision-season---philippine-rite-puts-boys-under-pressure--11640442 |url-status=dead }}</ref>
			===Ethical and legal issues===
	{{Main|Ethics of circumcision}}		{{Main|Ethics of circumcision}}
			{{See also|Circumcision controversies|Circumcision and law}}
			==== Ethics ====
	Views differ on whether limits should be placed on caregivers having a child circumcised.
			{{excerpt|Ethics of circumcision|paragraphs=2}}
			==== Legal ====
	Some medical associations take the position that the parents should determine what is in the best interest of the infant or child,<ref name = "CSA:I-99" /><ref name = "AAP1999">{{cite journal
			Worldwide, the large majority of polities do not have specific laws concerning the circumcision of males,<ref name=WHO_2007_GTDPSA/> with religious infant circumcision being legal in every country.<ref name="Cohen-Almagor-2020" /><ref name=RACP_2010/> A few countries have passed legislation on the procedure: Germany allows routine circumcision,<ref name=DW_2012/> while non-religious routine circumcision is illegal in South Africa and Sweden.<ref name=WHO_2007_GTDPSA/><ref name=RACP_2010/> No major medical organization recommends circumcising all males, and no major medical organization recommends banning the procedure.<ref name="Bolnick_2012_ch1" /><ref name="Basaran-2023">{{Cite book | vauthors = Basaran O |title=Circumcision and Medicine in Modern Turkey |publisher=] |year=2023 |isbn=978-1-4773-2702-9 |pages=156–157 |quote=Regardless of their ethical stances, scholars of both camps tend to agree that a blanket criminalization of male circumcision would be unhelpful and harmful to boys...}}</ref><ref name="Cohen-Almagor-2020" />
	| last = American Academy of Pediatrics Task Force on Circumcision
	| coauthors =
	| year = 1999
	| month = March 1,
	| title = Circumcision Policy Statement
	| journal = Pediatrics
	| volume = 103
	| issue = 3
	| pages = 686&ndash;693
	| doi = 10.1542/peds.103.3.686
	| id = {{ISSN|0031-4005}} PMID 10049981
	| url = http://pediatrics.aappublications.org/cgi/reprint/pediatrics;103/3/686.pdf
	| format = PDF
	| accessdate = 2006-07-01
	}}
	</ref><ref name="CMAJ2"/> but the ] (RACP) and the ] (BMA) observe that controversy exists on this issue.<ref name = "RACPSumm">{{cite web
	| url = http://www.racp.edu.au/download.cfm?DownloadFile=A453CFA1-2A57-5487-DF36DF59A1BAF527
	| title = Policy Statement On Circumcision
	| accessdate = 2007-02-28
	| year = 2004
	| month = September
	| format = PDF
	| publisher = ]
	| pages =
	| language =
	| archiveurl =
	| archivedate =
	| quote = <small>The Paediatrics and Child Health Division, The Royal Australasian College of Physicians (RACP) has prepared this statement on routine circumcision of infants and boys to assist parents who are considering having this procedure undertaken on their male children and for doctors who are asked to advise on or undertake it. After extensive review of the literature the RACP reaffirms that '''there is no medical indication for routine neonatal circumcision.''' Circumcision of males has been undertaken for religious and cultural reasons for many thousands of years. It remains an important ritual in some religious and cultural groups.…In recent years there has been evidence of possible health benefits from routine male circumcision. The most important conditions where some benefit may result from circumcision are urinary tract infections, HIV and later cancer of the penis.…The complication rate of neonatal circumcision is reported to be around 1% to 5% and includes local infection, bleeding and damage to the penis. Serious complications such as bleeding, septicaemia and meningitis may occasionally cause death. The possibility that routine circumcision may contravene human rights has been raised because circumcision is performed on a minor and is without proven medical benefit. Whether these legal concerns are valid will be known only if the matter is determined in a court of law. If the operation is to be performed, the medical attendant should ensure this is done by a competent operator, using appropriate anaesthesia and in a safe child-friendly environment. In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents. Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate.</small>
	{{Dead link|date=October 2009}}}}</ref>{{Dead link|date=October 2009}}<ref name = "BMAGuide">{{cite web
	| url = http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp
	| title = The law and ethics of male circumcision &ndash; guidance for doctors
	| accessdate = 2006-07-01
	| author = Medical Ethics Committee
	| year = 2006
	| month = June
	| publisher = ]
	}}
	</ref>
	The BMA state that in general, "the parents should determine how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices." They state that because the parents' interests and the child's interests sometimes differ, there are "limits on parents' rights to choose and parents are not entitled to demand medical procedures contrary to their child's best interests." They state that competent children may decide for themselves.<ref name = "BMAGuide" /> ] states that "ale circumcision is a voluntary surgical procedure and health
	care providers must ensure that men and young boys are given all the necessary information to
	enable them to make free and informed choices either for or against getting circumcised."<ref>{{cite web
	|url = http://data.unaids.org/pub/InformationNote/2007/mc_briefing_pack1_en.pdf
	|format=PDF|title = Information Package on Male Circumcision and HIV Prevention
	}}</ref>
			In the academic literature, there is general agreement among both supporters and opponents of the practice that an outright ban would be predominately ineffective and "harmful".<ref name="Bolnick_2012_ch1" /><ref name="Cohen-Almagor-2020" /><ref name="knmg.nl">{{cite web |title=Non-therapeutic circumcision of male minors | work = KNMG Viewpoint | location = Utrecht, The Netherlands | publisher = Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst (KNMG) (Royal Dutch Society for the Promotion of Medicine)| date = May 2010 |url=https://www.knmg.nl/advies-richtlijnen/knmg-publicaties/publications-in-english.htm |access-date=7 March 2018 |archive-date=8 March 2018 |archive-url=https://web.archive.org/web/20180308231353/https://www.knmg.nl/advies-richtlijnen/knmg-publicaties/publications-in-english.htm |url-status=live }}</ref><ref name="Basaran-2023" /> A consensus to keep the procedure within the purview of medical professionals is found across all major medical organizations, who advise medical professionals to yield to some degree to parental preferences in their decision to agree to circumcise.<ref name="Bolnick_2012_ch1" /><ref name="Cohen-Almagor-2020" /> The Royal Dutch Medical Association, which expresses some of the strongest opposition to routine neonatal circumcision, argues that while there are valid reasons for banning it, doing so could lead parents who insist on the procedure to turn to poorly trained practitioners instead of medical professionals.<ref name="Bolnick_2012_ch1" /><ref name=RACP_2010/>
	Some argue that the medical problems that have their risk reduced by circumcision are already rare, can be avoided, and, if they occur, can usually be treated in less invasive ways than circumcision. ] states that the removal of healthy genital tissue from a minor should not be subject to parental discretion and that physicians who perform the procedure are not acting in accordance with their ethical duties to the patient.<ref name = "Somerville" /> Denniston states that circumcision is harmful and asserts that in the absence of the individual's consent, non-therapeutic child circumcision violates several ethical principles that govern medicine.<ref>{{cite web|url=http://www.humanehealthcare.com/Article.asp?art_id=620|title=Circumcision and the Code of Ethics, George C. Denniston, Humane Health Care Volume 12, Number 2}}</ref>
			During the 2010s, several ] parties prominently called for the banning of circumcision.<ref>{{Cite book | vauthors = Bruns A, Bu Y, Merkt H |title=Legal Theory and Interpretation in a Dynamic Society |publisher=Nomos Verlagsgesellschaft |year=2021 |isbn=978-3-7489-2584-2 |pages=352}}</ref> Gressgård argued that politicians that supported Norway's proposed circumcision ban debated circumcision in a manner which constituted "]".<ref>{{Cite book | vauthors = Gressgård R |title=Multicultural Dialogue: Dilemmas, Paradoxes, Conflicts |publisher=] |year=2012 |isbn=978-0-85745-648-9 |pages=7, 94}}</ref>
	Others believe neonatal circumcision is permissible, if parents should so choose. Viens argues that, in a cultural or religious context, circumcision is of significant enough importance that parental consent is sufficient and that there is "an absence of sufficient evidence or persuasive argumentation" to support changing the present policy.<ref>{{cite journal |title=Value judgment, harm, and religious liberty |author=Viens AM |journal=J Med Ethics |volume=30 |pages=241–7 |year=2004 |doi=10.1136/jme.2003.003921}}</ref> Benatar and Benatar argue that circumcision can be beneficial to a male before he would be able to otherwise provide consent, that "it is far from obvious that circumcision reduces sexual pleasure," and that "it is far from clear that non-circumcision leaves open a future person’s options in every regard."<ref>{{cite journal |url=http://bioethics.net/journal/pdf/3_2_LT_w01_Benetar.pdf |first=David |last=Benatar |coauthors=Benatar, Michael |title=How not to argue about circumcision |journal=American Journal of
	Bioethics |volume=3 |issue=2 |year=2003 |pages=W1&ndash;W9 |doi=10.1162/152651603102387820|format=PDF}}</ref>
			===Economic considerations===
	====Acknowledgment of pain====
			The cost-effectiveness of circumcision has been studied to determine whether a policy of circumcising all newborns or a policy of promoting and providing inexpensive or free access to circumcision for all adult men who choose it would result in lower overall societal healthcare costs. As ] is an incurable disease that is expensive to manage, significant effort has been spent studying the cost-effectiveness of circumcision to reduce its spread in parts of Africa that have a relatively high infection rate and low circumcision prevalence.<ref name=doyle_2010/> Several analyses have concluded that circumcision programs for adult men in Africa are cost-effective and in some cases are cost-saving.<ref name=uthman_2010/><ref>{{cite journal | vauthors = Grimes CE, Henry JA, Maraka J, Mkandawire NC, Cotton M | title = Cost-effectiveness of surgery in low- and middle-income countries: a systematic review | journal = World Journal of Surgery | volume = 38 | issue = 1 | pages = 252–263 | date = January 2014 | pmid = 24101020 | doi = 10.1007/s00268-013-2243-y | s2cid = 2166354 }}</ref> In Rwanda, circumcision has been found to be cost-effective across a wide range of age groups from newborn to adult,<ref name=albero_2012/><ref name=binagwaho_2010/> with the greatest savings achieved when the procedure is performed in the newborn period due to the lower cost per procedure and greater timeframe for HIV infection protection.<ref name="kim_2010">{{cite journal | vauthors = Kim HH, Li PS, Goldstein M | title = Male circumcision: Africa and beyond? | journal = Current Opinion in Urology | volume = 20 | issue = 6 | pages = 515–519 | date = November 2010 | pmid = 20844437 | doi = 10.1097/MOU.0b013e32833f1b21 | s2cid = 2158164 }}</ref><ref name=binagwaho_2010/> Circumcision for the prevention of HIV transmission in adults has also been found to be cost-effective in South Africa, Kenya, and Uganda, with cost savings estimated in the billions of US dollars over 20 years.<ref name=doyle_2010/> Hankins ''et al.'' (2011) estimated that a $1.5 billion investment in circumcision for adults in 13 high-priority African countries would yield $16.5 billion in savings.<ref name=hankins_2011/>
	Williams (2003) argued that human attitudes toward the pain that animals (including humans) experience may not be based on ], developing an analogy between attitudes toward the pain pigs endure while having their tails ], and "our culture's indifference to the pain that male human infants experience while being circumcised."<ref>{{cite journal
	| last = Williams
	| first = R. M.
	| authorlink =
	| coauthors =
	| title = On the Tail-Docking of Pigs, Human Circumcision, and their Implications for Prevailing Opinion Regarding Pain
	| journal = Journal of Applied Philosophy
	| volume = 20
	| issue = 1
	| pages = 89–93
	| publisher =
	| location =
	| date = 2003-01
	| url = http://www.blackwell-synergy.com/doi/abs/10.1111/1468-5930.00237
	| doi = 10.1111/1468-5930.00237
	| id =
	| accessdate = 2008-06-24}}</ref>
			The overall cost-effectiveness of neonatal circumcision has also been studied in the United States, which has a different cost setting from Africa in areas such as public health infrastructure, availability of medications, and medical technology and the willingness to use it.<ref name=xu_2009/> A study by the CDC suggests that newborn circumcision would be societally cost-effective in the United States based on circumcision's efficacy against the transmission of HIV alone during ], without considering any other cost benefits.<ref name=AAP_2012/><!-- Quote = "The CDC study suggests that newborn circumcision performed in the United States to prevent HIV infection is cost-effective without consideration of other health benefits." --> The American Academy of Pediatrics (2012) recommends that neonatal circumcision in the United States be covered by third-party payers such as ] and insurance.<ref name=AAP_2012/> A 2014 review that considered reported benefits of circumcision such as reduced risks from HIV, HPV, and HSV-2 stated that circumcision is cost-effective in both the United States and Africa and may result in health care savings.<ref>{{cite journal | vauthors = Tobian AA, Kacker S, Quinn TC | title = Male circumcision: a globally relevant but under-utilized method for the prevention of HIV and other sexually transmitted infections | journal = Annual Review of Medicine | volume = 65 | pages = 293–306 | date = 2014 | pmid = 24111891 | pmc = 4539243 | doi = 10.1146/annurev-med-092412-090539 }}</ref> A 2014 literature review found that there are significant gaps in the current literature on male and female sexual health that need to be addressed for the literature to be applicable to North American populations.<ref name = bossio_2014/>
	===Psychological and emotional consequences===
	The British Medical Association (2006) states that "it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks."<ref name = "BMAGuide" /> ] and Macris (1992) argue that circumcision encodes the perinatal brain with violence and negatively affects infant-maternal bonding and trust.<ref name="Milos"/> Goldman (1999) discussed the possible trauma of circumcision on children and parents, anxieties over the circumcised state, a tendency to repeat the trauma, and suggested a need on the part of circumcised doctors to find medical justifications for the procedure.<ref>{{cite journal
	| last = Goldman
	| first = R.
	| year = 1999
	| month = January
	| title = The psychological impact of circumcision
	| journal = BJU International
	| volume = 83
	| issue = S1
	| pages = 93&ndash;102
	| doi = 10.1046/j.1464-410x.1999.0830s1093.x
	| id =
	| url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1093.x
	| format = PDF
	| accessdate = 2006-07-02
	}}
	</ref> Furthermore, there are reports of males attempting to undo the effects of circumcision through the practice of ].<ref>{{cite journal |author=Schultheiss D, Truss MC, Stief CG, Jonas U |title=Uncircumcision: A Historical Review of Preputial Restoration |journal=Plast Reconstr Surg. |year=1998 |volume=101(7) |pages=1990&ndash;8 |pmid=9623850 }}</ref>
	Moses ''et al.''' (1998) state, however, that "scientific evidence is lacking" for psychological and emotional harm, citing a longitudinal study which did not find a difference in developmental and behavioural indices.<ref>{{cite journal |author=Moses, S |coauthors=Bailey, RC; Ronald AR |title=Male circumcision: assessment of health benefits and risks |journal=Sex Transm Infect |year=1998 |volume=74 |pages=368&ndash;73 |doi=10.1136/sti.74.5.368}}</ref> A literature review by Gerharz and Haarmann (2000) reached a similar conclusion.<ref>{{cite journal |author=Gerharz EW, Haarmann C |title=The first cut is the deepest? Medicolegal aspects of male circumcision |journal=BJU Int. |volume=86 |issue=3 |pages=332–8 |year=2000 |month=August |pmid=10930942 |doi= |url=}}</ref>
	Boyle ''et al.'' (2002) state that circumcision may result in psychological harm, including post-traumatic stress disorder (]), citing a study reporting high rates of PTSD among Filipino boys after either ritual or medical circumcision.<ref name="Boyle ''et al.''">{{cite journal |author=Boyle, G |coauthors=Goldman, R; Svoboda, JS; Fernandez E |title=Male Circumcision: Pain, Trauma and Psychosexual Sequelae |journal=Journal of Health Psychology |volume=7 |issue=3 |pages=329–343 |year=2002}}</ref> Hirji ''et al.'' (2005) state that "Reports of psychological trauma are not borne out in studies but remain as an anecdotal cause for concern."<ref>{{cite journal |title=Male circumcision: a review of the evidence |author=Hirji, H |coauthors=Charlton, R; Sarmah S |journal=Journal of men's health |volume=2 |issue=1 |pages=21–30 |year=2005 |url=http://www.journals.elsevierhealth.com/periodicals/jmhg/article/PIIS1571891305000105/abstract}}</ref>
	===Legal issues===		== References ==
			{{Reflist|refs=
	{{Main|Circumcision and law}}
			<!-- A -->
			<ref name=AAFP_2013>{{cite web |title=Neonatal Circumcision |access-date=3 August 2015 |year=2013 |publisher=American Academy of Family Physicians |url=http://www.aafp.org/about/policies/all/neonatal-circumcision.html |url-status=live |archive-url=https://web.archive.org/web/20150721022442/http://www.aafp.org/about/policies/all/neonatal-circumcision.html |archive-date=21 July 2015 }}</ref>
			<ref name=AAP_2012>{{cite journal | vauthors = ((American Academy of Pediatrics Task Force on Circumcision)) | title = Male circumcision | journal = Pediatrics | volume = 130 | issue = 3 | pages = e756–e785 | date = September 2012 | pmid = 22926175 | doi = 10.1542/peds.2012-1990 | url = http://pediatrics.aappublications.org/content/130/3/e756.full | url-status = live | doi-access = free | archive-url = https://web.archive.org/web/20120920054623/http://pediatrics.aappublications.org/content/130/3/e756.full | archive-date = 20 September 2012 }}</ref>
	In 2001, Sweden passed a law allowing only persons certified by the National Board of Health to circumcise infants, requiring a medical doctor or an anesthesia nurse to accompany the circumciser and for anaesthetic to be applied beforehand. Jews and Muslims in Sweden objected to the law,<ref>{{cite web
	| url = http://news.bbc.co.uk/2/hi/europe/1572483.stm
	| title = Sweden restricts circumcisions
	| accessdate = 2006-10-18
	| date = October 1, 2001
	| publisher = ]
	| quote = Swedish Jews and Muslims object to the new law, saying it violates their religious rights.
	}}
	</ref> and in 2001, the ] stated that it was "the first legal restriction on Jewish religious practice in Europe since the Nazi era."<ref>{{cite news | title = Jews protest Swedish circumcision restriction | url = http://www.hrwf.net/religiousfreedom/news/sweden2001.html#JewsprotestSwedish | publisher = ] | date = 2001-06-07| quote = A WJC spokesman said, "This is the first legal restriction placed on a Jewish rite in Europe since the Nazi era. This new legislation is totally unacceptable to the Swedish Jewish community."}}</ref> In 2005, the Swedish National Board of Health and Welfare reviewed the law and recommended that it be maintained. In 2006, the U.S. State Department's report on Sweden stated that most Jewish ]s had been certified under the law and 3000 Muslim and 40&ndash;50 Jewish boys were circumcised each
	year.<ref>{{cite web
	| url = http://www.state.gov/g/drl/rls/irf/2006/71410.htm
	| title = Sweden
	| accessdate = 2007-07-04
	| author = Bureau of Democracy, Human Rights, and Labor
	| date = September 15, 2006
	| work = International Religious Freedom Report 2006
	| publisher = U.S. Department of State
	}}
	</ref>
			<ref name = "Afshar_2018">{{Cite book | vauthors = Afshar K, Kazemi B, MacNeily A |title=Diagnostics to Pathogenomics of Sexually Transmitted Infections |publisher=] |year=2018 |isbn=978-1-119-38084-9 | veditors = Singh S |pages=28–34 |chapter=The Role of Circumcision in Preventing Sexually Transmitted Infections}}</ref>
	In 2006, a Finnish court found that a parent's actions in having her 4-year-old son circumcised was illegal.<ref>{{cite web
	|url=http://www.hs.fi/english/article/Court+rules+circumcision+of+four-year-old+boy+illegal/1135220958830
	|title=Court rules circumcision of four-year-old boy illegal
	|accessdate=2007-09-17
	|date=2006-08-07
	|publisher=HELSINGIN SANOMAT, INTERNATIONAL EDITION}}</ref> However, no punishment was assigned by the court, and in 2008 the Finnish Supreme Court ruled that the mother's actions did not constitute a criminal offense and that circumcision of a child for religious reasons, when performed properly, is not a crime.<ref>{{cite news |first= |last= |authorlink= |coauthors= |title=Supreme Court: Properly performed religious based male circumcision no crime |url=http://www.hs.fi/english/article/Supreme+Court+Properly+performed+religious+based+male+circumcision+no+crime/1135240316614 |work= |publisher=Helsingin Sanomat |date=October 17, 2008 |accessdate=2008-10-17 }}</ref> In 2008, the Finnish government was reported to be considering a new law to legalize ritual circumcision if the practitioner is a doctor, "according to the parents' wishes, and with the child's consent", as reported.<ref>{{cite web
	|url=http://www.yle.fi/news/left/id97605.html
	|title=Finland Considers Legalising Male Circumcision
	|accessdate=2008-08-05
	|date=2008-07-31
	|publisher=Ylesiradio
	}}</ref>
			<ref name=albero_2012>{{cite journal | vauthors = Albero G, Castellsagué X, Giuliano AR, Bosch FX | title = Male circumcision and genital human papillomavirus: a systematic review and meta-analysis | journal = Sexually Transmitted Diseases | volume = 39 | issue = 2 | pages = 104–113 | date = February 2012 | pmid = 22249298 | doi = 10.1097/OLQ.0b013e3182387abd | s2cid = 26859788 | doi-access = free }}</ref>
	By 2007, the Australian states of Victoria, New South Wales, Western Australia and Tasmania had stopped the practice of non-therapeutic male circumcision in all public hospitals.<ref>{{cite news|url=http://www.abc.net.au/tasmania/stories/s2004776.htm |title=Circumcision debate on Mornings |date=2007-07-15 |publisher=ABC Tasmania}}.</ref>
			<ref name="alanis_2004">{{cite journal | vauthors = Alanis MC, Lucidi RS | title = Neonatal circumcision: a review of the world's oldest and most controversial operation | journal = Obstetrical & Gynecological Survey | volume = 59 | issue = 5 | pages = 379–395 | date = May 2004 | pmid = 15097799 | doi = 10.1097/00006254-200405000-00026 | s2cid = 25226185 }}</ref>
	==Medical aspects==
	<!-- Deleted image removed: ] -->
	{{Main|Medical analysis of circumcision}}
	] have varied. Some found a small net benefit of circumcision,<ref>{{cite journal
	| last = Schoen
	| first = Edgar J.
	| coauthors = Christopher J. Colby, Trinh T. To
	| year = 2006
	| month = March
	| title = Cost Analysis of Neonatal Circumcision in a Large Health Maintenance Organization
	| journal = The Journal of Urology
	| volume = 175
	| issue = 3
	| pages = 1111&ndash;1115
	| doi = 10.1016/S0022-5347(05)00399-X
	| pmid = 16469634
	| url = http://www.jurology.com/article/PIIS002253470500399X/abstract
	| format = Abstract
	| accessdate = 2006-07-01
	}}
	</ref><ref>{{cite journal
	| last = Alanis
	| first = Mark C.
	| coauthors = Richard S. Lucidi
	| year = 2004
	| month = May
	| title = Neonatal Circumcision: A Review of the World’s Oldest and Most Controversial Operation
	| journal = Obstetrical & Gynecological Survey
	| volume = 59
	| issue = 5
	| pages = 379&ndash;395
	| doi =10.1097/00006254-200405000-00026
	| pmid = 15097799
	| url = http://www.obgynsurvey.com/pt/re/obgynsurv/abstract.00006254-200405000-00026.htm;jsessionid=FbJT6LYnQxr66KhvWNsBW0msy7shpJgL39wbFTGLnQpzJ82BGLVQ!1096339265!-949856144!8091!-1
	| format = Abstract
	| accessdate = 2006-09-27
	}}
	</ref> some found a small net decrement,<ref>{{cite journal
	| last = Van Howe
	| first = Robert S.
	| year = 2004
	| month = November
	| title = A Cost-Utility Analysis of Neonatal Circumcision
	| journal = Medical Decision Making
	| volume = 24
	| issue = 6
	| pages = 584&ndash;601
	| doi = 10.1177/0272989X04271039
	| pmid = 15534340
	| url = http://mdm.sagepub.com/cgi/content/abstract/24/6/584
	| format = Abstract
	| accessdate = 2006-07-01
	}}
	</ref><ref>{{cite journal
	| last = Ganiats
	| first = TG
	| coauthors = Humphrey JB, Taras HL, Kaplan RM.
	| year = 1991
	| month = Oct&ndash;December
	| title = Routine neonatal circumcision: a cost-utility analysis
	| journal = Medical Decision Making
	| volume = 11
	| issue = 4
	| pages = 282&ndash;293
	| doi =10.1177/0272989X9101100406
	| pmid = 1766331
	| url =
	| format =
	| accessdate = 2006-07-01
	}}
	</ref> and one found that the benefits and risks balanced each other out and suggested that the decision could "most reasonably be made on nonmedical factors."<ref>{{cite journal
	| last = Lawler
	| first = FH
	| coauthors = Bisonni RS, Holtgrave DR.
	| year = 1991
	| month = Nov&ndash;December
	| title = Circumcision: a decision analysis of its medical value.
	| journal = Family Medicine
	| volume = 23
	| issue = 8
	| pages = 587&ndash;593
	| doi =
	| pmid = 1794670
	| url =
	| format =
	| accessdate = 2006-07-01
	}}
	</ref>
			<ref name=alsabbagh_1996>{{cite book |author=al-Sabbagh, Muhammad Lutfi |title=Islamic ruling on male and female circumcision |page= |year=1996 |publisher=World Health Organization |isbn=978-92-9021-216-4 |url=https://archive.org/details/islamicrulingonm0000alsa/page/16 }}</ref>
	===Pain and pain relief===
	According to the ]' 1999 Circumcision Policy Statement, “There is considerable evidence that newborns who are circumcised without analgesia experience pain and physiologic stress.”<ref name="AAP1999"/> It therefore recommended using pain relief for circumcision.<ref name="AAP1999"/> One of the supporting studies, Taddio 1997, found a correlation between circumcision and intensity of pain response during vaccination months later.<ref name = "Taddio"/> While acknowledging that there may be "other factors" besides circumcision to account for different levels of pain response, they stated that they did not find evidence of such. They concluded "]retreatment and postoperative management of neonatal circumcision pain is recommended based on these results."<ref name = "Taddio">{{cite journal
	| last = Taddio
	| first = Anna
	| coauthors = Joel Katz, A Lane Ilersich, ]
	| year = 1997
	| month = March
	| title = Effect of neonatal circumcision on pain response during subsequent routine vaccination
	| journal = ]
	| volume = 349
	| issue = 9052
	| pages = 599&ndash;603
	| doi = 10.1016/S0140-6736(96)10316-0
	| id =
	| url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673696103160.pdf
	| format = PDF &mdash; free registration required
	| accessdate = 2007-08-08
	}}
	</ref> Other medical associations also cite evidence that circumcision without anesthetic is painful.<ref name = "AAFP">{{cite web
	| url = http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html
	| title = Circumcision: Position Paper on Neonatal Circumcision
	| accessdate = 2007-01-30
	| year = 2007
	| publisher = ]
	}}
	</ref><ref name="CPSIFP2"/>
			<ref name=aridogan_2011>{{cite journal | vauthors = Aridogan IA, Izol V, Ilkit M | title = Superficial fungal infections of the male genitalia: a review | journal = Critical Reviews in Microbiology | volume = 37 | issue = 3 | pages = 237–244 | date = August 2011 | pmid = 21668404 | doi = 10.3109/1040841X.2011.572862 | s2cid = 31957918 }}</ref>
	Stang, 1998, found 45% of physicians responding to a survey who circumcise used anaesthesia &ndash; most commonly a dorsal penile nerve block &ndash; for infant circumcisions. The obstetricians in the sample used anaesthesia less often (25%) than the family practitioners (56%) or pediatricians (71%).<ref name = "Stang">{{cite journal
	| last = Stang
	| first = Howard J.
	| coauthors = Leonard W. Snellman
	| year = 1998
	| month = June
	| title = Circumcision Practice Patterns in the United States
	| journal = ]
	| volume = 101
	| issue = 6
	| pages = e5&ndash;
	| doi = 10.1542/peds.101.6.e5
	| id = {{ISSN|1098-4275}}
	| url = http://pediatrics.aappublications.org/cgi/reprint/101/6/e5.pdf
	| format = PDF
	| accessdate = 2006-06-29
	}}
	</ref> Howard ''et al.'' (1998) surveyed US medical doctor residency programs and directors, and found that 26% of the programs that taught the circumcision procedure "failed to provide instruction in anesthesia/analgesia for the procedure" and recommended that "residency training in neonatal circumcision should include instruction in pain relief techniques".<ref>{{cite journal
	| last = Howard
	| first = C.R.
	| authorlink =
	| coauthors = F.M. Howard, L.C. Garfunkel, E.A. de Blieck, M. Weitzman
	| title = Neonatal Circumcision and Pain Relief: Current Training Practices
	| journal = Pediatrics
	| volume = 101
	| issue = 3
	| pages = 423–428
	| publisher =
	| location =
	| year = 1998
	| url = http://pediatrics.aappublications.org/cgi/content/abstract/101/3/423
	| doi = 10.1542/peds.101.3.423
	| id =
	| accessdate = 2008-06-19}}</ref> A 2006 follow-up study revealed that the percentage of programs that taught circumcision and also taught administration of topical or local anesthetic had increased to 97%.<ref name=Yawman>{{cite journal
	| last = Yawman
	| first = D.
	| authorlink =
	| coauthors = C.R. Howard, P. Auinger, L.C. Garfunkel, M. Allan and M. Weitzman
	| title = Pain relief for neonatal circumcision: a follow-up of residency training practices
	| journal = Ambulatory Pediatrics
	| volume = 6
	| issue = 4
	| pages = 210–214
	| publisher =
	| location =
	| year = 2006
	| url =
	| doi = 10.1016/j.ambp.2006.04.008
	| pmid = 16843252
	| accessdate = }}</ref> However, the authors of the follow-up study also noted that only 84% of these programs used anesthetic "frequently or always" when the procedure was conducted.<ref name=Yawman/>
			<ref name=AUA_2007>{{cite web|url=http://www.auanet.org/about/policy-statements/circumcision.cfm|title=Circumcision|access-date=2 November 2008|author=American Urological Association|url-status=dead|archive-url=https://web.archive.org/web/20130825011022/http://www.auanet.org/about/policy-statements/circumcision.cfm|archive-date=25 August 2013}}</ref>
	Glass, 1999, stated that Jewish ritual circumcision is so quick that "most ''mohelim'' do not routinely use any anaesthesia as they feel there is probably no need in the neonate." Glass continued, "However, there is no Talmudic objection and should the parents wish for local anaesthetic cream to be applied there is no reason why this cannot be done." Glass also stated that for older children and adults, a penile block is used.<ref name="GlassJM"/>
			<ref name=AVAC_2015>{{cite web|title=Clearinghouse on Male Circumcision for HIV Prevention Redesigned|url=http://www.avac.org/blog/clearinghouse-male-circumcision-hiv-prevention-redesigned|website=AVAC|date=May 2015|access-date=11 March 2017|url-status=live|archive-url=https://web.archive.org/web/20170312065747/http://www.avac.org/blog/clearinghouse-male-circumcision-hiv-prevention-redesigned|archive-date=12 March 2017}}</ref>
	Lander ''et al.'' demonstrated that babies circumcised without anesthesia showed behavioral and physiological signs of pain and distress.<ref>{{cite journal |last=Lander |first=J. |coauthors=Brady-Fryer, B., Metcalfe, J.B., Nazarali, S. and S. Muttitt |year=1997 |month= |title=Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision: a randomized controlled trial |journal=JAMA |volume=278 |issue=24 |pages=2157–2162 |pmid=9417009 |url= |accessdate= |quote= |doi=10.1001/jama.278.24.2157 }}</ref> Comparisons of the dorsal penile nerve block and ] (lidocaine/prilocaine) topical cream methods of pain control have revealed that while both are safe,<ref name=Brady-Fryer/><ref>{{cite journal | last =Lehr | first =V.T. | coauthors =E. Cepeda, D.A. Frattarelli, R. Thomas, J. LaMothe and J.V. Aranda | year = 2005 | month = | title =Lidocaine 4% cream compared with lidocaine 2.5% and prilocaine 2.5% or dorsal penile block for circumcision | journal =Am J Perinatol | volume =22 | issue =5 | pages =231–237 | pmid =16041631 | url = | format = | accessdate = | doi =10.1055/s-2005-871655 }}</ref> the dorsal nerve block controls pain more effectively than topical treatments,<ref name=garry>{{cite journal | last =Garry | first =D.J. | coauthors =E. Swoboda, A. Elimian and R. Figueroa | year = 2006 | month = | title =A video study of pain relief during newborn male circumcision | journal =J Perinatology | volume =26 | issue =2 | pages =106–110 | pmid =16292334 | url = | format = | accessdate = | doi =10.1038/sj.jp.7211413 }}</ref> but neither method eliminates pain completely.<ref name=Brady-Fryer>{{cite journal | last = Brady-Fryer | first = B | coauthors = Wiebe N, Lander JA | year = 2004 | month = July | title = Pain relief for neonatal circumcision | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = Art. No.: CD004217 | doi = 10.1002/14651858.CD004217.pub2| pmid = 15495086 | url = | format = | accessdate = 2006-06-29 }}</ref> Razmus ''et al.'' reported that newborns circumcised with the dorsal block and the ring block in combination with the concentrated oral sucrose had the lowest pain scores.<ref>{{cite journal |author=Razmus I, Dalton M, Wilson D |title=Pain management for newborn circumcision |journal=Pediatr Nurs |volume=30 |issue=5 |pages=414&ndash;7, 427 |year= |pmid=15587537}}</ref> Ng ''et al.'' found that EMLA cream, in addition to local anaesthetic, effectively reduces the sharp pain induced by needle puncture.<ref>{{cite journal |first=WT |last=Ng |coauthors=''et al.''|title=The use of topical lidocaine/prilocaine cream prior to childhood circumcision under local anesthesia |journal=Ambul Surg |volume=9 |issue=1 |pages=9&ndash;12 |year=2001 |pmid=11179706|doi=10.1016/S0966-6532(00)00061-5}}</ref>
			<!-- B -->
	===Sexual effects===
			<ref name=becker_2011>{{cite journal | vauthors = Becker K | title = Lichen sclerosus in boys | journal = Deutsches Ärzteblatt International | volume = 108 | issue = 4 | pages = 53–58 | date = January 2011 | pmid = 21307992 | pmc = 3036008 | doi = 10.3238/arztebl.2011.0053 }}</ref>
	{{Main|Sexual effects of circumcision}}
			<ref name=binagwaho_2010>{{cite journal | vauthors = Binagwaho A, Pegurri E, Muita J, Bertozzi S | title = Male circumcision at different ages in Rwanda: a cost-effectiveness study | journal = PLOS Medicine | volume = 7 | issue = 1 | pages = e1000211 | date = January 2010 | pmid = 20098721 | pmc = 2808207 | doi = 10.1371/journal.pmed.1000211 | veditors = Kalichman SC | doi-access = free }}</ref>
	The sexual effects of circumcision are the subject of much debate. The American Academy of Pediatrics (1999) stated "A survey of adult males using self-report suggests more varied sexual practice and less sexual dysfunction in circumcised adult men. There are anecdotal reports that penile sensation and sexual satisfaction are decreased for circumcised males." They continued, "] noted no difference in exteroceptive and light tactile discrimination on the ventral or dorsal surfaces of the glans penis between circumcised and uncircumcised men."<ref name = "AAP1999" /> Conversely a 2002 review by Boyle ''et al.'' stated that "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings&mdash;many of which are lost to circumcision, with an inevitable reduction in sexual sensation experienced by circumcised males." They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."<ref>{{cite web |url=http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1036&context=hss_pubs |title=Male circumcision: pain, trauma, and psychosexual sequelae |first=Gregory J |last=Boyle |coauthors=Svoboda, J Steven; Goldman, Ronald; Fernandez, Ephrem |publisher=Bond University Faculty of Humanities and Social Sciences |year=2002}}</ref> In January 2007, The American Academy of Family Physicians (AAFP) stated "The effect of circumcision on penile sensation or sexual satisfaction is unknown. Because the epithelium of a circumcised glans becomes cornified, and because some feel nerve over-stimulation leads to desensitization, many believe that the glans of a circumcised penis is less sensitive. No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."<ref name = "AAFP" /> Payne ''et al.'' reported that direct measurement of penile sensation during ] failed to support the hypothesised sensory differences associated with circumcision status.<ref name = "Payne2007"> {{cite journal | last = Payne | first = Kimberley | coauthors = Lea Thaler, Tuuli Kukkonen, Serge Carrier, Yitzchak Binik | year = 2007 | month = April | title = Sensation and Sexual Arousal in Circumcised and Uncircumcised Men | journal = Journal of Sexual Medicine | volume = 4 | issue = 3 | pages = 667–674 | pmid = 17419812 | doi = 10.1111/j.1743-6109.2007.00471.x | url = http://www3.interscience.wiley.com/journal/118496134/abstract | accessdate = 2008-09-07}}</ref>
	In a 2007 study, Sorrells ''et al.'', using monofilament touch-test mapping, found that the foreskin contains the most sensitive parts of the penis, noting that these parts are lost to circumcision. They also found that "the glans of the circumcised penis is less sensitive to fine-touch than the glans of the uncircumcised penis."<ref>{{cite journal | last = Sorrells | first = M.L. | coauthors = J.L. Snyder, M.D. Reiss, C. Eden, M.F. Milos, N. Wilcox and R.S. Van Howe | year = 2007 | month = May | title = Fine-touch pressure thresholds in the adult penis | journal = BJU International | volume = 99 | issue = 4 | pages = 864–869 | pmid = 17378847 | doi = 10.1111/j.1464-410X.2006.06685.x }}</ref> In a 2008 study, Krieger ''et al.'' stated that "Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm."<ref name = "Krieger2008">{{cite journal
	| last = Krieger
	| first = JN
	| coauthors = Mehta SD, Bailey RC, Agot K, Ndinya-Achola JO, Parker C, Moses S
	| year = 2008
	| month = August
	| title = Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya
	| journal = The Journal of Sexual Medicine
	| volume = Epub ahead of print
	| issue =
	| pages =
	| publisher =
	| location =
	| issn =
	| pmid = 18761593
	| pmc =
	| doi =
	| bibcode =
	| oclc =
	| id =
	| url =
	| language =
	| format =
	| accessdate =
	| laysummary =
	| laysource =
	| laydate =
	| quote =
	}}
	</ref>
			<ref name="Bolnick_2012_ch1">{{cite book |title=Surgical Guide to Circumcision |vauthors=Jacobs M, Grady R, Bolnick DA |publisher=Springer |year=2012 |isbn=978-1-4471-2857-1 |veditors=Bolnick DA, Koyle M, Yosha A |location=London |pages=3–8, 255–257 |chapter=Current Circumcision Trends and Guidelines |doi=10.1007/978-1-4471-2858-8_1 |quote=Outside of strategic regions in sub-Saharan Africa, no call for routine circumcision has been made by any established medical organizations or governmental bodies. Positions on circumcision include "some medical benefit/parental choice" in the United States, "no medical benefit/parental choice" in Great Britain, and "no medical benefit/physical and psychological trauma/parental choice" in the Netherlands. |author2-link=<!--Not the Olympic athlete. Do not link-->}}</ref>
	Reports detailing the effect of circumcision on ] have been mixed. Studies have shown that circumcision can result in a statistically significant increase,<ref name = "Fink2002"> {{cite journal | last = Fink | first = K.S. | coauthors = C.C. Carson, R.S. DeVellis | year = 2002 | month = May | title = Adult Circumcision Outcomes Study: Effect on Erectile Dysfunction, Penile Sensitivity, Sexual Activity and Satisfation | journal = Journal of Urology | volume = 167 | issue = 5 | pages = 2113&ndash;2116 | pmid = 11956453 | url = http://www.cirp.org/library/sex_function/fink1/ | accessdate = 2008-06-28 | doi = 10.1016/S0022-5347(05)65098-7}}</ref><ref>{{cite journal | last = Shen | first = Z. | coauthors = S. Chen, C. Zhu, Q. Wan and Z. Chen | title = Erectile function evaluation after adult circumcision (in Chinese) | journal = Zhonghua Nan Ke Xue | volume = 10 | issue = 1 | pages = 18–19 | year = 2004 | pmid = 14979200}}</ref> or decrease,<ref name=Laumann>{{cite journal | last = Laumann | first = E. | coauthors = C. Masi and F. Zuckerman | title = Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice | journal = JAMA | volume = 277 | issue = 13 | pages = 1052–1057 | year = 1997 | pmid = 9091693 | url = http://www.circs.org/library/laumann/index.html | doi = 10.1001/jama.277.13.1052}}</ref><ref>{{cite journal |author=Richters J, Smith AM, de Visser RO, Grulich AE, Rissel CE |title=Circumcision in Australia: prevalence and effects on sexual health |journal=Int J STD AIDS |volume=17 |issue=8 |pages=547–54 |year=2006 |month=August |pmid=16925903 |doi=10.1258/095646206778145730 |url=}}</ref> in erectile dysfunction among circumcised men, while other studies have shown little to no effect.<ref>{{cite journal | last = Senkul | first = T. | coauthors = C. IşerI, B. şen, K. KarademIr, F. Saraçoğlu and D. Erden | title = Circumcision in adults: effect on sexual function | journal = Urology | volume = 63 | issue = 1 | pages = 155–8 | year = 2004 | pmid = 14751371 | doi = 10.1016/j.urology.2003.08.035}}</ref><ref>{{cite journal | author = Collins S, Upshaw J, Rutchik S, Ohannessian C, Ortenberg J, Albertsen P | title = Effects of circumcision on male sexual function: debunking a myth? | journal = J Urol | volume = 167 | issue = 5 | pages = 2111–2 | year = 2002 | pmid = 11956452 | doi = 10.1016/S0022-5347(05)65097-5}}</ref><ref>{{cite journal | author = Masood S, Patel H, Himpson R, Palmer J, Mufti G, Sheriff M | title = Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly? | journal = Urol Int | volume = 75 | issue = 1 | pages = 62–6 | year = 2005 | pmid = 16037710 | doi = 10.1159/000085930}}</ref>
			<ref name=Bolnick_2012_ch23>{{cite book | vauthors = Bolnick DA, Katz KE |year= 2012 |chapter= Jewish Ritual Circumcision| veditors = Bolnick DA, Koyle M, Yosha A |title=Surgical Guide to Circumcision |location= London |publisher=Springer |pages=265–274 |doi=10.1007/978-1-4471-2858-8_23 |isbn=978-1-4471-2857-1 }}</ref>
	===Complications===
			<ref name=Bolnick_2012_ch24>{{cite book | vauthors = El-Sheemy MS, Ziada AM |year= 2012 |chapter= Islam and Circumcision| veditors = Bolnick DA, Koyle M, Yosha A |title=Surgical Guide to Circumcision |location= London |publisher=Springer |pages=275–280 |doi=10.1007/978-1-4471-2858-8_24 |isbn=978-1-4471-2857-1 }}</ref>
	Complication rates ranging from 0.06% to 55% have been cited;<ref name = "CMAJ">{{cite journal
	| last = Fetus and Newborn Committee
	| year = 1996
	| month = March
	| title = Neonatal circumcision revisited
	| journal = Canadian Medical Association Journal
	| volume = 154
	| issue = 6
	| pages = 769&ndash;780
	| doi =
	| id =
	| url = http://www.cps.ca/english/statements/FN/fn96-01.htm
	| accessdate = 2006-07-02
	}}</ref> more specific estimates have included 2-10% (Williams and Kapila)<ref name="WillKap"/> and 0.2-0.6% (AMA<ref name="CSA:I-99"/> and AAP<ref name="AAP1999"/>).
			<ref name=Bolnick_2012_ch26>{{cite book | vauthors = Adams G, Adams K |year= 2012 |chapter= Circumcision in the Early Christian Church: The Controversy That Shaped a Continent| veditors = Bolnick DA, Koyle M, Yosha A |title=Surgical Guide to Circumcision |location= London |publisher=Springer |pages=291–298 |doi=10.1007/978-1-4471-2858-8_26 |isbn=978-1-4471-2857-1 }}</ref>
	According to the ] (AMA), blood loss and ] are the most common complications, but most bleeding is minor and can be stopped by applying pressure.<ref name = "CSA:I-99" /> A survey of circumcision complications by Kaplan in 1983 revealed that the rate of bleeding complications was between 0.1% and 35%.<ref name="kaplan">{{cite journal
	| last = Kaplan
	| first = G.W.
	| coauthors =
	| year = 1983
	| month = August
	| title = Complications of Circumcision
	| journal = Urologic Clinics of North America
	| volume = 10
	| issue = 3
	| pages = 543&ndash;549
	| pmid =6623741
	| url = http://www.cirp.org/library/complications/kaplan/
	| accessdate = 2006-09-29
	}}
	</ref> A 1999 study of 48 boys who had complications from traditional male circumcision in ] found that ] occurred in 52% of the boys, infection in 21% and one child had his penis amputated.<ref>{{cite journal
	| last = Ahmed A,
	| first = A
	| coauthors = Mbibi NH, Dawam D, Kalayi GD
	| year = 1999
	| month = March
	| title = Complications of traditional male circumcision
	| journal = Annals of Tropical Paediatrics
	| volume = 19
	| issue = 1
	| pages = 113&ndash;117
	| doi =10.1080/02724939992743
	| pmid = 10605531 {{ISSN|0272-4936}}
	| url =
	| format =
	| accessdate = 2006-07-01
	}}
	</ref>
			<ref name=bossio_2014>{{cite journal | vauthors = Bossio JA, Pukall CF, Steele S | title = A review of the current state of the male circumcision literature | journal = The Journal of Sexual Medicine | volume = 11 | issue = 12 | pages = 2847–2864 | date = December 2014 | pmid = 25284631 | doi = 10.1111/jsm.12703 }}</ref>
	]
	]
			<!-- C -->
	One study looking at 354,297 births in ] from 1987-1996 found that immediate post-birth complications occurred at a rate of 0.2% in the circumcised babies and at a rate of 0.01% in the uncircumcised babies. The authors judged that this was a conservative estimate because it did not capture the very rare but serious delayed complications associated with circumcisions (eg, ], ]) and the less serious but more common complications such as the ] or a less than ideal cosmetic result. They also stated that the risks of circumcision "do not seem to be mitigated by the hands of more experienced physicians".<ref name="UWstudy">{{cite journal
	| last = Christakis
	| first = Dmitry A.
	| coauthors = Eric Harvey, Danielle M. Zerr, Chris Feudtner, Jeffrey A. Wright, and Frederick A. Connell
	| year = 2000
	| month = January
	| title = A Trade-off Analysis of Routine Newborn Circumcision
	| journal = Pediatrics
	| volume = 105
	| issue = 1
	| pages = 246&ndash;249
	| doi = 10.1542/peds.105.1.S2.246
	| pmid = 10617731
	| url = http://pediatrics.aappublications.org/cgi/content/full/105/1/S2/246
	| accessdate = 2006-07-01
	| doi_brokendate = 2008-06-26
	}}
	</ref>
			<ref name=CDC_HPV>{{cite web |url=https://www.cdc.gov/std/HPV/STDFact-HPV.htm |title=STD facts&nbsp;– Human papillomavirus (HPV) |publisher=CDC |access-date=12 September 2012 |url-status=live |archive-url=https://web.archive.org/web/20120911095019/http://www.cdc.gov/STD/HPV/STDFact-HPV.htm |archive-date=11 September 2012 }}</ref>
	] (a narrowing of the urethral opening) may be a longer-term complication of circumcision. It is thought that because the foreskin no longer protects the ], ] formed from ] in wet diapers irritates and ] the exposed urethral opening. Meatal stenosis can lead to discomfort with urination, ], bleeding after urination and ].<ref>{{cite journal
	| last = Yegane
	| first = Rooh-Allah
	| coauthors = Abdol-Reza Kheirollahi, Nour-Allah Salehi, Mohammad Bashashati, Jamal-Aldin Khoshdel, and Mina Ahmadi
	| year = 2006
	| month = May
	| title = Late complications of circumcision in Iran
	| journal = Pediatric Surgery International
	| volume = 22
	| issue = 5
	| pages = 442&ndash;445
	| doi = 10.1007/s00383-006-1672-1
	| pmid = 16649052
	| url = http://www.springerlink.com/content/l62453357073k7mn/
	| format = Abstract
	| accessdate = 2008-09-25
	}}
	</ref><ref>{{cite web
	| url = http://www.emedicine.com/PED/topic2356.htm
	| title = Meatal Stenosis
	| accessdate = 2006-07-02
	| last = Angel
	| first = Carlos A.
	| date = June 12, 2006
	| work = eMedicine
	| publisher = WebMD
	}}
	</ref><ref name=vanhowe>{{cite journal |last=Van Howe |first=R.S. |authorlink= |year=2006 |month= |title=Incidence of meatal stenosis following neonatal circumcision in a primary care setting |journal=Clinical Pediatrics (Phila) |volume=45 |issue=1 |pages=49–54 |pmid=16429216 | doi= 10.1177/000992280604500108}}</ref>
			<ref name=CPSBC_2009>{{cite report |title=Professional Standards and Guidelines – Circumcision (Infant Male) |work=College of Physicians and Surgeons of British Columbia |date=September 2009 }}</ref>
	Circumcisions may remove too much or too little skin.<ref name="WillKap"/><ref name=Yagane>{{cite journal
	|last=Yegane
	|first=R.A.
	|coauthors=A.R. Kheirollahi, N.A. Salehi, M. Bashashati, J.A. Khoshdel and M. Ahmadi
	|year=2006
	|month=May
	|title=Late complications of circumcision in Iran
	|journal=Pediatr Surg Int
	|volume=22
	|issue=5
	|pages=442–445
	|pmid=16649052
	|doi=10.1007/s00383-006-1672-1
	|quote= }}</ref> If insufficient skin is removed, the child may still develop ] in later life.<ref name="WillKap"/> Van Howe states that "when operating on the infantile penis, the surgeon cannot adequately judge the appropriate amount of tissue to remove because the penis will change considerably as the child ages, such that a small difference at the time of surgery may translate into a large difference in the adult circumcised penis. To date (1997), there have been no published studies showing the ability of a circumciser to predict the later appearance of the penis."<ref name= "vanhowe1997">{{cite journal
	| last = Van Howe
	| first = R.S.
	| year = 1997
	| month = November
	| title = Variability in penile appearance and penile findings: a prospective study.
	| journal = British Journal of Urology
	| volume = 80
	| issue = 5
	| pages = 776–782
	| url = http://www.cirp.org/library/complications/vanhowe/
	| format =
	}}
	</ref>
			<ref name="caga-anan_2011">{{cite book |url=https://books.google.com/books?id=C1T6NrSPD_AC&pg=PA43 |title=Clinical Ethics in Pediatrics: A Case-Based Textbook |vauthors=Caga-anan EC, Thomas AJ, Diekema DS, Mercurio MR, Adam MR |date=8 September 2011 |publisher=Cambridge University Press |isbn=978-0-521-17361-2 |page=43 |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=C1T6NrSPD_AC&pg=PA43 |archive-date=18 January 2016 |url-status=live}}</ref>
	Cathcart ''et al.'' report that 0.5% of boys required a procedure to revise the circumcision.<ref name="cathcart">{{cite journal |author=Cathcart P, Nuttall M, van der Meulen J, Emberton M, Kenny SE |title=Trends in paediatric circumcision and its complications in England between 1997 and 2003 |journal=Br J Surg |volume=93 |issue=7 |pages=885–90 |year=2006 |month=July |pmid=16673355 |doi=10.1002/bjs.5369 |url=}}</ref>
			<ref name = "Clarence-Smith_2008">{{cite journal | vauthors = Clarence-Smith WG |date=2008 |title=Islam and Female Genital Cutting in Southeast Asia: The Weight of the Past |url= http://www.etmu.fi/fjem/pdf/FJEM_2_2008.pdf |archive-url=https://web.archive.org/web/20090306050235/http://www.etmu.fi/fjem/pdf/FJEM_2_2008.pdf |archive-date=6 March 2009 |journal=Finnish Journal of Ethnicity and Migration |volume=3 |issue=2: Special Issue: Female Genital Cutting in the Past and Today |pages=14–22 }}</ref>
	Other complications include concealed penis<ref>{{cite journal
	| last = Trier
	| first = William C.
	| coauthors = George W. Drach
	| year = 1973
	| month = February
	| title = Concealed Penis: Another Complication of Circumcision
	| journal = American Journal of diseases of children
	| volume = 125
	| issue = 2
	| pages = 276–277
	| pmid = 4685840
	| url = http://www.cirp.org/library/complications/trier1/
	| format =
	| accessdate = 2008-09-25
	}}
	</ref><ref>{{cite journal
	| last = Bergeson
	| first = Paul S.
	| coauthors = Robert J. Hopkin, Robert B. Bailey, Leigh C. MCGill, Janice P. Piatt
	| year = 1993
	| month = December
	| title = The inconspicuous penis
	| journal = Pediatrics
	| volume = 92
	| issue = 6
	| pages = 794–799
	| pmid =
	| url = http://www.cirp.org/library/complications/bergeson/
	| format =
	| accessdate = 2008-09-25
	}}
	</ref>, urinary ], ], ]s, ], ] of the glans, ] of all or part of the penis, ], ] and ].<ref name="kaplan"/> Kaplan stated “Virtually all of these complications are preventable with only a modicum of care" and "most such complications occur at the hands of inexperienced operators who are neither urologists nor surgeons.”<ref name="kaplan"/>
			<!-- D -->
	Another complication of infant circumcision is ] formation, whereby a remaining part of the foreskin fuses to other parts of the penis (often the ]) upon healing. This can result in pain during erections and minor bleeding can occur if the shaft skin is forcibly retracted.<ref>{{cite journal
			<ref name = "Dana_2003">{{cite book | vauthors = Dana N |year=2003 |title=The Druze in the Middle East: Their Faith, Leadership, Identity and Status| isbn=978-1-903900-36-9| page =56|publisher=University of Michigan Press|quote=}}</ref>
	| last = Naimer
	| first = Sody A.
	| coauthors = Roni Peleg, Yevgeni Meidvidovski, Alex Zvulunov, Arnon Dov Cohen, and Daniel Vardy
	| title = Office Management of Penile Skin Bridges with Electrocautery
	| journal = Journal of the American Board of Family Practice
	| volume = 15
	| issue = 6
	| pages = 485&ndash;488
	| pmid = 10605531
	| url = http://www.jabfm.org/cgi/reprint/15/6/485
	| format = PDF
	| accessdate = 2006-07-01
	| date = November 1, 2002 }}
	</ref> Van Howe advises that to prevent adhesions forming after circumcision, parents should be instructed to retract and clean any skin covering the glans.<ref name= "vanhowe1997"/>
			<ref name=darby_2003>{{cite journal| vauthors = Darby R |title=The Masturbation Taboo and the Rise of Routine Male Circumcision: A Review of the Historiography|journal=Journal of Social History|date=Spring 2003|volume=36|issue=3|pages=737–757|doi=10.1353/jsh.2003.0047|s2cid=72536074}}</ref>
	Although ]s have been reported,<ref name="kaplan"/><ref>{{cite web
	| url = http://www.pulsus.com/Paeds/12_04/Pdf/zwol_ed.pdf
	| title = Coroner's Corner Circumcision: A minor procedure?
	| author = Paediatric Death Review Committee: Office of the Chief Coroner of Ontario
	| accessdate = 2007-06-17
	| year = 2007
	| month = April
	| work = Paediatric Child Health Vol 12 No 4, April 2007 pages 311&ndash;312
	| publisher = Pulsus Group Inc.
	| format=PDF}}
	</ref> the ] states that death is rare, and cites an estimated death rate of 1 infant in 500,000 from circumcision.<ref name = "AAFP" /> Gairdner's 1949 study<ref name = "Gairdner">{{cite journal
	| last = Gairdner
	| first = Douglas
	| year = 1949
	| month = December
	| title = The Fate of the Foreskin
	| journal = British Medical Journal
	| volume = 2
	| issue = 4642
	| pages = 1433&ndash;1437
	| doi =10.1136/bmj.2.4642.1433
	| pmid = 15408299
	| url = http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2051968&blobtype=pdf
	| format = PDF
	| accessdate = 2006-07-01
	}}
	</ref> reported that an average of 16 children per year out of about 90,000 died following circumcision in the UK. He found that most deaths had occurred suddenly under anaesthesia and could not be explained further, but hemorrhage and infection had also proven fatal. Deaths attributed to phimosis and circumcision were grouped together, but Gairdner argued that such deaths were probably due to the circumcision operation. The penis is thought to be lost in 1 in 1,000,000 circumcisions.<ref name="RACPComp">{{cite web
	|url=http://www.racp.edu.au/hpu/paed/circumcision/complications.htm
	|title=Complications Of Circumcision
	|accessdate=2006-07-11
	|year=2004
	|month=October
	|work=Paediatric Policy &ndash; Circumcision
	|publisher=The Royal Australasian College of Physicians
	|archiveurl=http://web.archive.org/web/20070111015035/http://www.racp.edu.au/hpu/paed/circumcision/complications.htm
	|archivedate=2007-01-11}}</ref>
			<ref name=darby_2005>{{cite book| vauthors = Darby R |title=A surgical temptation: the demonization of the foreskin and the rise of circumcision in Britain|publisher=University of Chicago Press|location=Chicago|year=2005|isbn=978-0-226-13645-5|pages=262–}}</ref>
	===Sexually transmitted diseases===
	====Human immunodeficiency virus====
	{{Main|Circumcision and HIV}}
	Over forty observational studies have been conducted to investigate the relationship between circumcision and HIV infection.<ref>{{cite journal
	|last=Szabo
	|first=R.
	|coauthors=R.V. Short
	|year=2000
	|month=June
	|title=How does male circumcision protect against HIV infection?
	|journal=BMJ
	|volume=320
	|issue=
	|pages=1592–1594
	|id=
	|url=http://www.bmj.com/cgi/content/full/320/7249/1592?
	|accessdate=
	|quote=
	|doi=10.1136/bmj.320.7249.1592 }}</ref> Reviews of these studies have reached differing conclusions about whether circumcision could be used as a ].<ref name="VanHoweHIVmeta">{{cite journal
	|last= Van Howe
	|first=R.S.
	|authorlink=
	|coauthors=
	|year= 1999
	|month= January
	|title=Circumcision and HIV infection: review of the literature and meta-analysis
	|journal=International Journal of STD's and AIDS
	|volume=10
	|issue=
	|pages=8–16
	|id=
	|doi=10.1258/0956462991913015
	|url=http://www.cirp.org/library/disease/HIV/vanhowe4/
	|accessdate= 2008-09-23
	|quote=<small>Thirty-five articles and a number of abstracts have been published in the medical literature looking at the relationship between male circumcision and HIV infection. Study designs have included geographical analysis, studies of high-risk patients, partner studies and random population surveys. Most of the studies have been conducted in Africa. A meta-analysis was performed on the 29 published articles where data were available. When the raw data are combined, a man with a circumcised penis is at greater risk of acquiring and transmitting HIV than a man with a non-circumcised penis (odds ratio (OR)=1.06, 95% confidence interval (CI)=1.01-1.12). Based on the studies published to date, recommending routine circumcision as a prophylactic measure to prevent HIV infection in Africa, or elsewhere, is scientifically unfounded.</small>}}</ref><ref>{{cite journal
	|last= O'Farrell
	|first=R.S.
	|authorlink=
	|coauthors=M. Egger
	|year=2000
	|month= March
	|title=Circumcision in men and the prevention of HIV infection: a 'meta-analysis' revisited
	|journal=International Journal of STD's and AIDS
	|volume=11
	|issue=3
	|pages=137–142
	|id=
	|doi=10.1258/0956462001915480
	|url=http://www.ncbi.nlm.nih.gov/pubmed/10726934
	|accessdate= 2008-09-25
	|quote=<small>The results from this re-analysis thus support the contention that male circumcision may offer protection against HIV infection, particularly in high-risk groups where genital ulcers and other STDs 'drive' the HIV epidemic. A systematic review is required to clarify this issue. Such a review should be based on an extensive search for relevant studies, published and unpublished, and should include a careful assessment of the design and methodological quality of studies. Much emphasis should be given to the exploration of possible sources of heterogeneity. In view of the continued high prevalence and incidence of HIV in many countries in sub-Saharan Africa, the question of whether circumcision could contribute to prevent infections is of great importance, and a sound systematic review of the available evidence should be performed without delay.</small> }}</ref><ref>{{cite journal
	|last=Weiss
	|first=HA
	|authorlink=
	|coauthors=Quigley MA, Hayes RJ.
	|year=2000
	|month=October 20
	|title=Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis.
	|journal= Aids. 2000
	|volume=14
	|issue=15
	|pages=2361&ndash;70
	|id=
	|url=http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=11089625
	|accessdate= 2007-12-27
	|quote=<small>Male circumcision is associated with a significantly reduced risk of HIV infection among men in sub-Saharan Africa, particularly those at high risk of HIV. These results suggest that consideration should be given to the acceptability and feasibility of providing safe services for male circumcision as an additional HIV prevention strategy in areas of Africa where men are not traditionally circumcised.</small> }}</ref><ref name="SiegfriedCochrane2003">{{cite journal
	|last=Siegfried
	|first=N
	|authorlink=
	|coauthors=M Muller, J Volmink, J Deeks, M Egger, N Low, H Weiss, S Walker, P Williamson
	|year= 2003
	|month= July
	|title=Male circumcision for prevention of heterosexual acquisition of HIV in men
	|journal=Cochrane Database of Systematic Reviews
	|volume=
	|issue= 3
	|pages=
	|id=
	|doi=
	|url=http://www.cirp.org/library/disease/HIV/cochrane2003/
	|accessdate= 2009-07-25
	|quote=<small>We found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men. The results from existing observational studies show a strong epidemiological association between male circumcision and prevention of HIV, especially among high-risk groups. However, observational studies are inherently limited by confounding which is unlikely to be fully adjusted for. In the light of forthcoming results from RCTs, the value of IPD analysis of the included studies is doubtful. The results of these trials will need to be carefully considered before circumcision is implemented as a public health intervention for prevention of sexually transmitted </small> }}</ref>
			<ref name="Doy2005">{{cite journal | vauthors = Doyle D | title = Ritual male circumcision: a brief history | journal = The Journal of the Royal College of Physicians of Edinburgh | volume = 35 | issue = 3 | pages = 279–285 | date = October 2005 | pmid = 16402509 | url = https://www.rcpe.ac.uk/sites/default/files/doyle_circumcision.pdf | access-date = 16 January 2023 | url-status = live | archive-url = https://web.archive.org/web/20230314204243/https://www.rcpe.ac.uk/sites/default/files/doyle_circumcision.pdf | archive-date = 14 March 2023 }}</ref>
	Experimental evidence was needed to establish a causal relationship between lack of circumcision and HIV, so three ] were commissioned as a means to reduce the effect of any ].<ref name="SiegfriedCochrane2003"/> Trials took place in South Africa,<ref name = "ANRS">{{cite journal
	| last = Auvert
	| first = B.
	| coauthors = D. Taljaard, E. Lagarde, J. Sobngwi-Tambekou, R. Sitta and A. Puren
	| year = 2005
	| month = November
	| title = Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial
	| journal = PLoS Medicine
	| volume = 2
	| issue = 11
	| pages = 1112&ndash;1122
	| doi = 10.1371/journal.pmed.0020298
	| pmid = 16231970
	| url = http://medicine.plosjournals.org/archive/1549-1676/2/11/pdf/10.1371_journal.pmed.0020298-S.pdf
	|format=PDF| quote = <small>There were 20 HIV infections (incidence rate = 0.85 per 100 person-years) in the intervention group and 49 (2.1 per 100 person-years) in the control group, corresponding to an RR of 0.40 (95% CI: 0.24%-0.68%; p < 0.001). This RR corresponds to a protection of 60% (95% CI: 32%-76%).</small>
	| accessdate =
	}}
	</ref> ]<ref name="baileyrct">{{cite journal
	| last = Bailey
	| first = Robert C.
	| coauthors = Stephen Moses, Corette B Parker, Kawango Agot, Ian Maclean, John N Krieger, Carolyn F M Williams, Richard T Campbell, Jeckoniah O Ndinya-Achola
	| date = February 24, 2007
	| title = Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial
	| journal = ]
	| volume = 369
	| issue = 9562
	| pages = 643–656
	| publisher = ]
	| location = London
	| pmid = 17321310
	| doi = 10.1016/S0140-6736(07)60312-2
	| oclc = 1755507
	| url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673607603122.pdf
	| format = PDF (free registration required)
	| accessdate = 2008-09-04
	| quote = <small>The two year HIV incidence was 2.1% (95% CI 1.2-3.0) in the circumcision group and 4.2% (3.0-5.4) in the control group (p=0.0065); the relative risk of HIV infection in circumcised men was 0.47 (0.28-0.78), which corresponds to a reduction in the risk of acquiring an HIV infection of 53% (22-72).</small>
	}}
	</ref> and ].<ref>{{cite journal
	|last=Gray
	|first=R.H.
	|authorlink=
	|coauthors=''et al.''
	|year=2007
	|month=February
	|title=Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial
	|journal=Lancet
	|volume=369
	|issue=9562
	|pages=657–666
	|pmid=17321311
	|url=
	|accessdate=
	|quote=<small>In the modified intention-to-treat analysis, HIV incidence over 24 months was 0.66 cases per 100 person-years in the intervention group and 1.33 cases per 100 person-years in the control group (estimated efficacy of intervention 51%, 95% CI 16-72; p=0.006). The as-treated efficacy was 55% (95% CI 22-75; p=0.002); efficacy from the Kaplan-Meier time-to-HIV-detection as-treated analysis was 60% (30-77; p=0.003).</small>
	|doi=10.1016/S0140-6736(07)60313-4 }}</ref> All three trials were stopped early by their monitoring boards on ethical grounds, because those in the circumcised group had a lower rate of HIV contraction than the control group.<ref name="baileyrct" /> The results showed that circumcision reduced vaginal-to-penile transmission of HIV by 60%, 53%, and 51%, respectively.<ref name="Cochrane2009">{{cite journal
	|last=Siegfried
	|first=N
	|authorlink=
	|coauthors=M Muller, J Volmink, J Deeks
	|date= April 15, 2009
	|title=Male circumcision for prevention of heterosexual acquisition of HIV in men
	|journal=Cochrane Database of Systematic Reviews
	|volume=
	|issue= 2
	|pages=
	|pmid=19370585
	|doi=
	|url= http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003362/frame.html
	|accessdate= 2009-09-25}}
	</ref> A meta-analysis of the African randomised controlled trials found that the risk in circumcised males was 0.44 times that in uncircumcised males, and that 72 circumcisions would need to be performed to prevent one HIV infection. The authors also stated that using circumcision as a means to reduce HIV infection would, on a national level, require consistently safe sexual practices to maintain the protective benefit.<ref>{{cite journal |author= E.Mills |coauthors= C.Cooper, A.Anema, G.Guyatt |year=2008 |month=July |title=Male circumcision for the prevention of heterosexually acquired HIV infection: a meta-analysis of randomized trials involving 11050 men |journal=HIV Medicine |volume=9 |issue=6 |pages=332–335 |doi=10.1111/j.1468-1293.2008.00596.x |url=http://www3.interscience.wiley.com/journal/120747249/abstract |accessdate=2008-08-24 |quote= }}</ref>
			<ref name=doyle_2010>{{cite journal | vauthors = Doyle SM, Kahn JG, Hosang N, Carroll PR | title = The impact of male circumcision on HIV transmission | journal = The Journal of Urology | volume = 183 | issue = 1 | pages = 21–26 | date = January 2010 | pmid = 19913816 | doi = 10.1016/j.juro.2009.09.030 }}</ref>
	As a result of these findings, the ] and the Joint United Nations Programme on HIV/AIDS (]) stated that male circumcision is an efficacious intervention for HIV prevention but should be carried out by well trained medical professionals and under conditions of informed consent.<ref name="WHO-GTPDSA"/><ref name="WHO-C&R">{{cite paper
	| title = New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications
	| publisher = ]
	| date = March 28, 2007
	| url = http://www.who.int/hiv/mediacentre/MCrecommendations_en.pdf
	| format = PDF
	| id =
	| accessdate = 2007-08-13
	}}
	</ref><ref name="WHOpr0307">{{cite web |title=WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention |publisher=World Health Organisation |month=March |year=2007 |url=http://www.who.int/hiv/mediacentre/news68/en/index.html}}</ref> Both the WHO and ] indicate that circumcision may not reduce HIV transmission from men to women, and that data is lacking for the transmission rate of men who engage in anal sex with a female partner.<ref name="WHO-C&R"/><ref name="CDC-2008"/> The joint WHO/UNAIDS recommendation also notes that circumcision only provides partial protection from HIV and should never replace known methods of HIV prevention.<ref name="WHOpr0307"/>
			<ref name=DW_2012>{{cite news | url=http://www.dw.de/circumcision-remains-legal-in-germany/a-16399336 | title=Circumcision remains legal in Germany | work=Deutsche Welle | date=12 December 2012 | access-date=11 September 2013 | url-status=live | archive-url=https://web.archive.org/web/20131026154156/http://www.dw.de/circumcision-remains-legal-in-germany/a-16399336 | archive-date=26 October 2013 }}</ref>
	Circumcision has been judged to be a cost-effective method to reduce the spread of HIV in a population,<ref name="WHO-GTPDSA" /> though not necessarily more cost-effective than condoms.<ref name="WHO-GTPDSA" /><ref>{{cite journal | author = Mcallister RG, Travis JW, Bollinger D, Rutiser C, Sundar V| title = The cost to circumcise Africa | journal = ] | publisher = Men's Studies Press | isn = 1532-6306 (Print) 1933-0278 (Online) | volume = 7| number = 3 | year = Fall 2008 | doi = 10.3149/jmh.0703.307 | page = 307–316 | url = http://www.thefreelibrary.com/The+cost+to+circumcise+Africa.-a0189486243 }}</ref> Some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy.<ref>{{cite journal |last=Mills |first=J. |coauthors=N. Siegfried |year=2006 |month=October |title=Cautious optimism for new HIV/AIDS prevention strategies. |journal=Lancet |volume=368 |issue=9543 |pages=1236 |pmid=17027724 |url= |accessdate= |quote= <small>"The inferences drawn from the only completed randomised controlled trial (RCT) of circumcision could be weak because the trial stopped early. In a systematic review of RCTs stopped early for benefit, such RCTs were found to overestimate treatment effects. When trials with events fewer than the median number (n=66) were compared with those with event numbers above the median, the odds ratio for a magnitude of effect greater than the median was 28 (95% CI 11--73). The circumcision trial recorded 69 events, and is therefore at risk of serious effect overestimation. We therefore advocate an impartial meta-analysis of individual patients' data from this and other trials underway before further feasibility studies are done.</small> |doi=10.1016/S0140-6736(06)69513-5 }}</ref><ref>{{cite journal |last=Dowsett |first=G.W. |coauthors=M. Couch |year=2007 |month=May |title=Male circumcision and HIV prevention: is there really enough of the right kind of evidence? |journal=Reproductive Health Matters |volume=15 |issue=29 |pages= 33–44 |pmid=17512372 |url=http://download.journals.elsevierhealth.com/pdfs/journals/0968-8080/PIIS0968808007293024.pdf | format= PDF |accessdate= |quote= |doi=10.1016/S0968-8080(07)29302-4 }}</ref>
			<!-- E -->
	In addition to the studies which provided information about female-to-male transmission, some studies have addressed other transmission routes. A randomised controlled trial in Uganda found that male circumcision did not reduce male to female transmission of HIV. The authors could not rule out the possibility of higher risk of transmission from men who did not wait for the wound to fully heal before engaging in intercourse.<ref>{{cite journal
			<ref name=encyc_religion_2005>{{cite encyclopedia |year=2005 |title=Circumcision |encyclopedia=Encyclopedia of Religion |edition=2 |publisher=Gale}}</ref>
	| last = Wawer
	| first = Maria
	| coauthors = ''et al.''
	| date = 18 July 2009
	| title = Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial
	| journal = Lancet
	| volume = 374
	| issue = 9685
	| pages = 229–237
	| pmid = 19616720
	| doi = 10.1016/S0140-6736(09)60998-3
	| url = http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/fulltext
	| format =
	}}
	</ref> A meta-analysis of data from fifteen observational studies of ] found "insufficient evidence that male circumcision protects against HIV infection or other STIs."<ref>{{cite journal
	|journal=JAMA
	|title=Circumcision Status and Risk of HIV and Sexually Transmitted Infections Among Men Who Have Sex With Men
	|author=Millett GA, Flores SA, Marks G, ''et al.''
	|year=2008
	|volume=300
	|issue=14
	|pages=1674&ndash;1684
	|url=http://jama.ama-assn.org/cgi/content/short/300/14/1674
	|doi=10.1001/jama.300.14.1674
	}}</ref>
			<ref name=encyc_judaica_2006>{{cite encyclopedia | veditors = Skolnik F, Berenbaum M |year=2006 |title=Circumcision |encyclopedia=Encyclopaedia Judaica |edition=2nd |publisher=Macmillan Reference |location=USA |isbn=978-0-02-865928-2}}</ref>
	====Human papilloma virus====
			<!-- F -->
	Meta-analyses by Van Howe <ref>{{cite journal
	| last = Van Howe
	| first = Robert S.
	| month = May
	| year = 2007
	| title = Human papillomavirus and circumcision: A meta-analysis
	| journal = Journal of Infection
	| volume = 54
	| issue = 5
	| pages = 490&ndash;496
	| doi =10.1016/j.jinf.2006.08.005
	| pmid = 16997378
	| url = http://www.cirp.org/library/disease/cancer/vanhowe2006b/
	| accessdate = 2008-09-18
	}}
	</ref> and Bosch ''et al.''<ref name="Bosch2009">{{cite journal |author=Bosch FX, Albero G, Castellsagué X |title=Male circumcision, human papillomavirus and cervical cancer: from evidence to intervention |journal=J Fam Plann Reprod Health Care |volume=35 |issue=1 |pages=5–7 |year=2009 |month=January |pmid=19126309 |doi=10.1783/147118909787072270 |url=}}</ref> of observational studies reached differing conclusions as to whether circumcision reduces infection with ] (HPV). A recent prospective trial in Uganda <ref name = "NEJM">{{cite journal
	| last = Tobian
	| first = Aaron
	| coauthors = ''et al.''
	| year = 2009
	| month = March
	| title = Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis
	| journal = New England Journal of Medicine
	| volume = 360
	| issue = 13
	| pages = 1298–1309
	| doi =10.1056/NEJMoa0802556
	| pmid = 19321868
	| url = http://content.nejm.org/cgi/content/short/360/13/1298
	| accessdate =
	}}
	</ref> randomized 3393 subjects to circumcision or a control group and found a significant reduction of HPV infection in the circumcision group. At 24 month follow-up, there was a 27.9% prevalence of high-risk HPV genotypes in the control group and only a 18.0% prevalence in the circumcision group (adjusted risk ratio, 0.65; 95% CI, 0.46 to 0.90; P=0.009). Another recent trial by Auvert ''et al.'' in Orange Farm, South Africa, randomized men to either a circumcision or control group. At the 21 month visit, the prevalence of high-risk HPV infection was lower in the circumcised men than the uncircumcised participants (14.8% and 22.3% respectively, a prevalence rate ratio of 0.66) in the absence of any difference in reported sexual behaviour or gonorrhea prevalence.<ref>{{cite journal
	| last = Auvert
	| first = B.
	| coauthors = J. Sobngwi-Tambekou, E. Cutler, M. Nieuwoudt, P. Lissouba, A. Puren, D. Taljaard
	| year = 2009
	| month =
	| title = Effect of Male Circumcision on the Prevalence of High-Risk Human Papillomavirus in Young Men: Results of a Randomized Controlled Trial Conducted in Orange Farm, South Africa
	| journal = Journal of Infectious Diseases
	| volume = 199
	| issue = 1
	| pages = 14–19
	| doi =10.1086/595566
	| pmid = 19086814
	| url = http://www.journals.uchicago.edu/doi/pdf/10.1086/595566
	| accessdate = 2009-01-05
	}}
	</ref>
			<!-- G -->
	Two studies have shown that circumcised men report, or were found to have, a higher prevalence of ] than uncircumcised men;<ref>{{cite journal |last=Dinh |first=T.H. |authorlink= |coauthors=M. Sternberg, E.F. Dunne and L.E. Markowitz |year=2008 |month=April |title=Genital Warts Among 18- to 59-Year-Olds in the United States, National Health and Nutrition Examination Survey, 1999-2004 |journal=Sexually Transmitted Diseases |volume=35 |issue=4 |pages=357–360 |pmid=18360316 |url= |accessdate= |quote=The percentage of circumcised men reporting a diagnosis of genital warts was significantly higher than uncircumcised men, 4.5% (95% CI, 3.6%–5.6%) versus 2.4% (95% CI, 1.5%–4.0%) |doi=10.1097/OLQ.0b013e3181632d61 }}</ref><ref>{{cite journal |last=Cook |first=L.S |authorlink= |coauthors=L A Koutsky, K K Holmes |title=Clinical Presentation of Genital Warts Among Circumcised and Uncircumcised Heterosexual Men Attending an Urban STD Clinic |journal=] |volume=69 |issue=4 |pages=262–264 |pmid=7721284 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1195083 |date= August 1, 1993 }}</ref> however, a 2009 meta-analysis of multiple studies found a non-significant association between genital warts and the presence of a foreskin.<ref name="Bosch2009" />
			<ref name="Gable-2007">{{Cite book| vauthors = Gable L, Gamharter K, Gostin L, Hodge Jr J, Puymbroeck R |title=Legal Aspects of HIV/AIDS: A Guide for Policy and Law Reform |publisher=World Bank Publications|year=2007|isbn=978-0-8213-7105-3|pages=38–39|chapter=1.12 Male Circumcision}}</ref>
	====Other sexually transmitted infections====
	Studies evaluating the effect of circumcision on the incidence of other sexually transmitted infections have reached conflicting conclusions. A ] of observational data from twenty-six studies found that circumcision was associated with lower rates of syphilis, ] and possibly genital herpes.<ref name = "Weiss">{{cite journal |title=Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis |first=HA |last=Weiss |coauthors=Thomas, SL; Munabi SK; Hayes RJ |journal=Sex Transm Infect |year=2006 |month=April |volume=82 |issue=2 |pages=101&ndash;9 |pmid=16581731 |url=http://sti.bmj.com/cgi/content/full/82/2/101 |doi=10.1136/sti.2005.017442}}</ref> A large randomized prospective trial in Uganda found a reduction in HSV-2 infection, but not syphilis infection, in the circumcision arm of the study.<ref name = NEJM/> In contrast, some studies have failed to find a prophylactic benefit to circumcision. A prospective trial in India found that circumcision offered no protective benefit against herpes simplex virus type 2, syphilis, or ].<ref>{{cite journal |title=Male circumcision and risk of HIV-1 and other sexually transmitted infections in India |first= |last= |coauthors= S. Reynolds, M. Shepherd , A. Risbud , R. Gangakhedkar , R. Brookmeyer , A. Divekar , S. Mehendale , R. Bollinger |journal=The Lancet |year=2004 |month=March |volume=363 |issue=9414 |pages=1039&ndash;1040 |pmid=15051285 |doi=10.1016/S0140-6736(04)15840-6 |author=Reynolds, S}}</ref> A clinical study of 5,925 women from Uganda, Zimbabwe and Thailand found that the circumcision status of their partner did not significantly affect the incidence of ], ] or ].<ref name = "Turner">{{cite journal |title=Male circumcision and women's risk of incident chlamydial, gonococcal, and trichomonal infections |first=A.N. |last=Turner |coauthors=C.S. Morrison, N.S. Padian, J.S. Kaufman, F.M. Behets, R.A. Salata, F.A. Mmiro, T. Chipato, D.D. Celentano, S. Rugpao and W.C. Miller |journal=Sexually Transmitted Diseases |year=2008 |month=July |volume=35 |issue=7 |pages=689–695 |pmid=18418300 |doi=10.1097/OLQ.0b013e31816b1fcc}}</ref> Laumann ''et al.'' examined observational data from the United States and found no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases.<ref name=Laumann/>
			<ref name=gollaher_2001_ch1>{{cite book |vauthors=Gollaher D | chapter = Chapter 1: The Jewish Tradition | pages = 1–30 |title=Circumcision: A History of the World's Most Controversial Surgery |date=February 2001 |publisher=Basic Books |isbn=978-0-465-02653-1 |url=https://books.google.com/books?id=usEzSffvPBMC |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=usEzSffvPBMC |url-status=dead |archive-date=18 January 2016 }}</ref>
	===Hygiene, and infectious and chronic conditions===
			<ref name=gollaher_2001_ch2>{{cite book |vauthors=Gollaher D | chapter = Chapter 2: Christians and Muslims | pages = 31–52 |title=Circumcision: A History of the World's Most Controversial Surgery |date=February 2001 |publisher=Basic Books |isbn=978-0-465-02653-1 |url=https://books.google.com/books?id=usEzSffvPBMC |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=usEzSffvPBMC |url-status=dead |archive-date=18 January 2016 }}</ref>
	The ] (1999) stated: "Circumcision has been suggested as an effective method of maintaining penile hygiene since the time of the Egyptian dynasties, but there is little evidence to affirm the association between circumcision status and optimal penile hygiene."<ref name = "AAP1999" />
			<ref name=gollaher_2001_ch3>{{cite book |vauthors=Gollaher D | chapter = Chapter 3: Symbolic Wounds | pages = 53–72 |title=Circumcision: A History of the World's Most Controversial Surgery |date=February 2001 |publisher=Basic Books |isbn=978-0-465-02653-1 |url=https://books.google.com/books?id=usEzSffvPBMC |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=usEzSffvPBMC |url-status=dead |archive-date=18 January 2016 }}</ref>
	An inflammation of the glans penis and foreskin is called ]; that affecting the glans alone is called ]. Both conditions are usually treated with topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams. Although not as necessary as in the past, circumcision may be considered for recurrent or resistant cases.<ref>{{cite web
	| url = http://www.emedicine.com/derm/topic615.htm
	| title = Balanitis
	| accessdate = 2008-10-14
	| last = Leber
	| first = Mark J.
	| coauthors = Anuritha Tirumani
	| date = June 8, 2006
	| work =
	| publisher = ]
	}}
	</ref><ref>{{cite web
	| url = http://www.emedicine.com/derm/topic615.htm
	| title = Balanoposthitis
	| accessdate = 2006-11-20
	| last = Osipov
	| first = Vladimir O.
	| authorlink =
	| coauthors = Scott M. Acker
	| date = November 14, 2006
	| work = Reactive and Inflammatory Dermatoses
	| publisher = ]
	}}
	</ref> Escala and Rickwood recommend against a policy of routine infant circumcision to avoid balanitis saying that the condition affects no more than 4% of boys, does not cause pathological phimosis, and in most cases is not serious.<ref>{{cite journal
	| last = Escala
	| first = JM
	| coauthors = AMK Rickwood
	| year = 1988
	| month = March
	| title = Balanitis
	| journal = British journal of urology
	| volume = 63
	| issue = 2
	| pages = 196–197
	| doi =10.1111/j.1464-410X.1989.tb05164.x
	| pmid = 2702407
	| url = http://www.cirp.org/library/disease/balanitis/escala1/
	| accessdate = 2008-10-14
	}}</ref>
			<ref name=gollaher_2001_ch4>{{cite book |vauthors=Gollaher D | chapter = Chapter 4: From Ritual to Science | pages = 73–108 |title=Circumcision: A History of the World's Most Controversial Surgery |date=February 2001 |publisher=Basic Books |isbn=978-0-465-02653-1 |url=https://books.google.com/books?id=usEzSffvPBMC |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=usEzSffvPBMC |url-status=dead |archive-date=18 January 2016 }}</ref>
	Fergusson studied 500 boys and found that by 8 years, the circumcised children had a rate of 11.1 problems per 100 children, and the uncircumcised children had a rate of 18.8 per 100. During infancy, circumcised children were found to have a significantly higher risk of problems than uncircumcised children, but after infancy the rate of penile problems was significantly higher among the uncircumcised. Fergusson ''et al.'' said that the great majority of penile problems were relatively minor (penile inflammation including balanitis, meatitis, and inflammation of the prepuce) and most (64%) were resolved after a single medical consultation.<ref name = "Ferg">{{cite journal
	| last = Fergusson
	| first = DM
	| coauthors = JM Lawton and FT Shannon
	| year = 1988
	| month = April
	| title = Neonatal circumcision and penile problems: an 8-year longitudinal study
	| journal = Pediatrics
	| volume = 81
	| issue = 4
	| pages = 537&ndash;541
	| doi =
	| pmid = 3353186
	| url = http://www.circs.org/library/fergusson/index.html
	| accessdate = 2007-07-18
	}}</ref> Herzog and Alverez found the overall frequency of complications (including balanitis, irritation, adhesions, phimosis, and paraphimosis) to be higher among the uncircumcised children; again, most of the problems were minor.<ref>{{cite journal |last=Herzog |first=LW |coauthors=SR Alvarez |year=1986 |month=March |title=The frequency of foreskin problems in uncircumcised children |journal=Am J Dis Child |volume=140 |issue=3 |pages=254&ndash;6 |pmid=3946358| url=http://www.circs.org/library/herzog/index.html}}</ref> In a study of 398 randomly selected dermatology students, Fakjian ''et al.'' reported: "Balanitis was diagnosed in 2.3% of circumcised men and in 12.5% of uncircumcised men."<ref>{{cite journal |last=Fakjian |first=N |coauthors=S Hunter, GW Cole and J Miller |year=1990 |month=August |title=An argument for circumcision. Prevention of balanitis in the adult |journal=Arch Dermatol |volume=126 |issue=8 |pages=1046&ndash;7 |pmid=2383029 |doi=10.1001/archderm.126.8.1046 }}</ref> In a study of 225 men, O'Farrell ''et al.'' reported: "Overall, circumcised men were less likely to be diagnosed with a ]/balanitis (51% and 35%, P = 0.021) than those non-circumcised."<ref name="OF1">{{cite journal
	| last = O’Farrel
	| first = Nigel
	| coauthors = Maria Quigley and Paul Fox
	| year = 2005
	| month = August
	| title = Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study
	| journal = International Journal of STD & AIDS
	| volume = 16
	| issue = 8
	| pages = 556–588(4)
	| doi = 10.1258/0956462054679151
	| pmid = 16105191
	| url = http://ijsa.rsmjournals.com/cgi/content/abstract/16/8/556
	| format = Abstract
	| accessdate = 2008-09-06
	| quote = <small>Overall, circumcised men were less likely to be diagnosed with a STI/balanitis (51% and 35%, P = 0.021) than those non-circumcised.</small>
	}}{verify source}
	</ref> Van Howe found that circumcised penises required more care in the first 3 months of life, and that circumcised boys are more likely to develop balanitis.<ref>{{cite journal
	| last = Van Howe
	| initial = Robert S.
	| year = 2007
	| month = May
	| title = Neonatal Circumcision and Penile Inflammation in Young Boys
	| journal = Clinical Pediatrics
	| volume = 46
	| issue = 4
	| pages = 329–333
	| doi = 10.1177/0009922806295708
	| pmid = 17475991
	| url = http://cpj.sagepub.com/cgi/content/abstract/46/4/329
	| quote = <small>Penile inflammation was more common in circumcised than noncircumcised boys, especially in the first 3 years of life (exact odds ratio, 8.01, 95% confidence interval, 31-329.15). When adjusted for the number of genital examinations and age younger than 3 years, exact logistic regression found an adjusted exact odds ratio of 7.91 (95% confidence interval, 1.76-77.66).</small>
	}}</ref>
			<!-- H -->
	The American Medical Association states that circumcision, properly performed, protects against the development of phimosis.<ref name = "CSA:I-99" /> Rickwood and other authors have argued that many infant circumcisions are performed unnecessarily for developmental non-retractability of the prepuce rather than for pathological phimosis.<ref name="Rickwood">{{cite journal
			<ref name="Hamilton-1990">{{Cite book | vauthors = Hamilton V |title=The Book of Genesis, Chapters 1-17 |publisher=] |year=1990 |isbn=978-0-8028-2521-6 |pages=473 |quote=In fact, circumcision is only one of two performative commands, the neglect of which bring the kareth penalty. (The other is the failure to be cleansed from corpse contamination, umb. 19:11-22.) |author-link=Victor P. Hamilton}}</ref>
	| last = Rickwood
	| initial = A. M. K.
	| coauthors = Jenny Walker
	| title = Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence?
	| journal = Annals of the royal college of surgery
	| volume = 71
	| issue = 5
	| pages = 275–277
	| url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2499015
	| pmid = 2802472
	| date = September 1, 1989 }}
	</ref><ref>{{cite journal
	| last = Shankar
	| initial = KR
	| coauthors = AM Rickwood
	| year = 1999
	| month = July
	| title = The incidence of phimosis in boys
	| journal = BJU International
	| volume = 84
	| issue = 1
	| pages = 101–102
	| pmid = 10444134
	| url = http://www3.interscience.wiley.com/cgi-bin/fulltext/119091453/PDFSTART
	| format = PDF
	| doi = 10.1046/j.1464-410x.1999.00147.x
	}}
	</ref> Metcalfe ''et al.'' stated that "Gairdner<ref name = "Gairdner"/> and Oster<ref name="oster">{{cite journal
	| last = Øster
	| first = Jakob
	| year = 1968
	| month = April
	| title = Incidence of Preputial Adhesions, Phimosis, and Smegma among Danish Schoolboys
	| journal = Archives of disease in childhood
	| volume = 43
	| issue = 228
	| pages = 200–203
	| url = http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2019851&blobtype=pdf
	| format = PDF
	| doi = 10.1136/adc.43.228.200
	}}
	</ref> made a strong case for leaving boys uncircumcised, allowing the natural separation of the foreskin from the glans to take place gradually, and instructing boys in proper hygiene. This obviates the need for 'preventive' circumcision."<ref name="Metcalfe">{{cite journal
	| last = Metcalfe
	| first = Thomas J.
	| coauthors = Lucy M. Osborn, E. Mark Mariani
	| year = 1983
	| month = August
	| title = Circumcision: A Study of Current Practices
	| journal = Clinical Pediatrics
	| volume = 22
	| issue = 8
	| pages = 575–579
	| doi = 10.1177/000992288302200811
	| pmid = 6861426
	| url = http://www.cirp.org/library/procedure/metcalf/
	}}
	</ref> In a study to determine the most cost-effective treatment for phimosis, Van Howe concluded that using cream was 75% more cost-effective than circumcision at treating pathological phimosis.<ref>{{cite journal
	| last = Van Howe
	| first = Robert S.
	| year = 1998
	| month = October
	| title = Cost effective treatment of phimosis
	| journal = Pediatrics
	| volume = 102
	| issue = 4
	| pages = e43
	| doi = 10.1542/peds.102.4.e43
	| pmid = 9755280
	| url = http://pediatrics.aappublications.org/cgi/content/full/102/4/e43
	| quote = <small>The argument that circumcision is a minor surgical procedure without complications is not only erroneous, but also irrelevant. It is ethically as well as economically questionable to operate on a child to treat a physiological process</small>
	}}</ref>
			<ref name=hankins_2011>{{cite journal | vauthors = Hankins C, Forsythe S, Njeuhmeli E | title = Voluntary medical male circumcision: an introduction to the cost, impact, and challenges of accelerated scaling up | journal = PLOS Medicine | volume = 8 | issue = 11 | pages = e1001127 | date = November 2011 | pmid = 22140362 | pmc = 3226452 | doi = 10.1371/journal.pmed.1001127 | veditors = Sansom SL | doi-access = free }}</ref>
	====Urinary tract infections====
	A meta-analysis of 12 studies (one ], four ] and seven ]) representing 402,908 children determined that circumcision was associated with a significantly reduced risk of ] (UTI). However, the authors noted that only 1% of boys with normal urinary tract function experience a UTI, and the number-needed-to treat (number of circumcisions necessary) to prevent one urinary tract infection was calculated to be 111. Because haemorrhage and infection are the commonest complications of circumcision, occurring at rate of about 2%, assuming equal utility of benefits and harms, the authors concluded that the net clinical benefit of circumcision is only likely in boys at high risk of urinary tract infection (such as those with high grade ] or a history of recurrent UTIs, where the number needed to treat declined to 11 and 4, respectively).<ref name="singhgrewal2005">{{cite journal | last = Singh-Grewal | first = D. | coauthors = J. Macdessi, and J. Craig | date = August 1, 2005 | title = Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies | journal = Archives of Disease in Childhood | volume = 90 | issue = 8 | pages = 853&ndash;858 | doi = 10.1136/adc.2004.049353 | pmid = 15890696 | url = http://adc.bmjjournals.com/cgi/reprint/90/8/853.pdf | format = PDF | accessdate = 2006-09-21 | quote = Circumcision was associated with a significantly reduced risk of UTI (OR = 0.13; 95% CI, 0.08 to 0.20; p<0.001) with the same odds ratio (0.13) for all three types of study design.}}</ref>
			<ref name="hay_2012">{{cite book |vauthors=Hay W, Levin M |title=Current Diagnosis and Treatment Pediatrics 21/E |pages=18–19 |date=25 June 2012 |publisher=McGraw Hill Professional |isbn=978-0-07-177971-5 |url=https://books.google.com/books?id=V8lMJniWK_QC |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=V8lMJniWK_QC |archive-date=18 January 2016 }}</ref>
	Some UTI studies have been criticized for not taking into account a high rate of UTI's among premature infants, who are usually not circumcised because of their fragile health status.<ref name = "AAP1999" /> The AMA stated that “depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI," and noted one decision analysis model that concluded that circumcision was not justified as a preventative measure against UTI.<ref name = "CSA:I-99" />
			<ref name=hpv_prevalence_ref_bundle>See: Larke ''et al.'' "Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis" (2011), Albero ''et al.'' "Male Circumcision and Genital Human Papillomavirus: A Systematic Review and Meta-Analysis" (2012), Rehmeyer "Male Circumcision and Human Papillomavirus Studies Reviewed by Infection Stage and Virus Type" (2011).</ref>
	===Penile cancer===
	The ] (2009) stated, "Most experts agree that circumcision should not be recommended solely as a way to prevent ]."<ref>{{cite web |title=Can Penile Cancer be Prevented? |url=http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_penile_cancer_be_prevented_35.asp}}</ref>
			<!-- I -->
	The ] (1999) stated that studies suggest that neonatal circumcision confers some protection from penile cancer, but circumcision at a later age does not seem to confer the same level of protection. Further, because penile cancer is a rare disease, the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, remains low.<ref name = "AAP1999" />
			<!-- J -->
			<ref name=jagannath_2012>{{cite journal | vauthors = Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S | title = Routine neonatal circumcision for the prevention of urinary tract infections in infancy | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 5 | pages = CD009129 | date = November 2012 | pmid = 23152269 | doi = 10.1002/14651858.CD009129.pub2 | veditors = Fedorowicz Z }}</ref>
			<!-- K -->
	The age-adjusted annual incidence of penile cancer is 0.82 per 100,000 in Denmark, 2.9-6.8 per 100,000 in Brazil, 0.9 to 1 per 100,000 in the USA, and 2.0-10.5 per 100,000 in India.<ref name = "AAP1999" /> Researchers have reported that the risk of penile cancer is greater in never-circumcised men than in men who had been circumcised at birth; estimates of the relative risk include 3<ref>{{cite journal |title=History of circumcision, medical conditions, and sexual activity and risk of penile cancer |first=C |last=Maden |coauthors=''et al.'' |journal=J Natl Cancer Inst |year=1993 |month=January |volume=85 |issue=1 |pages=19&ndash;24 |pmid=8380060 |doi=10.1093/jnci/85.1.19}}</ref> and 22.<ref>{{cite journal |url=http://pediatrics.aappublications.org/cgi/content/full/105/3/e36 |title=The highly protective effect of newborn circumcision against invasive penile cancer |first=EJ |last=Schoen |coauthors=Oehrli, M; Colby, C; Machin, G | journal=Pediatrics |year=2000 |month=March |volume=105 |issue=3 |pages=e36 |doi=10.1542/peds.105.3.e36}}</ref>
			<!-- L -->
			<ref name=larke_penile_cancer_2011>{{cite journal | vauthors = Larke NL, Thomas SL, dos Santos Silva I, Weiss HA | title = Male circumcision and penile cancer: a systematic review and meta-analysis | journal = Cancer Causes & Control | volume = 22 | issue = 8 | pages = 1097–1110 | date = August 2011 | pmid = 21695385 | pmc = 3139859 | doi = 10.1007/s10552-011-9785-9 }}</ref>
	==Policies of various national medical associations==
	====Australasia====
	The ] (RACP; 2009) state that "after extensive review of the literature not recommend that routine circumcision in infancy be performed, but that parents should be able to make this decision with their doctors. One reasonable option is for routine circumcision to be delayed until males are old enough to make an informed choice. In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents. In the absence of evidence of substantial harm, parental choice should be respected."<ref>{{cite web |title=Current College Position on Circumcision |publisher=Royal Australasian College of Physicians |date=27 August 2009 |url=http://racp.edu.au/download.cfm?DownloadFile=59AE2C7C-9F08-B344-21061157DF3636B9}}</ref>
			<ref name="larke_HPV_2011">{{cite journal | vauthors = Larke N, Thomas SL, Dos Santos Silva I, Weiss HA | title = Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis | journal = The Journal of Infectious Diseases | volume = 204 | issue = 9 | pages = 1375–1390 | date = November 2011 | pmid = 21965090 | doi = 10.1093/infdis/jir523 | doi-access = free }}</ref>
	The Tasmanian President of the Australian Medical Association (AMA), Haydn Walters, has stated that the AMA would support a call to ban circumcision for non-medical, non-religious reasons.<ref>{{cite news |url=http://www.abc.net.au/news/stories/2007/12/09/2113665.htm |title=Doctors back call for circumcision ban |date=2007-12-09 |publisher=ABC News}}</ref>
			<ref name=leber_2006>{{cite web |url=http://www.emedicine.com/derm/topic615.htm |title=Balanitis |access-date=14 October 2008 |vauthors=Leber M, Tirumani A |date=8 June 2006 |publisher=EMedicine |url-status=live |archive-url=https://web.archive.org/web/20081007002704/http://www.emedicine.com/DERM/topic615.htm |archive-date=7 October 2008 }}</ref>
	====Canada====
	The Fetus and Newborn Committee of the ] posted "Neonatal circumcision revisited" in 1996 and "Circumcision: Information for Parents" in November 2004. The 1996 position statement says that "circumcision of newborns should not be routinely performed",<ref name = "CMAJ2">{{cite journal
	| last = Fetus and Newborn Committee
	| year = 1996
	| month = March
	| title = Neonatal circumcision revisited
	| journal = Canadian Medical Association Journal
	| volume = 154
	| issue = 6
	| pages = 769&ndash;780
	| doi =
	| id =
	| url = http://www.cps.ca/english/statements/FN/fn96-01.htm
	| accessdate = 2006-07-02
	}}
	<small>"We undertook this literature review to consider whether the CPS should change its position on routine neonatal circumcision from that stated in 1982. The review led us to conclude the following. There is evidence that circumcision results in an approximately 12-fold reduction in the incidence of UTI during infancy. The overall incidence of UTI in male infants appears to be 1% to 2%. The incidence rate of the complications of circumcision reported in published articles varies, but it is generally in the order of 0.2% to 2%. Most complications are minor, but occasionally serious complications occur. There is a need for good epidemiological data on the incidence of the surgical complications of circumcision, of the later complications of circumcision and of problems associated with lack of circumcision. Evaluation of alternative methods of preventing UTI in infancy is required. More information on the effect of simple hygienic interventions is needed. Information is required on the incidence of circumcision that is truly needed in later childhood. There is evidence that circumcision results in a reduction in the incidence of penile cancer and of HIV transmission. However, there is inadequate information to recommend circumcision as a public health measure to prevent these diseases. When circumcision is performed, appropriate attention needs to be paid to pain relief. The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns. There is therefore no indication that the position taken by the CPS in 1982 should be changed. When parents are making a decision about circumcision, they should be advised of the present state of medical knowledge about its benefits and harms. Their decision may ultimately be based on personal, religious or cultural factors."</small>
	</ref> and the 2004 information to parents says: 'Circumcision is a "non-therapeutic" procedure, which means it is not medically necessary. Parents who decide to circumcise their newborns often do so for religious, social, or cultural reasons. After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.'<ref name = "CPSIFP2">{{cite web
	| url = http://www.cps.ca/caringforkids/pregnancy&babies/Circumcision.htm
	| title = Circumcision: Information for parents
	| accessdate = 2006-10-24
	| year = 2004
	| month = November
	| work = Caring for kids
	| publisher = ]
	| quote = <small>Circumcision is a "non-therapeutic" procedure, which means it is not medically necessary. Parents who decide to circumcise their newborns often do so for religious, social, or cultural reasons. To help make the decision about circumcision, parents should have information about risks and benefits. It is helpful to speak with your baby’s doctor. After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.</small>
	}}
	</ref>
			<ref name="lissauer_2012">{{cite book|title=Illustrated Textbook of Paediatrics, Fourth edition|vauthors=Lissauer T, Clayden G|date=October 2011|publisher=Elsevier|isbn=978-0-7234-3565-5|pages=352–353|quote=}}</ref>
	====United Kingdom====
	“Male circumcision that is performed for any reason other than physical clinical need is termed non-therapeutic (or sometimes “ritual”) circumcision. Some people ask for non-therapeutic circumcision for religious reasons, some to incorporate a child into a community, and some want their sons to be like their fathers. Circumcision is a defining feature of some faiths.” “The Association has no policy on these issues.”
			<ref name=lonngvist_2010>{{cite journal | vauthors = Lönnqvist PA | title = Regional anaesthesia and analgesia in the neonate | journal = Best Practice & Research. Clinical Anaesthesiology | volume = 24 | issue = 3 | pages = 309–321 | date = September 2010 | pmid = 21033009 | doi = 10.1016/j.bpa.2010.02.012 }}</ref>
	The BMA provides that “male circumcision is generally assumed to be lawful provided that it is performed competently; it is believed to be in the child’s best interests; and there is valid consent” from both parents and the child, if possible."
			<!-- M -->
	The BMS stipulates that “competent children may decide for themselves; the wishes that children express must be taken into account; if parents disagree, non-therapeutic circumcision must not be carried out without the leave of a court; consent should be confirmed in writing."
			<ref name="Mark-2003a">{{Cite book | vauthors = Mark E |title=The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite |publisher=] |year=2003 |isbn=978-1-58465-307-3 |pages=141 |chapter=Frojmovic/Travelers to the Circumcision |quote=Circumcision became the single most important commandment... the one without which... no Jew could attain the world to come.}}</ref>
	"In the past, circumcision of boys has been considered to be either medically or socially beneficial or, at least, neutral. The general perception has been that no significant harm was caused to the child and therefore with appropriate consent it could be carried out. The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks. It is essential that doctors perform male circumcision only where this is demonstrably in the best interests of the child. The responsibility to demonstrate that non-therapeutic circumcision is in a particular child’s best interests falls to his parents. The BMA considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it."<ref name = "BMAGuide" />
			<ref name = "Marrazzo et al. 2014">{{cite journal | vauthors = Marrazzo JM, del Rio C, Holtgrave DR, Cohen MS, Kalichman SC, Mayer KH, Montaner JS, Wheeler DP, Grant RM, Grinsztejn B, Kumarasamy N, Shoptaw S, Walensky RP, Dabis F, Sugarman J, Benson CA | title = HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel | journal = JAMA | volume = 312 | issue = 4 | pages = 390–409 | date = 23–30 Jul 2014 | pmid = 25038358 | pmc = 6309682 | doi = 10.1001/jama.2014.7999 }}</ref>
	====United States====
	The ] (1999) stated: "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child."<ref name = "AAP1999" /> The AAP recommends that if parents choose to circumcise, analgesia should be used to reduce pain associated with circumcision. It states that circumcision should only be performed on newborns who are stable and healthy.<ref name = "AAP1999" />
			<ref name=matthew_2004>{{cite book| vauthors = Matthew HC |title=Oxford dictionary of national biography: in association with the British Academy: from the earliest times to the year 2000|url=https://archive.org/details/isbn_0198613644|url-access=registration|publisher=Oxford University Press|location=Oxford New York|year=2004|isbn=978-0-19-861411-1}}</ref>
	The ] supports the AAP's 1999 circumcision policy statement with regard to non-therapeutic circumcision, which they define as the non-religious, non-ritualistic, not medically necessary, elective circumcision of male newborns. They state that "policy statements issued by professional societies representing Australian, Canadian, and American pediatricians do not recommend routine circumcision of male newborns."<ref name = "CSA:I-99"/>
			<ref name="Merson-2017">{{Cite book | vauthors = Merson M, Inrig S |title=The AIDS Pandemic: Searching for a Global Response |publisher=] |year=2017 |isbn=978-3-319-47133-4 |pages=379 |quote=This led to a consensus that male circumcision should be a priority for HIV prevention in countries and regions with heterosexual epidemics and high HIV and low male circumcision prevalence.}}</ref>
	The ] (2007) recognizes the controversy surrounding circumcision and recommends that physicians "discuss the potential harms and benefits of circumcision with all parents or legal guardians considering this procedure for their newborn son."<ref name = "AAFP2">{{cite web
	| url = http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html
	| title = Circumcision: Position Paper on Neonatal Circumcision
	| accessdate = 2007-01-30
	| year = 2007
	| publisher = ]
	| quote = <small>Considerable controversy surrounds neonatal circumcision. Putative indications for neonatal circumcision have included preventing UTIs and their sequelae, preventing the contraction of STDs including HIV, and preventing penile cancer as well as other reasons for adult circumcision. Circumcision is not without risks. Bleeding, infection, and failure to remove enough foreskin occur in less than 1% of circumcisions. Evidence-based complications from circumcision include pain, bruising, and meatitis. More serious complications have also occurred. Although numerous studies have been conducted to evaluate these postulates, only a few used the quality of methodology necessary to consider the results as high level evidence.<br />
	<br />
	The evidence indicates that neonatal circumcision prevents UTIs in the first year of life with an absolute risk reduction of about 1% and prevents the development of penile cancer with an absolute risk reduction of less than 0.2%. The evidence suggests that circumcision reduces the rate of acquiring an STD, but careful sexual practices and hygiene may be as effective. Circumcision appears to decrease the transmission of HIV in underdeveloped areas where the virus is highly prevalent. No study has systematically evaluated the utility of routine neonatal circumcision for preventing all medically-indicated circumcisions in later life. Evidence regarding the association between cervical cancer and a woman’s partner being circumcised or uncircumcised, and evidence regarding the effect of circumcision on sexual functioning is inconclusive. If the decision is made to circumcise, anesthesia should be used.<br />
	<br />
	The American Academy of Family Physicians recommends physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering this procedure for their newborn son.</small>
	}}</ref>
			<!-- N -->
	The ] (2007) stated that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks.<ref name="AUApolicy"> {{cite web |url=http://www.auanet.org/content/guidelines-and-quality-care/policy-statements/c/circumcision.cfm |title=Circumcision |accessdate=2008-11-02 |author=American Urological Association |format= |work= }}</ref>
			<ref name=NYTimes_2009>{{cite news |title=AIDS: New Web Site Seeks to Fight Myths About Circumcision and H.I.V. | vauthors = McNeil Jr DG |author-link=Donald McNeil, Jr. |url=https://www.nytimes.com/2009/03/03/health/03glob.html |newspaper=The New York Times |date=3 March 2009 |page=D6 |access-date=1 February 2012 |url-status=live |archive-url=https://web.archive.org/web/20140108150300/http://www.nytimes.com/2009/03/03/health/03glob.html |archive-date=8 January 2014 }}</ref>
			<!-- O -->
	==See also==
			<ref name=osipov_2006>{{cite web |url=http://www.emedicine.com/derm/topic615.htm |title=Balanoposthitis |access-date=20 November 2006 |vauthors=Osipov V, Acker S |date=November 2006 |website=Reactive and Inflammatory Dermatoses |publisher=EMedicine |url-status=live |archive-url=https://web.archive.org/web/20061211115857/http://emedicine.com/DERM/topic615.htm |archive-date=11 December 2006 }}</ref>
	*]
	*]
	*]
	*], alternative to circumcision in the treatment for phimosis
	*]
	*](Islamic)
			<!-- P -->
	==Further reading==
			<ref name=perera_2010>{{cite journal | vauthors = Perera CL, Bridgewater FH, Thavaneswaran P, Maddern GJ | title = Safety and efficacy of nontherapeutic male circumcision: a systematic review | journal = Annals of Family Medicine | volume = 8 | issue = 1 | pages = 64–72 | year = 2010 | pmid = 20065281 | pmc = 2807391 | doi = 10.1370/afm.1073 }}</ref>
	<!-- The following references should be moved into cite tags as in ], above. -->
	* Billy Ray Boyd. ''Circumcision Exposed: Rethinking a Medical and Cultural Tradition.'' Freedom, CA: The Crossing Press, 1998. (ISBN 978-0-89594-939-4)
	* Anne Briggs. ''Circumcision: What Every Parent Should Know.'' Charlottesville, VA: Birth & Parenting Publications, 1985. (ISBN 978-0-9615484-0-7)
	* Robert Darby. ''A surgical temptation: The demonization of the foreskin and the rise of circumcision in Britain.'' Chicago: University of Chicago Press, 2005. (ISBN 978-0-226-13645-5)
	* Aaron J. Fink, M.D. ''Circumcision: A Parent's Decision for Life''. Kavanah Publishing Company, Inc., 1988. (ISBN 978-0-9621347-0-8)
	* Paul M. Fleiss, M.D. and Frederick Hodges, D. Phil. ''What Your Doctor May'' Not ''Tell You About Circumcision.'' New York: Warner Books, 2002. (ISBN 978-0-446-67880-3)
	* Leonard B. Glick. ''Marked in Your Flesh: Circumcision from Ancient Judea to Modern America.'' New York: Oxford University Press, 2005. (ISBN 978-0-19-517674-2)
	* ]. ''Circumcision: A History of the World's Most Controversial Surgery.'' New York: Basic Books, 2000. (ISBN 0465026532)
	* Ronald Goldman, Ph.D. ''Circumcision: The Hidden Trauma.'' Boston: Vanguard, 1996. (ISBN 978-0-9644895-3-0)
	* ], Rabbi. ''Bris Milah. Circumcision&mdash;The Covenant Of Abraham/A Compendium of Laws, Rituals, And Customs From Birth To Bris, Anthologized From Talmudic, And Traditional Sources.'' New York: Mesorah Publications, 1985, 2005.
	* Brian J. Morris, Ph.D., D.Sc. ''In Favour of Circumcision.'' Sydney: UNSW Press, 1999. (ISBN 978-0-86840-537-7)
	* ]. ''.'' Philadelphia and London; F. A. Davis; 1891.
	* Holm Putzke, Ph.D. ''Die strafrechtliche Relevanz der Beschneidung von Knaben. Zugleich ein Beitrag über die Grenzen der Einwilligung in Fällen der Personensorge'', in: H. Putzke u.a. (Hrsg.), ''Strafrecht zwischen System und Telos'', Festschrift für Rolf Dietrich Herzberg zum siebzigsten Geburtstag am 14. Februar 2008 , Mohr Siebeck: Tübingen 2008, p.&nbsp;669–709 (ISBN 978-3161495700)
	* Holm Putzke, Ph.D., Maximilian Stehr, Ph.D., and Hans-Georg Dietz, Ph.D. ''Liability to penalty for circumcision in boys. Medico-legal aspects of a controversial medical intervention'', in: Monatsschrift Kinderheilkunde 8/2008, p.&nbsp;783–788
	* Rosemary Romberg. ''Circumcision: The Painful Dilemma.'' South Hadley, MA Bergan & Garvey, 1985. (ISBN 978-0-89789-073-1)
	* Edgar J Schoen, M.D. ''Ed Schoen, MD on Circumcision.'' Berkeley, CA: RDR Books, 2005. (ISBN 978-1-57143-123-3)
	* Edward Wallerstein. ''Circumcision: An American Health Fallacy.'' New York: Springer, 1980 (ISBN 978-0-8261-3240-6)
	* Gerald N. Weiss M.D. and Andrea W Harter. ''Circumcision: Frankly Speaking.'' Wiser Publications, 1998. (ISBN 978-0-9667219-0-4)
	* Yosef David Weisberg, Rabbi. ''Otzar Habris. Encyclopedia of the laws and customs of Bris Milah and Pidyon Haben.'' Jerusalem: Hamoer, 2002.
			<!-- Q -->
	==Notes and references==
			<!-- R -->
	{| class="messagebox" style="background: {{{#666666}}};"
			<ref name=RACP_2010>{{cite web | url=https://www.racp.edu.au/docs/default-source/advocacy-library/circumcision-of-infant-males.pdf | title=Circumcision of Infant Males | publisher=The Royal Australasian College of Physicians | date=Sep 2010 | access-date=11 September 2013 | url-status=live | archive-url=https://web.archive.org/web/20150812092333/http://www.racp.edu.au/docs/default-source/advocacy-library/circumcision-of-infant-males.pdf | archive-date=12 August 2015 }}</ref>
	|-
	||Some referenced articles are available on-line only in the Circumcision Information and Resource Page’s (CIRP) library or in The Circumcision Reference Library (CIRCS). CIRP articles are chosen from an anti-circumcision point of view, and text in support of this position is often highlighted on-screen using ]. CIRCS articles are chosen from a pro-circumcision point of view. If documents are not freely available on-line elsewhere, links to articles in one or other of these two websites may be provided.
	|}
	{{Reflist|colwidth=30em}}
			<ref name="rehmeyer_2011">{{cite journal | vauthors = Rehmeyer CJ | title = Male circumcision and human papillomavirus studies reviewed by infection stage and virus type | journal = The Journal of the American Osteopathic Association | volume = 111 | issue = 3 Suppl 2 | pages = S11–S18 | date = March 2011 | pmid = 21415373 }}</ref>
	==External links==
	{{Commons category}}
	===Circumcision opposition===
	* by Georganne Chapin.
	* by ], RN.
	* by Geoffrey T. Falk.
	* Presided by George C. Denniston, MD, MPH.
	* by Dan Bollinger.
			<ref name=riggs_2006>{{cite book | vauthors = Riggs T |title=Worldmark Encyclopedia of Religious Practices: Religions and denominations |chapter=Christianity: Coptic Christianity |year=2006 |publisher=Thomson Gale |isbn=978-0-7876-6612-5 |chapter-url=https://books.google.com/books?id=uTMOAQAAMAAJ |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=uTMOAQAAMAAJ |archive-date=18 January 2016 }}</ref>
	===Circumcision promotion===
	* by ], the ], the ], and ]
	* by Professor ]
	* by ], BSc., M.D.
	* maintained by Jake Waskett.
	* by Rabbi ].
			<ref name=rudolph_2011>{{cite book |vauthors=Rudolph C, Rudolph A, Lister G, First L, Gershon A |title=Rudolph's Pediatrics | edition = 22nd |page=188 |date=18 March 2011 |publisher=McGraw-Hill Companies, Incorporated |isbn=978-0-07-149723-7 |url=https://books.google.com/books?id=or15PgAACAAJ |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=or15PgAACAAJ |archive-date=18 January 2016 }}</ref>
	===Circumcision techniques and videos===
	* from the ].
			<!-- S -->
	* Videos of infant circumcision: using a , a and a (all from Stanford Medical School.)
	*
			<ref name="Selekman-2020">{{Cite book| vauthors = Selekman R, Copp H |title=Campbell Walsh Wein Urology|publisher=Elsevier|year=2020|isbn=978-0-323-67227-6| veditors = Partin A |edition=12th |pages=388–402 |chapter=Urologic Evaluation of the Child}}</ref>
			<ref name="siegfried_Cochrane_2009">{{cite journal | vauthors = Siegfried N, Muller M, Deeks JJ, Volmink J | title = Male circumcision for prevention of heterosexual acquisition of HIV in men | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD003362 | date = April 2009 | pmid = 19370585 | doi = 10.1002/14651858.CD003362.pub2 | veditors = Siegfried N }}</ref>
			<ref name=shockley_2011>{{cite journal | vauthors = Shockley RA, Rickett K | title = Clinical inquiries. What's the best way to control circumcision pain in newborns? | journal = The Journal of Family Practice | volume = 60 | issue = 4 | pages = 233a–233b | date = April 2011 | pmid = 21472156 }}</ref>
			<!-- T -->
			<ref name=templeton_2010>{{cite journal | vauthors = Templeton DJ, Millett GA, Grulich AE | title = Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men | journal = Current Opinion in Infectious Diseases | volume = 23 | issue = 1 | pages = 45–52 | date = February 2010 | pmid = 19935420 | doi = 10.1097/QCO.0b013e328334e54d | s2cid = 43878584 }}</ref>
			<ref name="Thomas_2021">{{cite journal | vauthors = Thomas A, Necchi A, Muneer A, Tobias-Machado M, Tran AT, Van Rompuy AS, Spiess PE, Albersen M | title = Penile cancer | journal = Nature Reviews. Disease Primers | volume = 7 | issue = 1 | pages = 11 | date = February 2021 | pmid = 33574340 | doi = 10.1038/s41572-021-00246-5 | type = Review | s2cid = 231877615 }}</ref>
			<!-- U -->
			<ref name=uthman_2010>{{cite journal | vauthors = Uthman OA, Popoola TA, Uthman MM, Aremu O | title = Economic evaluations of adult male circumcision for prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa: a systematic review | journal = PLOS ONE | volume = 5 | issue = 3 | pages = e9628 | date = March 2010 | pmid = 20224784 | pmc = 2835757 | doi = 10.1371/journal.pone.0009628 | veditors = Van Baal PH | doi-access = free | bibcode = 2010PLoSO...5.9628U }}</ref>
			<!-- V -->
			<!-- W -->
			<ref name=weiss_2006_syphilis>{{cite journal | vauthors = Weiss HA, Thomas SL, Munabi SK, Hayes RJ | title = Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis | journal = Sexually Transmitted Infections | volume = 82 | issue = 2 | pages = 101–9; discussion 110 | date = April 2006 | pmid = 16581731 | pmc = 2653870 | doi = 10.1136/sti.2005.017442 }}</ref>
			<ref name="weiss_2010_complications">{{cite journal | vauthors = Weiss HA, Larke N, Halperin D, Schenker I | title = Complications of circumcision in male neonates, infants and children: a systematic review | journal = BMC Urology | volume = 10 | pages = 2 | date = February 2010 | pmid = 20158883 | pmc = 2835667 | doi = 10.1186/1471-2490-10-2 | doi-access = free }}</ref>
			<ref name=wetmore_2010>{{cite journal | vauthors = Wetmore CM, Manhart LE, Wasserheit JN | title = Randomized controlled trials of interventions to prevent sexually transmitted infections: learning from the past to plan for the future | journal = Epidemiologic Reviews | volume = 32 | issue = 1 | pages = 121–136 | date = April 2010 | pmid = 20519264 | pmc = 2912604 | doi = 10.1093/epirev/mxq010 }}</ref>
			<ref name=WHO_2007_GTDPSA>{{cite book |vauthors=Weiss H, Polonsky J, Bailey R, Hankins C, Halperin D, Schmid G |title=Male circumcision: global trends and determinants of prevalence, safety, and acceptability. |publisher=World Health Organization |publication-place=Geneva |date=2007 |isbn=978-92-4-159616-9 |oclc=425961131 |url=http://www.unaids.org/sites/default/files/media_asset/jc1360_male_circumcision_en_0.pdf |url-status=live |archive-url=https://web.archive.org/web/20151222194858/http://www.unaids.org/sites/default/files/media_asset/jc1360_male_circumcision_en_0.pdf |archive-date=22 December 2015 }}</ref>
			<ref name="WHO-2010a">{{Cite book|title=Manual for early infant male circumcision under local anaesthesia|publisher=]|year=2010|url=http://apps.who.int/iris/bitstream/handle/10665/44478/9789241500753_eng.pdf;jsessionid=53B12CB197A3AE365211417D2C812B5F?sequence=1|location=Geneva|language=English|quote=There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men.|access-date=14 April 2022|archive-date=14 April 2022|archive-url=https://web.archive.org/web/20220414143741/http://apps.who.int/iris/bitstream/handle/10665/44478/9789241500753_eng.pdf;jsessionid=53B12CB197A3AE365211417D2C812B5F?sequence=1|url-status=live}}</ref>
			<ref name="WHO-2010b">{{Cite book |url=http://apps.who.int/iris/bitstream/handle/10665/44478/9789241500753_eng.pdf;jsessionid=53B12CB197A3AE365211417D2C812B5F?sequence=1 |title=Manual for early infant male circumcision under local anaesthesia |publisher=] |year=2010 |location=Geneva |language=English |quote=There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men. |access-date=14 April 2022 |archive-date=14 April 2022 |archive-url=https://web.archive.org/web/20220414143741/http://apps.who.int/iris/bitstream/handle/10665/44478/9789241500753_eng.pdf;jsessionid=53B12CB197A3AE365211417D2C812B5F?sequence=1 |url-status=live }}</ref>
			<ref name=WHO_adult_devices_2012>{{cite web |year=2012 |title=Use of devices for adult male circumcision in public health HIV prevention programmes: Conclusions of the Technical Advisory Group on Innovations in Male Circumcision |website=World Health Organization |url=http://whqlibdoc.who.int/hq/2012/WHO_HIV_2012.7_eng.pdf |url-status=live |archive-url=https://web.archive.org/web/20130312062922/http://whqlibdoc.who.int/hq/2012/WHO_HIV_2012.7_eng.pdf |archive-date=12 March 2013 }}</ref>
			<ref name=wolter_2008>{{cite book |vauthors=Wolter C, Dmochowski R |title=Handbook of Office Urological Procedures |chapter=Circumcision |pages=88– |year=2008 |publisher=Springer |isbn=978-1-84628-523-3 |chapter-url=https://books.google.com/books?id=-ek1wPWaUKkC&pg=PA88 |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=-ek1wPWaUKkC&pg=PA88 |archive-date=18 January 2016 }}</ref>
			<!-- X -->
			<ref name=xu_2009>{{cite journal | vauthors = Xu X, Patel DA, Dalton VK, Pearlman MD, Johnson TR | title = Can routine neonatal circumcision help prevent human immunodeficiency virus transmission in the United States? | journal = American Journal of Men's Health | volume = 3 | issue = 1 | pages = 79–84 | date = March 2009 | pmid = 19430583 | pmc = 2678848 | doi = 10.1177/1557988308323616 }}</ref>
			<!-- Y -->
			<!-- Z -->
			}}
			== Notes ==
			{{notelist}}
			== External links ==
			{{Commons category}}
			{{Wikinews category}}
			* Videos of infant circumcision: using a , a and a (all from Stanford Medical School)
			* A from National Geographic
	<!-- Categorization -->
	{{Circumcision series}}		{{Circumcision series}}
	{{Urogenital surgical procedures}}		{{Male genital procedures}}
			{{Infants and their care}}
			{{Authority control}}
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Latest revision as of 12:53, 24 December 2024

Removal of the human foreskin Not to be confused with female circumcision. For the paintings, see The Circumcision.

Medical intervention

Circumcision
Circumcision surgery with hemostats and scissors
ICD-10-PCS	Z41.2
ICD-9-CM	V50.2
MeSH	D002944
OPS-301 code	5–640.2
MedlinePlus	002998
eMedicine	1015820
[edit on Wikidata]

Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. Topical or locally injected anesthesia is generally used to reduce pain and physiologic stress. Circumcision is generally electively performed, most commonly done as a form of preventive healthcare, as a religious obligation, or as a cultural practice. It is also an option for cases of phimosis, other pathologies that do not resolve with other treatments, and chronic urinary tract infections (UTIs). The procedure is contraindicated in cases of certain genital structure abnormalities or poor general health.

The procedure is associated with reduced rates of sexually transmitted infections and urinary tract infections. This includes reducing the incidence of cancer-causing forms of human papillomavirus (HPV) and significantly reducing HIV transmission among heterosexual men in high-risk populations; its prophylactic efficacy against HIV transmission in the developed world or among men who have sex with men is debated. Neonatal circumcision decreases the risk of penile cancer. Complication rates increase significantly with age. Bleeding, infection, and the removal of either too much or too little foreskin are the most common acute complications, while meatal stenosis is the most common long-term. There are various cultural, social, and ethical views on circumcision. Major medical organizations hold variant views on the strength of circumcision's prophylactic efficacy in developed countries. Some medical organizations take the position that it carries prophylactic health benefits which outweigh the risks, while other medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk.

Circumcision is one of the world's most common and oldest medical procedures. Prophylactic usage originated in England during the 1850s and subsequently widely spread, becoming predominately established as a way to prevent sexually transmitted infections. Beyond use as a prophylactic or treatment option in healthcare, circumcision plays a major role in many of the world's cultures and religions, most prominently Judaism and Islam. Circumcision is among the most important commandments in Judaism. In some African and Eastern Christian denominations male circumcision is an established practice, and require that their male members undergo circumcision. It is widespread in Australia, Canada, the United States, South Korea, most of Africa, and parts of Asia. It is relatively rare for non-religious reasons in parts of Southern Africa, Latin America, Europe, and parts of Asia. The origin of circumcision is not known with certainty, but the oldest documentation comes from ancient Egypt.

Uses

Elective

Around half of all circumcisions worldwide are performed for reasons of prophylactic healthcare.

Prophylactic usage in high-risk populations

There is a consensus among the world's major medical organizations and in the academic literature that circumcision is an efficacious intervention for HIV prevention in high-risk populations if carried out by medical professionals under safe conditions.

In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that they recommended adolescent and adult circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV, as long as the program includes "informed consent, confidentiality, and absence of coercion" — known as voluntary medical male circumcision, or VMMC. In 2010, this was expanded to routine neonatal circumcision, as long as those undergoing the procedure received assent from their parents. In 2020, the World Health Organization again concluded that male circumcision is an efficacious intervention for HIV prevention and that the promotion of male circumcision is an essential strategy, in addition to other preventive measures, for the prevention of heterosexually acquired HIV infection in men. Eastern and southern Africa had a particularly low prevalence of circumcised males. This region has a disproportionately high HIV infection rate, with a significant number of those infections stemming from heterosexual transmission. As a result, the promotion of prophylactic circumcision has been a priority intervention in that region since the WHO's 2007 recommendations. The International Antiviral Society–USA also suggests circumcision be discussed with men who have insertive anal sex with men, especially in regions where HIV is common. There is evidence that circumcision is associated with a reduced risk of HIV infection for such men, particularly in low-income countries.

The finding that circumcision significantly reduces female-to-male HIV transmission has prompted medical organizations serving communities affected by endemic HIV/AIDS to promote circumcision as an additional method of controlling the spread of HIV.

Prophylactic usage in developed countries

Major medical organizations hold varying positions on the prophylactic efficacy of the elective circumcision of minors in the context of developed countries. Literature on the matter is polarized, with the cost-benefit analysis being highly dependent on the kinds and frequencies of health problems in the population under discussion and how circumcision affects them.

The World Health Organization (WHO), UNAIDS, and American medical organizations take the position that it carries prophylactic health benefits which outweigh the risks, while European medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk. Advocates of circumcision consider it to have a net health benefit, and therefore feel that increasing the circumcision rate is "imperative". They recommend performing it during the neonatal period when it is less expensive and has a lower risk of complications. The American Academy of Pediatrics and Centers for Disease Control and Prevention stated that the potential benefits of circumcision outweigh the risks.

The World Health Organization in 2010 stated:

There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men.

Pathologies

Circumcision is also used to treat various pathologies. These include pathological phimosis, refractory balanoposthitis and chronic or recurrent urinary tract infections (UTIs).

Contraindications

Circumcision is contraindicated in certain cases.

These include infants with certain genital structure abnormalities, such as a misplaced urethral opening (as in hypospadias and epispadias), curvature of the head of the penis (chordee), or ambiguous genitalia, because the foreskin may be needed for reconstructive surgery. Circumcision is contraindicated in premature infants and those who are not clinically stable and in good health. If an individual is known to have or has a family history of serious bleeding disorders such as hemophilia, it is recommended that the blood be checked for normal coagulation properties before the procedure is attempted.

Technique

Main article: Circumcision surgical procedure

The foreskin is the double-layered fold of tissue at the distal end of the human penis that covers the glans and the urinary meatus. For adult medical circumcision, superficial wound healing takes up to a week, and complete healing 4 to 6 months. For infants, healing is usually complete within one week.

Removal of the foreskin

For infant circumcision, devices such as the Gomco clamp, Plastibell and Mogen clamp are commonly used in the USA. These follow the same basic procedure. First, the amount of foreskin to be removed is estimated. The practitioner opens the foreskin via the preputial orifice to reveal the glans underneath and ensures it is normal before bluntly separating the inner lining of the foreskin (preputial epithelium) from its attachment to the glans. The practitioner then places the circumcision device (this sometimes requires a dorsal slit), which remains until blood flow has stopped. Finally, the foreskin is amputated. For older babies and adults, circumcision is often performed surgically without specialized instruments, and alternatives such as Unicirc or the Shang ring are available.

Pain management

The circumcision procedure causes pain, and for neonates this pain may interfere with mother-infant interaction or cause other behavioral changes, so the use of analgesia is advocated. Ordinary procedural pain may be managed in pharmacological and non-pharmacological ways. Pharmacological methods, such as localized or regional pain-blocking injections and topical analgesic creams, are safe and effective. The ring block and dorsal penile nerve block (DPNB) are the most effective at reducing pain, and the ring block may be more effective than the DPNB. They are more effective than EMLA (eutectic mixture of local anesthetics) cream, which is more effective than a placebo. Topical creams have been found to irritate the skin of low birth weight infants, so penile nerve block techniques are recommended in this group.

For infants, non-pharmacological methods such as the use of a comfortable, padded chair and a sucrose or non-sucrose pacifier are more effective at reducing pain than a placebo, but the American Academy of Pediatrics (AAP) states that such methods are insufficient alone and should be used to supplement more effective techniques. A quicker procedure reduces duration of pain; use of the Mogen clamp was found to result in a shorter procedure time and less pain-induced stress than the use of the Gomco clamp or the Plastibell. The available evidence does not indicate that post-procedure pain management is needed. For adults, topical anesthesia, ring block, dorsal penile nerve block (DPNB) and general anesthesia are all options, and the procedure requires four to six weeks of abstinence from masturbation or intercourse to allow the wound to heal.

Effects

Sexually transmitted infections

Human immunodeficiency virus

See also: Circumcision in Africa § Circumcision to prevent the spread of human immunodeficiency virus in Africa This section is an excerpt from Circumcision and HIV.

Male circumcision reduces the risk of human immunodeficiency virus (HIV) transmission from HIV positive women to men in high risk populations.

In 2020, the World Health Organization (WHO) reiterated that male circumcision is an efficacious intervention for HIV prevention if carried out by medical professionals under safe conditions.

Circumcision reduces the risk that a man will acquire HIV and other sexually transmitted infections (STIs) from an infected female partner through vaginal sex. The evidence regarding whether circumcision helps prevent HIV is not as clear among men who have sex with men (MSM). The effectiveness of using circumcision to prevent HIV in the developed world is not determined.

Human papillomavirus

Human papillomavirus (HPV) is the most commonly transmitted sexually transmitted infection, affecting both men and women. While most infections are asymptomatic and are cleared by the immune system, some types of the virus cause genital warts, and other types, if untreated, cause various forms of cancer, including cervical cancer and penile cancer. Genital warts and cervical cancer are the two most common problems resulting from HPV.

Circumcision is associated with a reduced prevalence of oncogenic types of HPV infection, meaning that a randomly selected circumcised man is less likely to be found infected with cancer-causing types of HPV than an uncircumcised man. It also decreases the likelihood of multiple infections. As of 2012, there was no strong evidence that it reduces the rate of new HPV infection, but the procedure is associated with increased clearance of the virus by the body, which can account for the finding of reduced prevalence.

Although genital warts are caused by a type of HPV, there is no statistically significant relationship between being circumcised and the presence of genital warts.

Other infections

Studies evaluating the effect of circumcision on the rates of other sexually transmitted infections have, generally, found it to be protective. A 2006 meta-analysis found that circumcision was associated with lower rates of syphilis, chancroid, and possibly genital herpes. A 2010 review found that circumcision reduced the incidence of HSV-2 (herpes simplex virus, type 2) infections by 28%. The researchers found mixed results for protection against trichomonas vaginalis and chlamydia trachomatis, and no evidence of protection against gonorrhea or syphilis. It may also possibly protect against syphilis in MSM.

Phimosis, balanitis and balanoposthitis

Phimosis is the inability to retract the foreskin over the glans penis. At birth, the foreskin cannot be retracted due to adhesions between the foreskin and glans, and this is considered normal (physiological phimosis). Over time the foreskin naturally separates from the glans, and a majority of boys are able to retract the foreskin by age three. Less than one percent are still having problems at age 18. If the inability to do so becomes problematic (pathological phimosis) circumcision is a treatment option. This pathological phimosis may be due to scarring from the skin disease balanitis xerotica obliterans (BXO), repeated episodes of balanoposthitis or forced retraction of the foreskin. Steroid creams are also a reasonable option and may prevent the need for surgery including in those with mild BXO. The procedure may also be used to prevent the development of phimosis. Phimosis is also a complication that can result from circumcision.

An inflammation of the glans penis and foreskin is called balanoposthitis, and the condition affecting the glans alone is called balanitis. Most cases of these conditions occur in uncircumcised males, affecting 4–11% of that group. The moist, warm space underneath the foreskin is thought to facilitate the growth of pathogens, particularly when hygiene is poor. Yeasts, especially Candida albicans, are the most common penile infection and are rarely identified in samples taken from circumcised males. Both conditions are usually treated with topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams. Circumcision is a treatment option for refractory or recurrent balanoposthitis, but in the twenty-first century the availability of the other treatments has made it less necessary.

Urinary tract infections

A UTI affects parts of the urinary system including the urethra, bladder, and kidneys. There is about a one percent risk of UTIs in boys under two years of age, and the majority of incidents occur in the first year of life. There is good but not ideal evidence that circumcision of babies reduces the incidence of UTIs in boys under two years of age, and there is fair evidence that the reduction in incidence is by a factor of 3–10 times (100 circumcisions prevents one UTI). Circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects, and may be used to treat recurrent UTIs.

There is a plausible biological explanation for the reduction in UTI risk after circumcision. The orifice through which urine passes at the tip of the penis (the urinary meatus) hosts more urinary system disease-causing bacteria in uncircumcised boys than in circumcised boys, especially in those under six months of age. As these bacteria are a risk factor for UTIs, circumcision may reduce the risk of UTIs through a decrease in the bacterial population.

Cancers

Not being circumcised is the primary risk factor for penile cancer. Pre-adolescent circumcision has a strong protective effect against penile cancer in later life. Penile cancer is a rare disease in the developed world but much more prevalent in the developing world. The penile tissue removed during circumcision is a potential origin for penile cancer. Risk-benefit considerations around the use of circumcision as a cancer-preventive measure are a source of debate.

Penile cancer development can be detected in the carcinoma in situ (CIS) cancerous precursor stage and at the more advanced invasive squamous cell carcinoma stage. There is an association between adult circumcision and an increased risk of invasive penile cancer; this is believed to be from men being circumcised as a treatment for penile cancer or a condition that is a precursor to cancer rather than a consequence of circumcision itself. Penile cancer has been observed to be nearly eliminated in populations of males circumcised neonatally.

Important risk factors for penile cancer include phimosis and HPV infection, both of which are mitigated by circumcision. The mitigating effect circumcision has on the risk factor introduced by the possibility of phimosis is secondary, in that the removal of the foreskin eliminates the possibility of phimosis. This can be inferred from study results that show uncircumcised men with no history of phimosis are equally likely to have penile cancer as circumcised men. Circumcision is also associated with a reduced prevalence of cancer-causing types of HPV in men and a reduced risk of cervical cancer (which is caused by a type of HPV) in female partners of men.

There is some evidence that circumcision is associated with reduced risk of prostate cancer.

Women's health

A 2017 systematic review found consistent evidence that male circumcision prior to heterosexual contact was associated with a decreased risk of cervical cancer, cervical dysplasia, HSV-2, chlamydia, and syphilis among women. The evidence was less consistent in regards to the potential association of circumcision with women's risk of HPV and HIV.

Sexual effects

The accumulated data show circumcision does not have an adverse physiological effect on sexual pleasure, function, desire, or fertility. There is some evidence that circumcision has no effect on pain with intercourse, premature ejaculation, intravaginal ejaculation latency time, erectile dysfunction or difficulties with orgasm.

According to a 2014 review, the effect of circumcision on sexual partners' experiences is unclear as this has not been well studied. According to a policy statement from the Canadian Paediatric Society that was reaffirmed in 2021, "medical studies do not support circumcision as having an impact on sexual function or satisfaction for partners of circumcised individuals".

There are popular misconceptions that circumcision benefits or adversely impacts the sexual pleasure of the circumcised person.

Adverse effects

Neonatal circumcision is generally a safe, low-risk procedure when done by an experienced practitioner.

The most common acute complications are bleeding, infection and the removal of either too much or too little foreskin. These complications occur in approximately 0.13% of procedures, with bleeding being the most common acute complication in the United States. Minor complications are reported to occur in three percent of procedures. Severe complications are rare. A specific complication rate is difficult to determine due to scant data on complications and inconsistencies in their classification. Complication rates are greater when the procedure is performed by an inexperienced operator, in unsterile conditions, or when the child is at an older age. Significant acute complications happen rarely, occurring in about 1 in 500 newborn procedures in the United States. Severe to catastrophic complications, including death, are so rare that they are reported only as individual case reports. Where a Plastibell device is used, the most common complication is the retention of the device occurring in around 3.5% of procedures. Other possible complications include buried penis, chordee, phimosis, skin bridges, urethral fistulas, and meatal stenosis. These complications may be partly avoided with proper technique, and are often treatable without requiring surgical revision. The most common long-term complication is meatal stenosis, this is almost exclusively seen in circumcised children, it is thought to be caused by ammonia producing bacteria coming into contact with the meatus in circumcised infants. It can be treated by meatotomy.

Effective pain management should be used during the procedure. Inadequate pain relief may carry the risks of heightened pain response for newborns. Newborns that experience pain due to being circumcised have different responses to vaccines given afterwards, with higher pain scores observed. For adult men who have been circumcised, there is a risk that the circumcision scar may be tender. There is no good evidence that circumcision affects cognitive abilities.

History

Main article: History of circumcision

This section may lend undue weight to certain ideas, incidents, or controversies. Please help to create a more balanced presentation. Discuss and resolve this issue before removing this message. (November 2023)

Circumcision is the oldest known surgical procedure. Depictions of circumcised penises are found in Paleolithic art, predating the earliest signs of trepanation.

The history of the migration and evolution of circumcision is known mainly from the cultures of two regions. In the lands south and east of the Mediterranean, starting with Central Sahara, Sudan and Ethiopia, the procedure was practiced by the ancient Egyptians and the Semites, and then by the Jews and Muslims. In Oceania, circumcision is practiced by the Australian Aboriginals and Polynesians. There is also evidence that circumcision was practiced among the Aztec and Mayan civilizations in the Americas, but little is known about that history.

It has been speculated that circumcision originated as a substitute for castration of defeated enemies or as a religious sacrifice. In many traditions, it acts as a rite of passage marking a boy's entrance into adulthood.

Middle East, Africa and Europe

Further information: Circumcision in Africa

At Oued Djerat, in Algeria, engraved rock art with masked bowmen, which feature male circumcision and may be a scene involving ritual, have been dated to earlier than 6000 BP amid the Bubaline Period; more specifically, while possibly dating much earlier than 10,000 BP, rock art walls from the Bubaline Period have been dated between 9200 BP and 5500 BP. The cultural practice of circumcision may have spread from the Central Sahara, toward the south in Sub-Saharan Africa and toward the east in the region of the Nile. Based on engraved evidence found on walls and evidence from mummies, circumcision has been dated to at least as early as 6000 BCE in ancient Egypt. Some ancient Egyptian mummies, which have been dated as early as 4000 BCE, show evidence of circumcision.

Evidence suggests that circumcision was practiced in the Middle East by the fourth millennium BCE, when the Sumerians and the Semites moved into the area that is modern-day Iraq from the North and West. The earliest historical record of circumcision comes from Egypt, in the form of an image of the circumcision of an adult carved into the tomb of Ankh-Mahor at Saqqara, dating to about 2400–2300 BCE. Circumcision was possibly done by the Egyptians for hygienic reasons, but also was part of their obsession with purity and was associated with spiritual and intellectual development. No well-accepted theory explains the significance of circumcision to the Egyptians, but it appears to have been endowed with great honor and importance as a rite of passage, performed in a public ceremony emphasizing the continuation of family generations and fertility. It may have been a mark of distinction for the elite: the Egyptian Book of the Dead describes the sun god Ra as having circumcised himself.

Circumcision is prominent in the Hebrew Bible. In addition to proposing that circumcision was adopted by the Israelites purely as a religious mandate, scholars have suggested that Judaism's patriarchs and their followers adopted circumcision to make penile hygiene easier in hot, sandy climates; as a rite of passage into adulthood; or as a form of blood sacrifice.

Historical campaigns of ethnic, cultural, and religious persecution frequently included bans on circumcision as a means of forceful assimilation, conversion, and ethnocide. Alexander the Great conquered the Middle East in the fourth century BCE, and in the following centuries ancient Greek cultures and values came to the Middle East. The Greeks abhorred circumcision, making life for circumcised Jews living among the Greeks and later the Romans very difficult. Restrictions on the Jewish practice by European governments have occurred several times in world history, including the Seleucid Empire under Antiochus IV and the Roman Empire under Hadrian, where it was used as a means of forceful assimilation and conversion. Antiochus IV's restriction on Jewish circumcision was a major factor in the Maccabean Revolt. Hadrian's prohibition has also been considered by some to have been a contributing cause of the Bar Kokhba revolt. According to Silverman (2006), these restrictions were part of a "broad campaign" by the Romans to "civilize" the Jewish people, viewing the practice as repulsive and analogous to castration. His successor, Antoninus Pius, altered the edict to permit Brit Milah. During this period in history, Jewish circumcision called for the removal of only a part of the prepuce, and Hellenized Jews often attempted to look uncircumcised by stretching the extant parts of their foreskins. This was considered by the Jewish leaders to be a serious problem, and during the second century CE they changed the requirements of Jewish circumcision to call for the complete removal of the foreskin, emphasizing the Jewish view of circumcision as intended to be not just the fulfillment of a Biblical commandment but also an essential and permanent mark of membership in a people.

A narrative in the Christian Gospel of Luke makes a brief mention of the circumcision of Jesus, but physical circumcision is not part of the received teachings of Jesus. Circumcision has played an important role in Christian history and theology. Paul the Apostle reinterpreted circumcision as a spiritual concept, arguing literal circumcision to be unnecessary for Gentile converts to Christianity. The teaching that circumcision was unnecessary for membership in a divine covenant was instrumental to the separation of Christianity from Judaism. While the circumcision of Jesus is celebrated as a feast day in the liturgical calendar of many Christian denominations.

Although it is not explicitly mentioned in the Quran (early seventh century CE), circumcision is considered essential to Islam, and it is nearly universally performed among Muslims. The practice of circumcision spread across the Middle East, North Africa, and Southern Europe with Islam.

Genghis Khan and the following Yuan Emperors in China forbade Islamic practices such as halal butchering and circumcision.

The practice of circumcision is thought to have been brought to the Bantu-speaking tribes of Africa by either the Jews after one of their many expulsions from European countries, or by Muslim Moors escaping after the 1492 reconquest of Spain. In the second half of the first millennium CE, inhabitants from the Northeast of Africa moved south and encountered groups from Arabia, the Middle East, and West Africa. These people moved south and formed what is known today as the Bantu. Bantu tribes were observed to be upholding what was described as Jewish law, including circumcision, in the 16th century. Circumcision and elements of Jewish dietary restrictions are still found among Bantu tribes.

Indigenous peoples of the Americas and Oceania

Circumcision is practiced by some groups amongst Australian Aboriginal peoples, Polynesians, and Native Americans.

For Aboriginal Australians and Polynesians, circumcision likely started as a blood sacrifice and a test of bravery and became an initiation rite with attendant instruction in manhood in more recent centuries. Often seashells were used to remove the foreskin, and the bleeding was stopped with eucalyptus smoke.

Christopher Columbus reported circumcision being practiced by Native Americans. It probably started among South American tribes as a blood sacrifice or ritual to test bravery and endurance, and later evolved into a rite of initiation.

Prophylactic circumcision

Anglophonic adoption (1855–1918)

Circumcision began to be advocated as a means of prophylaxis in 1855, primarily as a means of preventing the transmission of sexually transmitted infections. At this time, British physician Jonathan Hutchinson published his findings that, among his venereal disease patients, Jews had a lower prevalence of syphilis. Hutchinson suggested that circumcision lowers the risk of contracting syphilis. Pursuing a successful career as a general practitioner, Hutchinson went on to advocate circumcision for health reasons for the next fifty years, eventually earned a knighthood for his contributions to medicine. His viewpoint that circumcision was prophylactic against disease was adopted by other medical professionals.

In 1870, orthopedic surgeon Lewis Sayre, a founder of the American Medical Association, introduced circumcision in the United States as a purported cure for several cases of young boys presenting with paralysis and other significant gross motor problems. He thought the procedure ameliorated such problems based on the then prominent "reflex neurosis" theory of disease, thinking that a tight foreskin inflamed the nerves and caused systemic problems. The use of circumcision to promote good health also fit the germ theory of disease, which saw validation during the same period: the foreskin was thought to harbor infection-causing smegma. Sayre published works on the subject and promoted it in speeches. Although later discredited, many contemporary physicians believed it could cure, reduce, or otherwise prevent a wide-ranging array of perceived medical problems and social ills, including that of epilepsy, hernia, headache, masturbation, clubfoot, alcoholism and gout. Its popularity spread with publications such as Peter Charles Remondino's History of Circumcision. By the late 19th century, circumcision had become common throughout the Anglophonic world—Australia, Canada, the United States, and the United Kingdom—as well as the Union of South Africa. In the United Kingdom and United States, it was universally recommended.

Historian David Gollaher proposes that "Americans found circumcision appealing not merely on medical grounds, but also for its connotations of science, health, and cleanliness—newly important class distinctions" in a country where 17 million immigrants arrived between 1890 and 1914.

Interwar period and World War II (1918–1945)

During the interwar period, medical organizations and doctors in mainland Europe experimented with the idea of routine circumcision for prophylactic reasons as well, alongside developments in the Anglophonic world. In France, the medical profession went so far as to recommend universal routine circumcision. However, prevalence in France and mainland Europe remained low. There is a lack of consensus in the academic literature on why this occurred.

Yosha & Bolnick & Koyle (2012) have suggested that a factor in its Anglophonic adoption and dismissal in mainland Europe relates to attitudes towards Judaism and Jewish practices. While many of these Anglophonic polities would not be considered tolerant by modern standards: the United Kingdom had Benjamin Disraeli—a Jew—as Prime Minister; Jews in the United States were prominent and generally well-respected; while in Australia "the racial issues of the time involved primarily Aborigines and Chinese immigration, and Jews were essentially below the radar". They argue that once "a substantial proportion of the male population circumcised, the idea that it a Jewish practice no longer relevant. In Britain this was aided by the fact that circumcision was well known to be as much a practice of the nobility as a Jewish religious rite, so that the racial-religious nexus was broken." These factors were absent in continental Europe.

Rates in the Anglophonic world began to sharply diverge after 1945.

Mid-20th century (1945–1985)

After the end of World War II, Britain implemented a National Health Service. Douglas Gairdner's 1949 article "The Fate of the Foreskin" argued that the evidence showed that the risks outweighed the benefits, leading to a significant reduction in circumcision incidence within the United Kingdom.

In contrast to Gairdner, American pediatrician Benjamin Spock argued in favor of circumcision in his popular The Common Sense Book of Baby and Child Care which led to rates in the United States significantly rising. In the 1970s, national medical associations in Australia and Canada issued recommendations against routine infant circumcision, leading to drops in the rates of both of those countries. The United States made similar statements in the 1970s but stopped short of recommending against it.

Modernity (since 1985)

An association between circumcision and reduced heterosexual HIV infection rates was first suggested in 1986.

Experimental evidence was needed to establish a causal relationship, so three randomized controlled trials were commissioned to exclude other confounding factors. Trials took place in South Africa, Kenya and Uganda. All three trials were stopped early by their monitoring boards because those in the circumcised group had a substantially lower rate of HIV contraction than the control group, so it was considered unethical to withhold the procedure, in light of strong evidence of prophylactic efficacy. WHO assessed these as "gold standard" studies and found "strong and consistent" evidence from later studies that confirmed the results of the studies. A scientific consensus subsequently developed that circumcision reduces heterosexual HIV infection rates in high-risk populations; the WHO, along with other major medical organizations, have since promoted circumcision of high-risk populations as part of the program to reduce the spread of HIV. The Male Circumcision Clearinghouse website was created in 2009 by WHO, UNAIDS, FHI and AVAC to provide evidence-based guidance, information, and resources to support the delivery of safe male circumcision services in countries that choose to scale up the procedure as one component of comprehensive HIV prevention services.

Society and culture

The word circumcision is from Latin circumcidere, meaning "to cut around".

Cultures and religions

See also: Cultural views on circumcision and Religious male circumcision

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Many societies hold cultural, ethical, or social views on the practice, with perspectives ranging widely. In some cultures, males are generally required to be circumcised shortly after birth, during childhood or around puberty as part of a rite of passage. Circumcision is commonly practiced in the Jewish and Islamic and Druze faiths and in Coptic Christianity and the Ethiopian Orthodox Church and the Eritrean Orthodox Tewahedo Church. In contrast, some religions, such as Mandaeism and Hinduism and Sikhism, strongly prohibit the practice of routine circumcision.

Judaism

Main article: Brit milah

Circumcision is near-universal among Jews. The mitzvah of circumcision on the eighth day of life is considered among the most important commandments in Judaism. Barring extraordinary circumstances, failure to undergo the rite is seen by followers of Judaism as leading to a state of Kareth: the extinction of the soul and denial of a share in the world to come. Reasons for biblical circumcision include to show off "patrilineal descent, sexual fertility, male initiation, cleansing of birth impurity, and dedication to God".

The basis for its observance is found in the Torah of the Hebrew Bible, in Genesis chapter 17, in which a covenant of circumcision is made with Abraham and his descendants. Jewish circumcision is part of the brit milah ritual, to be performed by a specialist ritual circumciser, a mohel, on the eighth day of a newborn son's life, with certain exceptions for poor health. Jewish law requires that the circumcision leaves the glans bare when the penis is flaccid. Converts to Conservative and Orthodox Judaism must also be circumcised; those who are already circumcised undergo a symbolic circumcision ritual. Circumcision is not required by Judaism for one to be considered Jewish, but mainstream Judaism foresees serious negative spiritual consequences if it is neglected. Circumcision is not considered a universal moral law within Judaism. Rather, the commandment to circumcise is seen as only applying to Jewish people. Those who are Gentiles are believed to have a portion in the "World to Come" as long as they follow the tenets of the Seven Laws of Noah. There are also certain exceptions for Jews with poor health.

According to traditional Jewish law, in the absence of an adult free Jewish male expert, a woman, a slave, or a child who has the required skills is also authorized to perform the circumcision, provided that they are Jewish. However, most streams of non-Orthodox Judaism allow female mohels, called mohalot (Hebrew: מוֹהֲלוֹת, the plural of מוֹהֶלֶת mohelet, feminine of mohel), without restriction. In 1984 Deborah Cohen became the first certified Reform mohelet; she was certified by the Berit Mila program of Reform Judaism. An increasing number of Jews in the United States have chosen not to circumcise their sons.

All major rabbinical organizations make the recommendation that male infants should be circumcised. The issue of converts remains controversial in Reform and Reconstructionist Judaism; circumcision of converts is not mandatory in either.

Islam

Main article: Khitan (circumcision)

Islamic scholars have diverse opinions on the obligatory nature of male circumcision, with some considering it mandatory (wājib), while others view it as only being recommended (sunnah). According to historians of religion and scholars of religious studies, the Islamic tradition of circumcision was derived from the Pagan practices and rituals of pre-Islamic Arabia. Although there is some debate within Islam over whether it is a religious requirement or mere recommendation, circumcision (called khitan) is practiced nearly universally by Muslim males. Islam bases its practice of circumcision on the Genesis 17 narrative, the same Biblical chapter referred to by Jews. The procedure is not explicitly mentioned in the Quran, however, it is a tradition established by Islam's prophet Muhammad directly (following Abraham), and so its practice is considered a sunnah (prophet's tradition) and is very important in Islam. For Muslims, circumcision is also a matter of cleanliness, purification and control over one's baser self (nafs).

There is no agreement across the many Islamic communities about the age at which circumcision should be performed. It may be done from soon after birth up to about age 15; most often it is performed at around six to seven years of age. The timing can correspond with the boy's completion of his recitation of the whole Quran, with a coming-of-age event such as taking on the responsibility of daily prayer or betrothal. Circumcision may be celebrated with an associated family or community event. Circumcision is recommended for, but is not required of, converts to Islam.

Christianity

Main article: Religious male circumcision § In Christianity

Traditionally, circumcision has not been practiced by Christians for religious reasons, with the practice being viewed as succeeded by Baptism, with the New Testament chapter Acts 15 recording that Christianity did not require circumcision from new converts. Christian denominations generally hold a neutral position on circumcision for prophylactic, cultural, and social reasons, while strongly opposing it for religious reasons. This includes the Catholic Church, which explicitly banned the practice of religious circumcision in the Council of Florence, and maintains a neutral position on the practice of circumcision for other reasons. A majority of other Christian denominations take a similar position on circumcision, prohibiting it for religious observance, but neither explicitly supporting or forbidding it for other reasons.

Thus, circumcision rates of Christians are predominately determined by the surrounding cultures which they live in. In some African and Eastern Christian denominations circumcision is an established practice, and generally boys undergo circumcision shortly after birth as part of a rite of passage. Circumcision is near-universal among Coptic Christians, and they practice circumcision as a rite of passage. The Ethiopian Orthodox Church calls for circumcision, with near-universal prevalence among Orthodox men in Ethiopia. Eritrean Orthodox practice circumcision as a rite of passage, and they circumcise their sons "anywhere from the first week of life to the first few year". Some Christian churches in South Africa disapprove of the practice, while others require it of their members.

Circumcision is practiced in many predominantly Christian countries and Christian communities. Christian communities in Africa, some Anglosphere countries, the Philippines, the Middle East, South Korea and Oceania have high circumcision rates, while Christian communities in Europe and South America have low circumcision rates, although none of these are performed out of perceived religious obligation. Scholar Heather L. Armstrong writes that, as of 2021, about half of Christian males worldwide are circumcised, with most of them being located in Africa, Anglosphere countries, and the Philippines.

Druze faith

Circumcision is widely practiced by the Druze; Druze practice Druzism, an Abrahamic, monotheistic, syncretic, and ethnic religion. The procedure is practiced as a cultural tradition, and has no religious significance in the Druze faith. There is no special date for this act in the Druze faith: male Druze infants are usually circumcised shortly after birth, however some remain uncircumcised until the age of ten or older.

Some Druses do not circumcise their male children and refuse to observe this "common Muslim practice".

Samaritanism

Like Judaism, the religion of Samaritanism requires ritual circumcision on the eighth day of life.

Mandaeism

Circumcision is forbidden in Mandaeism, and the sign of the Jews given to Abraham by God, circumcision, is considered abhorrent by the Mandaeans. According to Mandaean doctrine, a circumcised man cannot serve as a Mandaean priest.

Yazidism

Circumcision is not required in Yazidism, but is practised by some Yazidis due to regional customs. The ritual is usually performed soon after birth, it takes place on the knees of the kerîf (approximately "godfather"), with whom the child will have a life-long formal relationship.

Sikhism

Sikhism does not require the elective circumcision of its followers and strongly criticizes the practice.

For example, Bhagat Kabir criticizes the practise of circumcision in the hymn of Guru Granth Sahib.

African cultures

This section is an excerpt from Circumcision in Africa. Circumcision in Africa, and the rites of initiation in Africa, as well as "the frequent resemblance between details of ceremonial procedure in areas thousands of kilometres apart, indicate that the circumcision ritual has an old tradition behind it and in its present form is the result of a long process of development."

Australian cultures

Some Australian Aborigines use circumcision as a test of bravery and self-control as a part of a rite of passage into manhood, which results in full societal and ceremonial membership. It may be accompanied by body scarification and the removal of teeth, and may be followed later by penile subincision. Circumcision is one of many trials and ceremonies required before a youth is considered to have become knowledgeable enough to maintain and pass on the cultural traditions. During these trials, the maturing youth bonds in solidarity with the men. Circumcision is also strongly associated with a man's family, and it is part of the process required to prepare a man to take a wife and produce his own family.

Filipino culture

Main article: Tuli (rite)

In the Philippines, circumcision is known as "tuli" and is generally viewed as a rite of passage. An overwhelming majority of Filipino men are circumcised. Often this occurs, in April and May, when Filipino boys are taken by their parents. The practice dates back to the arrival of Islam in 1450. Pressure to be circumcised is even in the language: one Tagalog profanity for 'uncircumcised' is supot, meaning 'coward' literally. A circumcised eight or ten year-old is no longer considered a boy and is given more adult roles in the family and society.

Ethical and legal issues

Main article: Ethics of circumcision See also: Circumcision controversies and Circumcision and law

Ethics

This section is an excerpt from Ethics of circumcision. There is substantial disagreement amongst bioethicists and theologians over the practice of circumcision, with many believing that the routine circumcision of neonates for health purposes is a cost-ineffective and ethically-problematic intervention in developed countries, while circumcision on a consenting adult is generally viewed as a morally permissible action. Positions taken on the issue are heavily influenced by prevalence in the given area, religion, and culture. Some medical associations take the position that circumcision is an infringement of the child's autonomy and should be deferred until he is capable of making the decision himself. Others state that parents should be allowed to determine what is in his best interest.

Legal

Worldwide, the large majority of polities do not have specific laws concerning the circumcision of males, with religious infant circumcision being legal in every country. A few countries have passed legislation on the procedure: Germany allows routine circumcision, while non-religious routine circumcision is illegal in South Africa and Sweden. No major medical organization recommends circumcising all males, and no major medical organization recommends banning the procedure.

In the academic literature, there is general agreement among both supporters and opponents of the practice that an outright ban would be predominately ineffective and "harmful". A consensus to keep the procedure within the purview of medical professionals is found across all major medical organizations, who advise medical professionals to yield to some degree to parental preferences in their decision to agree to circumcise. The Royal Dutch Medical Association, which expresses some of the strongest opposition to routine neonatal circumcision, argues that while there are valid reasons for banning it, doing so could lead parents who insist on the procedure to turn to poorly trained practitioners instead of medical professionals.

During the 2010s, several right-wing nationalist parties prominently called for the banning of circumcision. Gressgård argued that politicians that supported Norway's proposed circumcision ban debated circumcision in a manner which constituted "ethnocentrism".

Economic considerations

The cost-effectiveness of circumcision has been studied to determine whether a policy of circumcising all newborns or a policy of promoting and providing inexpensive or free access to circumcision for all adult men who choose it would result in lower overall societal healthcare costs. As HIV/AIDS is an incurable disease that is expensive to manage, significant effort has been spent studying the cost-effectiveness of circumcision to reduce its spread in parts of Africa that have a relatively high infection rate and low circumcision prevalence. Several analyses have concluded that circumcision programs for adult men in Africa are cost-effective and in some cases are cost-saving. In Rwanda, circumcision has been found to be cost-effective across a wide range of age groups from newborn to adult, with the greatest savings achieved when the procedure is performed in the newborn period due to the lower cost per procedure and greater timeframe for HIV infection protection. Circumcision for the prevention of HIV transmission in adults has also been found to be cost-effective in South Africa, Kenya, and Uganda, with cost savings estimated in the billions of US dollars over 20 years. Hankins et al. (2011) estimated that a $1.5 billion investment in circumcision for adults in 13 high-priority African countries would yield $16.5 billion in savings.

The overall cost-effectiveness of neonatal circumcision has also been studied in the United States, which has a different cost setting from Africa in areas such as public health infrastructure, availability of medications, and medical technology and the willingness to use it. A study by the CDC suggests that newborn circumcision would be societally cost-effective in the United States based on circumcision's efficacy against the transmission of HIV alone during coitus, without considering any other cost benefits. The American Academy of Pediatrics (2012) recommends that neonatal circumcision in the United States be covered by third-party payers such as Medicaid and insurance. A 2014 review that considered reported benefits of circumcision such as reduced risks from HIV, HPV, and HSV-2 stated that circumcision is cost-effective in both the United States and Africa and may result in health care savings. A 2014 literature review found that there are significant gaps in the current literature on male and female sexual health that need to be addressed for the literature to be applicable to North American populations.

References

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Notes

1. The most commonly-done procedure is in actuality not a circumcision but a dorsal slit, where no foreskin is actually removed. When the foreskin is removed, it is commonly known locally as a "German cut" in reference to the introduction of the modern surgical technique by the founder of plastic and reconstructive surgery, Johann Friedrich Dieffenbach.

External links

• Videos of infant circumcision: using a Plastibell, a Gomco clamp and a Mogen clamp (all from Stanford Medical School)
• A Xhosa circumcision from National Geographic

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Category	Circumcision

v t e Tests and procedures involving the male reproductive system
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Categories:

• Circumcision
• Human penis
• Surgical removal procedures
• Cosmetic surgery
• Pediatric surgery
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• Men's rights
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