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{{POV}}

{{Otheruses4|male circumcision|the practice sometimes referred to as "female circumcision"|Female genital cutting}} {{Otheruses4|male circumcision|the practice sometimes referred to as "female circumcision"|Female genital cutting}}
[[Image:Circumcision set.jpg|right|thumb|Seixas Family circumcision set and trunk, ca. eighteenth century
Wooden box covered in cow hide with silver implements: silver trays, clip, pointer, silver flask, spice vessel.]]
'''Circumcision''' is the procedure that cuts some or all of the ] (]) from the ]. The ] may also be cut away at the same time, in a procedure called a ]. The word "circumcision" comes from ] ''circum'' (meaning "around") and ''caedere'' (meaning "to cut").


'''Circumcision''' is the procedure that removes some or all of the ] (]) from the ]. The ] may also be cut away at the same time, in a procedure called a ]. The word "circumcision" comes from ] ''circum'' (meaning "around") and ''caedere'' (meaning "to cut").
Circumcision predates recorded ], with depictions found in ] ]s and ]ian ]s.<ref>{{cite journal | last = Wrana | first = P. | year = 1939 | title = Historical review: Circumcision | 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 = Journal of Men’s Studies | volume = 6 | issue = 2 | pages = 189&ndash;208 | url = http://www.noharmm.org/zoske.htm|accessdate = 2006-06-14}} </ref> The origins of the practice are lost in antiquity. Theories include that circumcision is a form of ritual ] or offering, a health precaution, a sign of submission to a ], a rite of passage to adulthood, a mark of defeat or ], or an attempt to alter ] or ].<ref name = "Gollaher">{{cite book

Circumcision predates recorded ], with depictions found in ] ]s and ]ian ]s.<ref>{{cite journal | last = Wrana | first = P. | year = 1939 | title = Historical review: Circumcision | 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 = Journal of Men’s Studies | volume = 6 | issue = 2 | pages = 189&ndash;208 | url = http://www.noharmm.org/zoske.htm|accessdate = 2006-06-14}} </ref> Circumcision has been performed as a form of ritual ] or offering, a health precaution, a sign of submission to a ], a rite of passage to adulthood, a mark of defeat or ], or an attempt to alter ] or ].<ref name = "Gollaher">{{cite book
| last = Gollaher | last = Gollaher
| first = David L. | first = David L.
Line 21: Line 22:
| quote = | quote =
}} }}
</ref>
</ref> Circumcision of males is a religious commandment in ] and ],<ref>{{cite web

] circumcision is controversial in English-speaking countries. The ] states that neonatal circumcision is “non-therapeutic” and “not medically necessary,” but rather “elective” removal of the foreskin. The AMA statement does not comment on circumcision for religious or ritual purposes.<ref name = "CSA:I-99">{{cite web
| year = 1999
| month = December
| url = http://www.ama-assn.org/ama/pub/category/13585.html
| title = Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision
| format =
| work = 1999 AMA Interim Meeting: Summaries and Recommendations of Council on Scientific Affairs Reports
| pages = 17
| publisher = ]
| accessdate = 2006-06-13
}}
</ref> According to the AMA's 1999 literature review, in the US when parents choose elective circumcision for their child, it is largely because of social or cultural expectations, rather than medical concerns.<ref name = "CSA:I-99" />

Circumcision of males is a religious commandment in ] and ],<ref>{{cite web
| url = http://www.jewishvirtuallibrary.org/jsource/Judaism/circumcision.html | url = http://www.jewishvirtuallibrary.org/jsource/Judaism/circumcision.html
| title = Circumcision | title = Circumcision
Line 41: Line 57:
| id = {{LCCN|86|00|5432}} ISBN 978-0-02-909480-8 | id = {{LCCN|86|00|5432}} ISBN 978-0-02-909480-8
| pages = 511–514 | pages = 511–514
}}</ref> and is customary in some ] and other Christian churches in Africa.<ref name=Christian>Customary in some Coptic and other churches: }}</ref> and is customary in some ], ] Christian and other Christian churches in Africa.<ref name=Christian>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." , ], ], 2007. *"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." , ], ], 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.</ref> It is also practiced by the majority of South Koreans,<ref>{{cite journal *"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.</ref> It is also practiced by the majority of South Koreans,<ref>{{cite journal
Line 59: Line 75:
| accessdate = 2006-10-03 | accessdate = 2006-10-03
}} }}
</ref> Americans,<ref>{{cite paper </ref> Americans,{{Fact|date=March 2007}} and Filipinos.<ref>{{cite journal
| author = Xu, F, L Markowitz, M Sternberg, and S Aral
| title = Prevalence of circumcision in men in the United States: data from the National Health and Nutrition Examination Survey (NHANES), 1999-2002
| publisher = XVI International AIDS Conference
| date = 2006
| url = http://www.iasociety.org/abstract/show.asp?abstract_id=2193307
| accessdate = 2006-09-21
}}
</ref> and Filipinos.<ref>{{cite journal
| last = Lee | last = Lee
| first = R.B. | first = R.B.
Line 83: Line 91:
}} }}
</ref> </ref>

] circumcision is controversial in several English-speaking countries. The ] defines “non-therapeutic” circumcision as the non-religious, non-ritualistic, not medically necessary, elective circumcision of male newborns. It states that medical associations in the US, Australia, and Canada do not recommend the routine non-therapeutic circumcision of newborns.<ref name = "CSA:I-99">{{cite web
Proponents of ] condemn all infant circumcision as male ] comparable to ],<ref name = "Milos">{{cite journal
| year = 1999
| month = December
| url = http://www.ama-assn.org/ama/pub/category/13585.html
| title = Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision
| format =
| work = 1999 AMA Interim Meeting: Summaries and Recommendations of Council on Scientific Affairs Reports
| pages = 17
| publisher = ]
| accessdate = 2006-06-13
}}
</ref> ] supporters condemn all infant circumcision as male ] comparable to ],<ref name = "Milos">{{cite journal
| last = Milos | last = Milos
| first = Marilyn Fayre | first = Marilyn Fayre
Line 110: Line 108:
| accessdate = 2007-04-06 | accessdate = 2007-04-06
}} }}
</ref> while ] consider that infant circumcision is a worthwhile public health measure.<ref name="Schoen">{{cite journal </ref> while others consider that infant circumcision is a worthwhile public health measure.<ref name="Schoen">{{cite journal
| last = Schoen | last = Schoen
| first = Edgar J | first = Edgar J
Line 126: Line 124:
</ref> </ref>


Circumcision of adults may be used to treat chronic inflammation of the penis and ].<ref name = "Schoen" /> The use of circumcision to treat ] is debated in medical literature.<ref name="dewan">{{cite journal | last = Dewan | first = P.A. | coauthors = Tieu H.C., and Chieng B.S. | year = 1996 | month = August | title = Phimosis: Is circumcision necessary? | journal = Journal of Paediatrics and Child Health | volume = 32 | issue = 4 | pages = 285&ndash;289 | id = PMID 8844530}}</ref><ref name="beauge">{{cite journal | last = Beaugé | first = Michel | year = 1997 | month = September/October | title = The causes of adolescent phimosis | journal = British Journal of Sexual Medicine | volume = 26 | url = http://www.cirp.org/library/treatment/phimosis/beauge2/ | accessdate = 2006-06-14}}</ref>
According to Newell and Bärnighausen, three randomised trials "now provide firm evidence that the risk of acquiring HIV is halved by male circumcision".<ref name = "Newell">{{cite journal
| last = Newell
| first = Marie-Lousie
| coauthors = Till Bärnighausen
| date = ], ]
| title = Male circumcision to cut HIV risk in the general population
| journal = ]
| volume = 369
| issue = 9562
| pages = 617–619
| pmid = 17321292
| doi = DOI:10.1016/S0140-6736(07)60288-8
| url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673607602888.pdf
|format = PDF
| accessdate = 2007-04-01
}}
</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 = ], ]
| title = Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial
| journal = ]
| volume = 369
| issue = 9562
| pages = 643–656
| pmid = 17321310
| doi = DOI:10.1016/S0140-6736(07)60312-2
| url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673607603122.pdf
| format = PDF
| accessdate = 2007-04-01
}}
</ref><ref name="grayrct">{{cite journal
| last = Gray
| first = Ronald H
| coauthors = Godfrey Kigozi, David Serwadda, Frederick Makumbi, Stephen Watya, Fred Nalugoda, Noah Kiwanuka, Lawrence H Moulton, Mohammad A Chaudhary, Michael Z Chen, Nelson K Sewankambo, Fred Wabwire-Mangen, Melanie C Bacon, Carolyn F M Williams, Pius Opendi, Steven J Reynolds, Oliver Laeyendecker, Thomas C Quinn, Maria J Wawer
| date = ], ]
| title = Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial
| journal = ]
| volume = 369
| issue = 9562
| pages = 657–666
| pmid = 17321311
| doi = DOI:10.1016/S0140-6736(07)60313-4
| url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673607603134.pdf
| format = PDF
| accessdate = 2007-04-01
}}
</ref>. Although some have voiced doubts about the value of male circumcision in reducing an epidemic <ref name = "Garenne">{{cite journal
| last = Garenne
| first = Michel
| year = 2006
| month = January
| title = Male Circumcision and HIV Control in Africa
| journal = ]
| volume = 3
| issue = 1
| pages = e78
| pmid = 16435906
| doi = doi:10.1371/journal.pmed.0030078
| url = http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030078
| accessdate = 2007-04-01
}}
</ref>, the World Health Organisation recommended in 2007 that "promoting male circumcision should be recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men."<ref name = "WHO HIV 1">{{cite web
| url = http://www.who.int/hiv/mediacentre/MCrecommendations_en.pdf
| title = New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications
| accessdate = 2007-04-01
| date = ], ]
| format = PDF
| publisher = ]
}}
</ref>


==The procedures of circumcision==
Circumcision may be used to treat ]<ref>{{cite journal
| last = Holman
| first = John R.
| coauthors = Keith A. Stuessi
| year = 1999
| month = ],
| title = Adult Circumcision
| journal = American Family Physician
| volume = 59
| issue = 6
| pages = 1514&ndash;1518
| doi =
| id = {{ISSN|0002-838X}} PMID 10193593
| url = http://www.aafp.org/afp/990315ap/1514.html
| accessdate = 2006-06-30
}}
</ref> and ].<ref>{{cite journal |title=Carcinoma of the penis: experience from 360 cases |author=Rempelakos A |coauthors=''et al'' |journal=J BUON |year=2004 |month=Jan-Mar |volume=9 |issue=1 |pages=51-5 |quote="The surgical treatment which was performed included: circumcision 32 patients"}}</ref> The use of circumcision to treat ] is debated in medical literature.<ref name="dewan">{{cite journal | last = Dewan | first = P.A. | coauthors = Tieu H.C., and Chieng B.S. | year = 1996 | month = August | title = Phimosis: Is circumcision necessary? | journal = Journal of Paediatrics and Child Health | volume = 32 | issue = 4 | pages = 285&ndash;289 | id = PMID 8844530}}</ref><ref name="beauge">{{cite journal | last = Beaugé | first = Michel | year = 1997 | month = September/October | title = The causes of adolescent phimosis | journal = British Journal of Sexual Medicine | volume = 26 | url = http://www.cirp.org/library/treatment/phimosis/beauge2/ | accessdate = 2006-06-14}}</ref>


==The procedures of circumcision==
]
]
Circumcision removes the ] from the ]. For infant circumcision, clamps, such as the ], ], and Mogen are often used.<ref>{{cite journal Circumcision removes the ] from the ]. For infant circumcision, clamps, such as the ], ], and Mogen are often used.<ref>{{cite journal
| last = Holman | last = Holman
Line 235: Line 143:
| accessdate = 2006-06-29 | accessdate = 2006-06-29
}} }}
</ref> These clamps are meant to protect the glans while they cut the blood supply to the foreskin and prevent any ]. With the Plastibell clamp, the foreskin and the clamp come away in three to seven days. Before a Gomco clamp is used, a section of skin is crushed with a ] 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 then tightened, "crushing the foreskin between the bell and the base plate." The crushing limits the bleeding (provides the hemostasis). With the flared bottom of the bell fitting tightly against the hole of the base plate, the foreskin is cut away with a scalpel from above the base plate. The bell covers the glans to prevent it being reached by the scalpel. <ref>{{cite journal </ref> These clamps are meant to protect the glans while they cut the blood supply to the foreskin and prevent any ]. With the Plastibell clamp, the foreskin and the clamp come away in three to seven days. Before a Gomco clamp is used, a section of skin is crushed with a ] 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 then tightened, "crushing the foreskin between the bell and the base plate." The crushing limits the bleeding (provides the hemostasis). With the flared bottom of the bell fit tightly against the hole of the base plate, the foreskin is cut away with a scalpel from above the base plate, while the bell covers the glans to prevent it being reached by the scalpel.<ref>{{cite journal
| last = Peleg | last = Peleg
| first = David | first = David
Line 294: Line 202:
| accessdate = 2006-07-18 | accessdate = 2006-07-18
}} }}
</ref> Taeusch ''et al'' report that as compared with the Plastibell, Mogen circumcisions are quicker, less painful, and preferred by trainees. Kurtis ''et al'' report that it is quicker and less painful than circumcisions using the Gomco clamp.The World Health Organization reports that the Mogen clamp "compares favourably, because it is easy to use and has no parts to assemble. In the literature, the fewest complications with this method have been reported in the context of circumcision in 8 day old babies."
</ref>


The frenulum is cut if frenular chordee is evident.<ref>{{cite journal |author=Griffin A, Kroovand R |title=Frenular chordee: implications and treatment |journal=Urology |volume=35 |issue=2 |pages=133-4 |year=1990 |id=PMID 2305537}}</ref><ref name = "Shechet" /> The frenulum is cut if frenular chordee is evident.<ref>{{cite journal |author=Griffin A, Kroovand R |title=Frenular chordee: implications and treatment |journal=Urology |volume=35 |issue=2 |pages=133-4 |year=1990 |id=PMID 2305537}}</ref><ref name = "Shechet" /> Chordee of the glans may be the result of circumcision.


According to a 1998 study, 45% of physicians used anaesthesia for infant circumcisions. Dorsal penile nerve block was the most commonly used form. Obstetricians had a significantly lower rate of anaesthesia use (25%) than pediatricians (71%) or family practitioners (56%).<ref name = "Stang">{{cite journal
==Cultures and religions==
Cultures may circumcise their males either shortly after birth, during childhood or around puberty as part of a rite of passage. Circumcision is most prevalent in Muslim countries, the United States, the Philippines and South Korea. It is less common in Europe, Latin America, China and India. Circumcision is most prevalent in the ]ish and ] faiths.

===Judaism===
{{main|Brit milah}}
{{see also|Circumcision in the Bible}}

Circumcision is a fundamental rite of ]. It is a positive ] obligatory under ] for Jewish males, and is only postponed or abrogated in the case of threat to the life or health of the child.<ref>{{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 = doi:10.1046/j.1464-410x.1999.0830s1017.x
| id = 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 in a ceremony called a '']'' (or ''Bris milah'', colloquially simply ''bris'') (] for "Covenant of circumcision"). A '']'' performs the ceremony on the eighth day after birth unless health reasons force a delay. According to the ] (], chapter 17 verses 9-14), ] commanded ] to circumcise himself, his offspring and his slaves as a sign of an everlasting covenant. According to Jewish law, failure to follow the commandment carries the penalty of ''karet'', or being cut off from the community by God. ''Brit milah'' is considered to be so important that should the eighth day fall on ], actions that would normally be forbidden because of the sanctity of the day are permitted in order to fulfill the requirement to circumcise. The expressly ritual element of circumcision in Judaism, as distinguished from its non-ritual requirement in Islam, is shown by the requirement that a child who either is born ] (without a foreskin) or who has been circumcised without the ritual must nevertheless undergo a ''Brit milah'' in which a drop of blood (''hatafat-dam'', הטפת דם) is drawn from the penis at the point where the foreskin would have been or was attached.<ref>], ], 263:4</ref>

Less commonly practised, and more controversial, is '']'', or oral suction,<ref>{{cite web
| url = http://www.thejewishweek.com/news/newscontent.php3?artid=11539
| title = City Risking Babies' Lives With Brit Policy: Health Experts
| accessdate = 2007-04-19
| last = Nussbaum Cohen
| first = Debra
| date = ], ]
| publisher = ]
}}
</ref><ref>{{cite web
| url = http://www.thejewishweek.com/news/newscontent.php3?artid=11833&print=yes
| title = City Challenged On Ritual Practice
| accessdate = 2007-04-19
| last = Nussbaum Cohen
| first = Debra
| coauthors = Larry Cohler-Esses
| date = ], ]
| publisher = ]
}}
</ref> where the '']'' sucks blood from the circumcision wound. The traditional reason for this procedure is to promote healing,<ref>] Tractate Shabbos 133b: Rav Pappa said, “A mohel who does not perform metzitzah endangers the baby and is dismissed.”
</ref><ref>{{cite news
| first = Mordechai
| last = Halperin
| authorlink = Mordechai Halperin
| coauthors = <small>(translated by Yocheved Lavon)</small>
| title = Metzitzah B’peh Controversy: The View from Israel
| url = http://www.ou.org/jewish_action/article/8987
| work = Jewish Action 67(2)
| publisher = ]
| id = {{ISSN|0447-7049}} {{OCLC|5763983}}
| pages = 25, 33–39
| date = Winter 2006
| accessdate = 2007-02-15
| quote = <small>The original technique for the performance of metzitzah employs the human mouth. The mohel brings the baby’s organ into his mouth immediately after the excision of the foreskin and sucks blood from it vigorously. This action lowers the internal pressure in the tissues of the organ, in the blood vessels of the head of the organ and in the exposed ends of the arterioles that have just been cut. Thus, the difference between the pressure in the blood vessels in the base of the organ and the pressure in the blood vessels at its tip is increased. This requirement has deep religious significance as well as medical benefits.…The Gemara states that the requirement of metzitzah stems from medical considerations; it is meant to minimize risk to the infant’s life and health</small>}}
</ref> though the practice has been implicated in the spreading of herpes to the infant.<ref name = "Gesundheit">{{cite journal
| last = Gesundheit
| first = B.
| coauthors = et al.
| year = 2004
| month = August
| title = Neonatal Genital Herpes Simplex Virus Type 1 Infection After Jewish Ritual Circumcision: Modern Medicine and Religious Tradition
| journal = Pediatrics
| volume = 114
| issue = 2
| pages = e259&ndash;e263
| id = {{ISSN|1098-4275}}
| url = http://pediatrics.aappublications.org/cgi/reprint/114/2/e259.pdf
| format = PDF
| accessdate = 2006-06-28
}}
</ref> Today, if it is performed, the mohel generally uses a sterilized glass tube.<ref name = "RCAMetzitzah">{{cite web
| url = http://www.rabbis.org/news/article.cfm?id=100605
| title = Metzitza Be'Peh - Halachic Clarification
| accessdate = 2007-04-06
| date = ], ]
| publisher = ]
| quote = <small>The poskim consulted by the RCA…agree that the normative halacha undoubtedly permits the third view , and that it is proper for mohalim to conduct themselves in this way given the health issues involved in the fourth view.…However, although Rav Yosef Dov Soloveitchik also generally prohibited metzitza be’peh with direct oral contact, he did not ban it by those who insisted upon it, and neither does the RCA advocate any such ban. Those who wish to follow their customs in accordance with the above-noted authorities are certainly entitled to do so, but the RCA is firmly of the opinion that in light of current realities and medical knowledge it is proper, and preferable, to use a tube.</small>
}}
</ref><ref>{{cite news
|first = Kelly
|last = Hartog
|url = http://www.jewishjournal.com/home/preview.php?id=13676
|title = Death Spotlights Old Circumcision Rite
|publisher = ]
|date = ] ]
|accessdate = 2006-11-22
|quote = <small>Metzizah b’peh — loosely translated as oral suction — is the part of the circumcision ceremony where the mohel removes the blood from the baby’s member; these days the removal of the blood is usually done using a sterilized glass tube, instead of with the mouth, as the Talmud suggests.</small>
}}</ref>

===Christianity===
] does not prescribe ]. The ] decided that circumcision was not necessary (). ] had Timothy circumcised () but in his letters he warned gentile Christians against adopting the practice (, ). Individual Christians and Christian traditions may have different customs. Circumcision is customary among members of three of the ] Churches, the ], ], and ] churches in their home countries, and also some other African churches.<ref name=Christian/> On ], the Catholic Church used to celebrate the ]. This has been superseded by the ]. The ] condemned the observance of circumcision as a ] and ordered against its practice in the ] in 1442.<ref name = "CoF">{{cite book
| last = Eugenius IV
| first = Pope
| authorlink = Pope Eugene IV
| editor = Norman P. Tanner ed.
| title = Decrees of the ecumenical councils
| origyear = 1442
| url =
| format =
| accessdate = 2007-04-25
| series = 2 volumes
| year = 1990
| publisher = ]
| location = ]
| isbn = 0878404902
| oclc =
| language = English, Greek, and Latin
| id = {{LCCN|90|00|3209}}
| pages =
| chapter = ECCUMENICAL COUNCIL OF FLORENCE (1438-1445): Session 11—4 February 1442; Bull of union with the Copts
| chapterurl = http://www.ewtn.com/library/COUNCILS/FLORENCE.HTM#5
| quote = <small>It firmly believes, professes and teaches that the legal prescriptions of the old Testament or the Mosaic law, which are divided into ceremonies, holy sacrifices and sacraments, because they were instituted to signify something in the future, although they were adequate for the divine cult of that age, once our lord Jesus Christ who was signified by them had come, came to an end and the sacraments of the new Testament had their beginning.…But it asserts that after the promulgation of the gospel they cannot be observed without loss of eternal salvation. Therefore it denounces all who after that time observe circumcision, the sabbath and other legal prescriptions as strangers to the faith of Christ and unable to share in eternal salvation, unless they recoil at some time from these errors. 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> Anglican and Lutheran churches have also renamed the Feast of the Circumcision in their liturgical calendars as, for example, the Holy Name of Jesus.<ref> For example, "The Calendar of the Church Year" in The (Online) Book of Common Prayer (Episcopal Church in the United States of America), http://www.bcponline.org/ retrieved ] ].</ref>

===Islam===
The origin of circumcision in ] is a matter of religious and scholarly debate. It is mentioned in some parts of the ], but not in the ]. ] scholars have different opinions about circumcision in ], depending on which Hadith are accepted and how they are interpreted. According to some it is ''recommended'' (]); according to others, 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 ] to argue that the requirement of circumcision is based on the covenant 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>

The timing of Muslim circumcision varies. Turkish, ], rural Egyptians and Central and South Asian Muslims typically circumcise boys between the ages of six and eleven and traditionally the event may be a joyous occasion and celebrated with sweets and feasting. However, in the middle class it is more usually done in infancy and is largely unremarked upon. In Turkey the celebratory feast is called "Sünnet Düğünü", or "Circumcision Feast/Celebration" and is considered a very important celebration in man's life as a passage to a manhood.<ref>Hamdullah Aydın, M.D. and Zeynep Gülçat, Ph.D., "Turkey," in ''The International Encyclopedia of Sexuality'', http://www2.hu-berlin.de/sexology/IES/turkey.html retrieved ] ].</ref> In ], Muslims may be circumcised at all ages from the newborn period to adulthood, though the medical profession has encouraged medical circumcisions in the first week after birth to reduce complications: "Circumcision is performed by barbers, medical technicians, quacks and doctors including paediatric surgeon yet there is no consensus for the best age and method."<ref>Iftikhar Ahmad Jan, "Circumcision in babies and children with Plastibell technique: An easy procedure with minimal complications - Experience of 316 cases," Pak J Med Sci 2004, 20(3) 175-180.</ref> In Iran, Dr. Paula Drew states that “circumcision, which formerly celebrated the onset of manhood, has for many years now been more customarily performed at the age of 5 or 6 for children born at home, and at two days old for those born in a medical setting.…By puberty, all Muslim Iranian boys must be circumcised if they are to participate fully in religious activities.”<ref>{{cite encyclopedia
| last = Drew
| first = Paula E.
| coauthors = F. A. Sadeghpour and anonymous
| editor = ]
| encyclopedia = The International Encyclopedia of Sexuality
| title = Iran
| url = http://www2.hu-berlin.de/sexology/IES/iran.html
| accessdate = 2006-10-18
| publisher = Continuum Publishing Company
| location = ]
}}
</ref> Kamyar ''et al'' describe circumcision as an "obligatory custom" and note that it is not necessary for the circumciser to be a Muslim.<ref>Kamyar M. Hedayat, MD and Roya Pirzadeh, MD, "Issues in Islamic Biomedical Ethics: A Primer for the Pediatrician," ''Pediatrics'' Vol. 108 No. ] ], pp. 965-971, http://imamreza.net/eng/imamreza.php?print=3107 retrieved ] ].</ref>

===Other faiths and traditions===
] do not have any particular tradition or rituals regarding male circumcision, but view female circumcision as mutilation.<ref>{{cite web
| url = http://www.bahai.org.nz/public/patientisbahai.htm
| title = WHEN YOUR PATIENT IS A BAHA'I
| accessdate = 2007-01-30
| publisher = National Spiritual Assembly of the Bahá'ís of New Zealand
| quote = <small>Bahá'ís are not advised on a particular course of action in respect to circumcision of males; circumcision of females is considered mutilation.</small>
}}</ref>

The ] have no male circumcision in their religion,<ref>{{cite web
| url = http://www.semp.us/biots/biot_176.html
| title = Who Are the Druze?
| accessdate = 2007-01-30
| date = ], ]
| work = SEMP Biot #176
| publisher = Suburban Emergency Management Project
}}</ref> although, according to one source, it is a practiced among those living in urban areas or outside the Middle East, mainly for hygienic reasons.

There is no specific reference to male circumcision in the Hindu holy books , and Hindus in India generally do not practice circumcision.

] male infants are not circumcised.<ref>{{cite web
| url = http://www.kyha.com/documents/CG-Sikh.pdf
| title = Guidelines for health Care Providers Interacting with Patients of the Sikh Religion and their Families
| accessdate = 2007-05-01
| publisher =Metropolitan Chicago Healthcare Council
| date = November 2000
}}</ref>

Circumcision in South Korea is largely the result of American cultural and military influence following the ]. The origin of circumcision in the Philippines is uncertain. One newspaper article speculates that it is due to the influence of western colonizers.<ref>{{cite news
|first = Rommel G.
|last = Rebollido
|url = http://www.sunstar.com.ph/static/gen/2005/03/21/feat/passage.to.manhood.html
|title = Passage to manhood
|work = General Santos
|publisher = Sun Star Publishing, Inc.
|date = ], ]
|accessdate = 2006-07-01
|language =
}}
</ref> However, ]'s ] ''History of the Philippine Islands'', speculates that it is due to Islamic influence.<ref>{{cite book
| last = de Morga
| first = Antonio
| others = Translated by Alfonso de Salvio, Norman F. Hall, and James Alexander Robertson
| title = History of the Philippine Islands
| origyear = 1609
| url = http://www.nalanda.nitc.ac.in/resources/english/etext-project/history/philippine/index.htm
| accessdate = 2006-07-01
| date = 1907
| id = {{LCCN|unk82|0|42869}}
| chapter = 11
| chapterurl = http://www.nalanda.nitc.ac.in/resources/english/etext-project/history/philippine/chapter11.html
| quote = <small>These Borneans are Mahometans, and were already introducing their religion among the natives of Luzon, and were giving them instructions, ceremonies, and the form of observing their religion.…and those the chiefest men, were commencing, although by piecemeal, to become Moros, and were being circumcised and taking the names of Moros.</small>}}</ref> 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 Nigerian 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: 379-384 Health Educ. Res..1995; 10: 379-384 Retrieved ] ]</ref> In early 2007 it was announced that rural aidpost orderlies in the East Sepik Province of Papua New Guinea are to undergo training in the circumcision of men and boys of all ages with a view to introducing the procedure as a means of prophylaxis against HIV/AIDS, which is becoming a significant problem in the country.<ref>{{cite web
| title = "PNG circumcision campaign hopes to halt HIV,"
| publisher = ABC Radio Australia citing the ''Papua New Guinea Post-Courier''
| url = http://www.radioaustralia.net.au/news/stories/s1842948.htm
| format = htm
| date = 2007-02-08, 14:21:13,
}}</ref>

Circumcision is part of ]s in some African, Pacific Islander, and Australian aboriginal ] in areas such as Arnhem Land,<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 = ]
| date = 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 Sulawesi in the Indonesian 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, including ] for 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> Circumcision is also commonly practised in the Polynesian islands of ], ], ], and ]. In Samoa, it is accompanied by a celebration. Among some West African animist groups, such as the ] and ], it 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> Although in many West African traditional societies circumcision has become medicalised and is simply performed in infancy without ado or any particular conscious cultural significance, among the Urhobo people 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 age set 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 = 249-260
| 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 ].<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>

==Ethical issues==
{{main|Bioethics of neonatal circumcision}}

Circumcising infants is controversial. ] assert that circumcision is a significant public health measure, preventing infections, and slowing down the spread of ].<ref name = "ANRS">{{cite journal
| last = Auvert
| first = Bertran
| coauthors = Dirk Taljaard, Emmanuel Lagarde, Joëlle Sobngwi-Tambekou, Rémi Sitta, Adrian 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
| id = PMID 16231970
| url = http://medicine.plosjournals.org/archive/1549-1676/2/11/pdf/10.1371_journal.pmed.0020298-S.pdf
| format = PDF
| accessdate = 2006-07-09
}}
</ref> ], however, question the legality of infant circumcision by asserting that infant circumcision is a ] or a ].<ref>{{cite book
| last = Sommerville
| 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
| issn =
| 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>

===Consent===
Views differ on whether limits should be placed on caregivers having a child circumcised. One argument questions why the genital cutting of males is allowed while the ] is prohibited.<ref>{{cite web
| url = http://www.fgmnetwork.org/intro/mgmfgm.html
| title = Similarities in Attitudes and Misconceptions toward Infant Male Circumcision in North America and Ritual Female Genital Mutilation in Africa.
| accessdate = 2006-07-01
| last = Lightfoot-Klein
| first = Hanny
| year = 2003
| publisher = The FGC Education and Networking Project
}}
</ref> Another argument is that as it is his body, any decision to circumcise should only be made by the owner of the foreskin when he reaches adulthood.

Others argue that there is no convincing evidence of sexual or emotional harm, and that there are greater monetary and psychological costs in circumcising later rather than in infancy.<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-W9}}</ref>

Some medical associations accept that the parents should determine what is in the best interest of the infant or child,<ref name = "AAP1999">{{cite journal
| last = Task Force on Circumcision
| coauthors =
| year = 1999
| month = ],
| 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 = "CSA:I-99" /><ref name="CMAJ2"/><ref name="BMAGuide2"/> 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>
}}
</ref><ref name = "BMAGuide">{{cite web
| url = http://www.bma.org.uk/ap.nsf/Content/malecircumcision2006?OpenDocument&Highlight=2,circumcision
| title = The law and ethics of male circumcision - guidance for doctors
| accessdate = 2006-07-01
| author = Medical Ethics Committee
| year = 2006
| month = June
| publisher = ]
}}
</ref> The BMA insists that a circumcision must not go ahead without the consent of both parents and the competent child.<ref name = "BMAGuide" />

===Emotional consequences===
Goldman discussed the extent to which circumcision may cause emotional harm to males.<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> Some organizations have been formed as support groups for men who are upset with being circumcised.<ref>{{cite web
| url = http://www.norm.org/
| title = National Organization of Restoring Men
| accessdate = 2006-07-01
| year = 2006
}}
</ref>

===Legality===
{{main|Circumcision and law}}

Traditionally, circumcision has been presumed to be legal when performed by a trained operator.

In 2001, ] allowed 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 = ], ]
| 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 web
| url = http://www.canadiancrc.com/articles/Jews_Protest_Swedish_Circumcision_Restriction_07JUN01.htm
| title = Jews protest Swedish circumcision restriction
| accessdate = 2006-10-18
| author = ]
| date = ], ]
| publisher = Canadian Children's Rights Council
| 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> However, in 2006, the United States State Department reported that most Jewish ]s had been certified under the law and 3000 Muslim and 40-50 Jewish boys were circumcised each
year. The National Board of Health and Welfare reviewed the law in 2005 and recommended that it be maintained.<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 = ], ]
| work = International Religious Freedom Report 2006
| publisher = US Department of State
}}
</ref>

==Pain and pain relief during circumcision==

Stang, 1998, found 45% of physicians used anaesthesia for infant circumcisions. Dorsal penile nerve block was the most commonly used. Obstetricians used anaesthesia significantly less often (25%) than pediatricians (71%) or family practitioners (56%).<ref name = "Stang">{{cite journal
| last = Stang | last = Stang
| first = Howard J. | first = Howard J.
Line 767: Line 213:
| month = June | month = June
| title = Circumcision Practice Patterns in the United States | title = Circumcision Practice Patterns in the United States
| journal = ] | journal = Pediatrics
| volume = 101 | volume = 101
| issue = 6 | issue = 6
Line 779: Line 225:
</ref> </ref>


==Sexual Effects==
Taddio, 1997, showed that infants are affected by the pain of circumcision. It found a correlation between circumcision and intensity of pain response during ] months later. While the researchers stated that their results were speculative they recommended that "analgesia should be routine for circumcision" to avoid long-term effects in pain responses,<ref name = "Taddio">{{cite journal
{{main|Sexual effects of circumcision}}
| 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 = 2006-07-01
}}
</ref> Taddio's paper was referred to in the American Academy of Pediatrics' 1999 Circumcision Policy Statement, which, for the first time recommended the use of pain relief for circumcision.


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. Masters and Johnson 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" /> 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. Opinions differ about how this decreased sensitivity, which may result in prolonged time to orgasm, affects sexual satisfaction. An investigation of the exteroceptive and light tactile discrimination of the glans of circumcised and uncircumcised men found no difference on comparison. No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."<ref name = "AAFP" />
J.M. 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. 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."<ref>{{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 = doi:10.1046/j.1464-410x.1999.0830s1017.x
| id = PMID 10766529
| url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1017.x
| format = PDF
| accessdate = 2007-04-25
}}
</ref> Tannenbaum and Shechet, 2000, stated that an “authentic, traditional ] performed by a ] does not use clamps, so there is no pain associated with crushing tissue.”<ref name = "Shechet">{{cite journal
| last = Shechet
| first = Jacob
| coauthors = Barton Tanenbaum
| year = 2000
| title = Circumcision---The Debates Goes On
| journal = ]
| volume = 105
| issue = 3
| pages = 682–683
| pmid = 10733391
| doi = doi:10.1542/peds.105.3.681
| url = http://pediatrics.aappublications.org/cgi/reprint/105/3/681.pdf
| format = PDF
| accessdate = 2007-04-06
}}
</ref> They also asserted that due to the speed of the procedure and rarity of complication, it is “more humane not to subject the infant to a local anesthetic.”<ref name = "Shechet" />


Boyle ''et al.'' (2002) argued that "although the frenulum was reported as an area of heightened erogenous sensitivity, in the typical circumcised male, either no frenulum remains or only a small severely damaged remnant exists. The complex innervation of the foreskin and frenulum has been well-documented, and the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings--many of which are lost to circumcision, with an inevitable reduction in sexual sensation experienced by circumcised males.<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> The authors conclude: “Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."
==Sexual Effects==
{{main|Sexual effects of circumcision}}


Taves argued that the foreskin may have an intromission function, facilitating penetration, or that circumcision may decrease vaginal wetness and orgasm in female partners. Sadovsky, noting a preliminary study that found decreased erectile function and penile sensitivity but increased satisfaction after adult circumcision, argued that research on adult circumcision, sexual function, and satisfaction should not be generalized to neonatal circumcision.
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. ] 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" /> 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. Opinions differ about how this decreased sensitivity, which may result in prolonged time to orgasm, affects sexual satisfaction. An investigation of the exteroceptive and light tactile discrimination of the glans of circumcised and uncircumcised men found no difference on comparison. No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."<ref name = "AAFP" />


Sorrells, M. et al., conducted controlled sensitivity testing of fine touch pressure thresholds at 19 locations of the adult penis. They state that the glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. They also found that “circumcision ablates the most sensitive parts of the penis.”
Boyle ''et al.'' (2002) argued that circumcision and frenectomy remove tissues with "heightened erogenous sensitivity," stating "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings&mdash;many of which are lost to circumcision."<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>. They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."


==Medical aspects== ==Medical aspects==
{{main|Medical analysis of circumcision}} {{main|Medical analysis of circumcision}}


The ], states that “there is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research.”<ref name = "BMAGuide" /> ] have varied. Some found a small net benefit,<ref>{{cite journal The medical risks and potential benefits of neonatal circumcision have been studied. The ], states that “there is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research.”<ref name = "BMAGuide" /> Studies making ] comparing circumcision complications with the potential gain in expected longevity, and the medical costs of circumcision compared with the expected reduction in lifetime health costs have varied. Some found a small net benefit,<ref>{{cite journal
| last = Schoen | last = Schoen
| first = Edgar J. | first = Edgar J.
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| accessdate = 2006-07-01 | accessdate = 2006-07-01
}} }}
</ref> and one found that the benefits and risks of circumcision balanced each other out and suggested that the circumcision decision "most reasonably be made on nonmedical factors."<ref>{{cite journal </ref> and others found that the benefits and risks of circumcision balanced each other out and suggest the circumcision decision "most reasonably be made on nonmedical factors."<ref>{{cite journal
| last = Lawler | last = Lawler
| first = FH | first = FH
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===Risks of circumcision=== ===Risks of circumcision===
While the risk in a competently performed medical circumcision is very low,<ref name="UWstudy">{{cite journal While the immediate risk in a competently performed medical circumcision is low,<ref name="UWstudy">{{cite journal
| last = Christakis | last = Christakis
| first = Dmitry A. | first = Dmitry A.
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| accessdate = 2006-09-29 | accessdate = 2006-09-29
}} }}
</ref> ]<!-- Image is at http://en.wikipedia.org/Image:Flaccid-erect.jpg in case the tag needs an administrator's touch. --> Infant circumcision may result in skin bridges, when the cut skin does not heal neatly but attaches to the ] instead. This does not commonly require surgical correction; rather, a brief, simple office procedure may be performed.<ref>{{cite journal </ref>Infant circumcision may result in skin bridges, when the cut skin does not heal neatly but attaches to the ] instead and can be repaired in an office procedure.<ref>{{cite journal
| last = Naimer | last = Naimer
| first = Sody A. | first = Sody A.
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| accessdate = 2006-07-11 | accessdate = 2006-07-11
}} }}
</ref> suggested that 2-10% is a realistic estimate.<ref name = "CMAJ" /> ] may be a common longer-term complication from circumcision. Recent publications give a frequency of occurrence between 0.9%<ref>{{cite journal </ref> suggested that 2-10% is a realistic estimate.<ref name = "CMAJ" /> The RACP states that the penis is 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 - Circumcision
| publisher = The Royal Australasian College of Physicians
}}
</ref>

] may be a common longer-term complication from circumcision. Recent publications give a frequency of occurrence between 0.9% in Iran,<ref>{{cite journal
| last = Yegane | last = Yegane
| first = Rooh-Allah | first = Rooh-Allah
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| accessdate = 2006-07-02 | accessdate = 2006-07-02
}} }}
</ref> and 9% to 10%.<ref>{{cite web </ref> and 9% to 10% in the US.<ref>{{cite web
| url = http://www.emedicine.com/PED/topic2356.htm | url = http://www.emedicine.com/PED/topic2356.htm
| title = http://www.emedicine.com/PED/topic2356.htm | title = http://www.emedicine.com/PED/topic2356.htm
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| work = eMedicine | work = eMedicine
| publisher = WebMD | publisher = WebMD
}}
</ref> The RACP states that the penis is 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 - Circumcision
| publisher = The Royal Australasian College of Physicians
}} }}
</ref> </ref>
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</ref> </ref>


Lander ''et al.'', found that babies circumcised without pain relief "exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the circumcision and following. Two newborns ... became ill following circumcision (choking and apnea)." A 2004 Cochrane review, which compared the dorsal penile nerve block and EMLA (topical anaesthesia) found both anaesthetics appear safe, but neither of them completely eliminated pain.<ref>{{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 | id = PMID 15495086 | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15495086&query_hl=2&itool=pubmed_docsum | 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=414-7, 427 |year= |id=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=9-12 |year=2001 |id=PMID 11179706}}</ref> Lander ''et al.'', found that babies circumcised without pain relief "exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the circumcision and following. Two newborns ... became ill following circumcision (choking and apnea)." A 2004 Cochrane review, which compared the dorsal penile nerve block and EMLA (topical anaesthesia) found both anaesthetics appear safe, but neither of them completely eliminated pain.<ref>{{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 | id = PMID 15495086 | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15495086&query_hl=2&itool=pubmed_docsum | 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=414-7, 427 |year= |id=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=9-12 |year=2001 |id=PMID 11179706}}</ref>


==History of circumcision==
Adult circumcisions are often performed without clamps, and require 4 to 6 weeks of abstinence from masturbation or intercourse after the operation to allow the wound to heal.<ref name="aafpadult" />
{{main|History of male circumcision}}

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 (or enhancing) sexual pleasure, as an aid to ] where regular ] was impractical, as a means of marking those of lower (or higher) social status, as a means of differentiating a circumcising group from their non-circumcising neighbors, as a means of discouraging ] or other socially proscribed sexual behaviors, to remove "excess" pleasure, to increase a man's attractiveness to women, as a symbolic ], as a demonstration of one's ability to endure pain, or as a male counterpart to ] or the breaking of the ]. It has been suggested that the custom of circumcision gave advantages to tribes that practiced it and thus led to its spread regardless of whether the people understood this.<ref>{{cite journal
| author = ] and ]
| year = 1997
| title = A Biocultural Analysis of Circumcision
| journal = ]
| volume = 44
| pages = 265-275
| url = http://www.cirp.org/library/psych/immerman2/
}}</ref>
It is possible that circumcision arose independently in different cultures for different reasons.

] at the ], ], Egypt. ], ], c. 1360 BC.]]

] at a fair'''<br>Köçek troupe dancing at Sultan ]'s 14-day celebration of his sons' circumcision in 1720. Miniature from the ''Surname-i Vehbi'', ], ].]]

===Circumcision in the ancient world===
The oldest documentary evidence for circumcision comes from ]. Tomb artwork from the ] (2345-2181 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.

Circumcision was common, although not universal, among ancient ] peoples. The ], written in the sixth century BCE, lists the Egyptians, Jews, ], ], and ] as circumcising cultures. ], writing in the fifth century BCE, would add the ], ]ns, ], and ]ns to that list.

In the aftermath of the conquests of ], Greek dislike of circumcision led to a decline in its incidence among many peoples that had previously practised it. 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.

===Medical circumcision in the 19th century and early 20th century===
Several hypotheses have been raised in explaining the American public's acceptance of infant circumcision as preventive medicine. The success of the ] had not only enabled physicians to combat many of the postoperative complications of surgery, but had made the wider public deeply suspicious of dirt and bodily secretions. Accordingly, the ] that collects under the foreskin was viewed as unhealthy, and circumcision readily accepted as good penile hygiene. Second, moral sentiment of the day regarded ] as not only ]ful, but also physically and mentally unhealthy, stimulating the foreskin to produce the host of maladies of which it was suspected. In this climate, circumcision could be employed as a means of discouraging masturbation. ''All About the Baby'', a popular parenting book of the 1890s, recommended infant circumcision for precisely this purpose. However, a survey of 1410 men in the United States in 1992, found that circumcised men were ''more'' likely to report masturbating at least once a month.

In 1855, the ] surgeon, Jonathan Hutchinson, observed that circumcision appeared to protect against ].<ref>{{cite journal | Hutchinson J | title=On the influence of circumcision in preventing syphilis | journal=Medical Times and Gazette | volume=NS Vol II | year=1855 | pages=542&ndash;3 }}</ref> Although this observation was challenged (the protection that Jews appear to have are more likely due to cultural factors<ref>{{cite journal | author=Epstein E | title=Have the Jews any Immunity from Certain Diseases? | journal=Medical and Surgical Reporter (Philadelphia) | volume=XXX | year=1874 | pages=40&ndash;41 }}</ref>), a 2006 systematic review concluded that the evidence "strongly indicates that circumcised men are at lower risk ... syphilis."<ref>{{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=Apr |volume=82 |issue=2 |pages=101-9 |id=PMID 16581731 |url=http://sti.bmj.com/cgi/content/full/82/2/101}}</ref>

With the proliferation of ]s in urban areas, ], at least among the upper and middle classes, was increasingly undertaken in the care of a physician in a hospital rather than that of a ] in the home. It has been suggested that once a critical mass of infants were being circumcised in the hospital, circumcision became a class marker of those wealthy enough to afford a hospital birth.<ref>{{cite journal |url=http://www.law.uc.edu/lawreview/uclaw72pdf/0455waldeck.pdf |title=Using Male Circumcision to Understand Social Norms as Multipliers |journal=UNIVERSITY OF CINCINNATI LAW REVIEW |first=S.E. |last=Waldeck |year=2003 |volume=72 |issue=2 |pages=455-526}}</ref>

By the 1920s, advances in the understanding of disease had undermined much of the original medical basis for preventive circumcision. Doctors continued to promote it, however, as good penile hygiene and as a preventive for a handful of conditions local to the penis: balanitis, phimosis, and penile cancer. {{Fact|date=March 2007}}

Routine infant circumcision was taken up in the English-speaking parts of ], the ] and ], and to a lesser extent in ] and the ] In England, the Royal House had a long tradition requiring that all male children be circumcised” (Alfred J. Kolatach’s The Jewish Book of Why, Middle Village, New York; Jonathan David, 1981).
. Although it is difficult to determine historical circumcision rates, one estimate of infant circumcision rates in the United States holds that 30% of newborn American boys were being circumcised in 1900, 55% in 1925, and 72% in 1950.

===Circumcision since 1950===
In 1949, a lack of consensus in the medical community as to whether circumcision carried with it any notable health benefit motivated the United Kingdom's newly-formed ] to remove routine infant circumcision from its list of covered services. One factor in this rejection of circumcision may have been Douglas Gairdner’s famous study, ''The fate of the foreskin'', which revealed that for the years 1942&ndash;1947, about 16 children per year had died because of circumcision in England and Wales, a rate of about 1 per 6000 performed circumcisions.<ref name = "Gairdner" /> Since then, circumcision has been an ] to parents, and the proportion of newborns circumcised in England and Wales has fallen to less than one percent.

In Canada (where public medical insurance is universal, and where private insurance does not replicate services already paid from the public purse), individual provincial health services began delisting circumcision in the 1980s. <!--Commenting out pending a reliable source: The infant circumcision rate in Canada has fallen from roughly 50% in the 1970s to 13.9% in 2003. However, the figures varied from 29.5% on Prince Edward Island to zero in Newfoundland and Labrador. -->

In ], circumcision has steadily grown in popularity following the establishment of the United States trusteeship in 1945 and the spread of American influence. More than 90% of South Korean high school boys are now circumcised, but the average age of circumcision is 12 years.<ref>{{cite journal |url=http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410X.2002.02545.x |first=MG |last=Pang |coauthors=Kim DS |title=Extraordinarily high rates of male circumcision in South Korea: history and underlying causes |journal=BJU Int |year=2002 |volume=89 |issue=1 |pages=48-54}}</ref>

In some ]n ethnic groups, circumcision has roots in several belief systems, and is performed most of the time on teenage boys:
:''"...The young men in the eastern Cape belong to the Xhosa ethnic group for whom circumcision is considered part of the passage into manhood... A law was recently introduced requiring initiation schools to be licensed and only allowing circumcisions to be performed on youths aged 18 and older. But Eastern Cape provincial Health Department spokesman Sizwe Kupelo told Reuters news agency that boys as young as 11 had died. Each year thousands of young men go into the bush alone, without water, to attend initiation schools. Many do not survive the ordeal..."'' .

Prior to 1989, the American Academy of Pediatrics had a long-standing opinion that medical indications for routine circumcision were lacking. This stance, according to the AMA, was reversed in 1989, following new evidence of reduction in risk of urinary tract infection.<ref name = "CSA:I-99" /> A study in 1987 found that the prominent reasons for parents choosing circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns. A 1999 study reported that reasons for circumcision included "ease of hygiene (67 percent), ease of infant circumcision compared with adult circumcision (63 percent), medical benefit (41 percent), and father circumcised (37 percent)." The authors commented that "Medical benefits were cited more frequently in this study than in past studies, although medical issues remain secondary to hygience and convenience." A 2001 study reported that "The most important reason to circumcise or not circumcise the child was health reasons."<ref name="adler">{{cite journal |url=http://pediatrics.aappublications.org/cgi/content/full/107/2/e20 |title=Circumcision: we have heard from the experts; now let's hear from the parents |first=R |last=Adler |coauthors=''et al'' |journal=Pediatrics |year=2001 |volume=107 |issue=2 |pages=E20}}</ref> A 2005 study speculated that increased recognition of the potential benefits relative to risks may be responsible for an observed increase in the rate of neonatal circumcision in the USA between 1988 and 2000.
In a 2001 survey, 86.6% of parents felt respected by their medical provider, and parents who did not circumcise "felt less respected by their medical provider".<ref name="adler" />

The AMA noted that, in one study, physicians in "nearly half" of neonatal circumcisions "did not discuss the potential medical risks and benefits of elective circumcision prior to delivery of the infant son. Deferral of discussion until after birth, combined with the fact that many parents' decisions about circumcision are preconceived, contribute to the high rate of elective circumcision." Two studies in the United States found that strong parental cultural expectations clash with deliberate informed consent, and “a significant number of parents expressed animosity toward the care provider.” Discord arises from the implication that parental desire to circumcise involves “undue risks” and provides “limited medical benefit” to their child.{{ref|Brown}} {{ref|Rand}}<ref name="CSA:I-99" />

{| border="2" cellpadding="4" cellspacing="0" style="margin-left:auto; margin-right:auto; border-collapse: collapse; border:1px solid #999"
|+'''Table 1: International circumcision rates'''
|- bgcolor="#f2f2f2"
! Country
! Year
! Neonatal circumcisions (%)
|-
| United States
| 2003
| 55.9%*
|-
| Canada
| 2005
| &lt; 14%
|-
| Australia
| 2004
| 10%-20%
|-
| New Zealand
| 1995
| 10%-20%
|-
|- style="border-top:1px solid #999; border-bottom: hidden; border-left: hidden; border-right: hidden;"
| colspan="3" | <small>*The percentage refers to infants born in non-Federal hospitals; see p 52, Table 44 of the reference.</small>
|- style="border-top: hidden; border-bottom: hidden; border-left: hidden; border-right: hidden;"
| colspan="3" | <small>**Samoans, Tongans and Niueans in New Zealand continue to practice circumcision, but not in public hospitals, to which these data refer.</small>
|}


===HIV=== ===HIV===
Population based studies suggested that circumcision may protect against HIV but factors such as religion may have skewed the results. In March 2005, the Cochrane review of the medical evidence found the evidence at that point "insufficient" to consider implementing circumcision "as a public-health intervention" but the positive results of observational studies suggested that circumcision was "worth evaluating in randomised controlled trials.”<ref name="Sig">{{cite journal Initial population based studies suggested that circumcision might protect against HIV infection. However, in these studies, factors such as religion may skew the results. In March 2005, the Cochrane review of the medical evidence found the current quality of evidence at that point "insufficient" to consider implementing circumcision "as a public-health intervention" but the positive results of observational studies suggested that circumcision was "worth evaluating in randomised controlled trials.”<ref name="Sig">{{cite journal
| last = Siegfried | last = Siegfried
| first = N | first = N
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</ref> </ref>


Three recent studies indicate that circumcision is correlated with a 50-60% reduction in risk of HIV transmission (from female to male) during heterosexual intercourse.<ref>{{cite web | url = http://www.who.int/mediacentre/news/statements/2007/s04/en/index.html | title = WHO and UNAIDS Secretariat welcome corroborating findings of trials assessing impact of male circumcision on HIV risk | accessdate = 2007-02-23 | date = ], ] | publisher = World Health Organization}}</ref> The results of the first randomised controlled trial were published in November 2005. It found a 60% reduction in the rate of new HIV infection (from 2.1 per 100 to 0.85 per 100 in the intervention group. The authors said, “Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa.”<ref name = "ANRS" /> Two further randomised trials conducted in Uganda and Kenya were stopped early on December 13, 2006 on grounds that circumcision was so effective that it would be unethical to continue the experiment and not offer circumcision in the uncircumcised men who were acting as controls. The results showed that circumcised males in Uganda were, depending upon the analysis, 51%-60% less likely to be infected.<ref name="grayrct" /> In Kenya, circumcised males were 53%-60% less likely to be infected.<ref name="baileyrct" /> A paper published in the journal ] in July, 2006, calculated that if all men in sub-Saharan Africa were circumcised over the next 10 years, two million new infections could potentially be avoided.<ref name = "PLoS-7-06">{{cite journal The most recent data indicate that circumcision is correlated with a 50-60% reduction in risk of HIV transmission (from female to male) during heterosexual intercourse.<ref>{{cite web | url = http://www.who.int/mediacentre/news/statements/2007/s04/en/index.html | title = WHO and UNAIDS Secretariat welcome corroborating findings of trials assessing impact of male circumcision on HIV risk | accessdate = 2007-02-23 | date = ], ] | publisher = World Health Organization}}</ref> The results of the first randomised controlled trial was published in November 2005. It found a 60% reduction in the rate of new HIV infection (from 2.1 per 100 to 0.85 per 100 in the intervention group. The authors said, “Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa.”<ref name = "ANRS" /> Two further randomised trials conducted in Uganda and Kenya were stopped early on December 13, 2006 on grounds that circumcision was so effective that it would be unethical to continue the experiment and not offer circumcision in the uncircumcised men who were acting as controls. The results showed that circumcised males in Uganda were, depending upon the analysis, 51%-60% less likely to be infected.<ref name="grayrct" /> In Kenya, circumcised males were 53%-60% less likely to be infected.<ref name="baileyrct" /> A paper published in the journal ] in July, 2006, calculated that if all men in sub-Saharan Africa were circumcised over the next 10 years, two million new infections could potentially be avoided.<ref name = "PLoS-7-06">{{cite journal
| last = Williams | last = Williams
| first = Brian G. | first = Brian G.
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There is also a danger of HIV being spread from unhygienic circumcision procedures. Brewer ''et al.'' studied HIV infection rates in Kenya, Lethotho and Tanzania and found that " male and female virgins were substantially more likely to be HIV infected than uncircumcised virgins. Among adolescents, regardless of sexual experience, circumcision was just as strongly associated with prevalent HIV infection. However, uncircumcised adults were more likely to be HIV positive than circumcised adults." The authors concluded, "HIV transmission may occur through circumcision-related blood exposures in eastern and southern Africa."<ref>{{cite journal | last = Brewer | first= Devon | year = 2007| month= February | title = Male and Female Circumcision Associated with Prevalent HIV Infection in Virgins and Adolescents in Kenya, Lesotho, and Tanzania | journal = Annals of Epidemiology | volume = 17 | issue = 3| pages = pp.217-226 | url = http://www.annalsofepidemiology.org/article/PIIS1047279706002651/abstract| accessdate = 2007-03-04| quote = <small> (Kenyan females: 3.2% vs. 1.4%, odds ratio = 2.38; Kenyan males: 1.8% vs. 0%, OR undefined; Lesothoan males: 6.1% vs. 1.9%, OR 3.36; Tanzanian males: 2.9% vs. 1.0%, OR 2.99; weighted mean phi correlation = 0.07, 95% confidence interval, 0.03 to 0.11).</small>}}</ref> There is also a danger of HIV being spread from unhygienic circumcision procedures. Brewer ''et al.'' studied HIV infection rates in Kenya, Lethotho and Tanzania and found that " male and female virgins were substantially more likely to be HIV infected than uncircumcised virgins. Among adolescents, regardless of sexual experience, circumcision was just as strongly associated with prevalent HIV infection. However, uncircumcised adults were more likely to be HIV positive than circumcised adults." The authors concluded, "HIV transmission may occur through circumcision-related blood exposures in eastern and southern Africa."<ref>{{cite journal | last = Brewer | first= Devon | year = 2007| month= February | title = Male and Female Circumcision Associated with Prevalent HIV Infection in Virgins and Adolescents in Kenya, Lesotho, and Tanzania | journal = Annals of Epidemiology | volume = 17 | issue = 3| pages = pp.217-226 | url = http://www.annalsofepidemiology.org/article/PIIS1047279706002651/abstract| accessdate = 2007-03-04| quote = <small> (Kenyan females: 3.2% vs. 1.4%, odds ratio = 2.38; Kenyan males: 1.8% vs. 0%, OR undefined; Lesothoan males: 6.1% vs. 1.9%, OR 3.36; Tanzanian males: 2.9% vs. 1.0%, OR 2.99; weighted mean phi correlation = 0.07, 95% confidence interval, 0.03 to 0.11).</small>}}</ref>


On March 28, 2007, the ] and ] issued joint recommendations about male circumcision and HIV/AIDS.<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> These are: On March 28, 2007, the ] and ] issued joint recommendations concerning male circumcision and HIV/AIDS.<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> These recommendations are:


* Male circumcision should now be recognized as an efficacious intervention for HIV prevention. * Male circumcision should now be recognized as an efficacious intervention for HIV prevention.
Line 1,302: Line 781:
}} }}
</ref> While their specific hypothesis was criticised on technical grounds.<ref>{{cite web </ref> While their specific hypothesis was criticised on technical grounds.<ref>{{cite web
| url = http://sti.bmj.com/cgi/eletters/74/5/364#112 | url = http://sti.bmjjournals.com/cgi/eletters/74/5/364#112
| title = Apocrine glands in inner prepuce doubtful | title = Apocrine glands in inner prepuce doubtful
| accessdate = 2006-07-09 | accessdate = 2006-07-09
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The ] observes “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>Although the Academy's 1975 statement asserted that "A program of education leading to continuing good personal hygiene would offer all the advantages of circumcision without the attendant surgical risk," the 1999 statement cites a study which found that "appropriate hygiene decreased significantly the incidence of phimosis, adhesions, and inflammation, but did not eliminate all problems."</ref> It states that the "relationship among hygiene, phimosis, and penile cancer is uncertain" and further remarks that "genital hygiene needs to be emphasized as a preventive health topic throughout a patient's lifetime." The ] observes “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>Although the Academy's 1975 statement asserted that "A program of education leading to continuing good personal hygiene would offer all the advantages of circumcision without the attendant surgical risk," the 1999 statement cites a study which found that "appropriate hygiene decreased significantly the incidence of phimosis, adhesions, and inflammation, but did not eliminate all problems."</ref> It states that the "relationship among hygiene, phimosis, and penile cancer is uncertain" and further remarks that "genital hygiene needs to be emphasized as a preventive health topic throughout a patient's lifetime."


The ] emphasizes that the penis of an uncircumcised infant requires no special care and should be left alone. It states that attempts to ], e.g. to clean it, are painful, often injure the foreskin, and can lead to scarring, infections and pathologic phimosis.<ref name = "RACPAnat">{{cite web The ] emphasizes that a non-circumcised infant's penis requires no special care and should be left alone, stating that attempts to ], e.g. to clean it, are painful, often injure the foreskin, and can lead to scarring, infections and pathologic phimosis.<ref name = "RACPAnat">{{cite web
| url = http://www.racp.edu.au/hpu/paed/circumcision/anatomy.htm | url = http://www.racp.edu.au/hpu/paed/circumcision/anatomy.htm
| title = Care Of The Foreskin | title = Care Of The Foreskin
Line 1,389: Line 868:
| publisher = The Royal Australasian College of Physicians | publisher = The Royal Australasian College of Physicians
}} }}
</ref> It is recommended that, while there is no special age where the foreskin should be retractable, once the foreskin becomes retractable, the child should gently wash it with water. The use of soap to wash the foreskin and the glans can lead to ]. <ref>{{cite journal </ref> It is recommended that, while there is no special age where the foreskin should be retractable, once the foreskin becomes retractable, the child should gently wash it with soap and water. It has been suggested, however, that excessive washing of the foreskin and the glans will make infections such as ] more likely.{{Fact|date=December 2006}}
| last = Birley
| initial = HDL
| year = 1993
| month = October
| title = Clinical Features and management of recurrent balanitis; association with atopy and genital washing
| journal = Genitourinary Medicine
| volume = 69
| issue = 5
| pages = 400&ndash;403
| doi = 10.1136/jme.2002.001313
| id = PMID 15173354
| url = http://www.cirp.org/library/disease/balanitis/birley/
| accessdate = 2007-07-04
}}
</ref>


Smegma is a combination of exfoliated ], transudated skin oils, and moisture that can accumulate under the ] of males and within the female ] area. It is common to all ]—male and female. In rare cases, accumulating smegma may help cause balanitis.<ref>{{cite journal |first=C |last=Sonnex |coauthors=Croucher, PE; Dockerty WG |title=Balanoposthitis associated with the presence of subpreputial "smegma stones" |journal=Genitourin Med |year=1997 |month=Dec |volume=73 |issue=6 |pages=567}}</ref> Circumcision reduces the amount of ] produced by the male.{{Fact|date=December 2006}} Smegma is a combination of exfoliated ], transudated skin oils, and moisture that can accumulate under the ] of males and within the female ] area. It has a characteristic strong odor and taste {{Fact|date=March 2007}}, and is common to all ]—male and female. While smegma is generally not believed to be harmful to health, the strong odour may be considered to be a nuisance or give the impression of a lack of ]. In rare cases, accumulating smegma may help cause balanitis.<ref>{{cite journal |first=C |last=Sonnex |coauthors=Croucher, PE; Dockerty WG |title=Balanoposthitis associated with the presence of subpreputial "smegma stones" |journal=Genitourin Med |year=1997 |month=Dec |volume=73 |issue=6 |pages=567}}</ref>


Hutson speculated that circumcision arose in peoples living in arid and sandy regions as a public health measure intended to prevent recurring irritation and infection caused by sand accumulating under the foreskin.<ref>{{cite journal It has been suggested that circumcision arose in peoples living in arid and sandy regions as a public health measure intended to prevent recurring irritation and infection caused by sand accumulating under the foreskin.<ref>{{cite journal
| last = Hutson | last = Hutson
| first = J.M. | first = J.M.
Line 1,536: Line 1,000:
| chapterurl = http://www.hkmj.org.hk/skin/balaniti.htm | chapterurl = http://www.hkmj.org.hk/skin/balaniti.htm
}} }}
</ref> Some of these, such as anaerobic infection, occur more frequently in uncircumcised men.<ref name = "EdwardsGU">{{cite journal </ref> Some of these, such as anaerobic infection, occur more frequently in uncircumcised men, while others, such as fungal infection, have no statistically significant differences in frequency of occurrence between circumcised and uncircumcised men.<ref name = "EdwardsGU">{{cite journal
| last = Edwards | last = Edwards
| first = Sarah | first = Sarah
Line 1,552: Line 1,016:
}} }}
</ref> There are less invasive treatments than circumcision that have been shown to be effective in treating most mild cases of balanitis.<ref name = "HKhandbook" /> Birley, et al, found that in 90% of their cases of chronic or recurring balanitis "use of emollient creams and restriction of soap washing alone controlled symptoms satisfactorily". They also state that circumcision “might be of benefit in a patient whose balanitis relapses despite these measures, and remains the principal treatment for specific conditions such as ] and plasma cell balanitis.”<ref name = "birley" /> The, less invasive procedures are not as successful in treating ], or '''BXO''',<ref>{{cite journal </ref> There are less invasive treatments than circumcision that have been shown to be effective in treating most mild cases of balanitis.<ref name = "HKhandbook" /> Birley, et al, found that in 90% of their cases of chronic or recurring balanitis "use of emollient creams and restriction of soap washing alone controlled symptoms satisfactorily". They also state that circumcision “might be of benefit in a patient whose balanitis relapses despite these measures, and remains the principal treatment for specific conditions such as ] and plasma cell balanitis.”<ref name = "birley" /> The, less invasive procedures are not as successful in treating ], or '''BXO''',<ref>{{cite journal


| last = Vincent | last = Vincent
| first = Michelle Valerie | first = Michelle Valerie
Line 1,738: Line 1,204:
| accessdate = 2006-09-21 | accessdate = 2006-09-21
}} }}
</ref> The March 1999 AAP statement notes that premature infants are usually not circumcised because of their fragile health status.<ref name = "AAP1999" /> Studies have found that 1 in 10 premature infants will have a urinary tract infection during the first month of life. Some of the UTI studies have been criticised for not taking these and other factors into account. A Swedish study found that the cumulative incidence of UTIs in boys under 2 years of age was 2.2%.<ref name="jakobsson1999">Jakobsson 1999, ''et al''. Minimum incidence and diagnostic rate of first urinary tract infection. ''Pediatrics.'' 1999 August;104 (2 Pt 1):222–6. ()</ref> The AMA cites evidence that the incidence of UTI’s is “small (0.4%–1%)” in uncircumcised infants, and “depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI…One model of decision analysis concluded that the incidence of UTI would have to be substantially higher in uncircumcised males to justify circumcision as a preventive measure against this condition.”<ref name = "CSA:I-99" /> </ref> The March 1999 AAP statement notes that premature infants are usually not circumcised because of their fragile health status.<ref name = "AAP1999" /> Studies have found that 1 in 10 premature infants will have a urinary tract infection during the first month of life. Some of the UTI studies have been criticised for not taking these and other factors into account. A Swedish study found that the cumulative incidence of UTIs in boys under 2 years of age was 2.2%.<ref name="jakobsson1999">Jakobsson 1999, ''et al''. Minimum incidence and diagnostic rate of first urinary tract infection. ''Pediatrics.'' 1999 August;104(2 Pt 1):222–6. ()</ref> The AMA cites evidence that the incidence of UTI’s is “small (0.4%–1%)” in uncircumcised infants, and “depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI…One model of decision analysis concluded that the incidence of UTI would have to be substantially higher in uncircumcised males to justify circumcision as a preventive measure against this condition.”<ref name = "CSA:I-99" />


The ] poses the question of whether increased ] and ] rates in non-circumcised male infants may be caused by ].<ref name = "CMAJ" /> According to the Lerman and Liao, aside from its effects on UTI infection rates, "Most of the other medical benefits of circumcision probably can be realized without circumcision as long as access to clean water and proper penile hygiene are achieved."<ref name="lerman2001">Lerman SE, Liao JC. Neonatal circumcision. ''Pediatr Clin North Am.'' 2001 December;48(6):1539-57. PMID 11732129</ref> The ] poses the question of whether increased ] and ] rates in non-circumcised male infants may be caused by ].<ref name = "CMAJ" /> According to the Lerman and Liao, aside from its effects on UTI infection rates, "Most of the other medical benefits of circumcision probably can be realized without circumcision as long as access to clean water and proper penile hygiene are achieved."<ref name="lerman2001">Lerman SE, Liao JC. Neonatal circumcision. ''Pediatr Clin North Am.'' 2001 December;48(6):1539-57. PMID 11732129</ref>


==Cultures and religions==
===Policies of various national medical associations===
Some cultures circumcise their males either shortly after birth, in childhood or around puberty, when it may be part of a rite of passage. . Geographically, circumcision is prevalent in Muslim countries, the United States, the Philippines and South Korea. It is less prevalent in Europe, Latin America, China and India. Among religious groups, circumcision is most prevalent among ]s and ]s.
====United States====
===Judaism===
The ] recommends that physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering circumcision for newborn boys.<ref name = "AAFP2">{{cite web
{{main|Brit milah}}
| url = http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html
{{see also|Circumcision in the Bible}}
| title = Circumcision: Position Paper on Neonatal Circumcision

Circumcision is a fundamental rite of ]. An essential component of Jewish practice, it is a positive ] obligatory under ] for Jewish males, and is only postponed or abrogated in the case of threat to the life or health of the child.<ref>{{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 = doi:10.1046/j.1464-410x.1999.0830s1017.x
| id = 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 in a ceremony called a '']'' (or ''Bris milah'', colloquially simply ''bris'') (] for "Covenant of circumcision"). A '']'' performs the ceremony on the eighth day after birth unless health reasons force a delay. According to the ] (], chapter 17 verses 9-14), ] commanded ] to circumcise himself, his offspring and his slaves as a sign of an everlasting covenant. According to Jewish law, failure to follow the commandment carries the penalty of ''karet'', or being cut off from the community by God. ''Brit milah'' is so important that should the eighth day fall on ], actions that would normally be forbidden because of the sanctity of the day are permitted in order to fulfill the requirement to circumcise. The original Brit milah consisted of excising the foreskin tissue which extended beyond the tip of the glans penis, while current practice (Brit periah) removes the foreskin to completely expose the glans. The expressly ritual element of circumcision in Judaism, as distinguished from its non-ritual requirement in Islam, is shown by the requirement that a child who either is born ] (without a foreskin) or who has been circumcised without the ritual must nevertheless undergo a ''Brit milah'' in which a drop of blood (''hatafat-dam'', הטפת דם) is drawn from the penis at the point where the foreskin would have been or was attached.<ref>], ], 263:4</ref>

Less commonly practised and more controversial is '']'', or oral suction. This is when the '']'' sucks blood from the circumcision wound. The traditional reasons for this are to promote healing.<ref>] Tractate Shabbos 133b: Rav Pappa said, “A mohel who does not perform metzitzah endangers the baby and is dismissed.”
</ref><ref>{{cite news
| first = Mordechai
| last = Halperin
| authorlink = Mordechai Halperin
| coauthors = <small>(translated by Yocheved Lavon)</small>
| title = Metzitzah B’peh Controversy: The View from Israel
| url = http://www.ou.org/jewish_action/article/8987
| work = Jewish Action 67(2)
| publisher = ]
| id = {{ISSN|0447-7049}} {{OCLC|5763983}}
| pages = 25, 33–39
| date = Winter 2006
| accessdate = 2007-02-15
| quote = <small>The original technique for the performance of metzitzah employs the human mouth. The mohel brings the baby’s organ into his mouth immediately after the excision of the foreskin and sucks blood from it vigorously. This action lowers the internal pressure in the tissues of the organ, in the blood vessels of the head of the organ and in the exposed ends of the arterioles that have just been cut. Thus, the difference between the pressure in the blood vessels in the base of the organ and the pressure in the blood vessels at its tip is increased. This requirement has deep religious significance as well as medical benefits.…The Gemara states that the requirement of metzitzah stems from medical considerations; it is meant to minimize risk to the infant’s life and health</small>}}
</ref> However, the practice has been implicated in the spreading of herpes to the infant.<ref name = "Gesundheit">{{cite journal
| last = Gesundheit
| first = B.
| coauthors = et al.
| year = 2004
| month = August
| title = Neonatal Genital Herpes Simplex Virus Type 1 Infection After Jewish Ritual Circumcision: Modern Medicine and Religious Tradition
| journal = Pediatrics
| volume = 114
| issue = 2
| pages = e259&ndash;e263
| id = {{ISSN|1098-4275}}
| url = http://pediatrics.aappublications.org/cgi/reprint/114/2/e259.pdf
| format = PDF
| accessdate = 2006-06-28
}}
</ref> Today, if it is performed, the mohel generally uses a glass tube.<ref name = "RCAMetzitzah">{{cite web
| url = http://www.rabbis.org/news/article.cfm?id=100605
| title = Metzitza Be'Peh - Halachic Clarification
| accessdate = 2007-04-06
| date = ], ]
| publisher = ]
| quote = <small>The poskim consulted by the RCA…agree that the normative halacha undoubtedly permits the third view , and that it is proper for mohalim to conduct themselves in this way given the health issues involved in the fourth view.…However, although Rav Yosef Dov Soloveitchik also generally prohibited metzitza be’peh with direct oral contact, he did not ban it by those who insisted upon it, and neither does the RCA advocate any such ban. Those who wish to follow their customs in accordance with the above-noted authorities are certainly entitled to do so, but the RCA is firmly of the opinion that in light of current realities and medical knowledge it is proper, and preferable, to use a tube.</small>
}}
</ref><ref>{{cite news
|first = Kelly
|last = Hartog
|url = http://www.jewishjournal.com/home/preview.php?id=13676
|title = Death Spotlights Old Circumcision Rite
|publisher = ]
|date = ] ]
|accessdate = 2006-11-22
|quote = Metzizah b’peh — loosely translated as oral suction — is the part of the circumcision ceremony where the mohel removes the blood from the baby’s member; these days the removal of the blood is usually done using a sterilized glass tube, instead of with the mouth, as the Talmud suggests.
}}
</ref>

===Christianity===
] does not prescribe ]. The ] decided that circumcision was not a requirement (Acts 15). ] had Timothy circumcised (Acts 16:1-3) but in his letters he warned gentile Christians against adopting the practice (Galatians 6:12-16, Philippians 3:2-3). Individual Christians and Christian traditions may have different customs. For example, circumcision is customary among members of three of the ] Churches, the ], ], and ] churches in their home countries, as well as some other African churches.<ref name=Christian/> On ], the Catholic Church used to celebrate the ]. This has been superseded by the ]. The ] condemned the belief that the practice of circumcision was necessary for salvation as a ] in the ] in 1442<ref>" denounces all who after that time observe circumcision, the sabbath and other legal prescriptions as strangers to the faith of Christ and unable to share in eternal salvation, unless they recoil at some time from these errors. 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." (Bull of Union with the ] <i>Cantate Domino</i>, 4 February 1442, Session 11, ]), http://www.geocities.com/Heartland/Valley/8920/churchcouncils/ retrieved ] ]</ref>. Regarded among many Catholics nowadays, however, is that "the practice of circumcising male neonates is a violation of the natural law as conceived within the Catholic moral tradition and Church teaching."<ref name = "Slosar">{{cite journal
| last = Slosar
| first = John Paul
| year = 2003
| title = The Ethics of Neonatal Male Circumcision: A Catholic Perspective
| journal = The American Journal of Bioethics
| volume = 3
| issue = 2
| pages = 62&ndash;64
| url = http://muse.jhu.edu/login?uri=/journals/american_journal_of_bioethics/v003/3.2slosar.pdf
| format = PDF
| accessdate = 2007-04-03
}}
</ref> Anglican and Lutheran churches have other feast days at this time such as the Holy Name of Jesus.<ref> For example, "The Calendar of the Church Year" in The (Online) Book of Common Prayer (Episcopal Church in the United States of America), http://www.bcponline.org/ retrieved ] ].</ref>

===Islam===
The origin of circumcision in ] is a matter of religious and scholarly debate. It is mentioned in some parts of the ], but not in the ]. ] scholars have different opinions about circumcision in ], depending on which Hadith are accepted and how they are interpreted. According to some it is ''recommended'' (]); according to others, 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 ] to argue that the requirement of circumcision is based on the covenant 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>

The timing of Muslim circumcision varies. Turkish, ], rural Egyptians and Central and South Asian Muslims typically circumcise boys between the ages of six and eleven and traditionally the event may be a joyous occasion and celebrated with sweets and feasting. However, in the middle class it is more usually done in infancy and is largely unremarked upon. In Turkey the celebratory feast is called "Sünnet Düğünü" and is considered a very important celebration in man's life as a passage to a manhood.<ref>Hamdullah Aydın, M.D. and Zeynep Gülçat, Ph.D., "Turkey," in ''The International Encyclopedia of Sexuality'', http://www2.hu-berlin.de/sexology/IES/turkey.html retrieved ] ].</ref> In ], Muslims may be circumcised at all ages from the newborn period to adulthood, though the medical profession has encouraged medical circumcisions in the first week after birth to reduce complications: "Circumcision is performed by barbers, medical technicians, quacks and doctors including paediatric surgeon yet there is no consensus for the best age and method."<ref>Iftikhar Ahmad Jan, "Circumcision in babies and children with Plastibell technique: An easy procedure with minimal complications - Experience of 316 cases," Pak J Med Sci 2004, 20(3) 175-180.</ref> In Iran, Dr. Paula Drew states that “circumcision, which formerly celebrated the onset of manhood, has for many years now been more customarily performed at the age of 5 or 6 for children born at home, and at two days old for those born in a medical setting.…By puberty, all Muslim Iranian boys must be circumcised if they are to participate fully in religious activities.”<ref>{{cite encyclopedia
| last = Drew
| first = Paula E.
| coauthors = F. A. Sadeghpour and anonymous
| editor = ]
| encyclopedia = The International Encyclopedia of Sexuality
| title = Iran
| url = http://www2.hu-berlin.de/sexology/IES/iran.html
| accessdate = 2006-10-18
| publisher = Continuum Publishing Company
| location = ]
}}
</ref> Kamyar ''et al'' describe circumcision as an "obligatory custom" and note that it is not necessary for the circumciser to be a Muslim.<ref>Kamyar M. Hedayat, MD and Roya Pirzadeh, MD, "Issues in Islamic Biomedical Ethics: A Primer for the Pediatrician," ''Pediatrics'' Vol. 108 No. ] ], pp. 965-971, http://imamreza.net/eng/imamreza.php?print=3107 retrieved ] ].</ref>

===Other faiths and traditions===
] do not have any particular tradition or rituals regarding male circumcision, but view female circumcision as mutilation.<ref>{{cite web
| url = http://www.bahai.org.nz/public/patientisbahai.htm
| title = WHEN YOUR PATIENT IS A BAHA'I
| accessdate = 2007-01-30 | accessdate = 2007-01-30
| publisher = National Spiritual Assembly of the Bahá'ís of New Zealand
| year = 2007
| quote = <small>Bahá'ís are not advised on a particular course of action in respect to circumcision of males; circumcision of females is considered mutilation.</small>
| publisher = ]
}}</ref>
| 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 ] have no male circumcision in their religion,<ref>{{cite web
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 />
| url = http://www.semp.us/biots/biot_176.html
<br />
| title = Who Are the Druze?
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>
| accessdate = 2007-01-30
| date = ], ]
| work = SEMP Biot #176
| publisher = Suburban Emergency Management Project
}}</ref> although it is a practiced among those living in urban areas or outside the Middle East, mainly for hygienic reasons.

There is no specific reference to male circumcision in the Hindu holy books , and Hindus in India generally do not practice circumcision.

"Circumcision holds no relevance to a ]." All rituals which do not hold relevance are strictly forbidden<ref>{{cite web
| url = http://www.info-sikh.com/GoraPage1.html
| title = Sikh basics and misconceptions
| accessdate = 2006-07-01
}}</ref> and, "acceptance of Nature's beautiful body is an important component of the Sikh value system."<ref>{{cite web
| url = http://www.akalsangat.com/qa1.html
| title = Questions and Answers
| accessdate = 2006-07-01
| last = Singh
| first = Jasprit
| work = Akal Sangat
| publisher = Akal Publications
}}</ref>

Circumcision in South Korea is largely the result of American cultural and military influence following the ]. The origin of circumcision in the Philippines is uncertain. One newspaper article speculates that it is due to the influence of western colonizers.<ref>{{cite news
|first = Rommel G.
|last = Rebollido
|url = http://www.sunstar.com.ph/static/gen/2005/03/21/feat/passage.to.manhood.html
|title = Passage to manhood
|work = General Santos
|publisher = Sun Star Publishing, Inc.
|date = ], ]
|accessdate = 2006-07-01
|language =
}}
</ref> However, ]'s ] ''History of the Philippine Islands'', speculates that it is due to Islamic influence.<ref>{{cite book
| last = de Morga
| first = Antonio
| others = Translated by Alfonso de Salvio, Norman F. Hall, and James Alexander Robertson
| title = History of the Philippine Islands
| origyear = 1609
| url = http://www.nalanda.nitc.ac.in/resources/english/etext-project/history/philippine/index.htm
| accessdate = 2006-07-01
| date = 1907
| id = {{LCCN|unk82|0|42869}}
| chapter = 11
| chapterurl = http://www.nalanda.nitc.ac.in/resources/english/etext-project/history/philippine/chapter11.html
| quote = <small>These Borneans are Mahometans, and were already introducing their religion among the natives of Luzon, and were giving them instructions, ceremonies, and the form of observing their religion.…and those the chiefest men, were commencing, although by piecemeal, to become Moros, and were being circumcised and taking the names of Moros.</small>}}</ref> 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 Nigerian 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: 379-384 Health Educ. Res..1995; 10: 379-384 Retrieved ] ]</ref> In early 2007 it was announced that rural aidpost orderlies in the East Sepik Province of Papua New Guinea are to undergo training in the circumcision of men and boys of all ages with a view to introducing the procedure as a means of prophylaxis against HIV/AIDS, which is becoming a significant problem in the country.<ref>{{cite web
| title = "PNG circumcision campaign hopes to halt HIV,"
| publisher = ABC Radio Australia citing the ''Papua New Guinea Post-Courier''
| url = http://www.radioaustralia.net.au/news/stories/s1842948.htm
| format = htm
| date = 2007-02-08, 14:21:13,
}}</ref>

Circumcision is part of ]s in some African, Pacific Islander, and Australian aboriginal ] in remote areas, such as Arnhem Land,<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 = ]
| date = 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 Sulawesi in the Indonesian 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, including ] for 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> </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> Circumcision is also commonly practised in the Polynesian islands of ], ], ], and ]. In Samoa, it is accompanied by a celebration. Among some West African animist groups, such as the ] and ], it 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> Although in many West African traditional societies circumcision has become medicalised and is simply performed in infancy without ado or any particular conscious cultural significance, among the Urhobo people 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 age set 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 = 249-260
| 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 ].<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>

==Ethical issues==
{{main|Bioethics of neonatal circumcision}}

Circumcising infants is controversial. ] assert that circumcision is a significant public health measure, preventing infections, and slowing down the spread of ].<ref name = "ANRS">{{cite journal
| last = Auvert
| first = Bertran
| coauthors = Dirk Taljaard, Emmanuel Lagarde, Joëlle Sobngwi-Tambekou, Rémi Sitta, Adrian 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
| id = PMID 16231970
| url = http://medicine.plosjournals.org/archive/1549-1676/2/11/pdf/10.1371_journal.pmed.0020298-S.pdf
| format = PDF
| accessdate = 2006-07-09
}}
</ref> ], however, question the legality of infant circumcision by asserting that infant circumcision is a ] or a ].<ref>{{cite book
| last = Sommerville
| 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
| issn =
| 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>

===Consent===
Views differ on whether limits should be placed on caregivers having a child circumcised. One argument is that male circumcision is ethically identical to ]. It questions why the genital cutting of males is allowed while the genital cutting of females is prohibited.<ref>{{cite web
| url = http://www.fgmnetwork.org/intro/mgmfgm.html
| title = Similarities in Attitudes and Misconceptions toward Infant Male Circumcision in North America and Ritual Female Genital Mutilation in Africa.
| accessdate = 2006-07-01
| last = Lightfoot-Klein
| first = Hanny
| year = 2003
| publisher = The FGC Education and Networking Project
}}
</ref>. Another argument is that as it's his body, any decision to circumcise should be only be made by the owner of the foreskin when he reaches adulthood.

Others argue that there is no convincing evidence of sexual or emotional harm, and that there are greater monetary and psychological costs in circumcising later rather than in infancy.<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-W9}}</ref> Many are concerned that restrictions on circumcision would cut across the religious or cultural rites and practices of Jews, Muslims, and others or limit the traditional right of parents to have their child circumcised.


A number of medical associations accept that the parents should determine what is in the best interest of the infant or child,<ref name = "AAP1999">{{cite journal
The ] finds both potential benefits and risks in infant circumcision. At current it feels that there is insufficient data to recommend routine neonatal circumcision, and recommends that parental decisions on elective circumcision should be made with as much accurate and unbiased information as possible, taking medical, cultural, ethnic, traditional, and religious factors into account. The AAP also recommends using analgesia as a safe and effective method for reducing procedural pain associated with circumcision, and that circumcision on newborns only be performed on infants who are stable and healthy.<ref name = "AAP19992">{{cite journal
| last = Task Force on Circumcision | last = Task Force on Circumcision
| coauthors = | coauthors =
Line 1,774: Line 1,561:
| accessdate = 2006-07-01 | accessdate = 2006-07-01
}} }}
</ref><ref name = "CSA:I-99" /> though the ] and the ] observe that controversy exists on this issue.<ref name = "RACPSumm">{{cite web
<small>“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. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided. If circumcision is performed in the newborn period, it should only be done on infants who are stable and healthy.”</small>
| url = http://www.racp.edu.au/download.cfm?DownloadFile=A453CFA1-2A57-5487-DF36DF59A1BAF527
</ref>
| title = Policy Statement On Circumcision

| accessdate = 2007-02-28
The American Medical Association supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics.<ref name = "CSA:I-99" />

====Canada====
The Fetus and Newborn Committee of the ] posted "Circumcision: Information for Parents" in November 2004,<ref name = "CPSIFP2">{{cite web
| url = http://www.caringforkids.cps.ca/babies/Circumcision.htm
| title = Circumcision: Information for parents
| accessdate = 2006-10-24
| year = 2004 | year = 2004
| month = November | month = September
| format = PDF
| work = Caring for kids
| publisher = ] | publisher = ]
| pages =
| 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>
| 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>
}} }}
</ref><ref name = "BMAGuide">{{cite web
</ref> as well as "Neonatal circumcision revisited" in 1996. The 2004 statement said it "does not recommend circumcision for newborn boys. Many
paediatricians no longer perform circumcisions." <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
| format =
| 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>

====United Kingdom====
As of June of 2006, the British Medical Association's position was that male circumcision for medical purposes should only be used where less invasive procedures are either unavailable or not as effective. The BMA specifically refrained from issuing a policy regarding “non-therapeutic circumcision,” stating that as a general rule, it “believes that parents should be entitled to make choices about how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices.”<ref name = "BMAGuide2">
{{cite web
| url = http://www.bma.org.uk/ap.nsf/Content/malecircumcision2006?OpenDocument&Highlight=2,circumcision | url = http://www.bma.org.uk/ap.nsf/Content/malecircumcision2006?OpenDocument&Highlight=2,circumcision
| title = The law and ethics of male circumcision - guidance for doctors | title = The law and ethics of male circumcision - guidance for doctors
Line 1,820: Line 1,583:
| month = June | month = June
| publisher = ] | publisher = ]
}}
| quote = <small>'''Circumcision for medical purposes'''<br />
</ref> and the BMA insists that a circumcision must not go ahead without the consent of both parents and the competent child.<ref name = "BMAGuide" />
Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.


===Emotional consequences===
Male circumcision in cases where there is a clear clinical need is not normally controversial. Nevertheless, normal anatomical and physiological characteristics of the infant foreskin have in the past been misinterpreted as being abnormal. The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision. Doctors should be aware of this and reassure parents accordingly.<br />
Goldman discussed the extent to which circumcision may cause emotional harm to males.<ref>{{cite journal
<br />
| last = Goldman
'''Non-therapeutic circumcision'''<br />
| first = R.
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.<br />
| year = 1999
<br />
| month = January
There is a spectrum of views within the BMA’s membership about whether non-therapeutic male circumcision is a beneficial, neutral or harmful procedure or whether it is superfluous, and whether it should ever be done on a child who is not capable of deciding for himself. The medical harms or benefits have not been unequivocally proven except to the extent that there are clear risks of harm if the procedure is done inexpertly. The Association has no policy on these issues. Indeed, it would be difficult to formulate a policy in the absence of unambiguously clear and consistent medical data on the implications of the intervention. As a general rule, however, the BMA believes that parents should be entitled to make choices about how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices.</small>
| 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> Some organizations have been formed as support groups for men who are upset with being circumcised.<ref>{{cite web
| url = http://www.norm.org/
| title = National Organization of Restoring Men
| accessdate = 2006-07-01
| year = 2006
}} }}
</ref> </ref>
A study by Taddio showed that infants are affected by the pain of circumcision. It found a correlation between circumcision and intensity of pain response during ] months later. While the researchers stated that their results were "speculative" and suggested that "analgesia should be routine for circumcision" to avoid long-term effects in pain responses,<ref name = "Taddio">{{cite journal

| last = Taddio
====Australasia====
| first = Anna
The ] states '''there is no medical indication for routine neonatal circumcision''' (emphasis as in the original). It states, "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"<ref name = "RACPSumm" />
| coauthors = Joel Katz, A Lane Ilersich, Gideon Koren

==History of circumcision==
{{main|History of male circumcision}}

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 (or enhancing) sexual pleasure, as an aid to ] where regular ] was impractical, as a means of marking those of lower (or higher) social status, as a means of differentiating a circumcising group from their non-circumcising neighbors, as a means of discouraging ] or other socially proscribed sexual behaviors, to remove "excess" pleasure, to increase a man's attractiveness to women, as a symbolic ], as a demonstration of one's ability to endure pain, or as a male counterpart to ] or the breaking of the ]. It has been suggested that the custom of circumcision gave advantages to tribes that practiced it and thus led to its spread regardless of whether the people understood this.<ref>{{cite journal
| author = ] and ]
| year = 1997 | year = 1997
| month = March
| title = A Biocultural Analysis of Circumcision
| title = Effect of neonatal circumcision on pain response during subsequent routine vaccination
| journal = ]
| volume = 44 | journal = ]
| pages = 265-275 | volume = 349
| issue = 9052
| url = http://www.cirp.org/library/psych/immerman2/
| pages = 599&ndash;603
}}</ref>
| doi = 10.1016/S0140-6736(96)10316-0
It is possible that circumcision arose independently in different cultures for different reasons.
| id =
| url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673696103160.pdf
| format = PDF &mdash; free registration required
| accessdate = 2006-07-01
}}
</ref> Taddio's paper was referred to in the American Academy of Pediatrics' 1999 Circumcision Policy Statement, which, for the first time recommended the use of pain relief for circumcision.


===Legality===
] at the ], ], Egypt. ], ], c. 1360 BC.]]
{{main|Circumcision and law}}


Traditionally, ] has been presumed to be legal when performed by a trained operator.
] at a fair'''<br>Köçek troupe dancing at Sultan ]'s 14-day celebration of his sons' circumcision in 1720. Miniature from the ''Surname-i Vehbi'', ], ].]]


In 2001, ] passed a law restricting the performance of neo-natal circumcisions to persons certified by the National Board of Health. This law requires that a medical doctor or an anesthesia nurse accompany the circumcisor, and that anaesthetic is applied prior to the procedure. Most Jewish ]s have been so certified.<ref>{{cite web
===Circumcision in the ancient world===
| url = http://www.state.gov/g/drl/rls/irf/2005/51583.htm
The oldest documentary evidence for circumcision comes from ]. Tomb artwork from the ] (2345-2181 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.
| title = Sweden
| accessdate = 2006-07-01
| author = Bureau of Democracy, Human Rights, and Labor
| date = ], ]
| work = International Religious Freedom Report 2005
| publisher = US Department of State
}}
</ref> 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 = ], ]
| publisher = ]
| quote = Swedish Jews and Muslims object to the new law, saying it violates their religious rights.
}}
</ref> and the ] stated that it was “the first legal restriction on Jewish religious practice in Europe since the Nazi era.”<ref>{{cite web
| url = http://www.canadiancrc.com/articles/Jews_Protest_Swedish_Circumcision_Restriction_07JUN01.htm
| title = Jews protest Swedish circumcision restriction
| accessdate = 2006-10-18
| author = ]
| date = ], ]
| publisher = Canadian Children's Rights Council
| 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>


==Policies of various national medical associations==
Circumcision was common, although not universal, among ancient ] peoples. The ], written in the sixth century BCE, lists the Egyptians, Jews, ], ], and ] as circumcising cultures. ], writing in the fifth century BCE, would add the ], ]ns, ], and ]ns to that list.
The medical associations noted below find the current data insufficient to recommend routine neonatal circumcision. They agree that parental choice remains a legitimate reason to perform the procedure.


===United States===
In the aftermath of the conquests of ], Greek dislike of circumcision led to a decline in its incidence among many peoples that had previously practised it. 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.
The ] states the following:<ref name = "AAP1999" />
{{quotation|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. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided. If circumcision is performed in the newborn period, it should only be done on infants who are stable and healthy. ''Circumcision Policy Statement''|]}}


The American Medical Association supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics.<ref name = "CSA:I-99" />
===Medical circumcision in the 19th century and early 20th century===
Several hypotheses have been raised to explain the acceptance of infant circumcision in the United States about the turn of the Twentieth Century. The success of the ] made surgery safer, and made the public deeply suspicious of dirt and bodily secretions. So ] was viewed as unhealthy, and circumcision was seen as good penile hygiene. At that time when people regarded ] as both ]ful, and physically and mentally unhealthy, circumcision was promoted as a way of discouraging it. ''All About the Baby'', a popular parenting book of the 1890s, recommended infant circumcision for this purpose. (However, a survey of 1410 men in the United States in 1992, found that circumcised men were ''more'' likely to report masturbating at least once a month.)


===Canada===
In 1855, the ] surgeon, Jonathan Hutchinson, observed that circumcision appeared to protect against ].<ref>{{cite journal | Hutchinson J | title=On the influence of circumcision in preventing syphilis | journal=Medical Times and Gazette | volume=NS Vol II | year=1855 | pages=542&ndash;3 }}</ref> Although this observation was challenged (the protection that Jews appear to have are more likely due to cultural factors<ref>{{cite journal | author=Epstein E | title=Have the Jews any Immunity from Certain Diseases? | journal=Medical and Surgical Reporter (Philadelphia) | volume=XXX | year=1874 | pages=40&ndash;41 }}</ref>), a 2006 systematic review concluded that the evidence "strongly indicates that circumcised men are at lower risk ... syphilis."<ref>{{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=Apr |volume=82 |issue=2 |pages=101-9 |id=PMID 16581731 |url=http://sti.bmj.com/cgi/content/full/82/2/101}}</ref>
The Fetus and Newborn Committee of the ] posted Circumcision: Information for Parents in 2004, and Neonatal circumcision revisited statements in 1996, undergoing revision as of 2004:<ref name = "CMAJ" />


{{quotation|'''Circumcision: Information for parents'''
As ]s proliferated in urban areas, ], at least among the upper and middle classes, was increasingly under the care of physicians in hospitals rather than with ] in the home. It has been suggested that once a critical mass of infants were being circumcised in the hospital, circumcision became a class marker of those wealthy enough to afford a hospital birth.<ref>{{cite journal |url=http://www.law.uc.edu/lawreview/uclaw72pdf/0455waldeck.pdf |title=Using Male Circumcision to Understand Social Norms as Multipliers |journal=UNIVERSITY OF CINCINNATI LAW REVIEW |first=S.E. |last=Waldeck |year=2003 |volume=72 |issue=2 |pages=455-526}}</ref>
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.<br />
<br />
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.<br />
<br />
'''Neonatal circumcision revisited'''
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.|Neonatal circumcision revisited|]}}
|]}}


===United Kingdom===
By the 1920s, advances in the understanding of disease had undermined much of the original medical basis for preventive circumcision but doctors continued to promote it as good penile hygiene and as a preventive for balanitis, phimosis, and penile cancer. {{Fact|date=March 2007}}
As of June of 2006, the British Medical Association's position was as follows:<ref name = "BMAGuide" />
{{quotation|'''Circumcision for medical purposes'''<br />
Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.


Male circumcision in cases where there is a clear clinical need is not normally controversial. Nevertheless, normal anatomical and physiological characteristics of the infant foreskin have in the past been misinterpreted as being abnormal. The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision. Doctors should be aware of this and reassure parents accordingly.<br />
Routine infant circumcision was taken up in the English-speaking parts of ], the ] and ], and to a lesser extent in ] and the ] In England, the Royal House had a long tradition requiring that all male children be circumcised” (Alfred J. Kolatach’s The Jewish Book of Why, Middle Village, New York; Jonathan David, 1981). Although it is difficult to determine historical circumcision rates, one estimate of infant circumcision rates in the United States holds that 30% of newborn American boys were being circumcised in 1900, 55% in 1925, and 72% in 1950.
<br />
'''Non-therapeutic circumcision'''<br />
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.<br />
<br />
There is a spectrum of views within the BMA’s membership about whether non-therapeutic male circumcision is a beneficial, neutral or harmful procedure or whether it is superfluous, and whether it should ever be done on a child who is not capable of deciding for himself. The medical harms or benefits have not been unequivocally proven except to the extent that there are clear risks of harm if the procedure is done inexpertly. The Association has no policy on these issues. Indeed, it would be difficult to formulate a policy in the absence of unambiguously clear and consistent medical data on the implications of the intervention. As a general rule, however, the BMA believes that parents should be entitled to make choices about how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices.|The law and ethics of male circumcision - guidance for doctors|]}}


===Australasia (Australia, New Zealand and nearby islands)===
===Circumcision since 1950===
The ] takes the position that there is no medical indication for routine neonatal circumcision, and if the procedure is to be performed for non-medical reasons, it should be performed by competent operator, using appropriate anaesthesia and in a safe child-friendly environment.<ref name = "RACPSumm" />
In 1949, the United Kingdom's newly-formed ] removed infant circumcision from its list of covered services. One reason may have been Douglas Gairdner’s famous study, ''The fate of the foreskin'', which revealed that for the years 1942&ndash;1947, about 16 children per year in England and Wales had died because of circumcision, a rate of about 1 per 6000 circumcisions.<ref name = "Gairdner" /> Since then, circumcision has been an ] to parents, and the proportion of newborns circumcised in England and Wales has fallen to less than one percent.

In Canada (where public medical insurance is universal, and where private insurance does not replicate services already paid from the public purse), individual provincial health services began delisting circumcision in the 1980s. <!--Commenting out pending a reliable source: The infant circumcision rate in Canada has fallen from roughly 50% in the 1970s to 13.9% in 2003. However, the figures varied from 29.5% on Prince Edward Island to zero in Newfoundland and Labrador. -->

In ], circumcision grew in popularity following the establishment of the United States trusteeship in 1945 and the spread of American influence. More than 90% of South Korean high school boys are now circumcised, but the average age of circumcision is 12 years.<ref>{{cite journal |url=http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410X.2002.02545.x |first=MG |last=Pang |coauthors=Kim DS |title=Extraordinarily high rates of male circumcision in South Korea: history and underlying causes |journal=BJU Int |year=2002 |volume=89 |issue=1 |pages=48-54}}</ref>

In some ]n ethnic groups, circumcision has roots in several belief systems, and is performed most of the time on teenage boys:
:''"...The young men in the eastern Cape belong to the Xhosa ethnic group for whom circumcision is considered part of the passage into manhood... A law was recently introduced requiring initiation schools to be licensed and only allowing circumcisions to be performed on youths aged 18 and older. But Eastern Cape provincial Health Department spokesman Sizwe Kupelo told Reuters news agency that boys as young as 11 had died. Each year thousands of young men go into the bush alone, without water, to attend initiation schools. Many do not survive the ordeal..."'' .

Prior to 1989, the American Academy of Pediatrics had a long-standing opinion that medical indications for routine circumcision were lacking. This stance, according to the AMA, was reversed in 1989, following new evidence of reduction in risk of urinary tract infection.<ref name = "CSA:I-99" /> A study in 1987 found that the prominent reasons for parents choosing circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns. A 1999 study reported that reasons for circumcision included "ease of hygiene (67 percent), ease of infant circumcision compared with adult circumcision (63 percent), medical benefit (41 percent), and father circumcised (37 percent)." The authors commented that "Medical benefits were cited more frequently in this study than in past studies, although medical issues remain secondary to hygience and convenience." A 2001 study reported that "The most important reason to circumcise or not circumcise the child was health reasons."<ref name="adler">{{cite journal |url=http://pediatrics.aappublications.org/cgi/content/full/107/2/e20 |title=Circumcision: we have heard from the experts; now let's hear from the parents |first=R |last=Adler |coauthors=''et al'' |journal=Pediatrics |year=2001 |volume=107 |issue=2 |pages=E20}}</ref> A 2005 study speculated that increased recognition of the potential benefits may be responsible for an observed increase in the rate of neonatal circumcision in the USA between 1988 and 2000.
In a 2001 survey, 86.6% of parents felt respected by their medical provider, and parents who did not circumcise "felt less respected by their medical provider".<ref name="adler" />

The major medical societies in Britain, Canada, Australia and New Zealand do not support routine non-therapeutic infant circumcision. Major medical organizations in the United States do not recommend routine circumcision, but instead state that parents should decide what is in their child's best interests.

The AMA remarked that, in one study, physicians in "nearly half" of neonatal circumcisions "did not discuss the potential medical risks and benefits of elective circumcision prior to delivery of the infant son. Deferral of discussion until after birth, combined with the fact that many parents' decisions about circumcision are preconceived, contribute to the high rate of elective circumcision."<ref name="CSA:I-99" />

{| border="2" cellpadding="4" cellspacing="0" style="margin-left:auto; margin-right:auto; border-collapse: collapse; border:1px solid #999"
|+'''Table 1: International circumcision rates'''
|- bgcolor="#f2f2f2"
! Country
! Year
! Neonatal circumcisions (%)
|-
| United States
| 2003
| 55.9%*
|-
| Canada
| 2005
| &lt; 14%
|-
| Australia
| 2004
| 10%-20%
|-
| New Zealand
| 1995
| 10%-20%
|-
|- style="border-top:1px solid #999; border-bottom: hidden; border-left: hidden; border-right: hidden;"
| colspan="3" | <small>*The percentage refers to infants born in non-Federal hospitals; see p 52, Table 44 of the reference.</small>
|- style="border-top: hidden; border-bottom: hidden; border-left: hidden; border-right: hidden;"
| colspan="3" | <small>**Samoans, Tongans and Niueans in New Zealand continue to practice circumcision, but not in public hospitals, to which these data refer.</small>
|}


==Prevalence of circumcision== ==Prevalence of circumcision==
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| url = http://pt.wkhealth.com/pt/re/aunz/fulltext.00130494-200405000-00028.htm | url = http://pt.wkhealth.com/pt/re/aunz/fulltext.00130494-200405000-00028.htm
| accessdate = 2007-03-31 | accessdate = 2007-03-31
</ref>{{Verify source|date=April 2007}} although another notes indications of increasing demand in Southern Africa.<ref>{{cite journal |title=Demand for male circumcision rises in a bid to prevent HIV |journal=Bulletin of the World Health Organization |volume=84 |issue=7 |year=2006 |pages=505-588 |url=http://www.scielosp.org/pdf/bwho/v84n7/v84n7a05.pdf |quote=As a result, there are already indications of increasing demand for male circumcision in traditionally non-circumcising societies in southern Africa.}}</ref> </ref>{{verify source}} although another notes indications of increasing demand in Southern Africa.<ref>{{cite journal |title=Demand for male circumcision rises in a bid to prevent HIV |journal=Bulletin of the World Health Organization |volume=84 |issue=7 |year=2006 |pages=505-588 |url=http://www.scielosp.org/pdf/bwho/v84n7/v84n7a05.pdf |quote=As a result, there are already indications of increasing demand for male circumcision in traditionally non-circumcising societies in southern Africa.}}</ref>


===Australia=== ===Australia===
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===United Kingdom=== ===United Kingdom===
A national survey on sexual attitudes in 2000 found that 11.7% of 16-19 year olds, and 19.6% of 40-44 year olds said they had been circumcised. It also found that, apart from black Caribbeans, overseas born men were more likely to be circumcised.<ref>{{cite journal |title=Male circumcision in Britain: A national survey on sexual attitudes in 2000 found that 11.7% of 16-19 year olds, and 19.6% of 40-44 year olds said they had been circumcised. It also found that, apart from black Caribbeans, overseas born men were more likely to be circumcised.<ref>{{cite journal |url=http://sti.bmj.com/cgi/content/full/79/6/499 |title=Male circumcision in Britain:
findings from a national probability sample survey |url=http://sti.bmj.com/cgi/content/full/79/6/499 |first=SS |last=Dave |coauthors=''et al'' |journal=Sex Transm Infect |year=2003 |volume=79 |issue=6 |pages=499-500}}</ref> Rickwood ''et al'' reported that the proportion of English boys circumcised for medical reasons had fallen from 35% in the early 1930s to 6.5% by the mid-1980s. An estimated 3.8% of male children in the UK in 2000 were being circumcised by the age of 15 . The researchers stated that too many boys, especially under the age of 5, were still being circumcised because of a misdiagnosis of phimosis. They called for a target to reduce the percentage to 2%. findings from a national probability sample survey |first=SS |last=Dave |coauthors=''et al'' |journal=Sex Transm Infect |year=2003 |volume=79 |issue=6 |pages=499-500}}</ref> Rickwood ''et al'' reported that the proportion of English boys circumcised for medical reasons had fallen from 35% in the early 1930s to 6.5% by the mid-1980s. An estimated 3.8% of male children in the UK in 2000 were being circumcised by the age of 15 . The researchers stated that too many boys, especially under the age of 5, were still being circumcised because of a misdiagnosis of phimosis. They called for a target to reduce the percentage to 2%.


===United States=== ===United States===
Statistics from different sources give widely varying estimates of infant circumcision rates in the United States. Statistics from different sources give different pictures of infant circumcision rates in the United States.


Nelson, 2005 used data from the Nationwide Inpatient Sample (a sample of 5-7 million of the nation's total inpatient stays, and representing a 20% sample taken from 8 states in 1988 and 28 in 2000), stated that circumcisions rose from 48.3% in 1988 to 61.1% in 1997.<ref>{{cite journal A recent study, which used data from the Nationwide Inpatient Sample (a sample of 5-7 million of the nation's total inpatient stays, and representing a 20% sample taken from 8 states in 1988 and 28 in 2000), stated that circumcisions rose from 48.3% in 1988 to 61.1% in 1997.<ref>{{cite journal
| last = Nelson | last = Nelson
| first = CP. | first = CP.
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</ref> </ref>


The 2003 Nationwide Hospital Discharge Survey stated that circumcision rates declined from 64.7% in 1980 to 59.0% in 1990, rose to 64.1% in 1995, and fell again to 55.9% in 2003.<ref name = "NHDS">{{cite journal Figures from the 2003 Nationwide Hospital Discharge Survey state that circumcision rates declined from 64.7% in 1980 to 59.0% in 1990, rose to 64.1% in 1995, and fell again to 55.9% in 2003.<ref name = "NHDS">{{cite journal
| last = Kozak | last = Kozak
| first = LJ | first = LJ
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</ref> </ref>


Schoen, 2006, claimed that "the published results of national statistical surveys represent only coded diagnoses obtained from birth centers; the reported figures do not include males who are circumcised at a later date for religious, medical, or personal reasons or who received newborn circumcision that was not coded."<ref>{{cite journal Statistics from these national samples differs from higher rates that have been documented in individual centers. One explanation is that "the published results of national statistical surveys represent only coded diagnoses obtained from birth centers; the reported figures do not include males who are circumcised at a later date for religious, medical, or personal reasons or who received newborn circumcision that was not coded."<ref>{{cite journal
| last = Schoen | last = Schoen
| first = Edgar J. | first = Edgar J.
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==See also== ==See also==
*] *]
*] *]
*] *]
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==References== ==References==

{| class="messagebox" style="background: {{{#666666}}};" {| class="messagebox" style="background: {{{#666666}}};"
|- |-
||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. ||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 a 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.
|} |}
#{{note|Brown}}Brown M, Brown C: Circumcision decision: prominence of social concerns. Pediatrics 1987; 80:215-219
#{{note|Rand}}Rand C, Emmons C, Johnson J: The effect of an educational intervention on the rate of neonatal circumcision. Obstet Gynecol 1983; 62:64-67
<div class="references-small" style="-moz-column-count:2; column-count:2;"> <div class="references-small" style="-moz-column-count:2; column-count:2;">
<references /> <references />
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===Circumcision techniques=== ===Circumcision techniques===
*
* from the ]. * from the ].
* from the Medical College of Georgia. * from the Medical College of Georgia.
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* Rosemary Romberg. ''Circumcision: The Painful Dilemma.'' South Hadley, MA Bergan & Garvey, 1985. (ISBN 978-0-89789-073-1) * 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) * 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) * Edward Wallerstein. ''Circumcision: An American Heath 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) * Gerald N. Weiss M.D. and Andrea W Harter. ''Circumcision: Frankly Speaking.'' Wiser Publications, 1998. (ISBN 978-0-9667219-0-4)


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Revision as of 17:47, 5 July 2007

The neutrality of this article is disputed. Relevant discussion may be found on the talk page. Please do not remove this message until conditions to do so are met. (Learn how and when to remove this message)
This article is about male circumcision. For the practice sometimes referred to as "female circumcision", see Female genital cutting.

Circumcision is the procedure that removes some or all of the foreskin (prepuce) from the penis. The frenulum may also be cut away at the same time, in a procedure called a frenectomy. The word "circumcision" comes from Latin circum (meaning "around") and caedere (meaning "to cut").

Circumcision predates recorded human history, with depictions found in stone-age cave drawings and Ancient Egyptian tombs. Circumcision has been performed as a form of ritual sacrifice or offering, a health precaution, a sign of submission to a deity, a rite of passage to adulthood, a mark of defeat or slavery, or an attempt to alter esthetics or sexuality.

Infant circumcision is controversial in English-speaking countries. The American Medical Association states that neonatal circumcision is “non-therapeutic” and “not medically necessary,” but rather “elective” removal of the foreskin. The AMA statement does not comment on circumcision for religious or ritual purposes. According to the AMA's 1999 literature review, in the US when parents choose elective circumcision for their child, it is largely because of social or cultural expectations, rather than medical concerns.

Circumcision of males is a religious commandment in Judaism and Islam, and is customary in some Coptic, Oriental Orthodox Christian and other Christian churches in Africa. It is also practiced by the majority of South Koreans, Americans, and Filipinos.

Proponents of Genital integrity condemn all infant circumcision as male genital mutilation comparable to female genital cutting, while others consider that infant circumcision is a worthwhile public health measure.

Circumcision of adults may be used to treat chronic inflammation of the penis and penile cancer. The use of circumcision to treat phimosis is debated in medical literature.

The procedures of circumcision

Circumcision removes the foreskin from the penis. For infant circumcision, clamps, such as the Gomco clamp, Plastibell, and Mogen are often used. These clamps are meant to protect the glans while they cut the blood supply to the foreskin and prevent any bleeding. With the Plastibell clamp, the foreskin and the clamp come away in three to seven days. Before a Gomco clamp is used, a section of skin is crushed with a hemostat 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 then tightened, "crushing the foreskin between the bell and the base plate." The crushing limits the bleeding (provides the hemostasis). With the flared bottom of the bell fit tightly against the hole of the base plate, the foreskin is cut away with a scalpel from above the base plate, while the bell covers the glans to prevent it being reached by the scalpel.

With a Mogen clamp, the foreskin and the glans are separated with a blunt probe and/or curved hemostat (as with the first part of the Gomco and Plastibell procedure). The foreskin is then grabbed dorsally with a straight hemostat, and lifted up. 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," compared with Gomco or Plastibell circumcisions. The clamp is locked shut, and a scalpel is used to cut the foreskin from the flat (upper) side of the clamp. Taeusch et al report that as compared with the Plastibell, Mogen circumcisions are quicker, less painful, and preferred by trainees. Kurtis et al report that it is quicker and less painful than circumcisions using the Gomco clamp.The World Health Organization reports that the Mogen clamp "compares favourably, because it is easy to use and has no parts to assemble. In the literature, the fewest complications with this method have been reported in the context of circumcision in 8 day old babies."

The frenulum is cut if frenular chordee is evident. Chordee of the glans may be the result of circumcision.

According to a 1998 study, 45% of physicians used anaesthesia for infant circumcisions. Dorsal penile nerve block was the most commonly used form. Obstetricians had a significantly lower rate of anaesthesia use (25%) than pediatricians (71%) or family practitioners (56%).

Sexual Effects

Main article: Sexual effects of circumcision

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. Masters and Johnson noted no difference in exteroceptive and light tactile discrimination on the ventral or dorsal surfaces of the glans penis between circumcised and uncircumcised men." 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. Opinions differ about how this decreased sensitivity, which may result in prolonged time to orgasm, affects sexual satisfaction. An investigation of the exteroceptive and light tactile discrimination of the glans of circumcised and uncircumcised men found no difference on comparison. No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."

Boyle et al. (2002) argued that "although the frenulum was reported as an area of heightened erogenous sensitivity, in the typical circumcised male, either no frenulum remains or only a small severely damaged remnant exists. The complex innervation of the foreskin and frenulum has been well-documented, and the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings--many of which are lost to circumcision, with an inevitable reduction in sexual sensation experienced by circumcised males. The authors conclude: “Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."

Taves argued that the foreskin may have an intromission function, facilitating penetration, or that circumcision may decrease vaginal wetness and orgasm in female partners. Sadovsky, noting a preliminary study that found decreased erectile function and penile sensitivity but increased satisfaction after adult circumcision, argued that research on adult circumcision, sexual function, and satisfaction should not be generalized to neonatal circumcision.

Sorrells, M. et al., conducted controlled sensitivity testing of fine touch pressure thresholds at 19 locations of the adult penis. They state that the glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. They also found that “circumcision ablates the most sensitive parts of the penis.”

Medical aspects

Main article: Medical analysis of circumcision

The medical risks and potential benefits of neonatal circumcision have been studied. The British Medical Association, states that “there is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research.” Studies making cost-benefit analyses comparing circumcision complications with the potential gain in expected longevity, and the medical costs of circumcision compared with the expected reduction in lifetime health costs have varied. Some found a small net benefit, some found a small net decrement, and others found that the benefits and risks of circumcision balanced each other out and suggest the circumcision decision "most reasonably be made on nonmedical factors."

Risks of circumcision

While the immediate risk in a competently performed medical circumcision is low, the complications from bleeding, infection and poorly carried out circumcisions can be catastrophic. According to the AMA, blood loss and infection are the most common complications. Bleeding is mostly minor; applying pressure will stop it. Kaplan identified other complications, including urinary fistulas, chordee, cysts, lymphedema, ulceration of the glans, necrosis of all or part of the penis, hypospadias, epispadias, impotence and removal of too much tissue, sometimes causing secondary phimosis. He stated “Virtually all of these complications are preventable with only a modicum of care. Unfortunately, most such complications occur at the hands of inexperienced operators who are neither urologists nor surgeons.”Infant circumcision may result in skin bridges, when the cut skin does not heal neatly but attaches to the glans penis instead and can be repaired in an office procedure.

The American Medical Association quotes a complication rate of 0.2%–0.6%, based on the studies of Gee and Harkavy. These same studies are quoted by the American Academy of Pediatrics. The American Academy of Family Physicians quotes a range of anywhere between 0.1% and 35%. The Canadian Paediatric Society cite these results in addition to other figures ranging anywhere between 0.06% to 55%, and remark that Williams & Kapila suggested that 2-10% is a realistic estimate. The RACP states that the penis is lost in 1 in 1,000,000 circumcisions.

Meatal stenosis may be a common longer-term complication from circumcision. Recent publications give a frequency of occurrence between 0.9% in Iran, and 9% to 10% in the US.

Deaths have been reported. The American Academy of Family Physicians states that death is rare, and cites an estimated death rate of 1 infant in 500,000 from circumcision. Gairdner's 1949 study 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.

Lander et al., found that babies circumcised without pain relief "exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the circumcision and following. Two newborns ... became ill following circumcision (choking and apnea)." A 2004 Cochrane review, which compared the dorsal penile nerve block and EMLA (topical anaesthesia) found both anaesthetics appear safe, but neither of them completely eliminated pain. 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. Ng et al found that EMLA cream, in addition to local anaesthetic, effectively reduces the sharp pain induced by needle puncture.

History of circumcision

Main article: History of male circumcision

It has been variously proposed that circumcision began as a religious sacrifice, as a rite of passage marking a boy's entrance into adulthood, as a form of sympathetic magic to ensure virility, as a means of suppressing (or enhancing) sexual pleasure, as an aid to hygiene where regular bathing was impractical, as a means of marking those of lower (or higher) social status, as a means of differentiating a circumcising group from their non-circumcising neighbors, as a means of discouraging masturbation or other socially proscribed sexual behaviors, to remove "excess" pleasure, to increase a man's attractiveness to women, as a symbolic castration, as a demonstration of one's ability to endure pain, or as a male counterpart to menstruation or the breaking of the hymen. It has been suggested that the custom of circumcision gave advantages to tribes that practiced it and thus led to its spread regardless of whether the people understood this. It is possible that circumcision arose independently in different cultures for different reasons.

Ancient Egyptian carved scene of circumcision, from the inner northern wall of the Temple of Khonspekhrod at the Precinct of Mut, Luxor, Egypt. Eighteenth dynasty, Amenhotep III, c. 1360 BC.
Köçeks at a fair
Köçek troupe dancing at Sultan Ahmed III's 14-day celebration of his sons' circumcision in 1720. Miniature from the Surname-i Vehbi, Topkapı Palace, Istanbul.

Circumcision in the ancient world

The oldest documentary evidence for circumcision comes from ancient Egypt. Tomb artwork from the Sixth Dynasty (2345-2181 BCE) shows men with circumcised penises, and one relief from this period shows the rite being performed on a standing adult male. The Egyptian hieroglyph 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.

Circumcision was common, although not universal, among ancient Semitic peoples. The Book of Jeremiah, written in the sixth century BCE, lists the Egyptians, Jews, Edomites, Ammonites, and Moabites as circumcising cultures. Herodotus, writing in the fifth century BCE, would add the Colchians, Ethiopians, Phoenicians, and Syrians to that list.

In the aftermath of the conquests of Alexander the Great, Greek dislike of circumcision led to a decline in its incidence among many peoples that had previously practised it. The writer of the 1 Maccabees wrote that under the Seleucids, many Jewish men attempted to hide or reverse their circumcision so they could exercise in Greek gymnasia, where nudity was the norm. First Maccabees also relates that the Seleucids forbade the practice of brit milah (Jewish circumcision), and punished those who performed it–as well as the infants who underwent it–with death.

Medical circumcision in the 19th century and early 20th century

Several hypotheses have been raised in explaining the American public's acceptance of infant circumcision as preventive medicine. The success of the germ theory of disease had not only enabled physicians to combat many of the postoperative complications of surgery, but had made the wider public deeply suspicious of dirt and bodily secretions. Accordingly, the smegma that collects under the foreskin was viewed as unhealthy, and circumcision readily accepted as good penile hygiene. Second, moral sentiment of the day regarded masturbation as not only sinful, but also physically and mentally unhealthy, stimulating the foreskin to produce the host of maladies of which it was suspected. In this climate, circumcision could be employed as a means of discouraging masturbation. All About the Baby, a popular parenting book of the 1890s, recommended infant circumcision for precisely this purpose. However, a survey of 1410 men in the United States in 1992, Laumann found that circumcised men were more likely to report masturbating at least once a month.

In 1855, the Quaker surgeon, Jonathan Hutchinson, observed that circumcision appeared to protect against syphilis. Although this observation was challenged (the protection that Jews appear to have are more likely due to cultural factors), a 2006 systematic review concluded that the evidence "strongly indicates that circumcised men are at lower risk ... syphilis."

With the proliferation of hospitals in urban areas, childbirth, at least among the upper and middle classes, was increasingly undertaken in the care of a physician in a hospital rather than that of a midwife in the home. It has been suggested that once a critical mass of infants were being circumcised in the hospital, circumcision became a class marker of those wealthy enough to afford a hospital birth.

By the 1920s, advances in the understanding of disease had undermined much of the original medical basis for preventive circumcision. Doctors continued to promote it, however, as good penile hygiene and as a preventive for a handful of conditions local to the penis: balanitis, phimosis, and penile cancer.

Routine infant circumcision was taken up in the English-speaking parts of Canada, the United States and Australia, and to a lesser extent in New Zealand and the United Kingdom In England, the Royal House had a long tradition requiring that all male children be circumcised” (Alfred J. Kolatach’s The Jewish Book of Why, Middle Village, New York; Jonathan David, 1981). . Although it is difficult to determine historical circumcision rates, one estimate of infant circumcision rates in the United States holds that 30% of newborn American boys were being circumcised in 1900, 55% in 1925, and 72% in 1950.

Circumcision since 1950

In 1949, a lack of consensus in the medical community as to whether circumcision carried with it any notable health benefit motivated the United Kingdom's newly-formed National Health Service to remove routine infant circumcision from its list of covered services. One factor in this rejection of circumcision may have been Douglas Gairdner’s famous study, The fate of the foreskin, which revealed that for the years 1942–1947, about 16 children per year had died because of circumcision in England and Wales, a rate of about 1 per 6000 performed circumcisions. Since then, circumcision has been an out-of-pocket cost to parents, and the proportion of newborns circumcised in England and Wales has fallen to less than one percent.

In Canada (where public medical insurance is universal, and where private insurance does not replicate services already paid from the public purse), individual provincial health services began delisting circumcision in the 1980s.

In South Korea, circumcision has steadily grown in popularity following the establishment of the United States trusteeship in 1945 and the spread of American influence. More than 90% of South Korean high school boys are now circumcised, but the average age of circumcision is 12 years.

In some South African ethnic groups, circumcision has roots in several belief systems, and is performed most of the time on teenage boys:

"...The young men in the eastern Cape belong to the Xhosa ethnic group for whom circumcision is considered part of the passage into manhood... A law was recently introduced requiring initiation schools to be licensed and only allowing circumcisions to be performed on youths aged 18 and older. But Eastern Cape provincial Health Department spokesman Sizwe Kupelo told Reuters news agency that boys as young as 11 had died. Each year thousands of young men go into the bush alone, without water, to attend initiation schools. Many do not survive the ordeal..." .

Prior to 1989, the American Academy of Pediatrics had a long-standing opinion that medical indications for routine circumcision were lacking. This stance, according to the AMA, was reversed in 1989, following new evidence of reduction in risk of urinary tract infection. A study in 1987 found that the prominent reasons for parents choosing circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns. A 1999 study reported that reasons for circumcision included "ease of hygiene (67 percent), ease of infant circumcision compared with adult circumcision (63 percent), medical benefit (41 percent), and father circumcised (37 percent)." The authors commented that "Medical benefits were cited more frequently in this study than in past studies, although medical issues remain secondary to hygience and convenience." A 2001 study reported that "The most important reason to circumcise or not circumcise the child was health reasons." A 2005 study speculated that increased recognition of the potential benefits relative to risks may be responsible for an observed increase in the rate of neonatal circumcision in the USA between 1988 and 2000. In a 2001 survey, 86.6% of parents felt respected by their medical provider, and parents who did not circumcise "felt less respected by their medical provider".

The AMA noted that, in one study, physicians in "nearly half" of neonatal circumcisions "did not discuss the potential medical risks and benefits of elective circumcision prior to delivery of the infant son. Deferral of discussion until after birth, combined with the fact that many parents' decisions about circumcision are preconceived, contribute to the high rate of elective circumcision." Two studies in the United States found that strong parental cultural expectations clash with deliberate informed consent, and “a significant number of parents expressed animosity toward the care provider.” Discord arises from the implication that parental desire to circumcise involves “undue risks” and provides “limited medical benefit” to their child.

Table 1: International circumcision rates
Country Year Neonatal circumcisions (%)
United States 2003 55.9%*
Canada 2005 < 14%
Australia 2004 10%-20%
New Zealand 1995 10%-20%
*The percentage refers to infants born in non-Federal hospitals; see p 52, Table 44 of the reference.
**Samoans, Tongans and Niueans in New Zealand continue to practice circumcision, but not in public hospitals, to which these data refer.

HIV

Initial population based studies suggested that circumcision might protect against HIV infection. However, in these studies, factors such as religion may skew the results. In March 2005, the Cochrane review of the medical evidence found the current quality of evidence at that point "insufficient" to consider implementing circumcision "as a public-health intervention" but the positive results of observational studies suggested that circumcision was "worth evaluating in randomised controlled trials.”

The most recent data indicate that circumcision is correlated with a 50-60% reduction in risk of HIV transmission (from female to male) during heterosexual intercourse. The results of the first randomised controlled trial was published in November 2005. It found a 60% reduction in the rate of new HIV infection (from 2.1 per 100 to 0.85 per 100 in the intervention group. The authors said, “Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa.” Two further randomised trials conducted in Uganda and Kenya were stopped early on December 13, 2006 on grounds that circumcision was so effective that it would be unethical to continue the experiment and not offer circumcision in the uncircumcised men who were acting as controls. The results showed that circumcised males in Uganda were, depending upon the analysis, 51%-60% less likely to be infected. In Kenya, circumcised males were 53%-60% less likely to be infected. A paper published in the journal PLoS Medicine in July, 2006, calculated that if all men in sub-Saharan Africa were circumcised over the next 10 years, two million new infections could potentially be avoided.

The World Health Organization (WHO) said: “Although these results demonstrate that male circumcision reduces the risk of men becoming infected with HIV, the UN agencies emphasize that it does not provide complete protection against HIV infection. Circumcised men can still become infected with the virus and, if HIV-positive, can infect their sexual partners. Male circumcision should never replace other known effective prevention methods and should always be considered as part of a comprehensive prevention package, which includes correct and consistent use of male or female condoms, reduction in the number of sexual partners, delaying the onset of sexual relations, and HIV testing and counselling.”. Others have also expressed concern that some may mistakenly believe they will be fully protected against HIV through circumcision and see circumcision as a safe alternative to other forms of protection, such as condoms. An interim analysis from the Rakai Health Sciences Program in Uganda suggested that newly circumcised HIV positive men may be more likely to spread HIV to their female partners if they have sexual intercourse before the wound is fully healed. “Because the total number of men who resumed sex before certified wound healing is so small, the finding of increased transmission after surgery may have occurred by chance alone. However, we need to err on the side of caution to protect women in the context of any future male circumcision programme,” said Dr Maria Wawer, the study's principal investigator.

There is also a danger of HIV being spread from unhygienic circumcision procedures. Brewer et al. studied HIV infection rates in Kenya, Lethotho and Tanzania and found that " male and female virgins were substantially more likely to be HIV infected than uncircumcised virgins. Among adolescents, regardless of sexual experience, circumcision was just as strongly associated with prevalent HIV infection. However, uncircumcised adults were more likely to be HIV positive than circumcised adults." The authors concluded, "HIV transmission may occur through circumcision-related blood exposures in eastern and southern Africa."

On March 28, 2007, the World Health Organisation and UNAIDS issued joint recommendations concerning male circumcision and HIV/AIDS. These recommendations are:

  • Male circumcision should now be recognized as an efficacious intervention for HIV prevention.
  • Promoting male circumcision should be recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men.

Langerhans cells and HIV transmission

Langerhans cells are part of the human immune system. Three studies identified high concentrations of Langerhans and other "HIV target" cells in the foreskin and Szabo and Short suggested that the Langerhans cells in the foreskin may provide an entry point for viral infection. McCoombe, Cameron, and Short also found that the keratin is thinnest on the foreskin and frenulum. Fleiss, Hodges and Van Howe had previously stated a belief that the prepuce has an immunological function. While their specific hypothesis was criticised on technical grounds. a study published in 2007 by de Witte and others said that Langerlin, excreted by Langerhans cells, is a natural barrier to HIV-1 transmission by Langerhans cells.

HPV

Several studies have shown that uncircumcised men are at greater risk of human papilloma virus (HPV) infection. While most genital HPV strains are considered harmless, some can cause genital warts or cancer although there is a vaccine against most cancer causing strains of HPV. One study found no statistically significant difference between men with foreskins for HPV infection than those who are circumcised, but did note a significantly higher incidence of HPV lesions and urethritis in uncircumcised men.

Hygiene

The American Academy of Pediatrics observes “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.” It states that the "relationship among hygiene, phimosis, and penile cancer is uncertain" and further remarks that "genital hygiene needs to be emphasized as a preventive health topic throughout a patient's lifetime."

The Royal Australasian College of Physicians emphasizes that a non-circumcised infant's penis requires no special care and should be left alone, stating that attempts to forcibly retract the foreskin, e.g. to clean it, are painful, often injure the foreskin, and can lead to scarring, infections and pathologic phimosis. It is recommended that, while there is no special age where the foreskin should be retractable, once the foreskin becomes retractable, the child should gently wash it with soap and water. It has been suggested, however, that excessive washing of the foreskin and the glans will make infections such as balanitis more likely.

Circumcision reduces the amount of smegma produced by the male. Smegma is a combination of exfoliated epithelial cells, transudated skin oils, and moisture that can accumulate under the foreskin of males and within the female vulva area. It has a characteristic strong odor and taste , and is common to all mammals—male and female. While smegma is generally not believed to be harmful to health, the strong odour may be considered to be a nuisance or give the impression of a lack of hygiene. In rare cases, accumulating smegma may help cause balanitis.

It has been suggested that circumcision arose in peoples living in arid and sandy regions as a public health measure intended to prevent recurring irritation and infection caused by sand accumulating under the foreskin. Darby, after checking the official war histories of Britain, Australia and New Zealand and other records, and finding no mention of ‘balanitis’ or ‘foreskin’ or ‘circumcision’, dismissed this idea as a “medical urban myth,” concluding that “‘sand under the foreskin,’ balanitis, and circumcision were not significant problems during either of the World Wars.”

Infectious and chronic conditions

Studies have found that boys with foreskins tend to have higher rates of various infections and inflammations of the penis than those who are circumcised. The reasons are unclear, but several hypotheses have been suggested:

  • The foreskin may harbor bacteria and become infected if it is not cleaned properly.
  • The foreskin may become inflamed if it is cleaned too often with soap.
  • The forcible retraction of the foreskin in boys can lead to infections.

The usual treatment for balanoposthitis is to use topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams. There are less invasive treatments than circumcision for posthitis.

Balanitis

Main article: Balanitis

Balanitis, an inflammation of the glans penis, has a variety of causes. Some of these, such as anaerobic infection, occur more frequently in uncircumcised men, while others, such as fungal infection, have no statistically significant differences in frequency of occurrence between circumcised and uncircumcised men. There are less invasive treatments than circumcision that have been shown to be effective in treating most mild cases of balanitis. Birley, et al, found that in 90% of their cases of chronic or recurring balanitis "use of emollient creams and restriction of soap washing alone controlled symptoms satisfactorily". They also state that circumcision “might be of benefit in a patient whose balanitis relapses despite these measures, and remains the principal treatment for specific conditions such as lichen sclerosus and plasma cell balanitis.” The, less invasive procedures are not as successful in treating balanitis xerotica obliterans, or BXO, which is much less common but harder to treat.

Lichen sclerosus et atrophicus (LSA) produces a whitish-yellowish patch on the skin, and is not believed to be always harmful or painful, and may sometimes disappear without intervention. Some consider balanitis xerotica obliterans to be a form of LSA that happens to be on the foreskin, where it may cause pathological phimosis. Circumcision is believed to reliably reduce the threat of BXO.

Penile cancer

Main article: Penile cancer

Penile cancer is cancer of the penis, i.e. on the glans or the foreskin. Most cases have been found to occur in men over the age of 70. In 1979, Boczko and Freed remarked that since Wolbarst's 1932 review, "there have been only eight documented cases of penile carcinoma in an individual circumcised in infancy." They described the ninth reported case, concluding that "performing it in infancy continues to be the most effective prophylactic measure against penile carcinoma." The AMA remarked that in six case series published from 1932 and 1986, "all penile cancers occurred in uncircumcised individuals." Maden et al reported in 1993 that the risk of penile cancer was 3.2 times greater in men who were never circumcised and 3 times greater among those who were circumcised after the neonatal period; this study was referenced in an editorial by Holly and Palefsky. They compliment the study for noting other risk factors for penile cancer, as well as for providing corroborating evidence as to the association between a lack of neonatal circumcision and the development of penile cancer. However, their criticisms include the study's combining data from invasive and in situ cancers. They concluded that as the new study reported circumcision at birth in 20% of the men with penile cancer, the recommendation of circumcision for medical indications remains somewhat controversial and the risks and benefits must be weighed. The American Academy of Pediatrics made similar criticism, also noting the possibly inaccurate use of self-report to determine circumcision status. Schoen et al studied the association between neonatal circumcision and invasive penile cancer in 2000, and found that the relative risk for uncircumcised men was 22 times that of circumcised men.

In 2005, the American Cancer Society said that while studies suggest that circumcision may reduce the risk of more invasive forms of penile cancer, it is important to concentrate on the main risk factors: poor hygiene, having unprotected sex with multiple partners, and cigarette smoking. They further state that the current consensus of most experts is that circumcision should not be recommended as a prevention strategy for penile cancer.

The American Academy of Pediatrics states 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, penile cancer is a rare disease and the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, remains low. Similarly, the American Medical Association states that although neonatal circumcision seems to lower the risk of contracting penile cancer, because it is rare and occurs later in life, the use of circumcision as a preventive practice is not justified.

Kochen and McCurdy performed a life table analysis on penile cancer rates. They assumed that these cancers occur exclusively in uncircumcised males and that age-specific rates calculated from older groups were applicable to the 1971 birth cohort. Their overall analysis finds an estimated occurrence rate in uncircumcised males of 1 in 600, or 0.167%, with a median age of occurrence of 67 years old. However, they close their predictions section with the following “Since the uncircumcised male is uniquely susceptible, virtually all of these cancers are preventable by neo-natal circumcision. The number of lifetime incident cancers that could be prevented annually by circumcision can be estimated with birth statistics available for 1971. In that year, there were 1,822,910 recorded live male births. If none had been neonatally circumcised, our analysis predicts that one in 600, or more than 3,000 would have penile cancer in their lifetimes.”

Phimosis and paraphimosis

It is normal for an infant's foreskin to be attached to the glans. Pathological phimosis is a condition when the foreskin remains so tight that retraction over the glans is painful or impossible. Dawson and Whitfield, say "True phimosis is rare but may cause appreciable problems in either childhood or adolescence." Rickwood suggested that the term 'phimosis' should be restricted to cases in which the prepuce loses suppleness and becomes scarred. The AAP state that the true frequency of problems such as phimosis is unknown. Fergusson et al found phimosis in 16% of non-circumcised boys, while Herzog and Alvarez found it in 2.6%. Rickwood and Walker raised concern that phimosis is frequently misdiagnosed by physicians confusing it with the developmentally non-retractable foreskin. Several researchers have described less invasive treatments for phimosis than circumcision, and recommend that they be tried first.

Several studies have identified phimosis as a risk factor for penile cancer. The British Medical Journal published one letter that stated it would be irresponsible to expose a patient to risk for longer than necessary.

Paraphimosis is an acute condition when a tight foreskin is stuck behind the glans and cannot be returned to its original position, curbing the blood flow to the glans. In children, it is sometimes caused by a caregiver trying to forcibly retract the infant foreskin.

Urinary tract infections

Twelve studies have indicated that neonatal circumcision reduces the occurrence rate of Urinary tract infections in male infants by a factor of about 10. The March 1999 AAP statement notes that premature infants are usually not circumcised because of their fragile health status. Studies have found that 1 in 10 premature infants will have a urinary tract infection during the first month of life. Some of the UTI studies have been criticised for not taking these and other factors into account. A Swedish study found that the cumulative incidence of UTIs in boys under 2 years of age was 2.2%. The AMA cites evidence that the incidence of UTI’s is “small (0.4%–1%)” in uncircumcised infants, and “depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI…One model of decision analysis concluded that the incidence of UTI would have to be substantially higher in uncircumcised males to justify circumcision as a preventive measure against this condition.”

The Canadian Paediatric Society poses the question of whether increased UTI and balanitis rates in non-circumcised male infants may be caused by forced premature retraction. According to the Lerman and Liao, aside from its effects on UTI infection rates, "Most of the other medical benefits of circumcision probably can be realized without circumcision as long as access to clean water and proper penile hygiene are achieved."

Cultures and religions

Some cultures circumcise their males either shortly after birth, in childhood or around puberty, when it may be part of a rite of passage. . Geographically, circumcision is prevalent in Muslim countries, the United States, the Philippines and South Korea. It is less prevalent in Europe, Latin America, China and India. Among religious groups, circumcision is most prevalent among Jews and Muslims.

Judaism

Main article: Brit milah See also: Circumcision in the Bible

Circumcision is a fundamental rite of Judaism. An essential component of Jewish practice, it is a positive commandment obligatory under Jewish law for Jewish males, and is only postponed or abrogated in the case of threat to the life or health of the child. It is usually performed in a ceremony called a Brit milah (or Bris milah, colloquially simply bris) (Hebrew for "Covenant of circumcision"). A mohel performs the ceremony on the eighth day after birth unless health reasons force a delay. According to the Torah (Genesis, chapter 17 verses 9-14), God commanded Abraham to circumcise himself, his offspring and his slaves as a sign of an everlasting covenant. According to Jewish law, failure to follow the commandment carries the penalty of karet, or being cut off from the community by God. Brit milah is so important that should the eighth day fall on the Sabbath, actions that would normally be forbidden because of the sanctity of the day are permitted in order to fulfill the requirement to circumcise. The original Brit milah consisted of excising the foreskin tissue which extended beyond the tip of the glans penis, while current practice (Brit periah) removes the foreskin to completely expose the glans. The expressly ritual element of circumcision in Judaism, as distinguished from its non-ritual requirement in Islam, is shown by the requirement that a child who either is born aposthetic (without a foreskin) or who has been circumcised without the ritual must nevertheless undergo a Brit milah in which a drop of blood (hatafat-dam, הטפת דם) is drawn from the penis at the point where the foreskin would have been or was attached.

Less commonly practised and more controversial is metzitzah b'peh, or oral suction. This is when the mohel sucks blood from the circumcision wound. The traditional reasons for this are to promote healing. However, the practice has been implicated in the spreading of herpes to the infant. Today, if it is performed, the mohel generally uses a glass tube.

Christianity

Christianity does not prescribe circumcision. The first Church Council in Jerusalem decided that circumcision was not a requirement (Acts 15). St. Paul had Timothy circumcised (Acts 16:1-3) but in his letters he warned gentile Christians against adopting the practice (Galatians 6:12-16, Philippians 3:2-3). Individual Christians and Christian traditions may have different customs. For example, circumcision is customary among members of three of the Oriental Orthodox Churches, the Coptic Orthodox, Ethiopian Orthodox, and Eritrean Orthodox churches in their home countries, as well as some other African churches. On 1 January, the Catholic Church used to celebrate the Circumcision of Christ. This has been superseded by the Solemnity of Mary, Mother of God. The Catholic Church condemned the belief that the practice of circumcision was necessary for salvation as a mortal sin in the Council of Basel-Florence in 1442. Regarded among many Catholics nowadays, however, is that "the practice of circumcising male neonates is a violation of the natural law as conceived within the Catholic moral tradition and Church teaching." Anglican and Lutheran churches have other feast days at this time such as the Holy Name of Jesus.

Islam

The origin of circumcision in Islam is a matter of religious and scholarly debate. It is mentioned in some parts of the Hadith, but not in the Qur'an. Fiqh scholars have different opinions about circumcision in Shariah, depending on which Hadith are accepted and how they are interpreted. According to some it is recommended (Sunnah); according to others, it is obligatory. Some have quoted the Hadith to argue that the requirement of circumcision is based on the covenant with Abraham.

The timing of Muslim circumcision varies. Turkish, Balkan, rural Egyptians and Central and South Asian Muslims typically circumcise boys between the ages of six and eleven and traditionally the event may be a joyous occasion and celebrated with sweets and feasting. However, in the middle class it is more usually done in infancy and is largely unremarked upon. In Turkey the celebratory feast is called "Sünnet Düğünü" and is considered a very important celebration in man's life as a passage to a manhood. In Pakistan, Muslims may be circumcised at all ages from the newborn period to adulthood, though the medical profession has encouraged medical circumcisions in the first week after birth to reduce complications: "Circumcision is performed by barbers, medical technicians, quacks and doctors including paediatric surgeon yet there is no consensus for the best age and method." In Iran, Dr. Paula Drew states that “circumcision, which formerly celebrated the onset of manhood, has for many years now been more customarily performed at the age of 5 or 6 for children born at home, and at two days old for those born in a medical setting.…By puberty, all Muslim Iranian boys must be circumcised if they are to participate fully in religious activities.” Kamyar et al describe circumcision as an "obligatory custom" and note that it is not necessary for the circumciser to be a Muslim.

Other faiths and traditions

Bahá'ís do not have any particular tradition or rituals regarding male circumcision, but view female circumcision as mutilation.

The Druze have no male circumcision in their religion, although it is a practiced among those living in urban areas or outside the Middle East, mainly for hygienic reasons.

There is no specific reference to male circumcision in the Hindu holy books , and Hindus in India generally do not practice circumcision.

"Circumcision holds no relevance to a Sikh." All rituals which do not hold relevance are strictly forbidden and, "acceptance of Nature's beautiful body is an important component of the Sikh value system."

Circumcision in South Korea is largely the result of American cultural and military influence following the Korean War. The origin of circumcision in the Philippines is uncertain. One newspaper article speculates that it is due to the influence of western colonizers. However, Antonio de Morga's seventeenth century History of the Philippine Islands, speculates that it is due to Islamic influence. 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 Nigerian societies it is medicalised and is simply a cultural norm. In early 2007 it was announced that rural aidpost orderlies in the East Sepik Province of Papua New Guinea are to undergo training in the circumcision of men and boys of all ages with a view to introducing the procedure as a means of prophylaxis against HIV/AIDS, which is becoming a significant problem in the country.

Circumcision is part of initiation rites in some African, Pacific Islander, and Australian aboriginal traditions in remote areas, such as Arnhem Land, where the practice was introduced by Makassan traders from Sulawesi in the Indonesian Archipelago. Circumcision ceremonies among certain Australian aboriginal societies are noted for their painful nature, including subincision for some aboriginal peoples in the Western Desert. In the Pacific, ritual circumcision is nearly universal in the Melanesian islands of Fiji and Vanuatu; participation in the traditional land diving on Pentecost Island is reserved for those who have been circumcised. Circumcision is also commonly practised in the Polynesian islands of Samoa, Tonga, Niue, and Tikopia. In Samoa, it is accompanied by a celebration. Among some West African animist groups, such as the Dogon and Dowayo, it is taken to represent a removal of "feminine" aspects of the male, turning boys into fully masculine males. Although in many West African traditional societies circumcision has become medicalised and is simply performed in infancy without ado or any particular conscious cultural significance, among the Urhobo people 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 age set to another. For Nilotic peoples, such as the Kalenjin and Maasai, 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.

Ethical issues

Main article: Bioethics of neonatal circumcision

Circumcising infants is controversial. Those advocating circumcision assert that circumcision is a significant public health measure, preventing infections, and slowing down the spread of AIDS. Those opposing circumcision, however, question the legality of infant circumcision by asserting that infant circumcision is a human rights violation or a sexual assault.

Consent

Views differ on whether limits should be placed on caregivers having a child circumcised. One argument is that male circumcision is ethically identical to female genital cutting. It questions why the genital cutting of males is allowed while the genital cutting of females is prohibited.. Another argument is that as it's his body, any decision to circumcise should be only be made by the owner of the foreskin when he reaches adulthood.

Others argue that there is no convincing evidence of sexual or emotional harm, and that there are greater monetary and psychological costs in circumcising later rather than in infancy. Many are concerned that restrictions on circumcision would cut across the religious or cultural rites and practices of Jews, Muslims, and others or limit the traditional right of parents to have their child circumcised.

A number of medical associations accept that the parents should determine what is in the best interest of the infant or child, though the RACP and the BMA observe that controversy exists on this issue. and the BMA insists that a circumcision must not go ahead without the consent of both parents and the competent child.

Emotional consequences

Goldman discussed the extent to which circumcision may cause emotional harm to males. Some organizations have been formed as support groups for men who are upset with being circumcised. A study by Taddio showed that infants are affected by the pain of circumcision. It found a correlation between circumcision and intensity of pain response during vaccination months later. While the researchers stated that their results were "speculative" and suggested that "analgesia should be routine for circumcision" to avoid long-term effects in pain responses, Taddio's paper was referred to in the American Academy of Pediatrics' 1999 Circumcision Policy Statement, which, for the first time recommended the use of pain relief for circumcision.

Legality

Main article: Circumcision and law

Traditionally, Circumcision has been presumed to be legal when performed by a trained operator.

In 2001, Sweden passed a law restricting the performance of neo-natal circumcisions to persons certified by the National Board of Health. This law requires that a medical doctor or an anesthesia nurse accompany the circumcisor, and that anaesthetic is applied prior to the procedure. Most Jewish mohels have been so certified. Jews and Muslims in Sweden objected to the law, and the World Jewish Congress stated that it was “the first legal restriction on Jewish religious practice in Europe since the Nazi era.”

Policies of various national medical associations

The medical associations noted below find the current data insufficient to recommend routine neonatal circumcision. They agree that parental choice remains a legitimate reason to perform the procedure.

United States

The American Academy of Pediatrics states the following:

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. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided. If circumcision is performed in the newborn period, it should only be done on infants who are stable and healthy. Circumcision Policy Statement

— American Academy of Pediatrics

The American Medical Association supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics.

Canada

The Fetus and Newborn Committee of the Canadian Paediatric Society posted Circumcision: Information for Parents in 2004, and Neonatal circumcision revisited statements in 1996, undergoing revision as of 2004:

Circumcision: Information for parents

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.

Neonatal circumcision revisited

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.

— Neonatal circumcision revisited, Canadian Paediatric Society

|Canadian Paediatric Society}}

United Kingdom

As of June of 2006, the British Medical Association's position was as follows:

Circumcision for medical purposes

Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.

Male circumcision in cases where there is a clear clinical need is not normally controversial. Nevertheless, normal anatomical and physiological characteristics of the infant foreskin have in the past been misinterpreted as being abnormal. The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision. Doctors should be aware of this and reassure parents accordingly.

Non-therapeutic circumcision
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.

There is a spectrum of views within the BMA’s membership about whether non-therapeutic male circumcision is a beneficial, neutral or harmful procedure or whether it is superfluous, and whether it should ever be done on a child who is not capable of deciding for himself. The medical harms or benefits have not been unequivocally proven except to the extent that there are clear risks of harm if the procedure is done inexpertly. The Association has no policy on these issues. Indeed, it would be difficult to formulate a policy in the absence of unambiguously clear and consistent medical data on the implications of the intervention. As a general rule, however, the BMA believes that parents should be entitled to make choices about how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices.

— The law and ethics of male circumcision - guidance for doctors, British Medical Association

Australasia (Australia, New Zealand and nearby islands)

The Royal Australasian College of Physicians takes the position that there is no medical indication for routine neonatal circumcision, and if the procedure is to be performed for non-medical reasons, it should be performed by competent operator, using appropriate anaesthesia and in a safe child-friendly environment.

Prevalence of circumcision

Main article: Circumcision worldwide

Estimates of the proportion of males that are circumcised worldwide vary from one sixth (12.5%) to one third (33.3%). According to one author, the practice is "a falling trend internationally", although another notes indications of increasing demand in Southern Africa.

Australia

According to the Sydney Morning Herald, the infant circumcision rate in Australia was 12.9% as of 2003. However, rates in the states varied, with highest rates in Queensland (19.3%), New South Wales (16.3%) and South Australia (14.3%), and the lowest in Tasmania (1.6%).

Denmark

In 1986, only 511 out of approximately 478,000 Danish boys aged 0-14 years were circumcised. This corresponds to a cumulative national circumcision rate of around 1.6% by the age of 15 years.

South Korea

It has been estimated on the basis of an academic medical survey that some 78% of South Korean men may be circumcised and it has been stated that "South Korea has possibly the largest absolute number of teenage or adult circumcisions anywhere in the world. Because circumcision started through contact with the American military during the Korean War, South Korea has an unusual history of circumcision."

United Kingdom

A national survey on sexual attitudes in 2000 found that 11.7% of 16-19 year olds, and 19.6% of 40-44 year olds said they had been circumcised. It also found that, apart from black Caribbeans, overseas born men were more likely to be circumcised. Rickwood et al reported that the proportion of English boys circumcised for medical reasons had fallen from 35% in the early 1930s to 6.5% by the mid-1980s. An estimated 3.8% of male children in the UK in 2000 were being circumcised by the age of 15 . The researchers stated that too many boys, especially under the age of 5, were still being circumcised because of a misdiagnosis of phimosis. They called for a target to reduce the percentage to 2%.

United States

Statistics from different sources give different pictures of infant circumcision rates in the United States.

A recent study, which used data from the Nationwide Inpatient Sample (a sample of 5-7 million of the nation's total inpatient stays, and representing a 20% sample taken from 8 states in 1988 and 28 in 2000), stated that circumcisions rose from 48.3% in 1988 to 61.1% in 1997.

Figures from the 2003 Nationwide Hospital Discharge Survey state that circumcision rates declined from 64.7% in 1980 to 59.0% in 1990, rose to 64.1% in 1995, and fell again to 55.9% in 2003. On page 52, it is shown that the western region of the United States has seen the most significant change, declining from 61.8% in 1980 to 31.4% in 2003. The decline in the western region has been partly attributed to increasing births among Latin Americans, who usually do not circumcise.

A national survey of adult men found that 91% of men born in the 1970s, and 83% of men born in the 1980s were circumcised.

Statistics from these national samples differs from higher rates that have been documented in individual centers. One explanation is that "the published results of national statistical surveys represent only coded diagnoses obtained from birth centers; the reported figures do not include males who are circumcised at a later date for religious, medical, or personal reasons or who received newborn circumcision that was not coded."

There are various explanations why the infant circumcision rate in the United States are different from comparable countries. Some obstetricians have been accused of using circumcision as a quick and easy way of making money. Many parents’ decisions about circumcision are preconceived, and this may contribute to the high rate of elective circumcision.

Medicaid funding for infant circumcision used to be universal in the United States; however, sixteen states no longer pay for the procedure under Medicaid . One study in the Midwest of the U.S. found that this had no effect on the newborn circumcision rate but it did affect the demand for circumcision at a later time.

See also

References

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 a anti-circumcision point of view, and text in support of this position is often highlighted on-screen using HTML. 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.
  1. Brown M, Brown C: Circumcision decision: prominence of social concerns. Pediatrics 1987; 80:215-219
  2. Rand C, Emmons C, Johnson J: The effect of an educational intervention on the rate of neonatal circumcision. Obstet Gynecol 1983; 62:64-67
  1. Wrana, P. (1939). "Historical review: Circumcision". Archives of Pediatrics. 56: 385–392. as quoted in: Zoske, Joseph (1998). "Male Circumcision: A Gender Perspective". Journal of Men’s Studies. 6 (2): 189–208. Retrieved 2006-06-14. {{cite journal}}: Unknown parameter |month= ignored (help)
  2. Gollaher, David L. (2000). Circumcision: a history of the world’s most controversial surgery. New York, NY: Basic Books. pp. 53–72. ISBN 978-0-465-04397-2 LCCN 99-0 – 0. {{cite book}}: Cite has empty unknown parameter: |chapterurl= (help); Unknown parameter |month= ignored (help)
  3. ^ "Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision". 1999 AMA Interim Meeting: Summaries and Recommendations of Council on Scientific Affairs Reports. American Medical Association. 1999. p. 17. Retrieved 2006-06-13. {{cite web}}: Unknown parameter |month= ignored (help)
  4. "Circumcision". American-Israeli Cooperative Enterprise. Retrieved 2006-10-03.
  5. Beidelman, T. (1987). "CIRCUMCISION". In Mircea Eliade (ed.). The Encyclopedia of religion. Vol. Volume 3. New York, NY: Macmillan Publishers. pp. 511–514. LCCN 86-0 – 00 ISBN 978-0-02-909480-8. Retrieved 2006-10-03. {{cite encyclopedia}}: |volume= has extra text (help)
  6. ^ 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." Male Circumcision: context, criteria and culture (Part 1), Joint United Nations Programme on HIV/AIDS, 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." "circumcision", The Columbia Encyclopedia, Sixth Edition, 2001-05.
  7. Ku, J.H. (2003). "Circumcision practice patterns in South Korea: community based survey" (PDF). Sexually Transmitted Infections. 79 (1): 65–67. doi:10.1136/sti.79.1.65. PMID 12576619. Retrieved 2006-10-03. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  8. Lee, R.B. (2005). "Circumcision practice in the Philippines: community based study" (PDF). Sexually Transmitted Infections. 81 (1): 91. doi:10.1136/sti.2004.009993. PMID 15681733. Retrieved 2006-10-03.
  9. Milos, Marilyn Fayre (1992). "Circumcision: A medical or a human rights issue?". Journal of Nurse-Midwifery. 37 (2 S1): S87–S96. doi:10.1016/0091-2182(92)90012-R. PMID 1573462. Retrieved 2007-04-06. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
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  12. ^ Beaugé, Michel (1997). "The causes of adolescent phimosis". British Journal of Sexual Medicine. 26. Retrieved 2006-06-14. {{cite journal}}: Unknown parameter |month= ignored (help)
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  24. Schoen, Edgar J. (2006). "Cost Analysis of Neonatal Circumcision in a Large Health Maintenance Organization" (Abstract). The Journal of Urology. 175 (3): 1111–1115. doi:10.1016/S0022-5347(05)00399-X. PMID 16469634. Retrieved 2006-07-01. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
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  74. Lajous, Martín (July). "Determinants of Prevalence, Acquisition, and Persistence of Human Papillomavirus in Healthy Mexican Military Men" (PDF). Cancer Epidemiology Biomarkers and Prevention. 14 (7): 1710–1716. doi:10.1158/1055-9965.EPI-04-0926. PMID 16030106. Retrieved 2006-07-09. {{cite journal}}: Check date values in: |year= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)CS1 maint: year (link)
  75. Aynaud, O. (July). "Developmental factors of urethral human papillomavirus lesions: correlation with circumcision" (PDF). BJU International. 84 (1): 57–60. doi:10.1046/j.1464-410x.1999.00104.x. PMID 10444125. Retrieved 2006-07-09. {{cite journal}}: Check date values in: |year= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)CS1 maint: year (link)
  76. Although the Academy's 1975 statement asserted that "A program of education leading to continuing good personal hygiene would offer all the advantages of circumcision without the attendant surgical risk," the 1999 statement cites a study which found that "appropriate hygiene decreased significantly the incidence of phimosis, adhesions, and inflammation, but did not eliminate all problems."
  77. "Care Of The Foreskin". Paediatric Policy - Circumcision. The Royal Australasian College of Physicians. 2004. Retrieved 2006-07-13. {{cite web}}: Unknown parameter |month= ignored (help)
  78. Sonnex, C (1997). "Balanoposthitis associated with the presence of subpreputial "smegma stones"". Genitourin Med. 73 (6): 567. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  79. Hutson, J.M. (2004). "Circumcision: a surgeon's perspective" (PDF). Journal of Medical Ethics. 30 (3): 238–240. doi:10.1136/jme.2002.001313. PMID 15173354. Retrieved 2006-07-09. {{cite journal}}: Unknown parameter |month= ignored (help)
  80. Darby, Robert (2005). "The riddle of the sands: circumcision, history, and myth" (PDF). The New Zealand Medical Journal. 118 (1218): 76–82. ISSN 11758716 Parameter error in {{issn}}: Invalid ISSN. PMID 16027753. Retrieved 2006-07-09. {{cite journal}}: Unknown parameter |month= ignored (help)
  81. ^ Fergusson, DM (1988). "Neonatal circumcision and penile problems: an 8-year longitudinal study". Pediatrics. 81 (4): 537–541. PMID 3353186. Retrieved 2007-07-18. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  82. Fakjian, N (1990). "An argument for circumcision. Prevention of balanitis in the adult". Arch Dermatol. 126 (8): 1046–7. PMID 2383029. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  83. Herzog, LW (1986). "The frequency of foreskin problems in uncircumcised children". Am J Dis Child. 140 (3): 254–6. PMID 3946358. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  84. O’Farrel, Nigel (2005). "Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study" (Abstract). International Journal of STD & AIDS. 16 (8): 556–588(4). doi:10.1258/0956462054679151. PMID 16105191. Retrieved 2006-08-20. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help) Editor’s note: I cannot confirm that the article substantiates the claim as I cannot access the full article.
  85. ^ Birley, HD (1993). "Clinical Features and management of recurrent balanitis; association with atopy and genital washing". Genitourinary Medicine. 69 (5): 400–403. PMID 8244363. Retrieved 2006-08-20. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help); Unknown parameter |quotes= ignored (help)
  86. Osipov, Vladimir O. (November 14, 2006). "Balanoposthitis". Reactive and Inflammatory Dermatoses. EMedicine. Retrieved 2006-11-20. {{cite web}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  87. ^ Au, T.S. (2003). "Balanitis, Bacterial Vaginosis and Other Genital Conditions". In Pedro Sá Cabral, Luís Leite, and José Pinto (eds.) (ed.). HANDBOOK OF DERMATOLOGY & VENEREOLOGY (2nd ed. ed.). Lisbon, Portugal: Department of Dermatology—Hospital Pulido Valente. ISBN 978-962-334-030-4. Retrieved 2006-09-04. {{cite book}}: |edition= has extra text (help); |editor= has generic name (help); Cite has empty unknown parameters: |origmonth= and |origdate= (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: multiple names: editors list (link)
  88. Edwards, Sarah (1996). "Balanitis and balanoposthitis: a review". Genitourinary Medicine. 72 (3): 155–159. PMID 8707315. Retrieved 2006-09-04. {{cite journal}}: Unknown parameter |month= ignored (help)
  89. Vincent, Michelle Valerie (2005). "The response of clinical balanitis xerotica obliterans to the application of topical steroid-based creams" (Abstract). Journal of Pediatric Surgery. 40 (4): 709–712. doi:10.1016/j.jpedsurg.2004.12.001. PMID 15852285. Retrieved 2006-09-21. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  90. Wright, J.E. (1994). "The treatment of childhood phimosis with topical steroid". The Australian and New Zealand journal of surgery. 64 (5): 327–328. PMID 8179528. Retrieved 2006-09-21. {{cite journal}}: Unknown parameter |month= ignored (help)
  91. Webster, T.M. (2002). "Topical steroid therapy for phimosis" (Abstract). The Canadian journal of urology. 9 (2): 1492–1495. PMID 12010594. Retrieved 2006-09-21. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  92. Scheinfeld, Noah S. (January 11, 2006). "http://www.emedicine.com/derm/topic46.htm". Diseases Of The Dermis. EMedicine. Retrieved 2006-09-21. {{cite web}}: Check date values in: |date= (help); External link in |title= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  93. Mattioli, G. (2002). "Lichen sclerosus et atrophicus in children with phimosis and hypospadias" (Abstract). Pediatric Surgery International. 18 (4): 273–275. doi:10.1007/s003830100699. PMID 12021978. Retrieved 2006-09-21. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  94. "Cancer of the penis (penile cancer)". Questions and Answers: Penis cancer questions. Cancer Research UK. January 14, 2004. Retrieved 2006-09-26. Penile cancer is more common in older men. Most cases are in men over 70. It is rare in men under 40. {{cite web}}: Check date values in: |date= (help)
  95. Boczko, S (1979). "Penile carcinoma in circumcised males". N Y State J Med. 79 (12): 1903–4. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  96. Maden, C (1993). "History of circumcision, medical conditions, and sexual activity and risk of penile cancer". J Natl Cancer Inst. 85 (1): 19–24. PMID 8380060. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  97. Holly, EA (1993). "Factors related to risk of penile cancer: new evidence from a study in the Pacific Northwest". J Natl Cancer Inst. 85 (1): 2–4. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  98. Schoen, EJ (2000). "The highly protective effect of newborn circumcision against invasive penile cancer". Pediatrics. 105 (3): e36. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  99. "What Are the Risk Factors for Penile Cancer?". Cancer Reference Information. American Cancer Society. May 31, 2006. Retrieved 2006-10-01. {{cite web}}: Check date values in: |date= (help)
  100. "Can Penile Cancer Be Prevented?". Cancer Reference Information. American Cancer Society. May 31, 2006. Retrieved 2006-10-01. {{cite web}}: Check date values in: |date= (help)
  101. ^ Kochen, Mosze (1980). "Circumcision and the risk of cancer of the penis. A life-table analysis". American Journal of Diseases of Children. 134 (5): 484–486. doi:10.1001/archpedi.134.5.484. PMID 7377156. Retrieved 2006-09-26. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  102. Rickwood, AM. (1980). "Phimosis in boys". British Journal of Urology. 52 (2): 147–150. PMID 7191744. Retrieved 2006-10-10. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  103. Rickwood, AM. (1989). "Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence?". Annals of the Royal College of Surgeons of England. 71 (5): 275–277. PMID 2802472. Retrieved 2006-10-10. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  104. Robin J Willcourt, "Re: Circumcision is a last resort - to be avoided, whenever possible" - letters to the editor, British Medical Journal http://bmj.bmjjournals.com/cgi/eletters/321/7264/792#110919
  105. Singh-Grewal, D. (August 1, 2005). "Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies" (PDF). Archives of Disease in Childhood. 90 (8): 853–858. doi:10.1136/adc.2004.049353. PMID 15890696. Retrieved 2006-09-21. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  106. Jakobsson 1999, et al. Minimum incidence and diagnostic rate of first urinary tract infection. Pediatrics. 1999 August;104(2 Pt 1):222–6. (full text)
  107. Lerman SE, Liao JC. Neonatal circumcision. Pediatr Clin North Am. 2001 December;48(6):1539-57. PMID 11732129
  108. Glass, J.M. (1999). "Religious circumcision: a Jewish view" (PDF). BJU International. 83 (Supplement 1): 17–21. doi:doi:10.1046/j.1464-410x.1999.0830s1017.x. PMID 10766529. Retrieved 2006-10-18. {{cite journal}}: Check |doi= value (help); Unknown parameter |month= ignored (help)
  109. Shulchan Aruch, Yoreh De'ah, 263:4
  110. Talmud Bavli Tractate Shabbos 133b: Rav Pappa said, “A mohel who does not perform metzitzah endangers the baby and is dismissed.”
  111. Halperin, Mordechai (Winter 2006). "Metzitzah B'peh Controversy: The View from Israel". Jewish Action 67(2). Orthodox Union. pp. 25, 33–39. ISSN 0447-7049 OCLC 5763983. Retrieved 2007-02-15. The original technique for the performance of metzitzah employs the human mouth. The mohel brings the baby's organ into his mouth immediately after the excision of the foreskin and sucks blood from it vigorously. This action lowers the internal pressure in the tissues of the organ, in the blood vessels of the head of the organ and in the exposed ends of the arterioles that have just been cut. Thus, the difference between the pressure in the blood vessels in the base of the organ and the pressure in the blood vessels at its tip is increased. This requirement has deep religious significance as well as medical benefits.…The Gemara states that the requirement of metzitzah stems from medical considerations; it is meant to minimize risk to the infant's life and health {{cite news}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  112. Gesundheit, B. (2004). "Neonatal Genital Herpes Simplex Virus Type 1 Infection After Jewish Ritual Circumcision: Modern Medicine and Religious Tradition" (PDF). Pediatrics. 114 (2): e259–e263. ISSN 1098-4275. Retrieved 2006-06-28. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  113. "Metzitza Be'Peh - Halachic Clarification". Rabbinical Council of America. June 7, 2005. Retrieved 2007-04-06. The poskim consulted by the RCA…agree that the normative halacha undoubtedly permits the third view , and that it is proper for mohalim to conduct themselves in this way given the health issues involved in the fourth view.…However, although Rav Yosef Dov Soloveitchik also generally prohibited metzitza be'peh with direct oral contact, he did not ban it by those who insisted upon it, and neither does the RCA advocate any such ban. Those who wish to follow their customs in accordance with the above-noted authorities are certainly entitled to do so, but the RCA is firmly of the opinion that in light of current realities and medical knowledge it is proper, and preferable, to use a tube. {{cite web}}: Check date values in: |date= (help)
  114. Hartog, Kelly (February 18 2005). "Death Spotlights Old Circumcision Rite". The Jewish Journal of Greater Los Angeles. Retrieved 2006-11-22. Metzizah b'peh — loosely translated as oral suction — is the part of the circumcision ceremony where the mohel removes the blood from the baby's member; these days the removal of the blood is usually done using a sterilized glass tube, instead of with the mouth, as the Talmud suggests. {{cite news}}: Check date values in: |date= (help)
  115. " denounces all who after that time observe circumcision, the sabbath and other legal prescriptions as strangers to the faith of Christ and unable to share in eternal salvation, unless they recoil at some time from these errors. 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." (Bull of Union with the Copts Cantate Domino, 4 February 1442, Session 11, Council of Florence), http://www.geocities.com/Heartland/Valley/8920/churchcouncils/ retrieved 20 March 2006
  116. Slosar, John Paul (2003). "The Ethics of Neonatal Male Circumcision: A Catholic Perspective" (PDF). The American Journal of Bioethics. 3 (2): 62–64. Retrieved 2007-04-03.
  117. For example, "The Calendar of the Church Year" in The (Online) Book of Common Prayer (Episcopal Church in the United States of America), http://www.bcponline.org/ retrieved 11 October 2006.
  118. Al-Munajjid, Muhammed Salih. "Question #9412: Circumcision: how it is done and the rulings on it". Islam Q&A. Retrieved 2006-07-01.
  119. Al-Munajjid, Muhammed Salih. "Question #7073: The health and religious benefits of circumcision". Islam Q&A. Retrieved 2006-07-01.
  120. Hamdullah Aydın, M.D. and Zeynep Gülçat, Ph.D., "Turkey," in The International Encyclopedia of Sexuality, http://www2.hu-berlin.de/sexology/IES/turkey.html retrieved 11 October 2006.
  121. Iftikhar Ahmad Jan, "Circumcision in babies and children with Plastibell technique: An easy procedure with minimal complications - Experience of 316 cases," Pak J Med Sci 2004, 20(3) 175-180.
  122. Drew, Paula E. "Iran". In Robert T. Francoeur (ed.). The International Encyclopedia of Sexuality. New York, NY: Continuum Publishing Company. Retrieved 2006-10-18. {{cite encyclopedia}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  123. Kamyar M. Hedayat, MD and Roya Pirzadeh, MD, "Issues in Islamic Biomedical Ethics: A Primer for the Pediatrician," Pediatrics Vol. 108 No. 4 October 2001, pp. 965-971, http://imamreza.net/eng/imamreza.php?print=3107 retrieved 11 October 2006.
  124. "WHEN YOUR PATIENT IS A BAHA'I". National Spiritual Assembly of the Bahá'ís of New Zealand. Retrieved 2007-01-30. Bahá'ís are not advised on a particular course of action in respect to circumcision of males; circumcision of females is considered mutilation.
  125. "Who Are the Druze?". SEMP Biot #176. Suburban Emergency Management Project. February 17, 2005. Retrieved 2007-01-30. {{cite web}}: Check date values in: |date= (help)
  126. "Sikh basics and misconceptions". Retrieved 2006-07-01.
  127. Singh, Jasprit. "Questions and Answers". Akal Sangat. Akal Publications. Retrieved 2006-07-01.
  128. Rebollido, Rommel G. (March 21, 2005). "Passage to manhood". General Santos. Sun Star Publishing, Inc. Retrieved 2006-07-01. {{cite news}}: Check date values in: |date= (help)
  129. de Morga, Antonio (1907) . "11". History of the Philippine Islands. Translated by Alfonso de Salvio, Norman F. Hall, and James Alexander Robertson. LCCN unk8-2 – 0. Retrieved 2006-07-01. These Borneans are Mahometans, and were already introducing their religion among the natives of Luzon, and were giving them instructions, ceremonies, and the form of observing their religion.…and those the chiefest men, were commencing, although by piecemeal, to become Moros, and were being circumcised and taking the names of Moros. {{cite book}}: External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
  130. Ajuwon et al., "Indigenous surgical practices in rural southwestern Nigeria: Implications for disease," Health Educ. Res..1995; 10: 379-384 Health Educ. Res..1995; 10: 379-384 Retrieved 3 October 2006
  131. ""PNG circumcision campaign hopes to halt HIV,"" (htm). ABC Radio Australia citing the Papua New Guinea Post-Courier. 2007-02-08, 14:21:13,. {{cite web}}: Check date values in: |date= (help); Italic or bold markup not allowed in: |publisher= (help)CS1 maint: extra punctuation (link)
  132. Aaron David Samuel Corn (2001). "Ngukurr Crying: Male Youth in a Remote Indigenous Community" (PDF). Working Paper Series No. 2. University of Wollongong. Retrieved 2006-10-18. {{cite journal}}: Cite journal requires |journal= (help)
  133. "Migration and Trade". Green Turtle Dreaming. Retrieved 2006-10-18. In exchange for turtles and trepang the Makassans introduced tobacco, the practice of circumcision and knowledge to build sea-going canoes.
  134. Jones, IH (1969). "Subincision among Australian western desert Aborigines". British Journal of Medical Psychology. 42 (2): 183–190. ISSN 0007-1129 PMID 5783777. {{cite journal}}: Unknown parameter |month= ignored (help)
  135. "RECENT GUEST SPEAKER". Australian AIDS Fund Incorporated. 2006. Retrieved 2006-07-01.
  136. "Weird & Wonderful". United Travel. Retrieved 2006-07-01.
  137. "Circumcision amongst the Dogon". The Non-European Components of European Patrimony (NECEP) Database. 2006. Retrieved 2006-09-03.
  138. Agberia, John Tokpabere (2006). "Aesthetics and Rituals of the Opha Ceremony among the Urhobo People" (PDF). Journal of Asian and African Studies. 41 (3): 249–260. doi:10.1177/0021909606063880. Retrieved 2006-10-18.
  139. "Masai of Kenya". Retrieved 2007-04-06. 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.
  140. Sommerville, Margaret (2000). "Altering Baby Boys' Bodies: The Ethics of Infant Male Circumcision". The ethical canary: science, society, and the human spirit. New York, NY: Viking Penguin Canada. pp. 202–219. ISBN 0670893021. LCCN 20-1. {{cite book}}: |access-date= requires |url= (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help); Unknown parameter |month= ignored (help)
  141. Van Howe, R.S. (1999). "Involuntary circumcision: the legal issues" (PDF). BJU International. 83 (Supp1): 63–73. doi:10.1046/j.1464-410x.1999.0830s1063.x. PMID 10349416. Retrieved 2007-02-12. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  142. Lightfoot-Klein, Hanny (2003). "Similarities in Attitudes and Misconceptions toward Infant Male Circumcision in North America and Ritual Female Genital Mutilation in Africa". The FGC Education and Networking Project. Retrieved 2006-07-01.
  143. Benatar, David (2003). "How not to argue about circumcision" (PDF). American Journal of Bioethics. 3 (2): W1–W9. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); line feed character in |journal= at position 20 (help)
  144. ^ "Policy Statement On Circumcision" (PDF). Royal Australasian College of Physicians. 2004. Retrieved 2007-02-28. 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. {{cite web}}: Unknown parameter |month= ignored (help)
  145. Goldman, R. (1999). "The psychological impact of circumcision" (PDF). BJU International. 83 (S1): 93–102. doi:10.1046/j.1464-410x.1999.0830s1093.x. Retrieved 2006-07-02. {{cite journal}}: Unknown parameter |month= ignored (help)
  146. "National Organization of Restoring Men". 2006. Retrieved 2006-07-01.
  147. Taddio, Anna (1997). "Effect of neonatal circumcision on pain response during subsequent routine vaccination" (PDF — free registration required). The Lancet. 349 (9052): 599–603. doi:10.1016/S0140-6736(96)10316-0. Retrieved 2006-07-01. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  148. Bureau of Democracy, Human Rights, and Labor (November 8, 2005). "Sweden". International Religious Freedom Report 2005. US Department of State. Retrieved 2006-07-01. {{cite web}}: Check date values in: |date= (help)CS1 maint: multiple names: authors list (link)
  149. "Sweden restricts circumcisions". BBC Europe. October 1, 2001. Retrieved 2006-10-18. Swedish Jews and Muslims object to the new law, saying it violates their religious rights. {{cite web}}: Check date values in: |date= (help)
  150. Reuters (June 7, 2001). "Jews protest Swedish circumcision restriction". Canadian Children's Rights Council. Retrieved 2006-10-18. 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.' {{cite web}}: |author= has generic name (help); Check date values in: |date= (help)
  151. Williams N, Kapila L. Complications of circumcision. Brit J Surg. 1993;80:1231-6. (full text)
  152. Crawford DA. Circumcision: a consideration of some of the controversy. J Child Health Care. 2002 December;6(4):259-70. PMID 12503896
  153. {{cite journal | last = StanWisniewski | first = Z. | year = 2004 | title = Circumcision in Western Australia | journal = ANZ Journal of Surgery | volume = 74 | issue = 5 | pages = 387-388 | doi = 10.1111 | url = http://pt.wkhealth.com/pt/re/aunz/fulltext.00130494-200405000-00028.htm | accessdate = 2007-03-31
  154. "Demand for male circumcision rises in a bid to prevent HIV" (PDF). Bulletin of the World Health Organization. 84 (7): 505–588. 2006. As a result, there are already indications of increasing demand for male circumcision in traditionally non-circumcising societies in southern Africa.
  155. Skatssoon, Judy (2004). "Circumcision rates rise for some". Sydney, New South Wales, Australia: Sydney Morning Herald (reprint: CIRP.org). {{cite web}}: Unknown parameter |month= ignored (help)
  156. J.H. Ku1, M.E. Kim, N.K. Lee and Y.H. Park, "Circumcision practice patterns in South Korea: community based survey" (Sex Transm Inf 2003;79:65-67 http://sti.bmjjournals.com/cgi/content/full/79/1/65 retrieved 1 October 2006
  157. Dave, SS (2003). "Male circumcision in Britain: findings from a national probability sample survey". Sex Transm Infect. 79 (6): 499–500. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); line feed character in |title= at position 30 (help)
  158. Nelson, CP. (2005). "The increasing incidence of newborn circumcision: data from the nationwide inpatient sample" (Abstract). Journal of Urology. 173 (3): 978–981. doi:10.1097/01.ju.0000145758.80937.7d. ISSN 0022-5347 PMID 15711354. Retrieved 2006-09-21. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  159. ^ Kozak, LJ (2006). "National Hospital Discharge Survey: 2003 annual summary with detailed diagnosis and procedure data" (PDF). Vital Health Statistics. 13 (160). Retrieved 2007-01-30. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  160. "Trends in circumcisions among newborns". Health E-Stats. National Center for Health Statistics. January 11, 2007. Retrieved 2007-01-30. However, the most notable change occurred in the West where newborn circumcisions dropped from 62 percent in 1980 to 37 percent in 1999. This latest available figure for the West represents over a two-fold difference when compared with circumcision estimates for the Midwest. This dramatic decline, in part, reflects the increased birth rate among Hispanics who have been shown in several other studies to be less likely to receive circumcisions than other white and black infants. {{cite web}}: Check date values in: |date= (help)
  161. Xu, F, L Markowitz, M Sternberg, and S Aral (2006). "Prevalence of circumcision in men in the United States: data from the National Health and Nutrition Examination Survey (NHANES), 1999-2002". XVI International AIDS Conference. Retrieved 2006-09-21. {{cite journal}}: Cite journal requires |journal= (help)CS1 maint: multiple names: authors list (link)
  162. Schoen, Edgar J. (2006). "Ignoring evidence of circumcision benefits". Pediatrics. 118 (1): 385–387. ISSN 0031-4005 PMID 16818586. Retrieved 2006-09-21. {{cite journal}}: Unknown parameter |month= ignored (help)
  163. Betsy A., Lehman (June 22, 1987). "The Age-old Question of Circumcision" (CIRP (CIRP has modified text display)). The Boston Globe. pp. 41 & 43. Retrieved 2007-04-06. {{cite news}}: Check date values in: |date= (help)
  164. Quayle, SS. (2003). "The effect of health care coverage on circumcision rates among newborns". Journal of Urology. 170 (4 Pt 2): 1533–1536. ISSN 0022-5347 PMID 14501653. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)

External links

Circumcision opposition

Circumcision promotion

Circumcision techniques

Further reading

  • 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)
  • David L. Gollaher. 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)
  • Brian J. Morris, Ph.D., D.Sc. In Favour of Circumcision. Sydney: UNSW Press, 1999. (ISBN 978-0-86840-537-7)
  • 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 Heath 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)
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