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Male circumcision is the removal of 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 cædere (meaning "to cut").

Early depictions of circumcision are found in cave drawings and Ancient Egyptian tombs, though some pictures may be open to interpretation. Male circumcision is a commandment from God in Judaism. In Islam, though not discussed in the Qur'an, circumcision is widely practiced and most often considered to be a sunnah. It is also customary in some Christian churches in Africa, including some Oriental Orthodox Churches. According to the World Health Organization (WHO), global estimates suggest that 30% of males are circumcised, of whom two thirds are Muslim. The prevalence of circumcision varies widely between cultures. For example, circumcision is reported to be nearly universal in the Middle East, but under 2% in Scandinavia.

Advocates of routine neonatal circumcision argue that circumcision provides important health advantages which outweigh the risks, that it has no substantial effects on sexual function, has a complication rate of less than 0.5% when carried out by an experienced physician, and is best performed during the neonatal period. Opponents of routine neonatal circumcision argue that circumcision violates the individual's bodily rights, is medically unnecessary, adversely affects sexual pleasure and performance, and is a practice defended through the use of myths.

The American Medical Association stated in 1999: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."

The World Health Organization (WHO; 2007), the Joint United Nations Programme on HIV/AIDS (UNAIDS; 2007), and the Centers for Disease Control and Prevention (CDC; 2008) state that evidence indicates that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides partial protection and should not replace other interventions to prevent transmission of HIV.

Modern circumcision procedures

For infant circumcision, clamps, such as the Gomco clamp, Plastibell, and Mogen are often used. Clamps cut off blood supply to the foreskin, limiting bleeding and protecting the glans from being cut. Before using a clamp, synechia which adheres foreskin to the glans is torn with a blunt probe and/or curved hemostat.

• With the Plastibell, the adhesions between glans and foreskin are torn with a probe. The foreskin is cut longitudinally, the Plastibell is placed over the glans, and the foreskin is draped over the Plastibell. A ligature is then tied firmly around the foreskin and tightened into a groove in the Plastibell to crush the blood vessels. The parts of the foreskin protruding beyond the ligature are circumcised. The clamp is removed in three to seven days after the wound has sealed.
• With a Gomco clamp, a section of skin is first crushed with a hemostat then slit dorsally with scissors. The foreskin is drawn over the bell shaped portion of the clamp and inserted through a hole in the base of the clamp. The clamp is tightened, "crushing the foreskin between the bell and the base plate." The crushed blood vessels provide hemostasis. The flared bottom of the bell fits tightly against the hole of the base plate, so the foreskin may be cut away with a scalpel from above the base plate.
• With a Mogen clamp, the foreskin is pulled dorsally with a straight hemostat, and lifted. The Mogen clamp is then slid between the glans and hemostat, following the angle of the corona to "avoid removing excess skin ventrally and to obtain a superior cosmetic result" to Gomco or Plastibell circumcisions. The clamp is locked, and a scalpel is used to cut the skin from the flat (upper) side of the clamp.

In poor countries, male circumcision is often performed by non-medical personnel in unsterile conditions.

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

Cultures and religions

Circumcising 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 the Muslim world, parts of South East Asia, Africa, the United States, The Philippines, Israel, and South Korea. It is also a growing trend among young men in Japan, and it is estimated that around 25% of young men in China's major cities have been circumcised. It is also commonly practised in the Jewish and Islamic faiths.

Under Jewish law circumcision is a mitzva aseh ("positive commandment" to perform an act) and is obligatory for Jewish-born males, and some Jewish male converts. It is only postponed or abrogated in the case of threat to the life or health of the child. It is usually performed by a mohel on the eighth day after birth in a ceremony called a Brit milah (or Bris milah, colloquially simply bris), which means "Covenant of circumcision" in Hebrew. It is considered of such religious importance that the body of an uncircumcised Jewish male will sometimes be circumcised before burial.

In Islam, circumcision is mentioned in some hadith, but not in the Qur'an. Some Fiqh scholars state that circumcision is recommended (Sunnah); others that it is obligatory. Some have quoted the hadith to argue that the requirement of circumcision is based on the covenant with Abraham. While endorsing circumcision for males, scholars note that it is not a requirement for converting to Islam.

Circumcision is customary among the Coptic, Ethiopian, and Eritrean Orthodox Churches, and also some other African churches. Some Christian churches in South Africa oppose circumcision, viewing it as a pagan ritual, while others, including the Nomiya church in Kenya, require circumcision for membership. Some Christian churches celebrate the Circumcision of Christ.

Circumcision in South Korea is largely the result of American cultural and military influence following the Korean War. 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.

Circumcision is part of initiation rites in some African, Pacific Islander, and Australian aboriginal traditions in 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: subincision is practised amongst 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 practiced 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, circumcision is taken to represent a removal of "feminine" aspects of the male, turning boys into fully masculine males. Among the Urhobo of southern Nigeria it is symbolic of a boy entering into manhood. The ritual expression, Omo te Oshare ("the boy is now man"), constitutes a rite of passage from one 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, psychological and legal considerations

Ethical issues

The American Medical Association 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.

UNAIDS state (2007): "Male circumcision is a voluntary surgical procedure and health care providers must ensure that men and young boys are given all the necessary information to enable them to make free and informed choices either for or against getting circumcised."

Circumcision advocates argue that circumcision prevents infections and slows down the spread of AIDS. Opponents of circumcision question the ethical validity of removing healthy, functioning genital tissue from a minor, arguing that infant circumcision infringes upon individual autonomy and represents a human rights violation.

Consent

Views differ on whether limits should be placed on caregivers having a child circumcised.

Some medical associations take the position that the parents should determine what is in the best interest of the infant or child, but the Royal Australasian College of Physicians (RACP) and the British Medical Association (BMA) observe that controversy exists on this issue. The BMA state that in general, "the parents should determine how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices." They state that because the parents' interests and the child's interests sometimes differ, there are "limits on parents' rights to choose and parents are not entitled to demand medical procedures contrary to their child's best interests." They state that competent children may decide for themselves.

Some argue that the medical problems that have their risk reduced by circumcision are already rare, can be avoided, and, if they occur, can usually be treated in less invasive ways than circumcision. Medical Ethicist Professor Margaret Somerville states that the removal of healthy genital tissue from a minor should not be subject to parental discretion and that physicians who perform the procedure are not acting in accordance with their ethical duties to the patient. Dr. George Denniston contends that circumcision is harmful and asserts that in the absence of the individual's consent, non-therapeutic child circumcision violates several ethical principles that govern medicine.

Others believe neonatal circumcision is permissible, if parents should so choose. Dr. Adrian Viens argues that, in a cultural or religious context, circumcision is of significant enough importance that parental consent is sufficient and that there is "an absence of sufficient evidence or persuasive argumentation" to support changing the present policy. Benatar and Benatar argue that circumcision can be beneficial to a male before he would be able to otherwise provide consent, that "it is far from obvious that circumcision reduces sexual pleasure," and that "it is far from clear that non-circumcision leaves open a future person’s options in every regard."

Psychological and emotional consequences

The British Medical Association (2006) state that "it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks." Goldman (1999) discussed the possible trauma of circumcision on children and parents, anxieties over the circumcised state, a tendency to repeat the trauma, and suggested a need on the part of circumcised doctors to find medical justifications for the procedure. Milos asserts the existence of "excruciating pain, perinatal encoding of the brain with violence, interruption of maternal-infant bonding, betrayal of infant trust..." among other consequences, and points to support groups providing information to Jewish parents "who are grappling with this difficult issue" as well as men "who perceive themselves as victims of a sexual assault." Moses et al. (1998) state that "scientific evidence is lacking" for psychological and emotional harm, and cite a longitudinal study finding no difference in developmental and behavioural indices.

Legality

In 2001, Sweden 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, and in 2001, the World Jewish Congress stated that it was “the first legal restriction on Jewish religious practice in Europe since the Nazi era.” In 2005, the Swedish National Board of Health and Welfare reviewed the law and recommended that it be maintained. In 2006, the U.S. State Department's report on Sweden stated that most Jewish mohels had been certified under the law and 3000 Muslim and 40–50 Jewish boys were circumcised each year.

In 2006, a Finnish court found that a parent's actions in having her 4-year-old son circumcised were illegal. The prosecutor argued that, "part of healthy genitalia is removed without medical foundation, or competent consent". No punishment was assigned by the court. In 2008, the Finnish government was reported to be considering a new law to legalize circumcision if the practitioner is a doctor and if the child or parents consents.

Medical analysis

Pain and pain relief during circumcision

According to the American Academy of Pediatrics' 1999 Circumcision Policy Statement, “There is considerable evidence that newborns who are circumcised without analgesia experience pain and psychologic stress.” It therefore recommended using pain relief for circumcision. One of the supporting studies, Taddio 1997, found a correlation between circumcision and intensity of pain response during vaccination months later. While acknowledging that there may be "other factors" besides circumcision to account for different levels of pain response, they stated that they did not find evidence of such. They concluded "pretreatment and postoperative management of neonatal circumcision pain is recommended based on these results." Other medical associations also cite evidence that circumcision without anesthetic is painful.

Stang, 1998, found 45% of physicians used anaesthesia – most commonly a dorsal penile nerve block – for infant circumcisions. Obstetricians used anaesthesia significantly less often (25%) than family practitioners (56%) or pediatricians (71%). Howard et. al (1998) studied US medical doctor residency programs, and stated that 26% of the programs that taught the circumcision procedure "failed to provide instruction in anesthesia/analgesia for the procedure." They concluded: "Given the overwhelming evidence that neonatal circumcision is painful and the existence of safe and effective anesthesia/analgesia methods, residency training in neonatal circumcision should include instruction in pain relief techniques."

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." Tannenbaum and Shechet, 2000, stated that an “authentic, traditional bris performed by a mohel does not use clamps, so there is no pain associated with crushing tissue.” 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.”

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.

Williams (2003) argued that human attitudes toward the pain that animals (including humans) experience may not be based on speciesism; developing an analogy between attitudes toward the pain pigs endure while having their tails "docked", and "our culture's indifference to the pain that male human infants experience while being circumcised."

Sexual effects of circumcision

The sexual effects of circumcision are the subject of much debate. The American Academy of Pediatrics (1999) stated "There are anecdotal reports that penile sensation and sexual satisfaction are decreased for circumcised males", however they also stated that " survey of adult males using self-report suggests more varied sexual practice and less sexual dysfunction in circumcised adult men." They continued, "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. No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction." Payne et al. reported that direct measurement of penile sensation during sexual arousal failed to support the hypothesised sensory differences associated with circumcision status.

Conversely, Boyle et al. stated that "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." They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well." Sorrells et al., using monofilament touch-test mapping, found that the foreskin contains the most sensitive parts of the penis, noting that these parts are lost to circumcision. They also found that "the glans of the circumcised penis is less sensitive to fine-touch than the glans of the uncircumcised penis."

Schoen also argues that circumcision may play a role in sexual attraction. Some studies have shown that women, by a margin of about 3 to 1, prefer the circumcised penis, mainly because of cleanliness which is of particular importance in oral sex. There is a minimal difference in the sexual act itself – circumcised men take slightly longer to reach orgasm after vaginal insertion, an effect considered to be advantageous. The exact effect of circumcision on sexual attraction and performance remain controversial.

Reports detailing the effect of circumcision on erectile dysfunction have been mixed. Studies have shown that circumcision can result in a statistically significant increase, or decrease, in erectile dysfunction among circumcised men, while other studies have shown little to no effect.

Complications from circumcision

Complication rates ranging from 0.06% to 55% have been cited, though a 1993 survey of circumcision complications by Williams and Kapilla put a realistic rate at 2-10 percent.

Meatal stenosis may be a common longer-term complication from circumcision. Recent publications give a frequency of occurrence between 0.9% in young boys in Iran and 9% to 10% in U.S. neonates.

One study looking at 354,297 births in Washington State from 1987-1996 found that immediate post-birth complications occurred at a rate of 0.2% in the circumcised babies and at a rate of 0.01% in the intact babies. The study warned though that this was a conservative estimate because it did not capture the very rare but serious delayed complications associated with circumcisions (eg, necrotizing fasciitis, cellulitis) and the less serious but more common complications such as the circumcision scar or a less than ideal cosmetic result. It also warned that the risks of circumcision "do not seem to be mitigated by the hands of more experienced physicians". A 1999 study of 48 boys seen between January 1981 and December 1995 found that haemorrhage occured in 52% of boys, infection in 21% and one child had his penis amputated. According to the American Medical Association (AMA), blood loss and infection are the most common complications, but most bleeding is minor and can be stopped by applying pressure. A meta-analysis confirmed that haemorrhage and infection are the commonest complications of circumcision, occurring at rate of about 2%.

In 1983 G.W Kaplan looked at the complications of circumcision using previous studies done. He found one study that showed 9.5 per cent of patients had repeated circumcisions for inadequately performed initial operations. Another study noted the rate of bleeding complications to be between 0.1 percent and 35 percent. Other complications were too much skin or not enough skin being cut off. If insufficient skin is removed true phimosis can result. A concealed penis was another complication. This is where an excess of skin is removed from the penile shaft while not enough of the inner preputial epithelium has been removed. The new preputial orifice is distal to the tip of the penis and it fibroses so that as healing occurs, the penile shaft is forced into the suprapubic fat and the stenotic preputial ring that results lies at, or just above, the abdominal skin level. Other complications looked at were urinary fistulas, chordee, cysts, lymphedema, ulceration of the glans, necrosis of all or part of the penis, hypospadias, epispadias and impotence. He stated “Virtually all of these complications are preventable with only a modicum of care" and "most such complications occur at the hands of inexperienced operators who are neither urologists nor surgeons.”

Infant circumcision may result in skin bridges, whereby the end of the severed part of the foreskin fuses to other parts of the penis (normally the glans) on repair. Meatal stenosis (a narrowing of the urethra) may be a common longer-term complication of circumcision. This can lead to discomfort with urination, incontinence, bleeding after urination and urinary tract infections

Although 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. The penis is thought to be lost in 1 in a 1,000,000 circumcisions.

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.

HIV and other sexually transmitted diseases

According to Valiere Alcena , it was he who first hypothesised that low rates of circumcision in Africa were partly responsible for the continent's high rate of HIV infection. He did this via a letter to the New York State Journal of Medicine in August 1986. He also alleges that the late Aaron J. Fink stole his idea when Fink published a letter to the New England Journal of Medicine entitled A possible explanation for heterosexual male infection with AIDS, in October 1986.

Three randomised control trials were carried out in Africa to test the hypothesis that circumcision reduces female to male HIV transmission. All three trials were stopped early by their monitoring boards on ethical grounds, because those in the circumcised group had a lower rate of HIV contraction than the intact group.

In March 2007, WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that male circumcision is an efficacious intervention for HIV prevention, providing about a 60% reduction in HIV transmission from female to male when done by well trained medical professionals. The Centers for Disease Control and Prevention (CDC) state that several types of research have documented that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex. Both the WHO and CDC indicate that it may not reduce HIV transmission from men to women, and that data is lacking for the transmission rate of men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner.

WHO and UNAIDS have stated that scientific findings regarding the role of male circumcision in preventing heterosexual HIV infection are particularly relevant in regions where the incidence of heterosexually acquired HIV infection is high, such as Sub-Saharan Africa, and stressed that the procedure must be carried out safely and under conditions of informed consent. Before there were any results from randomized controlled trials, reviews of observational data differed as to whether there was sufficient evidence for an intervention effect of circumcision against HIV.

The joint WHO/UNAIDS recommendation on male circumcision notes that it is not a "magic bullet": it only provides partial protection from HIV and should never replace known methods of HIV prevention, such as the delayed onset of sexual relations, abstinence from penetrative sex, reduction in the number of sexual partners, increased male and female condom distribution and compliance, access to HIV testing and counselling, and promotion of treatment for sexually transmitted disease. A meta-analysis of the African randomised controlled trials and other observational studies confirmed that using circumcision as a means to reduce HIV infection would, on a national level, require consistently safe sexual practices to maintain the protective benefit. According to this particular meta-analysis, 72 circumcisions would need to be performed to prevent 1 HIV infection.

McCoombe et al. stated that a layer of keratin could provide protection from viral entry, and found that the keratin is thinner on the foreskin than the glans penis, and thinnest on the inner surface of the foreskin.

Other reports have indicated that circumcision has little to no effect on HIV transmission. Furthermore, some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy.

A meta-analysis found that circumcision is associated with lower rates of syphilis, chancroid and possibly genital herpes.

Hygiene, and infectious and chronic conditions

The American Academy of Pediatrics (1999) stated: "Circumcision has been suggested as an effective method of maintaining penile hygiene since the time of the Egyptian dynasties, but there is little evidence to affirm the association between circumcision status and optimal penile hygiene."

Some studies found that boys with foreskins had higher rates of various infections and inflammations of the penis than those who were circumcised. One study looked at 150 intact men and 75 circumcised men at a sexually transmitted infections (STI) clinic at Ealing Hospital, London. It found that the intact men did not wash as often as the circumcised men.

The usual treatment for balanoposthitis is to use topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams, but circumcision is another option.

In several studies, uncircumcised men were found to have a greater incidence of human papilloma virus (HPV) infection than circumcised men. One study found no statistically significant difference in the incidence of HPV infection between circumcised and uncircumcised men, but did note a higher prevalence of urethritis in the uncircumcised. Results of the 1999 to 2004 United States National Health and Nutrition Examination Survey demonstrated that more circumcised men reported having been diagnosed with genital warts compared with uncircumcised men (4.5% and 2.4%, respectively). Another study also found that circumcised men were more likely to have genital warts than uncircumcised men.

A meta-analysis of 12 studies (one randomised controlled trial, four cohort studies and seven case-control studies) representing 402,908 children determined that circumcision was associated with a significantly reduced risk of urinary tract infection (UTI). Given that the risk of UTI in normal boys was about 1%, it determined that the number-needed-to treat (number of circumcisions necessary) to prevent one urinary tract infection was 111. Because haemorrhage and infection are the commonest complications of circumcision, occurring at rate of about 2%, assuming equal utility of benefits and harms, the authors concluded that the net clinical benefit of circumcision is only likely in boys at high risk of urinary tract infection (such as those with high grade vesicoureteral reflux or a history of recurrent UTIs, where the number needed to treat declined to 11 and 4, respectively).

Some UTI studies have been criticized for not taking into account a high rate of UTI's among premature infants, who are usually not circumcised because of their fragile health status. The AMA stated that “depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI," and noted one decision analysis model that concluded that circumcision was not justified as a preventative measure against UTI.

Improper care of the intact penis

Many doctors and parents inadvertently cause harm by forcible retraction of the foreskin. After birth the foreskin naturally separates from the glans and should never be forced. The majority of boys can retract their foreskin by age 18. The only person to retract the foreskin should be the owner of the penis. Forcible retraction of the foreskin is not only painful but tends to produce tears in the preputial orifice resulting in inelastic scar tissue that may lead to pathologic phimosis. According to one study, a lot of unnecessary circumcisions are performed due to falsely diagnosed phimosis. Adhesions after forcible retraction, especially in infants, can fuse the foreskin with itself or the glans, leading to skin bridges.

Soap can cause inflammation so water alone is thought to be preferable to clean the foreskin.

Penile cancer

The American Cancer Society (2006) stated, "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 (1999) stated that studies suggest that neonatal circumcision confers some protection from penile cancer, but circumcision at a later age does not seem to confer the same level of protection. Further, because penile cancer is a rare disease, the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, remains low.

National circumcision rate statistics show no correlation between circumcision status and penile cancer. Penile cancer affects 0.82 per 100,000 in Denmark and 0.3 per 100,000 in Japan, where almost all men are intact. In the USA, where the majority of men are circumcised the rate is 0.9 to 1 per 100,000. In parts of India the rate is 10.5 per 100,000 men per year. Two other studies have reported a rate of penile cancer from 3 to 22 times higher in uncircumcised than circumcised men.

Policies of various national medical associations

The American Medical Association stated in 1999: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice." The British Medical Association, states “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.” Cost-benefit analyses have varied. Some found a small net benefit of circumcision, some found a small net decrement, and one found that the benefits and risks balanced each other out and suggested that the decision could "most reasonably be made on nonmedical factors."

Most guidelines make a distinction between therapeutic and non-therapeutic circumcision. Therapeutic circumcision (where there is a medical need to circumcise) is rarely controversial. Neonatal circumcision is not considered medically necessary and is therefore categorised as non-therapeutic. The medical harms or benefits have not been unequivocally proven but there are clear risks of harm if the procedure is done inexpertly. Reasons for non-therapeutic circumcision include religious beliefs as well as cultural and family conformity.

United States

The American Academy of Pediatrics (1999) does not recommend routine neonatal circumcision. If parents choose to circumcise, the AAP also recommends using analgesia to reduce pain associated with circumcision, and that circumcision only be performed on newborns who are stable and healthy. The American Medical Association echoes the 1999 Circumcision Policy Statement of the American Academy of Pediatrics.

The American Academy of Family Physicians (2007) recognizes the controversy surrounding circumcision and recommends that physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering circumcision for newborn boys.

The American Urological Association (2007) believes that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks. "

Canada

The Fetus and Newborn Committee of the Canadian Paediatric Society posted "Circumcision: Information for Parents" in November 2004, and "Neonatal circumcision revisited" in 1996. The 1996 position statement says that "circumcision of newborns should not be routinely performed," (a statement with which the Royal Australasian College of Physicians concurs,) and the 2004 advice to parents says it "does not recommend circumcision for newborn boys. Many pediatricians no longer perform circumcisions."

United Kingdom

There is a spectrum of views within the British Medical Association's (BMA) 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. As a general rule, the BMA believe 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." They also state that "both parents...must give consent for non-therapeutic circumcision", and that parents and children should be provided with up-to-date written information about the risks involved.

According to the BMA, circumcision for medical purposes should only be used where less invasive procedures are either unavailable or not as effective. They state that "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." Furthermore, the BMA believe that children who are capable of expressing a view should be involved in the decision making process with regard to their own circumcision, and their views should be taken into account. The BMA state that they "cannot envisage a situation in which it is ethically acceptable to circumcise a competent, informed young person who consistently refuses the procedure."

The BMA state that parents should be informed about the lack of concensus within the medical profession with regard to the potential health benefits of non-therapeutic circumcision, adding that they consider the evidence for such benefits to be insufficient as the sole reason for carrying out a circumcision.

Australasia

The Royal Australasian College of Physicians (RACP) state that "after extensive review of the literature" they "reaffirm that there is no medical indication for routine neonatal circumcision". They also state that "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." Additionally, the RACP state that there is an obligation to provide parents who request a circumcision for their child with accurate, up-to-date and unbiased information about the risks and benefits of circumcision, adding that "there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate."

The Tasmanian President of the Australian Medical Association (AMA), Haydn Walters, has stated that the AMA would support a call to ban circumcision for non-medical, non-religious reasons.

History of 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 or to increase a man's attractiveness to women, or as an aid to hygiene where regular bathing was impractical, among other possibilities. Immerman et al. suggest that circumcision causes lowered sexual arousal of pubescent males, and hypothesize that this was a competitive advantage to tribes practicing circumcision, leading to its spread regardless of whether the people understood this. It is possible that circumcision arose independently in different cultures for different reasons.

The oldest documentary evidence for circumcision comes from ancient Egypt. Circumcision was common, although not universal, among ancient Semitic peoples. In the aftermath of the conquests of Alexander the Great, however, Greek dislike of circumcision (they regarded a man as truly "naked" only if his prepuce was retracted) led to a decline in its incidence among many peoples that had previously practiced it.

Circumcision has ancient roots among several ethnic groups in sub-equitorial Africa, and is still performed on adolescent boys to symbolize their transition to warrior status or adulthood.

Circumcision in the English-speaking world

Infant circumcision was taken up in the United States, Australia and the English-speaking parts of Canada, South Africa and to a lesser extent in the United Kingdom and New Zealand. There are several hypotheses to explain why infant circumcision was accepted in the United States about the year 1900. The germ theory of disease elicited an image of the human body as a conveyance for many dangerous germs, making the public "germ phobic" and suspicious of dirt and bodily secretions. Because of its function, the penis became "dirty" by association, and from this premise circumcision was seen as preventative medicine to be practiced universally. In the view of many practitioners at the time, circumcision was a method of treating and preventing masturbation. It was also said to protect against syphilis, phimosis, paraphimosis, balanitis, and "excessive venery" (which was believed to produce paralysis). Gollaher states that physicians advocating circumcision in the late nineteenth century expected public skepticism, and refined their arguments to overcome it.

Although it is difficult to determine historical circumcision rates, one estimate of infant circumcision rates in the United States holds that 32% of newborn American boys were being circumcised in 1933. According to Laumann, Masi and Zuckerman, US circumcision rates were approximately 70% in 1945, 80% in 1955, 85% in 1965, and 77% in 1971. Between 1981 and 1999, National Hospital Discharge Survey data from the National Center for Health Statistics demonstrated that the US circumcision rate remained relatively stable within the 60% range, with a minimum rate of 60.7% in 1988 and a maximum rate of 67.8% in 1995. A 1987 study found that the most prominent reasons US parents choose circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns. However, a later study speculated that an increased recognition of the potential benefits of neonatal circumcision may have been responsible for the observed increase in the US rate between 1988 and 2000. A report by the Agency for Healthcare Research and Quality placed the 2005 national circumcision rate at 56%.

Circumcision grew in popularity in South Korea 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, and the average age of circumcision is 12 years.

In 1949, the United Kingdom's newly-formed National Health Service removed infant circumcision from its list of covered services, and circumcision has since been an out-of-pocket cost to parents. As a result, prevalence in the UK is age-graded, with 12% of those aged 16-19 years circumcised and 20% of those aged 40-44 years, and the proportion of newborns circumcised in England and Wales has fallen to less than one percent.

The circumcision rate has declined sharply in Australia since the 1970s, leading to an age-graded fall in prevalence, with a 2000-01 survey finding 32% of those aged 16-19 years circumcised, 50% for 20-29 years and 64% for those aged 30-39 years.

In Canada, individual provincial health services began delisting circumcision in the 1980s.

Prevalence of circumcision

Estimates of the proportion of males that are circumcised worldwide vary from one-sixth to a third. WHO has estimated that 664,500,000 males aged 15 and over are circumcised (30% global prevalence), with almost 70% of these being Muslim. Prevalence is near universal in the Middle East and Central Asia. WHO states that "there is generally little non-religious circumcision in Asia, with the exceptions of the Republic of Korea and the Philippines". WHO presents a map of estimated prevalence in which the level is generally low (< 20%) across Europe, and Klavs et al. report findings that "support the notion that the prevalence is low in Europe". In Latin America, prevalence is universally low. Estimates for individual countries include Spain, Colombia and Denmark less than 2%, Finland and Brazil 7%, Taiwan 9%, Thailand 13%, New Zealand less than 20% and Australia 58.7%.

WHO estimates prevalence in the United States and Canada at 75% and 30%, respectively. Prevalence in Africa varies from less than 20% in some southern African countries to near universal in North and West Africa.

Foreskin-based medical and consumer products

Foreskins from circumcised babies are used to make a commercial anti-wrinkle skin cream. A six-week supply costs US$130.

Foreskins of babies are also used for skin graft tissue, and for β-interferon-based drugs.

Foreskin fibroblasts have been used in biomedical research.

See also

• Brit milah
• Circumcision scar
• Foreskin restoration
• Genital integrity
• Genital modification and mutilation
• Holy Prepuce
• Preputioplasty, alternative to circumcision in the treatment for phimosis

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 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)
• Paysach J. Krohn, Rabbi. Bris Milah. Circumcision—The Covenant Of Abraham/A Compendium of Laws, Rituals, And Customs From Birth To Bris, Anthologized From Talmudic, And Traditional Sources. New York: Mesorah Publications, 1985, 2005.
• Brian J. Morris, Ph.D., D.Sc. In Favour of Circumcision. Sydney: UNSW Press, 1999. (ISBN 978-0-86840-537-7)
• Peter Charles Remondino. History of Circumcision from the Earliest Times to the Present. Philadelphia and London; F. A. Davis; 1891.
• Holm Putzke, Ph.D. Die strafrechtliche Relevanz der Beschneidung von Knaben. Zugleich ein Beitrag über die Grenzen der Einwilligung in Fällen der Personensorge, in: H. Putzke u.a. (Hrsg.), Strafrecht zwischen System und Telos, Festschrift für Rolf Dietrich Herzberg zum siebzigsten Geburtstag am 14. Februar 2008 , Mohr Siebeck: Tübingen 2008, p. 669–709 (ISBN 978-3161495700)
• Holm Putzke, Ph.D., Maximilian Stehr, Ph.D., and Hans-Georg Dietz, Ph.D. Strafbarkeit der Zirkumzision von Jungen. Medizinrechtliche Aspekte eines umstrittenen ärztlichen Eingriffs (Liability to penalty for circumcision in boys. Medico-legal aspects of a controversial medical intervention), in: Monatsschrift Kinderheilkunde 8/2008, p. 783–788
• Rosemary Romberg. Circumcision: The Painful Dilemma. South Hadley, MA Bergan & Garvey, 1985. (ISBN 978-0-89789-073-1)
• Edgar J Schoen, M.D. Ed Schoen, MD on Circumcision. Berkeley, CA: RDR Books, 2005. (ISBN 978-1-57143-123-3)
• Edward Wallerstein. Circumcision: An American Health Fallacy. New York: Springer, 1980 (ISBN 978-0-8261-3240-6)
• Gerald N. Weiss M.D. and Andrea W Harter. Circumcision: Frankly Speaking. Wiser Publications, 1998. (ISBN 978-0-9667219-0-4)
• Yosef David Weisberg, Rabbi. Otzar Habris. Encyclopedia of the laws and customs of Bris Milah and Pidyon Haben. Jerusalem: Hamoer, 2002.

Notes and references

1. Dictionary definitions of circumcision:
   • "The act of cutting off the prepuce or foreskin of males, or the internal labia of females." Webster's Revised Unabridged Dictionary (1913)
   • "to remove the foreskin of (males) sometimes as a religious rite." The Macquarie Dictionary (2nd Edition, 1991)
   • "Cut off foreskin of (as Jewish or Mohammedan rite, or surgically), Concise Oxford Dictionary, 5th Edition, 1964
   Circumcision defined in a medical context:
   • "Male circumcision is the surgical removal of all or part of the foreskin of the penis." Information Package on Male Circumcision and HIV Prevention:Insert 1, World Health Organization
   • "Circumcision, surgical removal of all or part of the foreskin of the human male...", "Circumcision", Microsoft Encarta, 2007.
   • "Male circumcision is an elective surgery to remove the foreskin..." Circumcision, British Columbia Health Guide, June 2, 2006. Retrieved July 18, 2007.
   • "Circumcision is surgery..." Pain and Your Infant: Medical Procedures, Circumcision and Teething, University of Michigan Health System, February 2007. Retrieved July 18, 2007.
   • " Circumcision is cutting away part of the foreskin... When this surgery is performed..." Newborn Care, Danbury Hospital website. Retrieved July 18, 2007.
2. Hodges, F.M. (2001). "The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme". The Bulletin of the History of Medicine. 75 (3): 375–405. doi:10.1353/bhm.2001.0119. PMID 11568485. {{cite journal}}: Cite has empty unknown parameter: |coauthors= (help); Unknown parameter |month= ignored (help)
3. Wrana, P. (1939). "Historical review: Circumcision". Archives of Pediatrics. 56: 385–392. as quoted in: Zoske, Joseph (1998). "Male Circumcision: A Gender Perspective". The Journal of Men's Studies. 6 (2): 189–208. Retrieved 2006-06-14. {{cite journal}}: Unknown parameter |month= ignored (help)
4. 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)
5. "Circumcision". American-Israeli Cooperative Enterprise. Retrieved 2006-10-03.
6. S.A.H Rizvi, S.A A Naqvi, M Hussain, A.S Hasan (1999). "Religious circumcision: a Muslim view" (PDF). BJU International. 83 (s1): 13–16. doi:10.1046/j.1464-410x.1999.0830s1013.x.{{cite journal}}: CS1 maint: multiple names: authors list (link)
7. ^ 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.
8. "Male circumcision: Global trends and determinants of prevalence, safety and acceptability" (PDF). World Health Organization. 2007. Retrieved 2008-08-20.
9. ^ "Insert 2" (PDF). Information Package on Male Circumcision and HIV Prevention. World Health Organization. 2007. Retrieved 2007-08-15.
10. A M K Rickwood, S E Kenny, S C Donnell (2000). "Towards evidence based circumcision of English boys: survey of trends in practice" (PDF). BMJ. 321 (7264): 792–793. doi:10.1136/bmj.321.7264.792.{{cite journal}}: CS1 maint: multiple names: authors list (link)
11. Schoen, Edgar J (2007). "Should newborns be circumcised? Yes". Can Fam Physician. 53 (12): 2096–8, 2100–2. PMID 18077736. Retrieved 2008-05-02.
12. ^ 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)
13. "Neonatal Circumcision". Retrieved 2008-04-20.
14. ^ "New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications" (PDF). World Health Organization. March 28, 2007. Retrieved 2007-08-13. {{cite journal}}: Check date values in: |date= (help); Cite journal requires |journal= (help)
15. ^ "Male Circumcision and Risk for HIV Transmission and Other Health Conditions: Implications for the United States". Centers for Disease Control and Prevention. 2008.
16. Holman, John R. (1995). "Neonatal circumcision techniques – includes patient information sheet". American Family Physician. 52 (2): 511–520. ISSN 0002-838X PMID 7625325. Retrieved 2006-06-29. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
17. Herbert, Barrie (1965). "The Plastibell Technique for Circumcision". Br Med J. 2 (5456): 273–275. PMID 14310205. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
18. Peleg, David (1998). "The Gomco Circumcision: Common Problems and Solutions". American Family Physician. 58 (4): 891–898. ISSN 0002-838X PMID 9767725. Retrieved 2006-06-29. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
19. Pfenninger, John L. (July 21, 2003) . Procedures for primary care (2nd ed.). Mosby. ISBN 978-0-323-00506-7 LCCN 20-3 – 0. {{cite book}}: Check date values in: |date= (help); Cite has empty unknown parameters: |origmonth=, |accessmonth=, |month=, |chapterurl=, and |accessyear= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
20. Reynolds, RD (1996). "Use of the Mogen clamp for neonatal circumcision". American Family Physician. 54 (1): 177–182. PMID 8677833. {{cite journal}}: |access-date= requires |url= (help); |format= requires |url= (help); Unknown parameter |month= ignored (help)
21. "In Africa, a problem with circumcision and AIDS".
22. Griffin A, Kroovand R (1990). "Frenular chordee: implications and treatment". Urology. 35 (2): 133–4. PMID 2305537.
23. ^ Shechet, Jacob (2000). "Circumcision—The Debates Goes On" (PDF). Pediatrics. 105 (3): 682–683. doi:10.1542/peds.105.3.681. PMID 10733391. Retrieved 2007-04-06. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
24. ^ Glass, J.M. (1999). "Religious circumcision: a Jewish view" (PDF). BJU International. 83 (Supplement 1): 17–21. doi:10.1046/j.1464-410x.1999.0830s1017.x. PMID 10766529. Retrieved 2006-10-18. {{cite journal}}: Unknown parameter |month= ignored (help)
25. Lamm, Maurice. The Jewish Way in Death and Mourning. New York: Jonathan David. pp. 239–240. {{cite book}}: Unknown parameter |origdate= ignored (|orig-date= suggested) (help)
26. Al-Munajjid, Muhammed Salih. "Question #9412: Circumcision: how it is done and the rulings on it". Islam Q&A. Retrieved 2006-07-01.
27. Al-Munajjid, Muhammed Salih. "Question #7073: The health and religious benefits of circumcision". Islam Q&A. Retrieved 2006-07-01.
28. al-Sabbagh, Muhammad Lutfi (1996). Islamic ruling on male and female circumcision. Alexandria: World Health Organization. p. 16.
29. Mattson, C.L. (2005). "Acceptability of male circumcision and predictors of circumcision preference among men and women in Nyanza Province, Kenya". AIDS Care. 17 (2): 182–194. doi:10.1080/09540120512331325671. PMID 15763713. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
30. "Greek Orthodox Archdiocese calendar of Holy Days".
31. "Russian Orthodox Church, Patriarchate of Moscow".
32. 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
33. Municipal Library of Clermont-Ferrand, France
34. 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)
35. "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.
36. 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)
37. "RECENT GUEST SPEAKER". Australian AIDS Fund Incorporated. 2006. Retrieved 2006-07-01.
38. "Weird & Wonderful". United Travel. Retrieved 2006-07-01.
39. "Circumcision amongst the Dogon". The Non-European Components of European Patrimony (NECEP) Database. 2006. Retrieved 2006-09-03.
40. 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.
41. "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.
42. ^ "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)
43. "Information Package on Male Circumcision and HIV Prevention" (PDF).
44. Auvert, Bertran (2005). "Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial" (PDF). PLoS Medicine. 2 (11): 1112–1122. doi:10.1371/journal.pmed.0020298. PMID 16231970. Retrieved 2006-07-09. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)CS1 maint: unflagged free DOI (link)
45. ^ Somerville, 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)
46. 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)
47. ^ American Academy of Pediatrics Task Force on Circumcision (1999). "Circumcision Policy Statement" (PDF). Pediatrics. 103 (3): 686–693. doi:10.1542/peds.103.3.686. ISSN 0031-4005 PMID 10049981. Retrieved 2006-07-01. {{cite journal}}: Cite has empty unknown parameter: |coauthors= (help); Unknown parameter |month= ignored (help)
48. ^ Fetus and Newborn Committee (1996). "Neonatal circumcision revisited". Canadian Medical Association Journal. 154 (6): 769–780. Retrieved 2006-07-02. {{cite journal}}: Unknown parameter |month= ignored (help) “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.
49. ^ "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)
50. ^ Medical Ethics Committee (2006). "The law and ethics of male circumcision – guidance for doctors". British Medical Association. Retrieved 2006-07-01. {{cite web}}: Unknown parameter |month= ignored (help)
51. "Circumcision and the Code of Ethics, George C. Denniston, Humane Health Care Volume 12, Number 2".
52. Viens AM (2004). "Value judgment, harm, and religious liberty". J Med Ethics. 30: 241–7. doi:10.1136/jme.2003.003921.
53. Benatar, David (2003). "How not to argue about circumcision" (PDF). American Journal of Bioethics. 3 (2): W1–W9. doi:10.1162/152651603102387820. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); line feed character in |journal= at position 20 (help)
54. 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)
55. Moses, S (1998). "Male circumcision: assessment of health benefits and risks". Sex Transm Infect. 74: 368–73. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
56. "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)
57. 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)
58. Bureau of Democracy, Human Rights, and Labor (September 15, 2006). "Sweden". International Religious Freedom Report 2006. US Department of State. Retrieved 2007-07-04. {{cite web}}: Check date values in: |date= (help)CS1 maint: multiple names: authors list (link)
59. "Court rules circumcision of four-year-old boy illegal". HELSINGIN SANOMAT, INTERNATIONAL EDITION. 2006-08-07. Retrieved 2007-09-17.
60. "Finland Considers Legalising Male Circumcision". Ylesiradio. 2008-07-31. Retrieved 2008-08-05.
61. 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 2007-08-08. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
62. ^ "Circumcision: Position Paper on Neonatal Circumcision". American Academy of Family Physicians. 2007. Retrieved 2007-01-30.
63. ^ "Circumcision: Information for parents". Caring for kids. Canadian Paediatric Society. 2004. Retrieved 2006-10-24. 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. {{cite web}}: Unknown parameter |month= ignored (help)
64. Stang, Howard J. (1998). "Circumcision Practice Patterns in the United States" (PDF). Pediatrics. 101 (6): e5–. doi:10.1542/peds.101.6.e5. ISSN 1098-4275. Retrieved 2006-06-29. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)CS1 maint: extra punctuation (link)
65. Howard, Cynthia R. (1998-03). "Neonatal Circumcision and Pain Relief: Current Training Practices". Pediatrics. 101 (3): 423–428. Retrieved 2008-06-19. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
66. Brady-Fryer, B (2004). "Pain relief for neonatal circumcision". The Cochrane Database of Systematic Reviews (3): Art. No.: CD004217. doi:10.1002/14651858.CD004217.pub2. PMID 15495086. Retrieved 2006-06-29. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
67. Razmus I, Dalton M, Wilson D. "Pain management for newborn circumcision". Pediatr Nurs. 30 (5): 414–7, 427. PMID 15587537.{{cite journal}}: CS1 maint: multiple names: authors list (link)
68. Ng, WT (2001). "The use of topical lidocaine/prilocaine cream prior to childhood circumcision under local anesthesia". Ambul Surg. 9 (1): 9–12. doi:10.1016/S0966-6532(00)00061-5. PMID 11179706. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
69. Williams, R. M. (2003-01). "On the Tail-Docking of Pigs, Human Circumcision, and their Implications for Prevailing Opinion Regarding Pain". Journal of Applied Philosophy. 20 (1): 89–93. doi:10.1111/1468-5930.00237. Retrieved 2008-06-24. {{cite journal}}: Check date values in: |date= (help); Cite has empty unknown parameter: |coauthors= (help)
70. Payne, Kimberley; Thaler, Lea; Kukkonen, Tuuli; Carrier, Serge; and Binik, Yitzchak. Sensation and Sexual Arousal in Circumcised and Uncircumcised Men. Journal of Sexual Medicine, May, 2007.
71. Boyle, Gregory J (2002). "Male circumcision: pain, trauma, and psychosexual sequelae". Bond University Faculty of Humanities and Social Sciences. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
72. Sorrells, M.L. (2007). "Fine-touch pressure thresholds in the adult penis". BJU International. 99 (4): 864–869. PMID 17378847. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
73. Dr. Edgar Schoen. Circumcision and Sexual Activity. "Opposing Views, August, 2008.
74. Fink, K.S. (2002). "Adult Circumcision Outcomes Study: Effect on Erectile Dysfunction, Penile Sensitivity, Sexual Activity and Satisfation". Journal of Urology. 167 (5): 2113–2116. PMID 11956453. Retrieved 2008-06-28. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
75. Shen, Z. (2004). "Erectile function evaluation after adult circumcision (in Chinese)". Zhonghua Nan Ke Xue. 10 (1): 18–19. PMID 14979200. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
76. ^ Laumann, E. (1997). "Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice". JAMA. 277 (13): 1052–1057. PMID 9091693. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
77. Senkul, T. (2004). "Circumcision in adults: effect on sexual function". Urology. 63 (1): 155–8. PMID 14751371. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
78. Collins S, Upshaw J, Rutchik S, Ohannessian C, Ortenberg J, Albertsen P (2002). "Effects of circumcision on male sexual function: debunking a myth?". J Urol. 167 (5): 2111–2. PMID 11956452.{{cite journal}}: CS1 maint: multiple names: authors list (link)
79. Masood S, Patel H, Himpson R, Palmer J, Mufti G, Sheriff M (2005). "Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly?". Urol Int. 75 (1): 62–6. PMID 16037710.{{cite journal}}: CS1 maint: multiple names: authors list (link)
80. ^ Williams, N (1993). "Complications of circumcision". British Journal of Surgery. 80 (10): 1231–1236. doi:10.1002/bjs.1800801005. Retrieved 2006-07-11. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
81. Yegane, Rooh-Allah (2006). "Late complications of circumcision in Iran" (Abstract). Pediatric Surgery International. 22 (5): 442–445. doi:10.1007/s00383-006-1672-1. PMID 16649052. Retrieved 2006-07-02. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
82. Angel, Carlos A. (June 12, 2006). "http://www.emedicine.com/PED/topic2356.htm". eMedicine. WebMD. Retrieved 2006-07-02. {{cite web}}: Check date values in: |date= (help); External link in |title= (help)
83. Christakis, Dmitry A. (2000). "A Trade-off Analysis of Routine Newborn Circumcision". Pediatrics. 105 (1): 246–249. doi:10.1542/peds.105.1.S2.246. PMID 10617731. Retrieved 2006-07-01. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help); Unknown parameter |month= ignored (help)
84. Ahmed A,, A (1999). "Complications of traditional male circumcision". Annals of Tropical Paediatrics. 19 (1): 113–117. PMID ISSN . {{cite journal}}: |access-date= requires |url= (help); Check |pmid= value (help); External link in |pmid= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help); templatestyles stripmarker in |pmid= at position 10 (help)CS1 maint: extra punctuation (link)
85. ^ 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. Circumcision was associated with a significantly reduced risk of UTI (OR = 0.13; 95% CI, 0.08 to 0.20; p<0.001) with the same odds ratio (0.13) for all three types of study design. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
86. ^ Kaplan, G.W. (1983). "Complications of Circumcision" (HTML). Urologic Clinics of North America. 10 (3): 543–549. PMID 6623741. Retrieved 2006-09-29. {{cite journal}}: Cite has empty unknown parameter: |coauthors= (help); Unknown parameter |month= ignored (help)
87. Naimer, Sody A. (2002). "Office Management of Penile Skin Bridges with Electrocautery" (PDF). Journal of the American Board of Family Practice. 15 (6): 485–488. PMID 10605531. Retrieved 2006-07-01. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
88. Yegane, Rooh-Allah (2006). "Late complications of circumcision in Iran" (Abstract). Pediatric Surgery International. 22 (5): 442–445. doi:10.1007/s00383-006-1672-1. PMID 16649052. Retrieved 2006-07-02. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
89. Angel, Carlos A. (June 12, 2006). "Meatal Stenosis". eMedicine. WebMD. Retrieved 2006-07-02. {{cite web}}: Check date values in: |date= (help)
90. Paediatric Death Review Committee: Office of the Chief Coroner of Ontario (2007). "Coroner's Corner Circumcision: A minor procedure?" (PDF). Paediatric Child Health Vol 12 No 4, April 2007 pages 311–312. Pulsus Group Inc. Retrieved 2007-06-17. {{cite web}}: Unknown parameter |month= ignored (help)
91. Gairdner, Douglas (1949). "The Fate of the Foreskin". British Medical Journal. 2 (4642): 1433–1437. PMID 15408299. Retrieved 2006-07-01. {{cite journal}}: Unknown parameter |month= ignored (help)
92. "Complications Of Circumcision". Paediatric Policy – Circumcision. The Royal Australasian College of Physicians. 2004. Retrieved 2006-07-11. {{cite web}}: Unknown parameter |month= ignored (help)
93. Alcena, Valiere (2006-10-16). "AIDS in Third World countries [letter]". response to "Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial". PLos Medicine. Retrieved 2008-08-24.
94. Alcena, Valiere (1986). "AIDS in Third World countries [letter]". New York State Journal of Medicine. 86 (8): 446. Retrieved 2008-08-24. {{cite journal}}: Unknown parameter |month= ignored (help).
95. Fink, Aaron J. (1986). "A possible explanation for heterosexual male infection with AIDS". New England Journal of Medicine. 315 (18): 1167. PMID 3762636. Retrieved 2008-08-24. {{cite journal}}: Cite has empty unknown parameter: |1= (help); Unknown parameter |month= ignored (help)
96. Szabo, R. (2000). "How does male circumcision protect against HIV infection?". BMJ. 320: 1592–1594. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
97. "WHO and UNAIDS Secretariat welcome corroborating findings of trials assessing impact of male circumcision on HIV risk". World Health Organization. February 23, 2007. Retrieved 2007-02-23. {{cite web}}: Check date values in: |date= (help)
98. Bailey, R.C. (February 24, 2007). "Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial" (PDF). The Lancet. 369 (9562): 643–656. doi:10.1016/S0140-6736(07)60312-2. PMID 17321310. Retrieved 2007-04-01. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
99. ^ "WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention". World Health Organisation. 2007. {{cite web}}: Unknown parameter |month= ignored (help)
100. "Male circumcision: Global trends and determinants of prevalence, safety and acceptability" (PDF). World Health Organisation/UNAIDS. 2007. {{cite web}}: Unknown parameter |month= ignored (help)
101. Weiss, HA (2000). "Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis". AIDS. 2000. 14 (15): 2361–70. Retrieved 2007-12-27. Male circumcision is associated with a significantly reduced risk of HIV infection among men in sub-Saharan Africa, particularly those at high risk of HIV. These results suggest that consideration should be given to the acceptability and feasibility of providing safe services for male circumcision as an additional HIV prevention strategy in areas of Africa where men are not traditionally circumcised. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
102. Siegfried, N (2003). "Male circumcision for prevention of heterosexual acquisition of HIV in men". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD003362. CD003362. Retrieved 2007-12-27. We found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men. The results from existing observational studies show a strong epidemiological association between male circumcision and prevention of HIV, especially among high-risk groups. However, observational studies are inherently limited by confounding which is unlikely to be fully adjusted for. In the light of forthcoming results from RCTs, the value of IPD analysis of the included studies is doubtful. The results of these trials will need to be carefully considered before circumcision is implemented as a public health intervention for prevention of sexually transmitted HIV. {{cite journal}}: Cite has empty unknown parameter: |month= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
103. "Male circumcision for the prevention of heterosexually acquired HIV infection: a meta-analysis of randomized trials involving 11050 men". HIV Medicine. 9 (6): 332-335(4). 2008. doi:10.1111/j.1468-1293.2008.00596.x. Retrieved 2008-08-24. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
104. McCoombe SG, Cameron PU, Short RV (July 7, 2002). "The distribution of HIV-1 target cells and keratin in the human penis" (Abstract). International AIDS Society. Retrieved 2006-07-09. {{cite journal}}: Check date values in: |date= (help); Cite journal requires |journal= (help)CS1 maint: multiple names: authors list (link)
105. Carael, M. (1988). "Human immunodeficiency virus transmission among heterosexual couples in Central Africa". AIDS. 2 (3): 201–205. PMID 3134914. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
106. Grosskurth, H. (1995). "A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results". AIDS. 9 (8): 927–934. PMID 7576329. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
107. Barongo, L.R. (1992). "The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania". AIDS. 6 (12): 1521–1528. PMID 1492935. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
108. Mills, J. (2006). "Cautious optimism for new HIV/AIDS prevention strategies". Lancet. 368 (9543): 1236. PMID 17027724. "The inferences drawn from the only completed randomised controlled trial (RCT) of circumcision could be weak because the trial stopped early. In a systematic review of RCTs stopped early for benefit, such RCTs were found to overestimate treatment effects. When trials with events fewer than the median number (n=66) were compared with those with event numbers above the median, the odds ratio for a magnitude of effect greater than the median was 28 (95% CI 11--73). The circumcision trial recorded 69 events, and is therefore at risk of serious effect overestimation. We therefore advocate an impartial meta-analysis of individual patients' data from this and other trials underway before further feasibility studies are done. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
109. Dowsett, G.W. (2007). "Male circumcision and HIV prevention: is there really enough of the right kind of evidence?". Reproductive Health Matters. 15 (29): 33–44. PMID 17512372. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
110. Weiss, HA (2006). "Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis". Sex Transm Infect. 82 (2): 101–9. doi:10.1136/sti.2005.017442. PMID 16581731. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
111. 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)
112. Fakjian, N (1990). "An argument for circumcision. Prevention of balanitis in the adult". Arch Dermatol. 126 (8): 1046–7. doi:10.1001/archderm.126.8.1046. PMID 2383029. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
113. 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)
114. 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)
115. 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)
116. Castellsagué, Xavier (2002). "Male circumcision, penile human papillomavirus infection, and cervical cancer" (PDF — free registration required). The New England Journal of Medicine. 346 (15): 1105–1112. doi:10.1056/NEJMoa011688. PMID 11948269. Retrieved 2006-07-09. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
117. Lajous, Martín (2005). "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}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
118. Hernandez, B.Y. (March). "Circumcision and Human Papillomavirus Infection in Men: A Site-Specific Comparison". The Journal of Infectious Diseases. 197 (6): 787–794. doi:10.1086/528379. PMID 18284369. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
119. 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: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
120. Dinh, T.H. (2008). "Genital Warts Among 18- to 59-Year-Olds in the United States, National Health and Nutrition Examination Survey, 1999-2004". Sexually Transmitted Diseases. 35 (4): 357–360. doi:10.1097/OLQ.0b013e3181632d61. PMID 18360316. The percentage of circumcised men reporting a diagnosis of genital warts was significantly higher than uncircumcised men, 4.5% (95% CI, 3.6%–5.6%) versus 2.4% (95% CI, 1.5%–4.0%) {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
121. Cook, L.S (1993). "Clinical Presentation of Genital Warts Among Circumcised and Uncircumcised Heterosexual Men Attending an Urban STD Clinic". Genitourinary medicine. 69 (4): 262–264. PMID 1195083. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
122. Rickwood (1989). "Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence?". Annals of the royal college of surgery. 71 (5): 275–277. {{cite journal}}: Unknown parameter |initial= ignored (help); Unknown parameter |month= ignored (help)
123. Birley (1993). "Clinical Features and management of recurrent balanitis; association with atopy and genital washing". Genitourinary Medicine. 69 (5): 400–403. doi:10.1136/jme.2002.001313. PMID 8244363. Retrieved 2008-04-12. {{cite journal}}: Unknown parameter |initial= ignored (help); Unknown parameter |month= ignored (help)
124. "Can Penile Cancer be Prevented?".
125. Maden, C (1993). "History of circumcision, medical conditions, and sexual activity and risk of penile cancer". J Natl Cancer Inst. 85 (1): 19–24. doi:10.1093/jnci/85.1.19. PMID 8380060. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
126. Schoen, EJ (2000). "The highly protective effect of newborn circumcision against invasive penile cancer". Pediatrics. 105 (3): e36. doi:10.1542/peds.105.3.e36. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
127. "Neonatal Circumcision". Retrieved 2008-04-20.
128. 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)
129. Alanis, Mark C. (2004). "Neonatal Circumcision: A Review of the World's Oldest and Most Controversial Operation" (Abstract). Obstetrical & Gynecological Survey. 59 (5): 379–395. PMID 15097799. Retrieved 2006-09-27. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
130. Van Howe, Robert S. (2004). "A Cost-Utility Analysis of Neonatal Circumcision" (Abstract). Medical Decision Making. 24 (6): 584–601. doi:10.1177/0272989X04271039. PMID 15534340. Retrieved 2006-07-01. {{cite journal}}: Unknown parameter |month= ignored (help)
131. Ganiats, TG (1991). "Routine neonatal circumcision: a cost-utility analysis". Medical Decision Making. 11 (4): 282–293. PMID 1766331. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
132. Lawler, FH (1991). "Circumcision: a decision analysis of its medical value". Family Medicine. 23 (8): 587–593. PMID 1794670. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
133. Task Force on Circumcision (1999). "Circumcision Policy Statement" (PDF). Pediatrics. 103 (3): 686–693. doi:10.1542/peds.103.3.686. ISSN 0031-4005 PMID 10049981. Retrieved 2006-07-01. {{cite journal}}: Cite has empty unknown parameter: |coauthors= (help); Unknown parameter |month= ignored (help) “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.”
134. "Circumcision: Position Paper on Neonatal Circumcision". American Academy of Family Physicians. 2007. Retrieved 2007-01-30. 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.
     
     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.
     
     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. {{cite web}}: line feed character in |quote= at position 739 (help)
135. American Urological Association. "Circumcision". Retrieved 2007-08-26.
136. "Doctors back call for circumcision ban". ABC News. 2007-12-09.
137. Immerman, R.S. (1997). "A biocultural analysis of circumcision". Social Biology. 44 (3–4): 265–275. doi:10.1111/j.1467-9744.1976.tb00285.x. PMID 9446966. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
138. 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.
139. 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.
140. 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.
141. Marck, J (1997). "Aspects of male circumcision in sub-equatorial African culture history". Health Transit Review. 7 (supplement): 337–360. PMID 10173099. {{cite journal}}: Cite has empty unknown parameter: |month= (help)
142. ^ Gollaher, David (1994). "From ritual to science: the medical transformation of circumcision in America". Journal of Social History. 28 (1): 5–36. Retrieved 2007-12-06. {{cite journal}}: Cite has empty unknown parameter: |coauthors= (help); Unknown parameter |month= ignored (help)
143. "On the influence of circumcision in preventing syphilis". Medical Times and Gazette. NS Vol II: 542–3. 1855. {{cite journal}}: Unknown parameter |unused_data= ignored (help)
144. "Trends in circumcisions among newborns". National Hospital Discharge Survey. National Center for Health Statistics. January 11, 2007. Retrieved 2008-08-19.
145. Brown, M.S. (1987). "Circumcision decision: prominence of social concerns". Pediatrics. 80 (2): 215–219. PMID 3615091. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
146. Nelson, C.P. (2005). "The increasing incidence of newborn circumcision: data from the nationwide inpatient sample". Journal of Urology. 173 (3): 978–981. PMID 15711354. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
147. "U.S. circumcision rates vary by region". UPI. January 21, 2008. Retrieved 2008-08-19.
148. Pang, MG (2002). "Extraordinarily high rates of male circumcision in South Korea: history and underlying causes". BJU Int. 89 (1): 48–54. doi:10.1046/j.1464-410X.2002.02545.x. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
149. Dave, SS (2003). "Male circumcision in Britain: findings from a national probability sample survey". Sex Transm Infect. 79: 499–500. doi:10.1136/sti.79.6.499. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
150. "In Australia and New Zealand, the circumcision rate has fallen considerably in recent years and it is estimated that currently only 10%-20% of male infants are routinely circumcised." (RACP: 2004)
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External links

Circumcision opposition

• The Circumcision Information and Resource Pages by Geoffrey T. Falk
• Doctors Opposing Circumcision presided by George C. Denniston, MD, MPH
• National Organization of Circumcision Information Resource Centers by Marilyn Milos, RN
• Sex as Nature Intended It by Kristen O'Hara.

Circumcision promotion

• Jewish Circumcision – Brit Milah Chabad.org
• Benefits of circumcision: medical, health and sexual by Professor Brian Morris
• Circumcision: a lifetime of medical benefits by Edgar Schoen, BSc., M.D.

Circumcision techniques

• Description of an adult circumcision from the American Academy of Family Physicians.
• Visualisation of amount of skin removed, showing 'styles' of circumcision.
• Video demonstration of infant circumcision using a Gomco clamp.

• Circumcision
• Body modification
• Penis
• Sexuality
• Surgical removal procedures