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			{{Short description|Removal of the human foreskin}}
	{{pp-semi-protected|small=yes}}
	{{Otheruses4|male circumcision|the practice sometimes referred to as "female circumcision"|Female genital cutting}}		{{Distinguish|female circumcision}}
			{{For|the paintings|The Circumcision (disambiguation){{!}}''The Circumcision''}}
	[[Image:Circumcision set.jpg|right|thumb|Seixas Family circumcision set and trunk, ca. eighteenth century
			{{pp-vandalism|small=yes}}
	Wooden box covered in cow hide with silver implements: silver trays, clip, pointer, silver flask, spice vessel.]]
			<!-- Definition, technique, and reasons -->
	'''Circumcision''' is the procedure that cuts some or all of the ] (]) from the ]. The ] may also be cut away at the same time, in a procedure called a ]. The word "circumcision" comes from ] ''circum'' (meaning "around") and ''caedere'' (meaning "to cut").
			{{Use dmy dates|date=February 2022}}
			{{cs1 config|name-list-style=vanc|display-authors=6}}
	Circumcision predates recorded ], with depictions found in ] ]s and ]ian ]s.<ref>{{cite journal | last = Wrana | first = P. | year = 1939 | title = Historical review: Circumcision | journal = Archives of Pediatrics | volume = 56 | issue = | pages = 385&ndash;392}} as quoted in: {{cite journal | last = Zoske | first = Joseph | month = Winter | year = 1998 | title = Male Circumcision: A Gender Perspective | journal = Journal of Men’s Studies | volume = 6 | issue = 2 | pages = 189&ndash;208 | url = http://www.noharmm.org/zoske.htm|accessdate = 2006-06-14}} </ref> The origins of the practice are lost in antiquity. Theories include that circumcision is a form of ritual ] or offering, a health precaution, a sign of submission to a ], a rite of passage to adulthood, a mark of defeat or ], or an attempt to alter ] or ].<ref name = "Gollaher">{{cite book
			{{Infobox medical intervention
	| last = Gollaher
			| Name = Circumcision
	| first = David L.
			| Image = Circumcision illustration.jpg
	| title = Circumcision: a history of the world’s most controversial surgery
			| Caption = Circumcision surgery with hemostats and scissors
	| year = 2000
	| month = February		| ICD10 = Z41.2
			| ICD9 = {{ICD9|V50.2}}
	| publisher = ]
	| location = ]		| ICD9_mult =
	| language =		| MeshID = D002944
	| id = ISBN 978-0-465-04397-2 {{LCCN|99|0|40015}}		| OPS301 = {{OPS301|5–640}}.2
	| doi =		| OtherCodes =
	| pages = 53&ndash;72		| MedlinePlus = 002998
	| chapter =		| eMedicine = 1015820
	| chapterurl =
	| quote =
	}}
	</ref> Circumcision of males is a religious commandment in ] and ],<ref>{{cite web
	| url = http://www.jewishvirtuallibrary.org/jsource/Judaism/circumcision.html
	| title = Circumcision
	| accessdate = 2006-10-03
	| publisher = ]
	}}
	</ref><ref>{{cite encyclopedia
	| last = Beidelman
	| first = T.
	| editor = Mircea Eliade
	| encyclopedia = The Encyclopedia of religion
	| title = CIRCUMCISION
	| url = http://www.male-initiation.net/anthropology/eliade.html
	| accessdate = 2006-10-03
	| year = 1987
	| publisher = ]
	| volume = Volume 3
	| location = ]
	| id = {{LCCN|86|00|5432}} ISBN 978-0-02-909480-8
	| pages = 511–514
	}}</ref> and is customary in some ] and other Christian churches in Africa.<ref name=Christian>Customary in some Coptic and other churches:
	*"The Coptic Christians in Egypt and the Ethiopian Orthodox Christians— two of the oldest surviving forms of Christianity— retain many of the features of early Christianity, including male circumcision. Circumcision is not prescribed in other forms of Christianity... Some Christian churches in South Africa oppose the practice, viewing it as a pagan ritual, while others, including the Nomiya church in Kenya, require circumcision for membership and participants in focus group discussions in Zambia and Malawi mentioned similar beliefs that Christians should practice circumcision since Jesus was circumcised and the Bible teaches the practice." , ], ], 2007.
	*"The decision that Christians need not practice circumcision is recorded in Acts 15; there was never, however, a prohibition of circumcision, and it is practiced by Coptic Christians." , The Columbia Encyclopedia, Sixth Edition, 2001-05.</ref> It is also practiced by the majority of South Koreans,<ref>{{cite journal
	| last = Ku
	| first = J.H.
	| coauthors = M.E. Kim, N.K. Lee, and Y.H. Park
	| year = 2003
	| title = Circumcision practice patterns in South Korea: community based survey
	| journal = Sexually Transmitted Infections
	| volume = 79
	| issue = 1
	| pages = 65–67
	| doi = 10.1136/sti.79.1.65
	| id = PMID 12576619
	| url = http://sti.bmjjournals.com/cgi/reprint/79/1/65.pdf
	| format = PDF
	| accessdate = 2006-10-03
	}}
	</ref> Americans,<ref>{{cite paper
	| author = Xu, F, L Markowitz, M Sternberg, and S Aral
	| title = Prevalence of circumcision in men in the United States: data from the National Health and Nutrition Examination Survey (NHANES), 1999-2002
	| publisher = XVI International AIDS Conference
	| date = 2006
	| url = http://www.iasociety.org/abstract/show.asp?abstract_id=2193307
	| accessdate = 2006-09-21
	}}
	</ref> and Filipinos.<ref>{{cite journal
	| last = Lee
	| first = R.B.
	| year = 2005
	| title = Circumcision practice in the Philippines: community based study
	| journal = Sexually Transmitted Infections
	| volume = 81
	| issue = 1
	| pages = 91
	| doi = 10.1136/sti.2004.009993
	| id = PMID 15681733
	| url = http://sti.bmjjournals.com/cgi/reprint/81/1/91.pdf
	| format = PDF
	| accessdate = 2006-10-03
	}}
	</ref>
	] circumcision is controversial in several English-speaking countries. The ] defines “non-therapeutic” circumcision as the non-religious, non-ritualistic, not medically necessary, elective circumcision of male newborns. It states that medical associations in the US, Australia, and Canada do not recommend the routine non-therapeutic circumcision of newborns.<ref name = "CSA:I-99">{{cite web
	| year = 1999
	| month = December
	| url = http://www.ama-assn.org/ama/pub/category/13585.html
	| title = Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision
	| format =
	| work = 1999 AMA Interim Meeting: Summaries and Recommendations of Council on Scientific Affairs Reports
	| pages = 17
	| publisher = ]
	| accessdate = 2006-06-13
	}}
	</ref> ] supporters condemn all infant circumcision as male ] comparable to ],<ref name = "Milos">{{cite journal
	| last = Milos
	| first = Marilyn Fayre
	| coauthors = Donna Macris
	| year = 1992
	| month = March-April
	| title = Circumcision: A medical or a human rights issue?
	| journal = Journal of Nurse-Midwifery
	| volume = 37
	| issue = 2 S1
	| pages = S87–S96
	| pmid = 1573462
	| doi = 10.1016/0091-2182(92)90012-R
	| url = http://www.cirp.org/library/ethics/milos-macris/
	| accessdate = 2007-04-06
	}}
	</ref> while ] consider that infant circumcision is a worthwhile public health measure.<ref name="Schoen">{{cite journal
	| last = Schoen
	| first = Edgar J
	| year = 1997
	| title = Benefits of newborn circumcision: is Europe ignoring medical evidence?
	| journal = Archives of Disease in Childhood
	| volume = 77
	| issue = 3
	| pages = 258-260
	| pmid = 9370910
	| format = (free registration required)
	| url = http://adc.bmj.com/cgi/content/full/77/3/258
	| accessdate = 2007-04-06
	}}		}}
	</ref>
			<!-- Note to editors: This article has a long history of intense debates, particularly over the wording of the lead, sexual function section, and describing the positions of major medical organizations. Please review the talk page before making changes to lines to see if there is a previous established consensus or compromise. Thank you. -->
	According to Newell and Bärnighausen, three randomised trials "now provide firm evidence that the risk of acquiring HIV is halved by male circumcision".<ref name = "Newell">{{cite journal
			'''Circumcision''' is a ] that removes the ] from the ]. In the most common form of the operation, the foreskin is extended with ], then a circumcision device may be placed, after which the foreskin is ]. Topical or locally injected ] is generally used to reduce pain and ].<ref name=AAP_2012 /> Circumcision is generally ], most commonly done as a form of ], as a ], or as a ].<ref name=WHO_2007_GTDPSA /> It is also an option for cases of ], other ] that do not resolve with other treatments, and chronic ]s (UTIs).<ref name="lissauer_2012" /><ref name=hay_2012/> The procedure is ] in cases of certain genital structure abnormalities or poor general health.<ref name="hay_2012" /><ref name=rudolph_2011 />
	| last = Newell
	| first = Marie-Lousie
	| coauthors = Till Bärnighausen
	| date = ], ]
	| title = Male circumcision to cut HIV risk in the general population
	| journal = ]
	| volume = 369
	| issue = 9562
	| pages = 617–619
	| pmid = 17321292
	| doi = DOI:10.1016/S0140-6736(07)60288-8
	| url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673607602888.pdf
	|format = PDF
	| accessdate = 2007-04-01
	}}
	</ref><ref name="baileyrct">{{cite journal
	| last = Bailey
	| first = Robert C
	| coauthors = Stephen Moses, Corette B Parker, Kawango Agot, Ian Maclean, John N Krieger, Carolyn F M Williams, Richard T Campbell, Jeckoniah O Ndinya-Achola
	| date = ], ]
	| title = Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial
	| journal = ]
	| volume = 369
	| issue = 9562
	| pages = 643–656
	| pmid = 17321310
	| doi = DOI:10.1016/S0140-6736(07)60312-2
	| url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673607603122.pdf
	| format = PDF
	| accessdate = 2007-04-01
	}}
	</ref><ref name="grayrct">{{cite journal
	| last = Gray
	| first = Ronald H
	| coauthors = Godfrey Kigozi, David Serwadda, Frederick Makumbi, Stephen Watya, Fred Nalugoda, Noah Kiwanuka, Lawrence H Moulton, Mohammad A Chaudhary, Michael Z Chen, Nelson K Sewankambo, Fred Wabwire-Mangen, Melanie C Bacon, Carolyn F M Williams, Pius Opendi, Steven J Reynolds, Oliver Laeyendecker, Thomas C Quinn, Maria J Wawer
	| date = ], ]
	| title = Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial
	| journal = ]
	| volume = 369
	| issue = 9562
	| pages = 657–666
	| pmid = 17321311
	| doi = DOI:10.1016/S0140-6736(07)60313-4
	| url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673607603134.pdf
	| format = PDF
	| accessdate = 2007-04-01
	}}
	</ref>. Although some have voiced doubts about the value of male circumcision in reducing an epidemic <ref name = "Garenne">{{cite journal
	| last = Garenne
	| first = Michel
	| year = 2006
	| month = January
	| title = Male Circumcision and HIV Control in Africa
	| journal = ]
	| volume = 3
	| issue = 1
	| pages = e78
	| pmid = 16435906
	| doi = doi:10.1371/journal.pmed.0030078
	| url = http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030078
	| accessdate = 2007-04-01
	}}
	</ref>, the World Health Organisation recommended in 2007 that "promoting male circumcision should be recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men."<ref name = "WHO HIV 1">{{cite web
	| url = http://www.who.int/hiv/mediacentre/MCrecommendations_en.pdf
	| title = New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications
	| accessdate = 2007-04-01
	| date = ], ]
	| format = PDF
	| publisher = ]
	}}
	</ref>
			<!-- Evidence, side effects, and positions -->
	Circumcision may be used to treat ]<ref>{{cite journal
			The procedure is associated with reduced rates of ]s<ref name="yuan" /> and ]s.<ref name="AAP_2012" /><ref name="rehmeyer_2011" /><ref name="larke_HPV_2011" /> This includes reducing the incidence of ] forms of ] (HPV) and significantly reducing ] among ] in high-risk populations;<ref name="Chikutsa-2015" /> its prophylactic efficacy against HIV transmission in the ] or among ] is debated.<ref name="WHO-2010b" /><ref name="siegfried_Cochrane_2009" /><ref name="Merson-2017" /> Neonatal circumcision decreases the risk of ].<ref name="Thomas_2021" /> Complication rates increase significantly with age.<ref name="weiss_2010_complications" /> Bleeding, infection, and the removal of either too much or too little foreskin are the most common acute complications, while ] is the most common long-term.<ref name="Selekman-2020" /> There are various ], and ] views on circumcision. Major medical organizations hold variant views on the strength of circumcision's prophylactic efficacy in developed countries. Some medical organizations take the position that it carries prophylactic health benefits which outweigh the risks, while other medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk.<ref name="Gable-2007" /><ref name="WHO-2010a" /><ref name="Bolnick_2012_ch1" /><ref name="caga-anan_2011" /> <!-- Epidemiology, history, and culture -->
	| last = Holman
	| first = John R.
	| coauthors = Keith A. Stuessi
	| year = 1999
	| month = ],
	| title = Adult Circumcision
	| journal = American Family Physician
	| volume = 59
	| issue = 6
	| pages = 1514&ndash;1518
	| doi =
	| id = {{ISSN|0002-838X}} PMID 10193593
	| url = http://www.aafp.org/afp/990315ap/1514.html
	| accessdate = 2006-06-30
	}}
	</ref> and ].<ref>{{cite journal |title=Carcinoma of the penis: experience from 360 cases |author=Rempelakos A |coauthors=''et al'' |journal=J BUON |year=2004 |month=Jan-Mar |volume=9 |issue=1 |pages=51-5 |quote="The surgical treatment which was performed included: circumcision 32 patients"}}</ref> The use of circumcision to treat ] is debated in medical literature.<ref name="dewan">{{cite journal | last = Dewan | first = P.A. | coauthors = Tieu H.C., and Chieng B.S. | year = 1996 | month = August | title = Phimosis: Is circumcision necessary? | journal = Journal of Paediatrics and Child Health | volume = 32 | issue = 4 | pages = 285&ndash;289 | id = PMID 8844530}}</ref><ref name="beauge">{{cite journal | last = Beaugé | first = Michel | year = 1997 | month = September/October | title = The causes of adolescent phimosis | journal = British Journal of Sexual Medicine | volume = 26 | url = http://www.cirp.org/library/treatment/phimosis/beauge2/ | accessdate = 2006-06-14}}</ref>
			Circumcision is one of the world's most common and oldest medical procedures.<ref name="WHO_2007_GTDPSA" /> Prophylactic usage originated in ] during the 1850s and subsequently widely spread, becoming predominately established as a way to prevent sexually transmitted infections.<ref name="Al-Salem-2016" /><ref name = "Afshar_2018" /> Beyond use as a prophylactic or treatment option in healthcare, circumcision plays a major role in many of the world's cultures and religions, most prominently ] and ]. Circumcision is among the ].<ref name="Mark-2003a" /><ref name="Hamilton-1990" /> In some ] and ] male circumcision is an established practice, and require that their male members undergo circumcision.<ref name="N. Stearns 2008 179" /><ref>{{cite book|title=Cultural Encyclopedia of the Body |first=Victoria |last=Pitts-Taylor|year= 2008| isbn= 9781567206913| page =394|publisher=ABC-CLIO|quote=For most part, Christianity does not require circumcision of its followers. Yet, some Orthodox and African Christian groups do require circumcision. These circumcisions take place at any point between birth and puberty.}}</ref> It is widespread in Australia, Canada, the United States, South Korea, most of Africa, and parts of Asia.<ref name="WHO_2007_GTDPSA" /> It is relatively rare for non-religious reasons in parts of Southern Africa, Latin America, Europe, and parts of Asia.<ref name="WHO_2007_GTDPSA" /> The origin of circumcision is not known with certainty, but the oldest documentation comes from ].<ref name="WHO_2007_GTDPSA" /><ref name="Doy2005" /><ref name="alanis_2004" />
	==The procedures of circumcision==
	]
	]
	Circumcision removes the ] from the ]. For infant circumcision, clamps, such as the ], ], and Mogen are often used.<ref>{{cite journal
	| last = Holman
	| first = John R.
	| coauthors = Evelyn L. Lewis, Robert L. Ringler
	| year = 1995
	| month = August
	| title = Neonatal circumcision techniques - includes patient information sheet
	| journal = American Family Physician
	| volume = 52
	| issue = 2
	| pages = 511&ndash;520
	| id = {{ISSN|0002-838X}} PMID 7625325
	| url = http://www.findarticles.com/p/articles/mi_m3225/is_n2_v52/ai_17281985
	| accessdate = 2006-06-29
	}}
	</ref> These clamps are meant to protect the glans while they cut the blood supply to the foreskin and prevent any ]. With the Plastibell clamp, the foreskin and the clamp come away in three to seven days. Before a Gomco clamp is used, a section of skin is crushed with a ] then slit with scissors. The foreskin is drawn over the bell shaped portion of the clamp and inserted through a hole in the base of the clamp. The clamp is then tightened, "crushing the foreskin between the bell and the base plate." The crushing limits the bleeding (provides the hemostasis). With the flared bottom of the bell fitting tightly against the hole of the base plate, the foreskin is cut away with a scalpel from above the base plate. The bell covers the glans to prevent it being reached by the scalpel. <ref>{{cite journal
	| last = Peleg
	| first = David
	| coauthors = Ann Steiner
	| year = 1998
	| month = ],
	| title = The Gomco Circumcision: Common Problems and Solutions
	| journal = American Family Physician
	| volume = 58
	| issue = 4
	| pages = 891&ndash;898
	| id = {{ISSN|0002-838X}} PMID 9767725
	| url = http://www.aafp.org/afp/980915ap/peleg.html
	| accessdate = 2006-06-29
	}}
	</ref>
			{{TOC limit}}
	With a Mogen clamp, the foreskin and the glans are separated with a blunt probe and/or curved hemostat (as with the first part of the Gomco and Plastibell procedure). The foreskin is then grabbed dorsally with a straight hemostat, and lifted up. The Mogen clamp is then slid between the glans and hemostat, following the angle of the corona to "avoid removing excess skin ventrally and to obtain a superior cosmetic result," compared with Gomco or Plastibell circumcisions. The clamp is locked shut, and a scalpel is used to cut the foreskin from the flat (upper) side of the clamp.<ref name="Pfenninger">{{cite book
	| last = Pfenninger
	| first = John L.
	| coauthors = Grant C. Fowler
	| title = Procedures for primary care
	| origyear = 1994
	| origmonth =
	| url =
	| format =
	| accessdate =
	| accessyear =
	| accessmonth =
	| edition = 2nd
	| date = ], ]
	| year =
	| month =
	| publisher = Mosby
	| location =
	| language =
	| id = ISBN 978-0-323-00506-7 {{LCCN|2003|0|56227}}
	| doi =
	| pages =
	| chapter =
	| chapterurl =
	| quote =
	}}
	</ref><ref name="Reynolds">{{cite journal
	| last = Reynolds
	| first = RD
	| year = 1996
	| month = July
	| title = Use of the Mogen clamp for neonatal circumcision
	| journal = American Family Physician
	| volume = 54
	| issue = 1
	| pages = 177&ndash;182
	| doi =
	| id = PMID 8677833
	| url =
	| format = Abstract
	| accessdate = 2006-07-18
	}}
	</ref>
			== Uses ==
	The frenulum is cut if frenular chordee is evident.<ref>{{cite journal |author=Griffin A, Kroovand R |title=Frenular chordee: implications and treatment |journal=Urology |volume=35 |issue=2 |pages=133-4 |year=1990 |id=PMID 2305537}}</ref><ref name = "Shechet" />
			=== Elective ===
	==Cultures and religions==
			Around half of all circumcisions worldwide are performed for reasons of prophylactic healthcare.<ref name="hay_2012" />
	Cultures may circumcise their males either shortly after birth, during childhood or around puberty as part of a rite of passage. Circumcision is most prevalent in Muslim countries, the United States, the Philippines and South Korea. It is less common in Europe, Latin America, China and India. Circumcision is most prevalent in the ]ish and ] faiths.
			==== Prophylactic usage in high-risk populations ====
	===Judaism===
			] became the 1 millionth ] in the ] of ], South Africa.<ref>{{Cite web | vauthors = Seeth A |date=June 1, 2018 |title='It's hassle-free,' says actor Melusi Yeni about his medical circumcision |url=https://www.news24.com/citypress/news/its-hassle-free-says-actor-melusi-yeni-about-his-medical-circumcision-20180601 |access-date=May 5, 2022 |website=] |language=en-US |quote=Actor Melusi Yeni was the millionth man to undergo voluntary male medical circumcision at the Sivananda Clinic in KwaZulu-Natal. |archive-date=5 May 2022 |archive-url=https://web.archive.org/web/20220505072202/https://www.news24.com/citypress/news/its-hassle-free-says-actor-melusi-yeni-about-his-medical-circumcision-20180601 |url-status=live }}</ref>]]
	{{main|Brit milah}}
			There is a consensus among the world's major medical organizations and in the academic literature that circumcision is an efficacious intervention for HIV prevention in high-risk populations if carried out by medical professionals under safe conditions.<ref name="WHO-PrevHIV">{{cite web |year=2020 |title=Preventing HIV Through Safe Voluntary Medical Male Circumcision For Adolescent Boys And Men In Generalized HIV Epidemics |url=https://www.who.int/publications/i/item/978-92-4-000854-0 |url-status=live |archive-url=https://web.archive.org/web/20211122140037/https://www.who.int/publications/i/item/978-92-4-000854-0 |archive-date=22 November 2021 |access-date=24 May 2021 |publisher=]}}</ref><ref name="siegfried_Cochrane_2009" /><ref name="Chikutsa-2015">For sources on this, see:
	{{see also|Circumcision in the Bible}}
			* {{cite journal | vauthors = Chikutsa A, Maharaj P | title = Social representations of male circumcision as prophylaxis against HIV/AIDS in Zimbabwe | journal = BMC Public Health | volume = 15 | issue = 1 | pages = 603 | date = July 2015 | pmid = 26133368 | pmc = 4489047 | doi = 10.1186/s12889-015-1967-z | quote = It is now generally accepted in public health spheres that medical male circumcision is efficacious in the prevention of HIV infection. | doi-access = free | issn = 1471-2458}}
	Circumcision is a fundamental rite of ]. It is a positive ] obligatory under ] for Jewish males, and is only postponed or abrogated in the case of threat to the life or health of the child.<ref>{{cite journal
			*{{Cite book | vauthors = Bell K |title=Health and Other Unassailable Values: Reconfigurations of Health, Evidence and Ethics |publisher=Taylor & Francis |year=2016 |isbn=978-1-317-48203-1 |pages=106 |quote=...defending the casual relation between male circumcision and reduced HIV transmission has become essentially hegemonic in the academic literature.}}
	| last = Glass
			*{{Cite book | vauthors = Merson M, Inrig S |title=The AIDS Pandemic: Searching for a Global Response |publisher=] |year=2017 |isbn=978-3-319-47133-4 |pages=379}}</ref>
	| first = J.M.
	| year = 1999
	| month = January
	| title = Religious circumcision: a Jewish view
	| journal = BJU International
	| volume = 83
	| issue = Supplement 1
	| pages = 17–21
	| doi = doi:10.1046/j.1464-410x.1999.0830s1017.x
	| id = PMID 10766529
	| url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1017.x
	| format = PDF
	| accessdate = 2006-10-18
	}}
	</ref> It is usually performed in a ceremony called a '']'' (or ''Bris milah'', colloquially simply ''bris'') (] for "Covenant of circumcision"). A '']'' performs the ceremony on the eighth day after birth unless health reasons force a delay. According to the ] (], chapter 17 verses 9-14), ] commanded ] to circumcise himself, his offspring and his slaves as a sign of an everlasting covenant. According to Jewish law, failure to follow the commandment carries the penalty of ''karet'', or being cut off from the community by God. ''Brit milah'' is considered to be so important that should the eighth day fall on ], actions that would normally be forbidden because of the sanctity of the day are permitted in order to fulfill the requirement to circumcise. The expressly ritual element of circumcision in Judaism, as distinguished from its non-ritual requirement in Islam, is shown by the requirement that a child who either is born ] (without a foreskin) or who has been circumcised without the ritual must nevertheless undergo a ''Brit milah'' in which a drop of blood (''hatafat-dam'', הטפת דם) is drawn from the penis at the point where the foreskin would have been or was attached.<ref>], ], 263:4</ref>
			In 2007, the WHO and the ] (UNAIDS) stated that they recommended adolescent and adult circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV, as long as the program includes "], ], and absence of ]" — known as voluntary medical male circumcision, or VMMC.<ref name="WHO-PrevHIV" /> In 2010, this was expanded to routine neonatal circumcision, as long as those undergoing the procedure received assent from their parents.<ref name="WHO-2010a" /> In 2020, the World Health Organization again concluded that male circumcision is an efficacious intervention for HIV prevention and that the promotion of male circumcision is an essential strategy, in addition to other preventive measures, for the prevention of heterosexually acquired HIV infection in men. Eastern and southern Africa had a particularly low prevalence of circumcised males. This region has a disproportionately high HIV infection rate, with a significant number of those infections stemming from heterosexual transmission. As a result, the promotion of prophylactic circumcision has been a priority intervention in that region since the WHO's 2007 recommendations.<ref name="WHO-PrevHIV" /><ref name="WHO-2010a" /> The International Antiviral Society–USA also suggests circumcision be discussed with ], especially in regions where HIV is common.<ref name="Marrazzo et al. 2014" /> There is evidence that circumcision is associated with a reduced risk of HIV infection for such men, particularly in low-income countries.<ref name="yuan">{{cite journal | vauthors = Yuan T, Fitzpatrick T, Ko NY, Cai Y, Chen Y, Zhao J, Li L, Xu J, Gu J, Li J, Hao C, Yang Z, Cai W, Cheng CY, Luo Z, Zhang K, Wu G, Meng X, Grulich AE, Hao Y, Zou H | title = Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data | journal = The Lancet. Global Health | volume = 7 | issue = 4 | pages = e436–e447 | date = April 2019 | pmid = 30879508 | pmc = 7779827 | doi = 10.1016/S2214-109X(18)30567-9 | type = Mata-analysis }}</ref>
	Less commonly practised, and more controversial, is '']'', or oral suction,<ref>{{cite web
	| url = http://www.thejewishweek.com/news/newscontent.php3?artid=11539
	| title = City Risking Babies' Lives With Brit Policy: Health Experts
	| accessdate = 2007-04-19
	| last = Nussbaum Cohen
	| first = Debra
	| date = ], ]
	| publisher = ]
	}}
	</ref><ref>{{cite web
	| url = http://www.thejewishweek.com/news/newscontent.php3?artid=11833&print=yes
	| title = City Challenged On Ritual Practice
	| accessdate = 2007-04-19
	| last = Nussbaum Cohen
	| first = Debra
	| coauthors = Larry Cohler-Esses
	| date = ], ]
	| publisher = ]
	}}
	</ref> where the '']'' sucks blood from the circumcision wound. The traditional reason for this procedure is to promote healing,<ref>] Tractate Shabbos 133b: Rav Pappa said, “A mohel who does not perform metzitzah endangers the baby and is dismissed.”
	</ref><ref>{{cite news
	| first = Mordechai
	| last = Halperin
	| authorlink = Mordechai Halperin
	| coauthors = <small>(translated by Yocheved Lavon)</small>
	| title = Metzitzah B’peh Controversy: The View from Israel
	| url = http://www.ou.org/jewish_action/article/8987
	| work = Jewish Action 67(2)
	| publisher = ]
	| id = {{ISSN|0447-7049}} {{OCLC|5763983}}
	| pages = 25, 33–39
	| date = Winter 2006
	| accessdate = 2007-02-15
	| quote = <small>The original technique for the performance of metzitzah employs the human mouth. The mohel brings the baby’s organ into his mouth immediately after the excision of the foreskin and sucks blood from it vigorously. This action lowers the internal pressure in the tissues of the organ, in the blood vessels of the head of the organ and in the exposed ends of the arterioles that have just been cut. Thus, the difference between the pressure in the blood vessels in the base of the organ and the pressure in the blood vessels at its tip is increased. This requirement has deep religious significance as well as medical benefits.…The Gemara states that the requirement of metzitzah stems from medical considerations; it is meant to minimize risk to the infant’s life and health</small>}}
	</ref> though the practice has been implicated in the spreading of herpes to the infant.<ref name = "Gesundheit">{{cite journal
	| last = Gesundheit
	| first = B.
	| coauthors = et al.
	| year = 2004
	| month = August
	| title = Neonatal Genital Herpes Simplex Virus Type 1 Infection After Jewish Ritual Circumcision: Modern Medicine and Religious Tradition
	| journal = Pediatrics
	| volume = 114
	| issue = 2
	| pages = e259&ndash;e263
	| id = {{ISSN|1098-4275}}
	| url = http://pediatrics.aappublications.org/cgi/reprint/114/2/e259.pdf
	| format = PDF
	| accessdate = 2006-06-28
	}}
	</ref> Today, if it is performed, the mohel generally uses a sterilized glass tube.<ref name = "RCAMetzitzah">{{cite web
	| url = http://www.rabbis.org/news/article.cfm?id=100605
	| title = Metzitza Be'Peh - Halachic Clarification
	| accessdate = 2007-04-06
	| date = ], ]
	| publisher = ]
	| quote = <small>The poskim consulted by the RCA…agree that the normative halacha undoubtedly permits the third view , and that it is proper for mohalim to conduct themselves in this way given the health issues involved in the fourth view.…However, although Rav Yosef Dov Soloveitchik also generally prohibited metzitza be’peh with direct oral contact, he did not ban it by those who insisted upon it, and neither does the RCA advocate any such ban. Those who wish to follow their customs in accordance with the above-noted authorities are certainly entitled to do so, but the RCA is firmly of the opinion that in light of current realities and medical knowledge it is proper, and preferable, to use a tube.</small>
	}}
	</ref><ref>{{cite news
	|first = Kelly
	|last = Hartog
	|url = http://www.jewishjournal.com/home/preview.php?id=13676
	|title = Death Spotlights Old Circumcision Rite
	|publisher = ]
	|date = ] ]
	|accessdate = 2006-11-22
	|quote = <small>Metzizah b’peh — loosely translated as oral suction — is the part of the circumcision ceremony where the mohel removes the blood from the baby’s member; these days the removal of the blood is usually done using a sterilized glass tube, instead of with the mouth, as the Talmud suggests.</small>
	}}</ref>
			The finding that circumcision significantly reduces female-to-male HIV transmission has prompted medical organizations serving communities affected by endemic HIV/AIDS to promote circumcision as an additional method of controlling the spread of HIV.<ref name="Bolnick_2012_ch1" />
	===Christianity===
	] does not prescribe ]. The ] decided that circumcision was not necessary (). ] had Timothy circumcised () but in his letters he warned gentile Christians against adopting the practice (, ). Individual Christians and Christian traditions may have different customs. Circumcision is customary among members of three of the ] Churches, the ], ], and ] churches in their home countries, and also some other African churches.<ref name=Christian/> On ], the Catholic Church used to celebrate the ]. This has been superseded by the ]. The ] condemned the observance of circumcision as a ] and ordered against its practice in the ] in 1442.<ref name = "CoF">{{cite book
	| last = Eugenius IV
	| first = Pope
	| authorlink = Pope Eugene IV
	| editor = Norman P. Tanner ed.
	| title = Decrees of the ecumenical councils
	| origyear = 1442
	| url =
	| format =
	| accessdate = 2007-04-25
	| series = 2 volumes
	| year = 1990
	| publisher = ]
	| location = ]
	| isbn = 0878404902
	| oclc =
	| language = English, Greek, and Latin
	| id = {{LCCN|90|00|3209}}
	| pages =
	| chapter = ECCUMENICAL COUNCIL OF FLORENCE (1438-1445): Session 11—4 February 1442; Bull of union with the Copts
	| chapterurl = http://www.ewtn.com/library/COUNCILS/FLORENCE.HTM#5
	| quote = <small>It firmly believes, professes and teaches that the legal prescriptions of the old Testament or the Mosaic law, which are divided into ceremonies, holy sacrifices and sacraments, because they were instituted to signify something in the future, although they were adequate for the divine cult of that age, once our lord Jesus Christ who was signified by them had come, came to an end and the sacraments of the new Testament had their beginning.…But it asserts that after the promulgation of the gospel they cannot be observed without loss of eternal salvation. Therefore it denounces all who after that time observe circumcision, the sabbath and other legal prescriptions as strangers to the faith of Christ and unable to share in eternal salvation, unless they recoil at some time from these errors. Therefore it strictly orders all who glory in the name of Christian, not to practise circumcision either before or after baptism, since whether or not they place their hope in it, it cannot possibly be observed without loss of eternal salvation.</small>
	}}
	</ref> Anglican and Lutheran churches have also renamed the Feast of the Circumcision in their liturgical calendars as, for example, the Holy Name of Jesus.<ref> For example, "The Calendar of the Church Year" in The (Online) Book of Common Prayer (Episcopal Church in the United States of America), http://www.bcponline.org/ retrieved ] ].</ref>
			==== Prophylactic usage in developed countries ====
	===Islam===
			Major medical organizations hold varying positions on the ] of the elective circumcision of minors in the context of ].<ref name="Bolnick_2012_ch1" /> Literature on the matter is polarized, with the cost-benefit analysis being highly dependent on the kinds and frequencies of health problems in the population under discussion and how circumcision affects them.<ref name="caga-anan_2011" /><ref name="pinto_2012" /><ref name="Wapner-2015">{{Cite web| vauthors = Wapner J |date=24 February 2015|title=The Troubled History of Foreskin|url=https://mosaicscience.com/story/troubled-history-foreskin/|website=Mosaic Science|quote=In the decades since, medical practice has come to rely increasingly on evidence from large research studies, which, as many American doctors see it, have supported the existing rationale... How can experts who have undergone similar training evaluate the same studies and come to opposing conclusions? I've spent months scrutinising the medical literature in an attempt to decide which side is right. The task turned out to be nearly impossible. That's partly because there is so much confused thinking around the risks and benefits of circumcision, even among trained practitioners.|access-date=3 February 2022|archive-date=26 December 2021|archive-url=https://web.archive.org/web/20211226154538/https://mosaicscience.com/story/troubled-history-foreskin/|url-status=live}}</ref>
	The origin of circumcision in ] is a matter of religious and scholarly debate. It is mentioned in some parts of the ], but not in the ]. ] scholars have different opinions about circumcision in ], depending on which Hadith are accepted and how they are interpreted. According to some it is ''recommended'' (]); according to others, it is ''obligatory''.<ref>{{cite web
	| url = http://www.islam-qa.com/index.php?ln=eng&ds=qa&lv=browse&QR=9412&dgn=4
	| title = Question #9412: Circumcision: how it is done and the rulings on it
	| accessdate = 2006-07-01
	| last = Al-Munajjid
	| first = Muhammed Salih
	| publisher = Islam Q&A
	}}
	</ref> Some have quoted the ] to argue that the requirement of circumcision is based on the covenant with ].<ref>{{cite web
	| url = http://www.islam-qa.com/index.php?ln=eng&ds=qa&lv=browse&QR=7073&dgn=3
	| title = Question #7073: The health and religious benefits of circumcision
	| accessdate = 2006-07-01
	| last = Al-Munajjid
	| first = Muhammed Salih
	| publisher = Islam Q&A
	}}
	</ref>
			The ] (WHO), ], and American medical organizations take the position that it carries prophylactic health benefits which outweigh the risks, while European medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk.<ref name="Gable-2007" /><ref name="WHO-2010a" /><ref name="Bolnick_2012_ch1" /><ref name="caga-anan_2011" /> Advocates of circumcision consider it to have a net health benefit, and therefore feel that increasing the circumcision rate is "imperative".<ref>{{cite journal | vauthors = Morris BJ | title = Why circumcision is a biomedical imperative for the 21(st) century | journal = BioEssays | volume = 29 | issue = 11 | pages = 1147–1158 | date = November 2007 | pmid = 17935209 | doi = 10.1002/bies.20654 | url = https://pubmed.ncbi.nlm.nih.gov/17935209/ | access-date = 26 December 2021 | url-status = live | archive-url = https://web.archive.org/web/20211226154518/https://pubmed.ncbi.nlm.nih.gov/17935209/ | archive-date = 26 December 2021 }}</ref> They recommend performing it during the neonatal period when it is less expensive and has a lower risk of complications.<ref name="pinto_2012">{{cite journal | vauthors = Pinto K | title = Circumcision controversies | journal = Pediatric Clinics of North America | volume = 59 | issue = 4 | pages = 977–986 | date = August 2012 | pmid = 22857844 | doi = 10.1016/j.pcl.2012.05.015 }}</ref> The ] and ] stated that the potential benefits of circumcision outweigh the risks.<ref name="AAP_2012" /><ref>{{Cite web |title=Background, Methods, and Synthesis of Scientific Information Used to Inform "Information for Providers to Share with Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV Infection, Sexually Transmitted Infections, and other Health Outcomes" |url=https://stacks.cdc.gov/view/cdc/58457 |access-date=2023-10-12 |website=stacks.cdc.gov |archive-date=22 October 2023 |archive-url=https://web.archive.org/web/20231022115215/https://stacks.cdc.gov/view/cdc/58457 |url-status=live }}</ref>
	The timing of Muslim circumcision varies. Turkish, ], rural Egyptians and Central and South Asian Muslims typically circumcise boys between the ages of six and eleven and traditionally the event may be a joyous occasion and celebrated with sweets and feasting. However, in the middle class it is more usually done in infancy and is largely unremarked upon. In Turkey the celebratory feast is called "Sünnet Düğünü", or "Circumcision Feast/Celebration" and is considered a very important celebration in man's life as a passage to a manhood.<ref>Hamdullah Aydın, M.D. and Zeynep Gülçat, Ph.D., "Turkey," in ''The International Encyclopedia of Sexuality'', http://www2.hu-berlin.de/sexology/IES/turkey.html retrieved ] ].</ref> In ], Muslims may be circumcised at all ages from the newborn period to adulthood, though the medical profession has encouraged medical circumcisions in the first week after birth to reduce complications: "Circumcision is performed by barbers, medical technicians, quacks and doctors including paediatric surgeon yet there is no consensus for the best age and method."<ref>Iftikhar Ahmad Jan, "Circumcision in babies and children with Plastibell technique: An easy procedure with minimal complications - Experience of 316 cases," Pak J Med Sci 2004, 20(3) 175-180.</ref> In Iran, Dr. Paula Drew states that “circumcision, which formerly celebrated the onset of manhood, has for many years now been more customarily performed at the age of 5 or 6 for children born at home, and at two days old for those born in a medical setting.…By puberty, all Muslim Iranian boys must be circumcised if they are to participate fully in religious activities.”<ref>{{cite encyclopedia
	| last = Drew
			The World Health Organization in 2010 stated:<ref name="WHO-2010a" />
	| first = Paula E.
	| coauthors = F. A. Sadeghpour and anonymous
	| editor = ]
	| encyclopedia = The International Encyclopedia of Sexuality
	| title = Iran
	| url = http://www2.hu-berlin.de/sexology/IES/iran.html
	| accessdate = 2006-10-18
	| publisher = Continuum Publishing Company
	| location = ]
	}}
	</ref> Kamyar ''et al'' describe circumcision as an "obligatory custom" and note that it is not necessary for the circumciser to be a Muslim.<ref>Kamyar M. Hedayat, MD and Roya Pirzadeh, MD, "Issues in Islamic Biomedical Ethics: A Primer for the Pediatrician," ''Pediatrics'' Vol. 108 No. ] ], pp. 965-971, http://imamreza.net/eng/imamreza.php?print=3107 retrieved ] ].</ref>
			{{Blockquote|There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men.<ref name="WHO-2010a" /> }}
	===Other faiths and traditions===
	] do not have any particular tradition or rituals regarding male circumcision, but view female circumcision as mutilation.<ref>{{cite web
	| url = http://www.bahai.org.nz/public/patientisbahai.htm
	| title = WHEN YOUR PATIENT IS A BAHA'I
	| accessdate = 2007-01-30
	| publisher = National Spiritual Assembly of the Bahá'ís of New Zealand
	| quote = <small>Bahá'ís are not advised on a particular course of action in respect to circumcision of males; circumcision of females is considered mutilation.</small>
	}}</ref>
			=== Pathologies ===
	The ] have no male circumcision in their religion,<ref>{{cite web
			Circumcision is also used to treat various pathologies. These include pathological ], refractory ] and chronic or recurrent ]s (UTIs).<ref name="lissauer_2012" /><ref name="hay_2012" />
	| url = http://www.semp.us/biots/biot_176.html
	| title = Who Are the Druze?
	| accessdate = 2007-01-30
	| date = ], ]
	| work = SEMP Biot #176
	| publisher = Suburban Emergency Management Project
	}}</ref> although, according to one source, it is a practiced among those living in urban areas or outside the Middle East, mainly for hygienic reasons.
			== Contraindications ==
	There is no specific reference to male circumcision in the Hindu holy books , and Hindus in India generally do not practice circumcision.
			Circumcision is ] in certain cases.<ref name="rudolph_2011" /><ref name="hay_2012" /><ref name="Jhpiego-2009" />
			These include infants with certain ] structure abnormalities, such as a misplaced ] (as in ] and ]), curvature of the head of the penis (]), or ], because the foreskin may be needed for reconstructive surgery. Circumcision is contraindicated in ] infants and those who are not clinically stable and in good health.<ref name="rudolph_2011" /><ref name="hay_2012" /><ref name="Jhpiego-2009" /> If an individual is known to have or has a family history of serious bleeding disorders such as ], it is recommended that the blood be checked for normal ] properties before the procedure is attempted.<ref name="hay_2012" /><ref name="Jhpiego-2009" />
	] male infants are not circumcised.<ref>{{cite web
	| url = http://www.kyha.com/documents/CG-Sikh.pdf
	| title = Guidelines for health Care Providers Interacting with Patients of the Sikh Religion and their Families
	| accessdate = 2007-05-01
	| publisher =Metropolitan Chicago Healthcare Council
	| date = November 2000
	}}</ref>
			==Technique==
	Circumcision in South Korea is largely the result of American cultural and military influence following the ]. The origin of circumcision in the Philippines is uncertain. One newspaper article speculates that it is due to the influence of western colonizers.<ref>{{cite news
			{{Main|Circumcision surgical procedure}}
	|first = Rommel G.
	|last = Rebollido
	|url = http://www.sunstar.com.ph/static/gen/2005/03/21/feat/passage.to.manhood.html
	|title = Passage to manhood
	|work = General Santos
	|publisher = Sun Star Publishing, Inc.
	|date = ], ]
	|accessdate = 2006-07-01
	|language =
	}}
	</ref> However, ]'s ] ''History of the Philippine Islands'', speculates that it is due to Islamic influence.<ref>{{cite book
	| last = de Morga
	| first = Antonio
	| others = Translated by Alfonso de Salvio, Norman F. Hall, and James Alexander Robertson
	| title = History of the Philippine Islands
	| origyear = 1609
	| url = http://www.nalanda.nitc.ac.in/resources/english/etext-project/history/philippine/index.htm
	| accessdate = 2006-07-01
	| date = 1907
	| id = {{LCCN|unk82|0|42869}}
	| chapter = 11
	| chapterurl = http://www.nalanda.nitc.ac.in/resources/english/etext-project/history/philippine/chapter11.html
	| quote = <small>These Borneans are Mahometans, and were already introducing their religion among the natives of Luzon, and were giving them instructions, ceremonies, and the form of observing their religion.…and those the chiefest men, were commencing, although by piecemeal, to become Moros, and were being circumcised and taking the names of Moros.</small>}}</ref> In West Africa infant circumcision may have had tribal significance as a rite of passage or otherwise in the past; today in some non-Muslim Nigerian societies it is medicalised and is simply a cultural norm.<ref>Ajuwon et al., "Indigenous surgical practices in rural southwestern Nigeria: Implications for disease," Health Educ. Res..1995; 10: 379-384 Health Educ. Res..1995; 10: 379-384 Retrieved ] ]</ref> In early 2007 it was announced that rural aidpost orderlies in the East Sepik Province of Papua New Guinea are to undergo training in the circumcision of men and boys of all ages with a view to introducing the procedure as a means of prophylaxis against HIV/AIDS, which is becoming a significant problem in the country.<ref>{{cite web
	| title = "PNG circumcision campaign hopes to halt HIV,"
	| publisher = ABC Radio Australia citing the ''Papua New Guinea Post-Courier''
	| url = http://www.radioaustralia.net.au/news/stories/s1842948.htm
	| format = htm
	| date = 2007-02-08, 14:21:13,
	}}</ref>
			]. After the operation, the ] is exposed even when the penis is ].]]
	Circumcision is part of ]s in some African, Pacific Islander, and Australian aboriginal ] in areas such as Arnhem Land,<ref>{{cite paper
	| author = Aaron David Samuel Corn
	| title = Ngukurr Crying: Male Youth in a Remote Indigenous Community
	| version = Working Paper Series No. 2
	| publisher = ]
	| date = 2001
	| url = http://www.uow.edu.au/arts/sealcp/wkgpapers/wp2.pdf
	| format = PDF
	| accessdate = 2006-10-18
	}}
	</ref> where the practice was introduced by Makassan traders from Sulawesi in the Indonesian Archipelago.<ref>{{cite web
	| url = http://www.mfgsc.vic.edu.au/greenturtledreaming/EKmigrate.htm
	| title = Migration and Trade
	| accessdate = 2006-10-18
	| publisher = Green Turtle Dreaming
	| quote = In exchange for turtles and trepang the Makassans introduced tobacco, the practice of circumcision and knowledge to build sea-going canoes.
	}}
	</ref> Circumcision ceremonies among certain Australian aboriginal societies are noted for their painful nature, including ] for some aboriginal peoples in the Western Desert.<ref>{{cite journal
	| last = Jones
	| first = IH
	| year = 1969
	| month = June
	| title = Subincision among Australian western desert Aborigines
	| journal = British Journal of Medical Psychology
	| volume = 42
	| issue = 2
	| pages = 183&ndash;190
	| doi =
	| id = {{ISSN|0007-1129}} PMID 5783777
	}}
	</ref>
	In the Pacific, ritual circumcision is nearly universal in the Melanesian islands of ] and ];<ref>{{cite web
	| url = http://www.aids.net.au/aids-png-project-20060403.htm
	| title = RECENT GUEST SPEAKER
	| accessdate = 2006-07-01
	| year = 2006
	| publisher = Australian AIDS Fund Incorporated
	}}
	</ref> participation in the traditional land diving on ] is reserved for those who have been circumcised.<ref>{{cite web
	| url = http://www.getaway.co.nz/destination.asp?id=34
	| title = Weird & Wonderful
	| accessdate = 2006-07-01
	| publisher = United Travel
	}}
	</ref> Circumcision is also commonly practised in the Polynesian islands of ], ], ], and ]. In Samoa, it is accompanied by a celebration. Among some West African animist groups, such as the ] and ], it is taken to represent a removal of "feminine" aspects of the male, turning boys into fully masculine males.<ref>{{cite web
	| url = http://www.necep.net/articles.php?id_soc=12&id_article=84
	| title = Circumcision amongst the Dogon
	| accessdate = 2006-09-03
	| year = 2006
	| publisher = The Non-European Components of European Patrimony (NECEP) Database
	}}
	</ref> Although in many West African traditional societies circumcision has become medicalised and is simply performed in infancy without ado or any particular conscious cultural significance, among the Urhobo people of southern Nigeria it is symbolic of a boy entering into manhood. The ritual expression, ''Omo te Oshare'' ("the boy is now man"), constitutes a rite of passage from one age set to another.<ref>{{cite journal
	| last = Agberia
	| first = John Tokpabere
	| year = 2006
	| title = Aesthetics and Rituals of the Opha Ceremony among the Urhobo People
	| journal = Journal of Asian and African Studies
	| volume = 41
	| issue = 3
	| pages = 249-260
	| doi = 10.1177/0021909606063880
	| url = http://jas.sagepub.com/cgi/reprint/41/3/249.pdf
	| format = PDF
	| accessdate = 2006-10-18
	}}
	</ref> For ] peoples, such as the ] and ], circumcision is a rite of passage observed collectively by a number of boys every few years, and boys circumcised at the same time are taken to be members of a single ].<ref>{{cite web
	| url = http://www.masaikenya.org/
	| title = Masai of Kenya
	| accessdate = 2007-04-06
	| quote = <small>Authority derives from the age-group and the age-set. Prior to circumcision a natural leader or olaiguenani is selected; he leads his age-group through a series of rituals until old age, sharing responsibility with a select few, of whom the ritual expert (oloiboni) is the ultimate authority. Masai youths are not circumcised until they are mature, and a new age-set is initiated together at regular intervals of twelve to fifteen years. The young warriors (ilmurran) remain initiates for some time, using blunt arrows to hunt small birds which are stuffed and tied to a frame to form a head-dress.</small>
	}}
	</ref>
			The ] is the double-layered fold of tissue at the distal end of the ] that covers the ] and the ].<ref name=WHO_2007_GTDPSA/> For adult medical circumcision, superficial wound healing takes up to a week, and complete healing 4 to 6 months. For infants, healing is usually complete within one week.<ref name="Jhpiego-2009">{{cite web | author1 =World Health Organization | author2 = UNAIDS | author3 = Jhpiego (Johns Hopkins Program for International Education in Gynecology and Obstetrics) |date=December 2009 |title=Manual for Male Circumcision Under Local Anaesthesia |url=https://www.who.int/hiv/pub/malecircumcision/who_mc_local_anaesthesia.pdf |archive-url=https://web.archive.org/web/20120115175057/http://www.who.int/hiv/pub/malecircumcision/who_mc_local_anaesthesia.pdf |archive-date=January 15, 2012 |publisher= |quote=...there are many myths about male circumcision that circulate. For example, some people think that circumcision can cause impotence (failure of erection) or reduce sexual pleasure. Others think that circumcision will cure impotence. Let me assure you that none of these is true. |author1-link=World Health Organization |author2-link=UNAIDS |author3-link=Jhpiego }} {{Webarchive|url=https://web.archive.org/web/20230330035156/https://www.scribd.com/document/186396682/Who-Mc-Local-Anaesthesia |date=30 March 2023 }}</ref>
	==Ethical issues==
	{{main|Bioethics of neonatal circumcision}}
			===Removal of the foreskin===
	Circumcising infants is controversial. ] assert that circumcision is a significant public health measure, preventing infections, and slowing down the spread of ].<ref name = "ANRS">{{cite journal
			For infant circumcision, ] such as the ], ] and ] are commonly used in the USA.<ref name=AAP_2012/> These follow the same basic procedure. First, the amount of foreskin to be removed is estimated. The practitioner opens the foreskin via the preputial ] to reveal the glans underneath and ensures it is normal before bluntly separating the inner lining of the foreskin (]) from its attachment to the glans. The practitioner then places the circumcision device (this sometimes requires a ]), which remains until blood flow has stopped. Finally, the foreskin is ].<ref name=AAP_2012/> For older babies and adults, circumcision is often performed surgically without specialized instruments,<ref name="Jhpiego-2009" /> and alternatives such as ] or the ] are available.<ref name=WHO_adult_devices_2012/>
	| last = Auvert
	| first = Bertran
	| coauthors = Dirk Taljaard, Emmanuel Lagarde, Joëlle Sobngwi-Tambekou, Rémi Sitta, Adrian Puren
	| year = 2005
	| month = November
	| title = Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial
	| journal = PLoS Medicine
	| volume = 2
	| issue = 11
	| pages = 1112&ndash;1122
	| doi = 10.1371/journal.pmed.0020298
	| id = PMID 16231970
	| url = http://medicine.plosjournals.org/archive/1549-1676/2/11/pdf/10.1371_journal.pmed.0020298-S.pdf
	| format = PDF
	| accessdate = 2006-07-09
	}}
	</ref> ], however, question the legality of infant circumcision by asserting that infant circumcision is a ] or a ].<ref>{{cite book
	| last = Sommerville
	| first = Margaret
	| title = The ethical canary: science, society, and the human spirit
	| url =
	| accessdate = 2007-02-12
	| year = 2000
	| month = November
	| publisher = ]
	| location = ]
	| isbn = 0670893021
	| id = {{LCCN|2001||369341}}
	| pages = 202–219
	| chapter = Altering Baby Boys’ Bodies: The Ethics of Infant Male Circumcision
			===Pain management===
	| chapterurl = http://www.intact.ca/canary.htm
			The circumcision procedure causes pain, and for neonates this pain may interfere with mother-infant interaction or cause other behavioral changes,<ref name=perera_2010/> so the use of ] is advocated.<ref name=AAP_2012/><ref name=CPSBC_2009/> Ordinary procedural pain may be managed in ] and non-pharmacological ways. Pharmacological methods, such as localized or regional pain-blocking injections and topical analgesic creams, are safe and effective.<ref name=AAP_2012/><ref name=lonngvist_2010/><ref name=shockley_2011/> The ] and dorsal penile nerve block (DPNB) are the most effective at reducing pain, and the ring block may be more effective than the DPNB. They are more effective than ] (eutectic mixture of local anesthetics) cream, which is more effective than a ].<ref name=lonngvist_2010/><ref name=shockley_2011/> Topical creams have been found to irritate the skin of ] infants, so penile nerve block techniques are recommended in this group.<ref name=AAP_2012/>
	| quote =
	}}
	</ref><ref name = "VanHoweLegal">{{cite journal
	| last = Van Howe
	| first = R.S.
	| coauthors = J.S. Svoboda, J.G. Dwyer, and C.P. Price
	| year = 1999
	| month = January
	| title = Involuntary circumcision: the legal issues
	| journal = BJU International
	| volume = 83
	| issue = Supp1
	| pages = 63–73
	| issn =
	| pmid = 10349416
	| doi = 10.1046/j.1464-410x.1999.0830s1063.x
	| id =
	| url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1063.x
	| language =
	| format = PDF
	| accessdate = 2007-02-12
	}}
	</ref>
			For infants, non-pharmacological methods such as the use of a comfortable, padded chair and a ] or non-sucrose pacifier are more effective at reducing pain than a placebo,<ref name=shockley_2011/> but the ] (AAP) states that such methods are insufficient alone and should be used to supplement more effective techniques.<ref name=AAP_2012/> A quicker procedure reduces duration of pain; use of the Mogen clamp was found to result in a shorter procedure time and less pain-induced stress than the use of the Gomco clamp or the Plastibell.<ref name=shockley_2011/> The available evidence does not indicate that post-procedure pain management is needed.<ref name=AAP_2012/> For adults, ], ring block, dorsal penile nerve block (DPNB) and ] are all options,<ref name=wolter_2008/> and the procedure requires four to six weeks of abstinence from ] or intercourse to allow the wound to heal.<ref name="Jhpiego-2009" />
	===Consent===
	Views differ on whether limits should be placed on caregivers having a child circumcised. One argument questions why the genital cutting of males is allowed while the ] is prohibited.<ref>{{cite web
	| url = http://www.fgmnetwork.org/intro/mgmfgm.html
	| title = Similarities in Attitudes and Misconceptions toward Infant Male Circumcision in North America and Ritual Female Genital Mutilation in Africa.
	| accessdate = 2006-07-01
	| last = Lightfoot-Klein
	| first = Hanny
	| year = 2003
	| publisher = The FGC Education and Networking Project
	}}
	</ref> Another argument is that as it is his body, any decision to circumcise should only be made by the owner of the foreskin when he reaches adulthood.
			==Effects==
	Others argue that there is no convincing evidence of sexual or emotional harm, and that there are greater monetary and psychological costs in circumcising later rather than in infancy.<ref>{{cite journal |url=http://bioethics.net/journal/pdf/3_2_LT_w01_Benetar.pdf |first=David |last=Benatar |coauthors=Benatar, Michael |title=How not to argue about circumcision |journal=American Journal of
	Bioethics |volume=3 |issue=2 |year=2003 |pages=W1-W9}}</ref>
			===Sexually transmitted infections===
	Some medical associations accept that the parents should determine what is in the best interest of the infant or child,<ref name = "AAP1999">{{cite journal
	| last = Task Force on Circumcision
	| coauthors =
	| year = 1999
	| month = ],
	| title = Circumcision Policy Statement
	| journal = Pediatrics
	| volume = 103
	| issue = 3
	| pages = 686&ndash;693
	| doi = 10.1542/peds.103.3.686
	| id = {{ISSN|0031-4005}} PMID 10049981
	| url = http://pediatrics.aappublications.org/cgi/reprint/pediatrics;103/3/686.pdf
	| format = PDF
	| accessdate = 2006-07-01
	}}
	</ref><ref name = "CSA:I-99" /><ref name="CMAJ2"/><ref name="BMAGuide2"/> but the ] (RACP) and the ] (BMA) observe that controversy exists on this issue.<ref name = "RACPSumm">{{cite web
	| url = http://www.racp.edu.au/download.cfm?DownloadFile=A453CFA1-2A57-5487-DF36DF59A1BAF527
	| title = Policy Statement On Circumcision
	| accessdate = 2007-02-28
	| year = 2004
	| month = September
	| format = PDF
	| publisher = ]
	| pages =
	| language =
	| archiveurl =
	| archivedate =
	| quote = <small>The Paediatrics and Child Health Division, The Royal Australasian College of Physicians (RACP) has prepared this statement on routine circumcision of infants and boys to assist parents who are considering having this procedure undertaken on their male children and for doctors who are asked to advise on or undertake it. After extensive review of the literature the RACP reaffirms that '''there is no medical indication for routine neonatal circumcision.''' Circumcision of males has been undertaken for religious and cultural reasons for many thousands of years. It remains an important ritual in some religious and cultural groups.…In recent years there has been evidence of possible health benefits from routine male circumcision. The most important conditions where some benefit may result from circumcision are urinary tract infections, HIV and later cancer of the penis.…The complication rate of neonatal circumcision is reported to be around 1% to 5% and includes local infection, bleeding and damage to the penis. Serious complications such as bleeding, septicaemia and meningitis may occasionally cause death. The possibility that routine circumcision may contravene human rights has been raised because circumcision is performed on a minor and is without proven medical benefit. Whether these legal concerns are valid will be known only if the matter is determined in a court of law. If the operation is to be performed, the medical attendant should ensure this is done by a competent operator, using appropriate anaesthesia and in a safe child-friendly environment. In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents. Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate.</small>
	}}
	</ref><ref name = "BMAGuide">{{cite web
	| url = http://www.bma.org.uk/ap.nsf/Content/malecircumcision2006?OpenDocument&Highlight=2,circumcision
	| title = The law and ethics of male circumcision - guidance for doctors
	| accessdate = 2006-07-01
	| author = Medical Ethics Committee
	| year = 2006
	| month = June
	| publisher = ]
	}}
	</ref> The BMA insists that a circumcision must not go ahead without the consent of both parents and the competent child.<ref name = "BMAGuide" />
			====Human immunodeficiency virus====
	===Emotional consequences===
			{{See also|Circumcision in Africa#Circumcision to prevent the spread of human immunodeficiency virus in Africa}}
	Goldman discussed the extent to which circumcision may cause emotional harm to males.<ref>{{cite journal
			{{excerpt|Circumcision and HIV|paragraphs=1-2}}
	| last = Goldman
	| first = R.
	| year = 1999
	| month = January
	| title = The psychological impact of circumcision
	| journal = BJU International
	| volume = 83
	| issue = S1
	| pages = 93&ndash;102
	| doi = 10.1046/j.1464-410x.1999.0830s1093.x
	| id =
	| url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1093.x
	| format = PDF
	| accessdate = 2006-07-02
	}}
	</ref> Some organizations have been formed as support groups for men who are upset with being circumcised.<ref>{{cite web
	| url = http://www.norm.org/
	| title = National Organization of Restoring Men
	| accessdate = 2006-07-01
	| year = 2006
	}}
	</ref>
	===Legality===		====Human papillomavirus====
			] (HPV) is the most commonly transmitted ], affecting both men and women. While most infections are ] and are cleared by the ], some types of the virus cause ]s, and other types, if untreated, cause various forms of cancer, including ] and ]. Genital warts and cervical cancer are the two most common problems resulting from HPV.<ref name=CDC_HPV/>
	{{main|Circumcision and law}}
			Circumcision is associated with a reduced ] of ] types of HPV infection, meaning that a randomly selected circumcised man is less likely to be found infected with cancer-causing types of HPV than an uncircumcised man.<ref name=hpv_prevalence_ref_bundle/><ref name=zhu>{{cite journal | vauthors = Zhu YP, Jia ZW, Dai B, Ye DW, Kong YY, Chang K, Wang Y | title = Relationship between circumcision and human papillomavirus infection: a systematic review and meta-analysis | journal = Asian Journal of Andrology | volume = 19 | issue = 1 | pages = 125–131 | date = 8 March 2016 | pmid = 26975489 | pmc = 5227661 | doi = 10.4103/1008-682X.175092 | doi-access = free }}</ref> It also decreases the likelihood of multiple infections.<ref name=rehmeyer_2011/> {{As of|2012}}, there was no strong evidence that it reduces the rate of new HPV infection,<ref name=larke_HPV_2011/><ref name=rehmeyer_2011/><ref name=albero_2012/> but the procedure is associated with increased ] of the virus by the body,<ref name=larke_HPV_2011/><ref name=rehmeyer_2011/> which can account for the finding of reduced prevalence.<ref name=rehmeyer_2011/>
	Traditionally, circumcision has been presumed to be legal when performed by a trained operator.
			Although genital warts are caused by a type of HPV, there is no ] between being circumcised and the presence of genital warts.<ref name=larke_HPV_2011/><ref name=zhu/><ref name=albero_2012/>
	In 2001, ] allowed only persons certified by the National Board of Health to circumcise infants, requiring a medical doctor or an anesthesia nurse to accompany the circumciser and for anaesthetic to be applied beforehand. Jews and Muslims in Sweden objected to the law,<ref>{{cite web
	| url = http://news.bbc.co.uk/2/hi/europe/1572483.stm
	| title = Sweden restricts circumcisions
	| accessdate = 2006-10-18
	| date = ], ]
	| publisher = ]
	| quote = Swedish Jews and Muslims object to the new law, saying it violates their religious rights.
	}}
	</ref> and in 2001, the ] stated that it was “the first legal restriction on Jewish religious practice in Europe since the Nazi era.”<ref>{{cite web
	| url = http://www.canadiancrc.com/articles/Jews_Protest_Swedish_Circumcision_Restriction_07JUN01.htm
	| title = Jews protest Swedish circumcision restriction
	| accessdate = 2006-10-18
	| author = ]
	| date = ], ]
	| publisher = Canadian Children's Rights Council
	| quote = A WJC spokesman said, ‘This is the first legal restriction placed on a Jewish rite in Europe since the Nazi era. This new legislation is totally unacceptable to the Swedish Jewish community.’
	}}
	</ref> However, in 2006, the United States State Department reported that most Jewish ]s had been certified under the law and 3000 Muslim and 40-50 Jewish boys were circumcised each
	year. The National Board of Health and Welfare reviewed the law in 2005 and recommended that it be maintained.<ref>{{cite web
	| url = http://www.state.gov/g/drl/rls/irf/2006/71410.htm
	| title = Sweden
	| accessdate = 2007-07-04
	| author = Bureau of Democracy, Human Rights, and Labor
	| date = ], ]
	| work = International Religious Freedom Report 2006
	| publisher = US Department of State
	}}
	</ref>
			====Other infections====
	==Pain and pain relief during circumcision==
			Studies evaluating the effect of circumcision on the rates of other sexually transmitted infections have, generally, found it to be protective. A 2006 meta-analysis found that circumcision was associated with lower rates of ], ], and possibly genital ].<ref name=weiss_2006_syphilis /> A 2010 review found that circumcision reduced the incidence of ]-2 (herpes simplex virus, type 2) infections by 28%.<ref name=wetmore_2010 /> The researchers found mixed results for protection against ] and ], and no evidence of protection against ] or syphilis.<ref name=wetmore_2010/> It may also possibly protect against syphilis in MSM.<ref name=templeton_2010 />
			===Phimosis, balanitis and balanoposthitis===
	Stang, 1998, found 45% of physicians used anaesthesia for infant circumcisions. Dorsal penile nerve block was the most commonly used. Obstetricians used anaesthesia significantly less often (25%) than pediatricians (71%) or family practitioners (56%).<ref name = "Stang">{{cite journal
			Phimosis is the inability to retract the foreskin over the glans penis.<ref name="hayashi_2011">{{cite journal | vauthors = Hayashi Y, Kojima Y, Mizuno K, Kohri K | title = Prepuce: phimosis, paraphimosis, and circumcision | journal = TheScientificWorldJournal | volume = 11 | pages = 289–301 | date = February 2011 | pmid = 21298220 | pmc = 5719994 | doi = 10.1100/tsw.2011.31 | doi-access = free }}</ref> At birth, the foreskin cannot be retracted due to ] between the foreskin and glans, and this is considered normal (physiological phimosis).<ref name="hayashi_2011"/> Over time the foreskin naturally separates from the glans, and a majority of boys are able to retract the foreskin by age three.<ref name="hayashi_2011"/> Less than one percent are still having problems at age 18.<ref name="hayashi_2011"/> If the inability to do so becomes problematic (pathological phimosis) circumcision is a treatment option.<ref name=lissauer_2012/><ref name=becker_2011/> This pathological phimosis may be due to scarring from the skin disease ] (BXO), repeated episodes of ] or forced retraction of the foreskin.<ref name=":1">{{cite journal | vauthors = Moreno G, Ramirez C, Corbalán J, Peñaloza B, Morel Marambio M, Pantoja T | title = Topical corticosteroids for treating phimosis in boys | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | pages = CD008973 | date = January 2024 | pmid = 38269441 | pmc = 10809033 | doi = 10.1002/14651858.CD008973.pub3 | pmc-embargo-date = January 25, 2025 }}</ref> ] creams are also a reasonable option and may prevent the need for surgery including in those with mild BXO.<ref name=":1" /><ref>{{cite journal | vauthors = Celis S, Reed F, Murphy F, Adams S, Gillick J, Abdelhafeez AH, Lopez PJ | title = Balanitis xerotica obliterans in children and adolescents: a literature review and clinical series | journal = Journal of Pediatric Urology | volume = 10 | issue = 1 | pages = 34–39 | date = February 2014 | pmid = 24295833 | doi = 10.1016/j.jpurol.2013.09.027 | doi-access = free }}</ref> The procedure may also be used to prevent the development of phimosis.<ref name=hay_2012/> Phimosis is also a complication that can result from circumcision.<ref name="Complications of circumcision">{{cite journal | vauthors = Krill AJ, Palmer LS, Palmer JS | title = Complications of circumcision | journal = TheScientificWorldJournal | volume = 11 | pages = 2458–2468 | date = 2011 | pmid = 22235177 | pmc = 3253617 | doi = 10.1100/2011/373829 | doi-access = free }}</ref>
	| last = Stang
	| first = Howard J.
	| coauthors = Leonard W. Snellman
	| year = 1998
	| month = June
	| title = Circumcision Practice Patterns in the United States
	| journal = ]
	| volume = 101
	| issue = 6
	| pages = e5&ndash;
	| doi = 10.1542/peds.101.6.e5
	| id = {{ISSN|1098-4275}}
	| url = http://pediatrics.aappublications.org/cgi/reprint/101/6/e5.pdf
	| format = PDF
	| accessdate = 2006-06-29
	}}
	</ref>
			An inflammation of the glans penis and foreskin is called balanoposthitis, and the condition affecting the glans alone is called ].<ref name=leber_2006/><ref name=osipov_2006/> Most cases of these conditions occur in uncircumcised males,<ref name=aridogan_2011/> affecting 4{{endash}}11% of that group.<ref name=hayashi_2011/> The moist, warm space underneath the foreskin is thought to facilitate the growth of pathogens, particularly when hygiene is poor. Yeasts, especially '']'', are the most common penile infection and are rarely identified in samples taken from circumcised males.<ref name=aridogan_2011/> Both conditions are usually treated with topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams.<ref name=leber_2006/><ref name=osipov_2006/> Circumcision is a treatment option for refractory or recurrent balanoposthitis, but in the twenty-first century the availability of the other treatments has made it less necessary.<ref name=leber_2006/><ref name=osipov_2006/>
	Taddio, 1997, showed that infants are affected by the pain of circumcision. It found a correlation between circumcision and intensity of pain response during ] months later. While the researchers stated that their results were speculative they recommended that "analgesia should be routine for circumcision" to avoid long-term effects in pain responses,<ref name = "Taddio">{{cite journal
	| last = Taddio
	| first = Anna
	| coauthors = Joel Katz, A Lane Ilersich, ]
	| year = 1997
	| month = March
	| title = Effect of neonatal circumcision on pain response during subsequent routine vaccination
	| journal = ]
	| volume = 349
	| issue = 9052
	| pages = 599&ndash;603
	| doi = 10.1016/S0140-6736(96)10316-0
	| id =
	| url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673696103160.pdf
	| format = PDF &mdash; free registration required
	| accessdate = 2006-07-01
	}}
	</ref> Taddio's paper was referred to in the American Academy of Pediatrics' 1999 Circumcision Policy Statement, which, for the first time recommended the use of pain relief for circumcision.
			===Urinary tract infections===
	J.M. Glass, 1999, stated that Jewish ritual circumcision, is so quick that "most ''mohelim'' do not routinely use any anaesthesia as they feel there is probably no need in the neonate. However, there is no Talmudic objection and should the parents wish for local anaesthetic cream to be applied there is no reason why this cannot be done."<ref>{{cite journal
			A UTI affects parts of the ] including the ], ], and ]s. There is about a one percent risk of UTIs in boys under two years of age, and the majority of incidents occur in the first year of life. There is good but not ] that circumcision of babies reduces the incidence of UTIs in boys under two years of age, and there is fair evidence that the reduction in incidence is by a factor of 3{{endash}}10 times (100 circumcisions prevents one UTI).<ref name=AAP_2012/><ref name="MorrisWiswell2013">{{cite journal | vauthors = Morris BJ, Wiswell TE | title = Circumcision and lifetime risk of urinary tract infection: a systematic review and meta-analysis | journal = The Journal of Urology | volume = 189 | issue = 6 | pages = 2118–2124 | date = June 2013 | pmid = 23201382 | doi = 10.1016/j.juro.2012.11.114 }}</ref>{{COI source|sure=yes|date=March 2023}}<ref name=jagannath_2012/> Circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects,<ref name=AAP_2012/> and may be used to treat recurrent UTIs.<ref name=lissauer_2012/>
	| last = Glass
	| first = J.M.
	| year = 1999
	| month = January
	| title = Religious circumcision: a Jewish view
	| journal = BJU International
	| volume = 83
	| issue = Supplement 1
	| pages = 17–21
	| doi = doi:10.1046/j.1464-410x.1999.0830s1017.x
	| id = PMID 10766529
	| url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1017.x
	| format = PDF
	| accessdate = 2007-04-25
	}}
	</ref> Tannenbaum and Shechet, 2000, stated that an “authentic, traditional ] performed by a ] does not use clamps, so there is no pain associated with crushing tissue.”<ref name = "Shechet">{{cite journal
	| last = Shechet
	| first = Jacob
	| coauthors = Barton Tanenbaum
	| year = 2000
	| title = Circumcision---The Debates Goes On
	| journal = ]
	| volume = 105
	| issue = 3
	| pages = 682–683
	| pmid = 10733391
	| doi = doi:10.1542/peds.105.3.681
	| url = http://pediatrics.aappublications.org/cgi/reprint/105/3/681.pdf
	| format = PDF
	| accessdate = 2007-04-06
	}}
	</ref> They also asserted that due to the speed of the procedure and rarity of complication, it is “more humane not to subject the infant to a local anesthetic.”<ref name = "Shechet" />
			There is a plausible biological explanation for the reduction in UTI risk after circumcision. The orifice through which urine passes at the tip of the penis (the ]) hosts more urinary system disease-causing bacteria in uncircumcised boys than in circumcised boys, especially in those under six months of age. As these bacteria are a risk factor for UTIs, circumcision may reduce the risk of UTIs through a decrease in the bacterial population.<ref name=AAP_2012/><ref name=jagannath_2012/>
	==Sexual Effects==
	{{main|Sexual effects of circumcision}}
			===Cancers===
	The American Academy of Pediatrics (1999) stated "a survey of adult males using self-report suggests more varied sexual practice and less sexual dysfunction in circumcised adult men. There are anecdotal reports that penile sensation and sexual satisfaction are decreased for circumcised males. ] noted no difference in exteroceptive and light tactile discrimination on the ventral or dorsal surfaces of the glans penis between circumcised and uncircumcised men."<ref name = "AAP1999" /> In January 2007, The American Academy of Family Physicians (AAFP) stated "The effect of circumcision on penile sensation or sexual satisfaction is unknown. Because the epithelium of a circumcised glans becomes cornified, and because some feel nerve over-stimulation leads to desensitization, many believe that the glans of a circumcised penis is less sensitive. Opinions differ about how this decreased sensitivity, which may result in prolonged time to orgasm, affects sexual satisfaction. An investigation of the exteroceptive and light tactile discrimination of the glans of circumcised and uncircumcised men found no difference on comparison. No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."<ref name = "AAFP" />
			Not being circumcised is the primary ] for ].<ref name=tpc>{{cite book |vauthors=Ottenhof SR, Bleeker MC, Heideman, DA, Snijders PJ, Meijer CJ, Horenblas S |chapter=Etiology of Penile Cancer |year=2016 |veditors=Muneer A, Horenblas S|title=Textbook of Penile Cancer |publisher=Springer |doi=10.1007/978-3-319-33220-8_2 |edition=2nd |pages=11–15 |isbn=978-3-319-33220-8}}</ref><ref>{{cite web |publisher=] |url=https://www.cancer.org/cancer/penile-cancer/causes-risks-prevention/risk-factors.html |title=Risk Factors for Penile Cancer |date=25 June 2018 |access-date=25 January 2023 |archive-date=25 July 2022 |archive-url=https://web.archive.org/web/20220725193031/https://www.cancer.org/cancer/penile-cancer/causes-risks-prevention/risk-factors.html |url-status=live }}</ref> Pre-adolescent circumcision has a strong protective effect against penile cancer in later life.<ref name="Thomas_2021" /> Penile cancer is a rare disease in the ] but much more prevalent in the ].<ref name="Thomas_2021" /> The penile tissue removed during circumcision is a potential origin for penile cancer.<ref>{{cite journal | vauthors = Hakenberg OW, Compérat EM, Minhas S, Necchi A, Protzel C, Watkin N | title = EAU guidelines on penile cancer: 2014 update | journal = European Urology | volume = 67 | issue = 1 | pages = 142–150 | date = January 2015 | pmid = 25457021 | doi = 10.1016/j.eururo.2014.10.017 | type = Practice guideline }}</ref> Risk-benefit considerations around the use of circumcision as a cancer-preventive measure are a source of debate.<ref name="tpc" />
			Penile cancer development can be detected in the carcinoma ''in situ'' (CIS) cancerous precursor stage and at the more advanced invasive squamous cell carcinoma stage.<ref name="AAP_2012" /> There is an association between adult circumcision and an increased risk of invasive penile cancer; this is believed to be from men being circumcised as a treatment for penile cancer or a condition that is a precursor to cancer rather than a consequence of circumcision itself.<ref name="larke_penile_cancer_2011" /> Penile cancer has been observed to be nearly eliminated in populations of males circumcised neonatally.<ref name="hayashi_2011" />
	Boyle ''et al.'' (2002) argued that circumcision and frenectomy remove tissues with "heightened erogenous sensitivity," stating "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings&mdash;many of which are lost to circumcision."<ref>{{cite web |url=http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1036&context=hss_pubs |title=Male circumcision: pain, trauma, and psychosexual sequelae |first=Gregory J |last=Boyle |coauthors=Svoboda, J Steven; Goldman, Ronald; Fernandez, Ephrem |publisher=Bond University Faculty of Humanities and Social Sciences |year=2002}}</ref>. They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."
			Important risk factors for penile cancer include phimosis and HPV infection, both of which are mitigated by circumcision.<ref name=larke_penile_cancer_2011/> The mitigating effect circumcision has on the risk factor introduced by the possibility of phimosis is secondary, in that the removal of the foreskin eliminates the possibility of phimosis. This can be inferred from study results that show uncircumcised men with no history of phimosis are equally likely to have penile cancer as circumcised men.<ref name=AAP_2012/><ref name=larke_penile_cancer_2011/> Circumcision is also associated with a reduced prevalence of cancer-causing types of HPV in men<ref name=rehmeyer_2011/> and a reduced risk of cervical cancer (which is caused by a type of HPV) in female partners of men.<ref name=hay_2012/>
	==Medical aspects==
	{{main|Medical analysis of circumcision}}
			There is some evidence that circumcision is associated with reduced risk of ].<ref name=prost>{{cite journal | vauthors = Morris BJ, Matthews JG, Pabalan N, Moreton S, Krieger JN | title = Male circumcision and prostate cancer: a meta-analysis revisited | journal = The Canadian Journal of Urology | volume = 28 | issue = 4 | pages = 10768–10776 | date = August 2021 | pmid = 34378513 | doi = | type = Meta-analysis }}</ref>
	The ], states that “there is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research.”<ref name = "BMAGuide" /> ] have varied. Some found a small net benefit,<ref>{{cite journal
	| last = Schoen
	| first = Edgar J.
	| coauthors = Christopher J. Colby, Trinh T. To
	| year = 2006
	| month = March
	| title = Cost Analysis of Neonatal Circumcision in a Large Health Maintenance Organization
	| journal = The Journal of Urology
	| volume = 175
	| issue = 3
	| pages = 1111&ndash;1115
	| doi = 10.1016/S0022-5347(05)00399-X
	| id = PMID 16469634
	| url = http://www.jurology.com/article/PIIS002253470500399X/abstract
	| format = Abstract
	| accessdate = 2006-07-01
	}}
	</ref><ref>{{cite journal
	| last = Alanis
	| first = Mark C.
	| coauthors = Richard S. Lucidi
	| year = 2004
	| month = May
	| title = Neonatal Circumcision: A Review of the World’s Oldest and Most Controversial Operation
	| journal = Obstetrical & Gynecological Survey
	| volume = 59
	| issue = 5
	| pages = 379-395
	| doi =
	| id = PMID 15097799
	| url = http://www.obgynsurvey.com/pt/re/obgynsurv/abstract.00006254-200405000-00026.htm;jsessionid=FbJT6LYnQxr66KhvWNsBW0msy7SHpJgL39wbFTGLnQpzJ82BGLVQ!1096339265!-949856144!8091!-1
	| format = Abstract
	| accessdate = 2006-09-27
	}}
	</ref> some found a small net decrement,<ref>{{cite journal
	| last = Van Howe
	| first = Robert S.
	| year = 2004
	| month = November
	| title = A Cost-Utility Analysis of Neonatal Circumcision
	| journal = Medical Decision Making
	| volume = 24
	| issue = 6
	| pages = 584&ndash;601
	| doi = 10.1177/0272989X04271039
	| id = PMID 15534340
	| url = http://mdm.sagepub.com/cgi/content/abstract/24/6/584
	| format = Abstract
	| accessdate = 2006-07-01
	}}
	</ref><ref>{{cite journal
	| last = Ganiats
	| first = TG
	| coauthors = Humphrey JB, Taras HL, Kaplan RM.
	| year = 1991
	| month = Oct&ndash;Dec
	| title = Routine neonatal circumcision: a cost-utility analysis
	| journal = Medical Decision Making
	| volume = 11
	| issue = 4
	| pages = 282&ndash;293
	| doi =
	| id = PMID 1766331
	| url =
	| format =
	| accessdate = 2006-07-01
	}}
	</ref> and one found that the benefits and risks of circumcision balanced each other out and suggested that the circumcision decision "most reasonably be made on nonmedical factors."<ref>{{cite journal
	| last = Lawler
	| first = FH
	| coauthors = Bisonni RS, Holtgrave DR.
	| year = 1991
	| month = Nov&ndash;Dec
	| title = Circumcision: a decision analysis of its medical value.
	| journal = Family Medicine
	| volume = 23
	| issue = 8
	| pages = 587&ndash;593
	| doi =
	| id = PMID 1794670
	| url =
	| format =
	| accessdate = 2006-07-01
	}}
	</ref>
	===Risks of circumcision===		=== Women's health ===
			A 2017 systematic review found consistent evidence that male circumcision prior to heterosexual contact was associated with a decreased risk of cervical cancer, ], HSV-2, chlamydia, and syphilis among women. The evidence was less consistent in regards to the potential association of circumcision with women's risk of HPV and HIV.<ref>{{cite journal | vauthors = Grund JM, Bryant TS, Jackson I, Curran K, Bock N, Toledo C, Taliano J, Zhou S, Del Campo JM, Yang L, Kivumbi A, Li P, Pals S, Davis SM | title = Association between male circumcision and women's biomedical health outcomes: a systematic review | journal = The Lancet. Global Health | volume = 5 | issue = 11 | pages = e1113–e1122 | date = November 2017 | pmid = 29025633 | pmc = 5728090 | doi = 10.1016/S2214-109X(17)30369-8 }}</ref>
	While the risk in a competently performed medical circumcision is very low,<ref name="UWstudy">{{cite journal
	| last = Christakis
	| first = Dmitry A.
	| coauthors = Eric Harvey, Danielle M. Zerr, Chris Feudtner, Jeffrey A. Wright, and Frederick A. Connell
	| year = 2000
	| month = January
	| title = A Trade-off Analysis of Routine Newborn Circumcision
	| journal = Pediatrics
	| volume = 105
	| issue = 1
	| pages = 246&ndash;249
	| doi = 10.1542/peds.105.1.S2.246
	| id = PMID 10617731
	| url = http://pediatrics.aappublications.org/cgi/reprint/105/1/S2/246
	| format = PDF
	| accessdate = 2006-07-01
	}}
	</ref> the complications from bleeding, infection and poorly carried out circumcisions can be catastrophic.<ref>{{cite journal
	| last = Ahmed A,
	| first = A
	| coauthors = Mbibi NH, Dawam D, Kalayi GD
	| year = 1999
	| month = March
	| title = Complications of traditional male circumcision
	| journal = Annals of Tropical Paediatrics
	| volume = 19
	| issue = 1
	| pages = 113&ndash;117
	| doi =
	| id = PMID 10605531 {{ISSN|0272-4936}}
	| url =
	| format =
	| accessdate = 2006-07-01
	}}
	</ref> According to the AMA, ] and ] are the most common complications. Bleeding is mostly minor; applying pressure will stop it.<ref name = "CSA:I-99" /> Kaplan identified other complications, including urinary ], ], ]s, ], ] of the glans, ] of all or part of the penis, ], ], ] and removal of too much tissue, sometimes causing secondary ]. He stated “Virtually all of these complications are preventable with only a modicum of care. Unfortunately, most such complications occur at the hands of inexperienced operators who are neither urologists nor surgeons.”<ref name="kaplan">{{cite journal
	| last = Kaplan
	| first = George W., M.D.
	| coauthors =
	| year = 1983
	| month = August
	| title = Complications of Circumcision
	| journal = UROLOGIC CLINICS OF NORTH AMERICA
	| volume = 10
	| issue = 3
	| pages = 543&ndash;549
	| id =
	| url = http://www.cirp.org/library/complications/kaplan/
	| format = HTML
	| accessdate = 2006-09-29
	}}
	</ref> ]<!-- Image is at http://en.wikipedia.org/Image:Flaccid-erect.jpg in case the tag needs an administrator's touch. --> Infant circumcision may result in skin bridges, when the cut skin does not heal neatly but attaches to the ] instead. This does not commonly require surgical correction; rather, a brief, simple office procedure may be performed.<ref>{{cite journal
	| last = Naimer
	| first = Sody A.
	| coauthors = Roni Peleg, Yevgeni Meidvidovski, Alex Zvulunov, Arnon Dov Cohen, and Daniel Vardy
	| year = 2002
	| month = November
	| title = Office Management of Penile Skin Bridges with Electrocautery
	| journal = Journal of the American Board of Family Practice
	| volume = 15
	| issue = 6
	| pages = 485&ndash;488
	| id = PMID 10605531
	| url = http://www.jabfm.org/cgi/reprint/15/6/485
	| format = PDF
	| accessdate = 2006-07-01
	}}
	</ref>
			===Sexual effects===
	The ] quotes a complication rate of 0.2%–0.6%,<ref name = "CSA:I-99" /> based on the studies of Gee<ref>{{cite journal
			The accumulated data show circumcision does not have an adverse physiological effect on sexual pleasure, function, desire, or fertility.<ref name=bless>{{cite journal | vauthors = Bañuelos Marco B, García Heil JL | title = Circumcision in childhood and male sexual function: a blessing or a curse? | journal = International Journal of Impotence Research | volume = 33 | issue = 2 | pages = 139–148 | date = March 2021 | pmid = 32994555 | pmc = 7985026 | doi = 10.1038/s41443-020-00354-y }}</ref><ref name="sexual_function">The American Academy of Pediatrics Task Force on Circumcision "Technical Report" (2012) addresses sexual function, sensitivity and satisfaction without qualification by age of circumcision. Sadeghi-Nejad ''et al.'' "Sexually transmitted diseases and sexual function" (2010) addresses adult circumcision and sexual function. Doyle ''et al.'' "The Impact of Male Circumcision on HIV Transmission" (2010) addresses adult circumcision and sexual function. Perera ''et al.'' "Safety and efficacy of nontherapeutic male circumcision: a systematic review" (2010) addresses adult circumcision and sexual function and satisfaction.
	| last = Gee
	| first = W.F.
	| coauthors = J.S. Ansell
	| year = 1976
	| month = December
	| title = Neonatal circumcision: a ten-year overview: with comparison of the Gomco clamp and the Plastibell device
	| journal = Pediatrics
	| volume = 58
	| issue = 6
	| pages = 824&ndash;827
	| doi =
	| id = PMID 995507
	| url = http://pediatrics.aappublications.org/cgi/content/abstract/58/6/824
	| format = Abstract
	| accessdate = 2006-07-11
	}}
	</ref> and Harkavy.<ref>{{cite journal
	| last = Harkavy
	| first = K.L.
	| year = 1987
	| month = April
	| title = The circumcision debate
	| journal = Pediatrics
	| volume = 79
	| issue = 4
	| pages = 649&ndash;650
	| doi =
	| id = PMID 3822689
	| url =
	| format = Pubmed Entry
	| accessdate = 2006-07-11
	}}
	</ref> These same studies are quoted by the ].<ref name = "AAP1999" /> The ] quotes a range of anywhere between 0.1% and 35%.<ref name = "AAFP">{{cite web
	| url = http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html
	| title = Circumcision: Position Paper on Neonatal Circumcision
	| accessdate = 2007-01-30
	| year = 2007
	| publisher = ]
	}}
	</ref> The ] cite these results in addition to other figures ranging anywhere between 0.06% to 55%, and remark that Williams & Kapila<ref>{{cite journal
	| last = Williams
	| first = N
	| coauthors = L. Kapila
	| year = 1993
	| month = October
	| title = Complications of circumcision
	| journal = British Journal of Surgery
	| volume = 80
	| issue = 10
	| pages = 1231&ndash;1236
	| doi = 10.1002/bjs.1800801005
	| id = PMID 8242285
	| url = http://www.bjs.co.uk/bjsCda/cda/microJournalArticleDetail.do;jsessionid=96BD3288E9BFA69C74CC1737D0AA6B90?DOI=10.1002%2Fbjs.1800801005&issueDOI=10.1002%2Fbjs.v80%3A10&vid=2
	| format = Abstract
	| accessdate = 2006-07-11
	}}
	</ref> suggested that 2-10% is a realistic estimate.<ref name = "CMAJ" /> ] may be a common longer-term complication from circumcision. Recent publications give a frequency of occurrence between 0.9%<ref>{{cite journal
	| last = Yegane
	| first = Rooh-Allah
	| coauthors = Abdol-Reza Kheirollahi, Nour-Allah Salehi, Mohammad Bashashati, Jamal-Aldin Khoshdel, and Mina Ahmadi
	| year = 2006
	| month = May
	| title = Late complications of circumcision in Iran
	| journal = Pediatric Surgery International
	| volume = 22
	| issue = 5
	| pages = 442&ndash;445
	| doi = 10.1007/s00383-006-1672-1
	| id = PMID 16649052
	| url = http://www.springerlink.com/(qzpwjv55lf23wj454qsmor45)/app/home/contribution.asp?referrer=parent&backto=issue,9,19;journal,4,147;linkingpublicationresults,1:101176,1
	| format = Abstract
	| accessdate = 2006-07-02
	}}
	</ref> and 9% to 10%.<ref>{{cite web
	| url = http://www.emedicine.com/PED/topic2356.htm
	| title = http://www.emedicine.com/PED/topic2356.htm
	| accessdate = 2006-07-02
	| last = Angel
	| first = Carlos A.
	| date = ], ]
	| work = eMedicine
	| publisher = WebMD
	}}
	</ref> The RACP states that the penis is lost in 1 in 1,000,000 circumcisions.<ref name = "RACPComp">{{cite web
	| url = http://www.racp.edu.au/hpu/paed/circumcision/complications.htm
	| title = Complications Of Circumcision
	| accessdate = 2006-07-11
	| year = 2004
	| month = October
	| work = Paediatric Policy - Circumcision
	| publisher = The Royal Australasian College of Physicians
	}}
	</ref>
			* {{cite journal | vauthors = Dave S, Afshar K, Braga LH, Anderson P | title = Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version) | journal = Canadian Urological Association Journal | volume = 12 | issue = 2 | pages = E76–E99 | date = February 2018 | pmid = 29381458 | pmc = 5937400 | doi = 10.5489/cuaj.5033 | quote = There is lack of any convincing evidence that neonatal circumcision will impact sexual function or cause a perceptible change in penile sensation in adulthood. }}
	Deaths have been reported.<ref name="kaplan"/> <ref>{{cite web
			* {{cite journal | vauthors = Shabanzadeh DM, Düring S, Frimodt-Møller C | title = Male circumcision does not result in inferior perceived male sexual function - a systematic review | journal = Danish Medical Journal | volume = 63 | issue = 7 | date = July 2016 | pmid = 27399981 | type = Systematic review }}
	| url = http://www.pulsus.com/Paeds/12_04/Pdf/zwol_ed.pdf
			* {{cite journal | vauthors = Friedman B, Khoury J, Petersiel N, Yahalomi T, Paul M, Neuberger A | title = Pros and cons of circumcision: an evidence-based overview | journal = Clinical Microbiology and Infection | volume = 22 | issue = 9 | pages = 768–774 | date = September 2016 | pmid = 27497811 | doi = 10.1016/j.cmi.2016.07.030 | doi-access = free }}
	| title = Coroner's Corner Circumcision: A minor procedure?
			*{{Cite web |last=Staff |title=Statement on Newborn Male Circumcision |url=https://www.acog.org/en/womens-health/faqs/newborn-male-circumcision |access-date=March 21, 2023 |website=] |language=en |quote=Some parents also may worry that circumcision harms a man's sexual function, sensitivity, or satisfaction. However, current evidence shows that it does not. |archive-date=21 March 2023 |archive-url=https://web.archive.org/web/20230321004554/https://www.acog.org/en/womens-health/faqs/newborn-male-circumcision |url-status=live }}
	| author = Paediatric Death Review Committee: Office of the Chief Coroner of Ontario
			* {{cite journal | vauthors = Shezi MH, Tlou B, Naidoo S | title = Knowledge, attitudes and acceptance of voluntary medical male circumcision among males attending high school in Shiselweni region, Eswatini: a cross sectional study | journal = BMC Public Health | volume = 23 | issue = 1 | pages = 349 | date = February 2023 | pmid = 36797696 | pmc = 9933013 | doi = 10.1186/s12889-023-15228-3 | quote = It was interesting to note that the young males in this study had misconceptions about sexual pleasure post male circumcision... | doi-access = free }}
	| accessdate = 2007-06-17
			* {{cite journal | vauthors = Sorokan ST, Finlay JC, Jefferies AL | title = Newborn male circumcision | journal = Paediatrics & Child Health | volume = 20 | issue = 6 | pages = 311–320 | date = September 8, 2015 | pmid = 26435672 | pmc = 4578472 | doi = 10.1093/pch/20.6.311 | quote = ...medical studies do not support circumcision as having a negative impact on sexual function or satisfaction in males or their partners. }}
	| year = 2007
			* {{cite web |last1=World Health Organization |last2=UNAIDS |last3=Jhpiego |date=December 2009 |title=Manual for Male Circumcision Under Local Anaesthesia |url=https://www.who.int/hiv/pub/malecircumcision/who_mc_local_anaesthesia.pdf |archive-url=https://web.archive.org/web/20120115175057/http://www.who.int/hiv/pub/malecircumcision/who_mc_local_anaesthesia.pdf |archive-date=January 15, 2012 |publisher= |quote=...there are many myths about male circumcision that circulate. For example, some people think that circumcision can cause impotence (failure of erection) or reduce sexual pleasure. Others think that circumcision will cure impotence. Let me assure you that none of these is true. |author1-link=World Health Organization |author2-link=UNAIDS |author3-link=Jhpiego }} {{Webarchive|url=https://web.archive.org/web/20230330035156/https://www.scribd.com/document/186396682/Who-Mc-Local-Anaesthesia |date=30 March 2023 }}</ref> There is some evidence that circumcision has no effect on ], ], ], ] or difficulties with ].<ref name=Tian2013>{{cite journal | vauthors = Tian Y, Liu W, Wang JZ, Wazir R, Yue X, Wang KJ | title = Effects of circumcision on male sexual functions: a systematic review and meta-analysis | journal = Asian Journal of Andrology | volume = 15 | issue = 5 | pages = 662–666 | date = September 2013 | pmid = 23749001 | pmc = 3881635 | doi = 10.1038/aja.2013.47 | type = Systematic review }}</ref>
	| month = April
	| work = Paediatric Child Health Vol 12 No 4, April 2007 pages 311-312
	| publisher = Pulsus Group Inc.
	}}
	</ref>
	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.<ref name = "AAFP" /> Gairdner's 1949 study reported that an average of 16 children per year out of about 90,000 died following circumcision in the ]. 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.<ref name = "Gairdner">{{cite journal
	| last = Gairdner
	| first = Douglas
	| year = 1949
	| month = December
	| title = The Fate of the Foreskin
	| journal = British Medical Journal
	| volume = 2
	| issue = 4642
	| pages = 1433&ndash;1437
	| doi =
	| id =
	| url = http://www.cirp.org/library/general/gairdner/
	| format =
	| accessdate = 2006-07-01
	}}
	</ref>
			According to a 2014 review, the effect of circumcision on sexual partners' experiences is unclear as this has not been well studied.<ref name="bossio_2014" /> According to a policy statement from the ] that was reaffirmed in 2021,<ref>{{Cite web |title=Newborn male circumcision | work = Canadian Paediatric Society |url=https://cps.ca/en/documents/position/circumcision |access-date=2023-04-10 |language=en |archive-date=11 April 2023 |archive-url=https://web.archive.org/web/20230411220045/https://cps.ca/en/documents/position/circumcision |url-status=live }}</ref> "medical studies do not support circumcision as having an impact on sexual function or satisfaction for partners of circumcised individuals".<ref name="sexual_function" />
	Lander ''et al.'', found that babies circumcised without pain relief "exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the circumcision and following. Two newborns ... became ill following circumcision (choking and apnea)." A 2004 Cochrane review, which compared the dorsal penile nerve block and EMLA (topical anaesthesia) found both anaesthetics appear safe, but neither of them completely eliminated pain.<ref>{{cite journal | last = Brady-Fryer | first = B | coauthors = Wiebe N, Lander JA | year = 2004 | month = July | title = Pain relief for neonatal circumcision | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = Art. No.: CD004217 | doi = 10.1002/14651858.CD004217.pub2 | id = PMID 15495086 | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15495086&query_hl=2&itool=pubmed_docsum | format = | accessdate = 2006-06-29 }} </ref> Razmus et al reported that newborns circumcised with the dorsal block and the ring block in combination with the concentrated oral sucrose had the lowest pain scores.<ref>{{cite journal |author=Razmus I, Dalton M, Wilson D |title=Pain management for newborn circumcision |journal=Pediatr Nurs |volume=30 |issue=5 |pages=414-7, 427 |year= |id=PMID 15587537}}</ref> Ng ''et al'' found that EMLA cream, in addition to local anaesthetic, effectively reduces the sharp pain induced by needle puncture.<ref>{{cite journal |first=WT |last=Ng |coauthors=''et al''|title=The use of topical lidocaine/prilocaine cream prior to childhood circumcision under local anesthesia |journal=Ambul Surg |volume=9 |issue=1 |pages=9-12 |year=2001 |id=PMID 11179706}}</ref>
			There are popular misconceptions that circumcision benefits or adversely impacts the sexual pleasure of the circumcised person.<ref name="sexual_function" />
	Adult circumcisions are often performed without clamps, and require 4 to 6 weeks of abstinence from masturbation or intercourse after the operation to allow the wound to heal.<ref name="aafpadult" />
	===HIV===		==Adverse effects==
			Neonatal circumcision is generally a safe, low-risk procedure when done by an experienced practitioner.<ref>{{cite journal | vauthors = Friedman B, Khoury J, Petersiel N, Yahalomi T, Paul M, Neuberger A | title = Pros and cons of circumcision: an evidence-based overview | journal = Clinical Microbiology and Infection | volume = 22 | issue = 9 | pages = 768–774 | date = September 2016 | pmid = 27497811 | doi = 10.1016/j.cmi.2016.07.030 | doi-access = free }}</ref><ref name=AUA_2007/><ref name="KrillPalmer2011"/>
	Population based studies suggested that circumcision may protect against HIV but factors such as religion may have skewed the results. In March 2005, the Cochrane review of the medical evidence found the evidence at that point "insufficient" to consider implementing circumcision "as a public-health intervention" but the positive results of observational studies suggested that circumcision was "worth evaluating in randomised controlled trials.”<ref name="Sig">{{cite journal
	| last = Siegfried
	| first = N
	| coauthors = M Muller, J Deeks, J Volmink, M Egger, N Low, S Walker, and P Williamson
	| year = 2005
	| month = March
	| title = HIV and male circumcision—a systematic review with assessment of the quality of studies
	| journal = The Lancet Infectious Diseases
	| volume = 5
	| issue = 3
	| pages = 165&ndash;173
	| doi = 10.1016/S1473-3099(05)01309-5
	| id = PMID 15766651
	| url = http://download.thelancet.com/pdfs/journals/1473-3099/PIIS1473309905013095.pdf
	| format = PDF &mdash; free registration required
	| accessdate = 2007-07-09
	}}
	</ref>
			The most common acute ] are bleeding, infection and the removal of either too much or too little foreskin.<ref name="AAP_2012" /><ref name="AAFP_2013" /> These complications occur in approximately 0.13% of procedures, with bleeding being the most common acute complication in the United States.<ref name="AAFP_2013" /><!-- Quote = Acute complications can include bleeding (0.8-1.8/1,000), infection (6/10,000), and injury to the penis (4/10,000). --> Minor complications are reported to occur in three percent of procedures.<ref name="AUA_2007" /> Severe complications are rare.<ref name="Complications of circumcision" /> A specific complication rate is difficult to determine due to scant data on complications and inconsistencies in their classification.<ref name="AAP_2012" /> Complication rates are greater when the procedure is performed by an inexperienced operator, in unsterile conditions, or when the child is at an older age.<ref name="weiss_2010_complications" /> Significant acute complications happen rarely,<ref name="AAP_2012" /><ref name="weiss_2010_complications" /> occurring in about 1 in 500 newborn procedures in the United States.<ref name="AAP_2012" /> Severe to catastrophic complications, including death, are so rare that they are reported only as individual case reports.<ref name="AAP_2012" /><ref name="KrillPalmer2011" /> Where a Plastibell device is used, the most common complication is the retention of the device occurring in around 3.5% of procedures.<ref name="Selekman-2020" /> Other possible complications include ], ], phimosis, ]s, urethral fistulas, and ].<ref name="KrillPalmer2011" /> These complications may be partly avoided with proper technique, and are often treatable without requiring surgical revision.<ref name="KrillPalmer2011">{{cite journal | vauthors = Krill AJ, Palmer LS, Palmer JS | title = Complications of circumcision | journal = TheScientificWorldJournal | volume = 11 | pages = 2458–2468 | year = 2011 | pmid = 22235177 | pmc = 3253617 | doi = 10.1100/2011/373829 | doi-access = free }}</ref> The most common long-term complication is meatal stenosis, this is almost exclusively seen in circumcised children, it is thought to be caused by ammonia producing bacteria coming into contact with the meatus in circumcised infants.<ref name="Selekman-2020" /> It can be treated by ].<ref name="Selekman-2020" />
	Three recent studies indicate that circumcision is correlated with a 50-60% reduction in risk of HIV transmission (from female to male) during heterosexual intercourse.<ref>{{cite web | url = http://www.who.int/mediacentre/news/statements/2007/s04/en/index.html | title = WHO and UNAIDS Secretariat welcome corroborating findings of trials assessing impact of male circumcision on HIV risk | accessdate = 2007-02-23 | date = ], ] | publisher = World Health Organization}}</ref> The results of the first randomised controlled trial were published in November 2005. It found a 60% reduction in the rate of new HIV infection (from 2.1 per 100 to 0.85 per 100 in the intervention group. The authors said, “Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa.”<ref name = "ANRS" /> Two further randomised trials conducted in Uganda and Kenya were stopped early on December 13, 2006 on grounds that circumcision was so effective that it would be unethical to continue the experiment and not offer circumcision in the uncircumcised men who were acting as controls. The results showed that circumcised males in Uganda were, depending upon the analysis, 51%-60% less likely to be infected.<ref name="grayrct" /> In Kenya, circumcised males were 53%-60% less likely to be infected.<ref name="baileyrct" /> A paper published in the journal ] in July, 2006, calculated that if all men in sub-Saharan Africa were circumcised over the next 10 years, two million new infections could potentially be avoided.<ref name = "PLoS-7-06">{{cite journal
	| last = Williams
	| first = Brian G.
	| authorlink =
	| coauthors = James O. Lloyd-Smith, Eleanor Gouws, Catherine Hankins, Wayne M. Getz, John Hargrove, Isabelle de Zoysa, Christopher Dye, Bertran Auvert
	| year = 2006
	| month = July
	| title = The Potential Impact of Male Circumcision on HIV in Sub-Saharan Africa
	| journal = ]
	| volume = 3
	| issue = 7
	| pages = e262
	| doi = 10.1371/journal.pmed.0030262
	| id = PMID 16822094
	| url = http://medicine.plosjournals.org/archive/1549-1676/3/7/pdf/10.1371_journal.pmed.0030262-p-L.pdf
	| format = PDF
	| accessdate = 2006-07-13
	}}
	</ref>
			Effective pain management should be used during the procedure.<ref name="AAP_2012" /> Inadequate pain relief may carry the risks of heightened pain response for newborns.<ref name=perera_2010/> Newborns that experience pain due to being circumcised have different responses to vaccines given afterwards, with higher pain scores observed.<ref>{{cite journal | vauthors = Sorokan ST, Finlay JC, Jefferies AL | title = Newborn male circumcision | journal = Paediatrics & Child Health | volume = 20 | issue = 6 | pages = 311–320 | date = 8 September 2015 | pmid = 26435672 | pmc = 4578472 | doi = 10.1093/pch/20.6.311 | url = http://www.cps.ca/documents/position/circumcision | url-status = live | archive-url = https://web.archive.org/web/20160118224324/http://www.cps.ca/documents/position/circumcision | archive-date = 18 January 2016 }}</ref> For adult men who have been circumcised, there is a risk that the ] may be tender.<ref name="crit">{{cite journal | vauthors = Morris BJ, Moreton S, Krieger JN | title = Critical evaluation of arguments opposing male circumcision: A systematic review | journal = Journal of Evidence-Based Medicine | volume = 12 | issue = 4 | pages = 263–290 | date = November 2019 | pmid = 31496128 | pmc = 6899915 | doi = 10.1111/jebm.12361 | type = Systematic review }}</ref> There is no good evidence that circumcision affects cognitive abilities.<ref name="nhs">{{cite web |date=22 February 2016 |title=Circumcision in men |url=https://www.nhs.uk/conditions/circumcision-in-men/ |publisher=National Health Service |access-date=30 October 2018 |archive-date=29 June 2020 |archive-url=https://web.archive.org/web/20200629155854/https://www.nhs.uk/conditions/circumcision-in-men/ |url-status=live }}</ref>
	The World Health Organization (WHO) said: “Although these results demonstrate that male circumcision reduces the risk of men becoming infected with HIV, the UN agencies emphasize that it does not provide complete protection against HIV infection. Circumcised men can still become infected with the virus and, if HIV-positive, can infect their sexual partners. Male circumcision should never replace other known effective prevention methods and should always be considered as part of a comprehensive prevention package, which includes correct and consistent use of male or female condoms, reduction in the number of sexual partners, delaying the onset of sexual relations, and HIV testing and counselling.”.<ref>{{cite web
	| url = http://www.who.int/mediacentre/news/statements/2007/s04/en/index.html
	| title = WHO and UNAIDS Secretariat welcome corroborating findings of trials assessing impact of male circumcision on HIV risk
	| accessdate = 2007-02-23
	| date = ], ]
	| publisher = World Health Organization
	}}
	</ref> Others have also expressed concern that some may mistakenly believe they will be fully protected against HIV through circumcision and see circumcision as a safe alternative to other forms of protection, such as condoms.<ref>{{cite web
	| url = http://www.who.int/mediacentre/news/statements/2006/s18/en/index.html
	| title = Male circumcision reduces the risk of becoming infected with HIV, but does not provide complete protection
	| accessdate = 2006-07-20
	| date = ], ]
	| publisher = World Health Organization
	}}
	</ref><ref>{{cite web
	| url = http://news.bbc.co.uk/2/hi/health/4371384.stm
	| title = Circumcision 'reduces HIV risk'
	| date = ], ]
	| publisher = BBC News
	}}
	</ref> An interim analysis from the Rakai Health Sciences Program in Uganda suggested that newly circumcised HIV positive men may be more likely to spread HIV to their female partners if they have sexual intercourse before the wound is fully healed. “Because the total number of men who resumed sex before certified wound healing is so small, the finding of increased transmission after surgery may have occurred by chance alone. However, we need to err on the side of caution to protect women in the context of any future male circumcision programme,” said Dr Maria Wawer, the study's principal investigator. <ref>{{cite web
	| url =http://www.aidsmap.com/en/news/3CBF12A3-A1AC-4A0E-A79C-54FC6EF93E28.asp
	| author = Virginia Differding
	| title = Women may be at heightened risk of HIV infection immediately after male partner is circumcised
	| accessdate = 2007-03-14
	| date = ], ]
	| publisher = Aidsmap News}}
	</ref>
			==History==
	There is also a danger of HIV being spread from unhygienic circumcision procedures. Brewer ''et al.'' studied HIV infection rates in Kenya, Lethotho and Tanzania and found that " male and female virgins were substantially more likely to be HIV infected than uncircumcised virgins. Among adolescents, regardless of sexual experience, circumcision was just as strongly associated with prevalent HIV infection. However, uncircumcised adults were more likely to be HIV positive than circumcised adults." The authors concluded, "HIV transmission may occur through circumcision-related blood exposures in eastern and southern Africa."<ref>{{cite journal | last = Brewer | first= Devon | year = 2007| month= February | title = Male and Female Circumcision Associated with Prevalent HIV Infection in Virgins and Adolescents in Kenya, Lesotho, and Tanzania | journal = Annals of Epidemiology | volume = 17 | issue = 3| pages = pp.217-226 | url = http://www.annalsofepidemiology.org/article/PIIS1047279706002651/abstract| accessdate = 2007-03-04| quote = <small> (Kenyan females: 3.2% vs. 1.4%, odds ratio = 2.38; Kenyan males: 1.8% vs. 0%, OR undefined; Lesothoan males: 6.1% vs. 1.9%, OR 3.36; Tanzanian males: 2.9% vs. 1.0%, OR 2.99; weighted mean phi correlation = 0.07, 95% confidence interval, 0.03 to 0.11).</small>}}</ref>
			{{Main|History of circumcision}}
			{{Undue weight section|date=November 2023}}
			]
	On March 28, 2007, the ] and ] issued joint recommendations about male circumcision and HIV/AIDS.<ref name="WHOpr0307">{{cite web |title=WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention |publisher=World Health Organisation |month=March |year=2007 |url=http://www.who.int/hiv/mediacentre/news68/en/index.html}}</ref> These are:
			Circumcision is the oldest known surgical procedure.<ref name=":0">{{cite book | vauthors = Cox G, Morris BJ |title=Surgical Guide to Circumcision |publisher=Springer Science & Business Media |year=2012 |isbn=978-1-4471-2858-8 | veditors = Bolnick D, Koyle M, Yosha A |chapter=Why Circumcision? From Prehistory to the Twenty-First Century |pages=243–244}}</ref> Depictions of circumcised penises are found in ],<ref>{{cite journal | vauthors = Angulo JC, García-Díez M | title = Male genital representation in paleolithic art: erection and circumcision before history | journal = Urology | volume = 74 | issue = 1 | pages = 10–14 | date = July 2009 | pmid = 19395004 | doi = 10.1016/j.urology.2009.01.010 | url = https://www.sciencedirect.com/science/article/pii/S0090429509000831 | access-date = 7 February 2024 | url-status = live | hdl-access = free | archive-date = 10 November 2011 | archive-url = https://web.archive.org/web/20111110225228/http://www.sciencedirect.com/science/article/pii/S0090429509000831 | hdl = 10400.26/23819 }}</ref> predating the earliest signs of ].<ref name=":0" /><ref>{{cite journal | vauthors = Faria MA | title = Neolithic trepanation decoded- A unifying hypothesis: Has the mystery as to why primitive surgeons performed cranial surgery been solved? | journal = Surgical Neurology International | volume = 6 | pages = 72 | date = 2015-05-07 | pmid = 25984386 | pmc = 4427816 | doi = 10.4103/2152-7806.156634 | doi-access = free }}</ref>
			The history of the migration and evolution of circumcision is known mainly from the cultures of two regions. In the lands south and east of the Mediterranean, starting with Central Sahara, Sudan and Ethiopia, the procedure was practiced by the ]ians and the ], and then by the Jews and Muslims. In Oceania, circumcision is practiced by the ] and ].<ref name="gollaher_2001_ch1" /> There is also evidence that circumcision was practiced among the ] and ] civilizations in the Americas,<ref name="WHO_2007_GTDPSA" /> but little is known about that history.<ref name="Doy2005" /><ref name="alanis_2004" />
	* Male circumcision should now be recognized as an efficacious intervention for HIV prevention.
	* Promoting male circumcision should be recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men.<ref name="WHOrec0307">{{cite web |title=New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications |publisher=World Health Organisation |year=2007 |month=March |url=http://www.who.int/entity/hiv/mediacentre/MCrecommendations_en.pdf}}</ref>
			It has been speculated that circumcision originated as a substitute for ] of defeated enemies or as a ].<ref name="alanis_2004" /> In many traditions, it acts as a ] marking a boy's entrance into ]hood.<ref name="alanis_2004" />
	====Langerhans cells and HIV transmission====
	] are part of the human immune system. Three studies identified high concentrations of Langerhans and other "HIV target" cells in the foreskin<ref>{{cite journal
	| last = Hussain LA
	| first = LA
	| authorlink =
	| coauthors = T. Lehner
	| year = 1995
	| month = July
	| title = Comparative investigation of Langerhans' cells and potential receptors for HIV in oral, genitourinary and rectal epithelia
	| journal = Immunology
	| volume = 85
	| issue = 3
	| pages = 475&ndash;484
	| doi =
	| id = PMID 7558138
	| url =
	| format = Abstract
	| accessdate = 2006-07-09
	}}
	</ref><ref>{{cite journal
	| last = Patterson
	| first = Bruce K.
	| authorlink =
	| coauthors = Alan Landay, Joan N. Siegel, Zareefa Flener, Dennis Pessis, Antonio Chaviano, and Robert C. Bailey
	| year = 2002
	| month =
	| title = Susceptibility to Human Immunodeficiency Virus-1 Infection of Human Foreskin and Cervical Tissue Grown in Explant Culture
	| journal = American Journal of Pathology
	| volume = 161
	| issue = 3
	| pages = 867&ndash;873
	| doi =
	| id = PMID 12213715
	| url = http://ajp.amjpathol.org/cgi/reprint/161/3/867.pdf
	| format = PDF
	| accessdate = 2006-07-09
	}}
	</ref><ref>{{cite journal
	| last = Donoval
	| first = BA
	| authorlink =
	| coauthors = AL Landay, S Moses, K Agot, JO Ndinya-Achola, EA Nyagaya, I MacLean, and RC Bailey
	| year = 2006
	| month = March
	| title = HIV-1 target cells in foreskins of African men with varying histories of sexually transmitted infections
	| journal = American Journal of Clinical Pathology
	| volume = 125
	| issue = 3
	| pages = 386&ndash;391
	| doi = 10.1309/JVHQ-VDJD-YKM5-8EPH
	| id = PMID 16613341
	| url = http://ajcp.metapress.com/link.asp?id=jvhqvdjdykm58eph
	| format = Abstract
	| accessdate = 2006-07-09
	}}
	</ref> and Szabo and Short suggested that the Langerhans cells in the foreskin may provide an entry point for viral infection.<ref name = "Szabo">{{cite journal
	| last = Szabo
	| first = Robert
	| coauthors = Roger V. Short
	| year = 2000
	| month = June
	| title = How does male circumcision protect against HIV infection?
	| journal = BMJ
	| volume = 320
	| issue = 7249
	| pages = 1592&ndash;1594
	| doi = 10.1136/bmj.320.7249.1592
	| id = PMID 10845974
	| url = http://bmj.bmjjournals.com/cgi/reprint/320/7249/1592
	| format = PDF
	| accessdate = 2006-07-09
	}}
	</ref> McCoombe, Cameron, and Short also found that the keratin is thinnest on the foreskin and frenulum.<ref>{{cite paper
	|author= McCoombe SG, Cameron PU, Short RV
	|date= ], ]
	|url= http://www.aegis.com/conferences/iac/2002/WePeA5739.html
	|format= Abstract
	|title= The distribution of HIV-1 target cells and keratin in the human penis.
	|publisher= International AIDS Society
	|version=
	|accessdate= 2006-07-09
	}}
	</ref> Fleiss, Hodges and Van Howe had previously stated a belief that the prepuce has an immunological function.<ref name=Fleiss>{{cite journal
	| last = Fleiss
	| first = PM
	| authorlink =
	| coauthors = FM Hodges, RS Van Howe
	| year = 1998
	| month = October
	| title = Immunological functions of the human prepuce
	| journal = Sexually Transmitted Infections
	| volume = 74
	| issue = 5
	| pages = 364&ndash;367
	| doi =
	| id = PMID 10195034
	| url = http://sti.bmjjournals.com/cgi/reprint/74/5/364.pdf
	| format = PDF
	| accessdate = 2006-07-09
	}}
	</ref> While their specific hypothesis was criticised on technical grounds.<ref>{{cite web
	| url = http://sti.bmj.com/cgi/eletters/74/5/364#112
	| title = Apocrine glands in inner prepuce doubtful
	| accessdate = 2006-07-09
	| last = Waskett
	| first = Jake H.
	| date = ], ]
	| work = Electronic letters
	| publisher = BMJ Publishing Group Ltd
	}}
	</ref> a study published in 2007 by de Witte and others said that Langerlin, excreted by Langerhans cells, is a natural barrier to HIV-1 transmission by Langerhans cells.<ref>{{cite web
	| url =http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17334373&query_hl=4&itool=pubmed_docsum
	| title = Langerin is a natural barrier to HIV-1 transmission by Langerhans cells
	| accessdate = 2007-03-19
	| last = de Witte
	| first = L.
	| date = ], ]
	| work = Abstract
	| publisher = www.Pubmed.gov
	}}
	</ref>
			===Middle East, Africa and Europe===
	===HPV===
			{{Further|Circumcision in Africa}}
	Several studies have shown that uncircumcised men are at greater risk of ] (HPV) infection.<ref>{{cite journal
	| last = Castellsagué
	| first = Xavier
	| coauthors = et al.
	| year = 2002
	| month = ],
	| title = Male circumcision, penile human papillomavirus infection, and cervical cancer
	| journal = The New England Journal of Medicine
	| volume = 346
	| issue = 15
	| pages = 1105&ndash;1112
	| doi = 10.1056/NEJMoa011688
	| id = PMID 11948269
	| url = http://content.nejm.org/cgi/reprint/346/15/1105.pdf
	| format = PDF &mdash; free registration required
	| accessdate = 2006-07-09
	}}
	</ref><ref>{{cite journal
	| last = Lajous
	| first = Martín
	| coauthors = Nancy Mueller, Aurelio Cruz-Valdéz, Luis Victor Aguilar, Silvia Franceschi, Mauricio Hernández-Ávila, and Eduardo Lazcano-Ponce
	| year = July
	| month = 2005
	| title = Determinants of Prevalence, Acquisition, and Persistence of Human Papillomavirus in Healthy Mexican Military Men
	| journal = Cancer Epidemiology Biomarkers and Prevention
	| volume = 14
	| issue = 7
	| pages = 1710&ndash;1716
	| doi = 10.1158/1055-9965.EPI-04-0926
	| id = PMID 16030106
	| url = http://cebp.aacrjournals.org/cgi/reprint/14/7/1710.pdf
	| format = PDF
	| accessdate = 2006-07-09
	}}
	</ref> While most genital ] strains are considered harmless, some can cause genital warts or ] although there is a vaccine against most cancer causing strains of HPV. One study found no statistically significant difference between men with foreskins for HPV infection than those who are circumcised, but did note a significantly higher incidence of HPV lesions and urethritis in uncircumcised men.<ref>{{cite journal
	| last = Aynaud
	| first = O.
	| coauthors = D. Piron, G. Bijaoui, and JM Casanova
	| year = July
	| month = 1999
	| title = Developmental factors of urethral human papillomavirus lesions: correlation with circumcision
	| journal = BJU International
	| volume = 84
	| issue = 1
	| pages = 57&ndash;60
	| doi = 10.1046/j.1464-410x.1999.00104.x
	| id = PMID 10444125
	| url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.00104.x
	| format = PDF
	| accessdate = 2006-07-09
	}}
	</ref>
			At ], in ], engraved rock art with masked bowmen, which feature male circumcision and may be a scene involving ritual, have been dated to earlier than 6000 BP amid the ];<ref name="Campbell">{{cite journal | vauthors = Campbell A, Coulson D |title=Big Hippo Site, Oued Afar, Algeria |journal=Sahara |date=2010 |volume=21 |pages=85, 90–91 |url=https://media.africanrockart.org.s3.amazonaws.com/wp-content/uploads/2018/12/26145300/NG_Ancient-art-of-the-Sahara-June-1999.pdf |issn=1120-5679 |s2cid=191103812 |access-date=27 August 2022 |archive-date=26 October 2022 |archive-url=https://web.archive.org/web/20221026015942/https://media.africanrockart.org.s3.amazonaws.com/wp-content/uploads/2018/12/26145300/NG_Ancient-art-of-the-Sahara-June-1999.pdf |url-status=dead }}</ref> more specifically, while possibly dating much earlier than 10,000 BP, rock art walls from the Bubaline Period have been dated between 9200 BP and 5500 BP.<ref name="Soukopova">{{cite journal | vauthors = Soukopova J |title=Central Saharan rock art: Considering the kettles and cupules |journal=Journal of Arid Environments |date=August 2017 |volume=143 |page=12 |doi=10.1016/j.jaridenv.2016.12.011 |bibcode=2017JArEn.143...10S |s2cid=132225521 |url=https://www.academia.edu/33092285 |access-date=27 August 2022 |archive-date=7 November 2021 |archive-url=https://web.archive.org/web/20211107084913/https://www.academia.edu/33092285 |url-status=live }}</ref> The cultural practice of circumcision may have spread from the Central ], toward the south in ] and toward the east in the region of the ].<ref name="Campbell" /> Based on ] evidence found on walls and evidence from ], circumcision has been dated to at least as early as 6000 BCE in ].<ref name="Al-Salem">{{cite book | vauthors = Al-Salem AH |title=An Illustrated Guide to Pediatric Urology |date=November 8, 2016 |publisher=Springer Cham |isbn=978-3-319-44182-5 |doi=10.1007/978-3-319-44182-5_22 |s2cid=79015190 |page=480 |chapter-url=https://link.springer.com/chapter/10.1007/978-3-319-44182-5_22 |chapter=Male Circumcision |access-date=27 August 2022 |archive-date=23 August 2022 |archive-url=https://web.archive.org/web/20220823235108/https://link.springer.com/chapter/10.1007/978-3-319-44182-5_22 |url-status=live }}</ref> Some ], which have been dated as early as 4000 BCE, show evidence of circumcision.<ref name="gollaher_2001_ch1" />{{rp|2–3}}<ref name="Dobanovački">{{cite journal | vauthors = Dobanovački D, Milovanović L, Slavković A, Tatić M, Mišković-Skeledžija S, Škorić-Jokić S, Pećanac M |title=Surgery Before Common Era (B.C.E.*) |journal=Archive of Oncology |date=2012 |volume=20 |issue=1–2 |page=29 |doi=10.2298/AOO1202028D |s2cid=53008076 |url=http://www.doiserbia.nb.rs/img/doi/0354-7310/2012/0354-73101202028D.pdf |access-date=27 August 2022 |archive-date=12 February 2023 |archive-url=https://web.archive.org/web/20230212202036/http://www.doiserbia.nb.rs/img/doi/0354-7310/2012/0354-73101202028D.pdf |url-status=live }}</ref>
	===Hygiene===
	The ] observes “Circumcision has been suggested as an effective method of maintaining penile hygiene since the time of the Egyptian dynasties, but there is little evidence to affirm the association between circumcision status and optimal penile hygiene.”<ref name="AAP1999" /><ref>Although the Academy's 1975 statement asserted that "A program of education leading to continuing good personal hygiene would offer all the advantages of circumcision without the attendant surgical risk," the 1999 statement cites a study which found that "appropriate hygiene decreased significantly the incidence of phimosis, adhesions, and inflammation, but did not eliminate all problems."</ref> It states that the "relationship among hygiene, phimosis, and penile cancer is uncertain" and further remarks that "genital hygiene needs to be emphasized as a preventive health topic throughout a patient's lifetime."
			Evidence suggests that circumcision was practiced in the Middle East by the fourth millennium BCE, when the ]ians and the Semites moved into the area that is modern-day Iraq from the North and West.<ref name=Doy2005/> The earliest historical record of circumcision comes from Egypt, in the form of an image of the circumcision of an adult carved into the tomb of Ankh-Mahor at ], dating to about 2400{{endash}}2300 BCE. Circumcision was possibly done by the Egyptians for hygienic reasons, but also was part of their obsession with purity and was associated with spiritual and intellectual development. No well-accepted theory explains the significance of circumcision to the Egyptians, but it appears to have been endowed with great honor and importance as a ], performed in a public ceremony emphasizing the continuation of family generations and fertility. It may have been a mark of distinction for the elite: the Egyptian '']'' describes the sun god ] as having circumcised himself.<ref name=alanis_2004/><ref name=gollaher_2001_ch1/>
	The ] emphasizes that the penis of an uncircumcised infant requires no special care and should be left alone. It states that attempts to ], e.g. to clean it, are painful, often injure the foreskin, and can lead to scarring, infections and pathologic phimosis.<ref name = "RACPAnat">{{cite web
			]; the Greeks abhorred circumcision, making life difficult for circumcised Jews living among the Greeks.]]
	| url = http://www.racp.edu.au/hpu/paed/circumcision/anatomy.htm
	| title = Care Of The Foreskin
	| accessdate = 2006-07-13
	| year = 2004
	| month = October
	| work = Paediatric Policy - Circumcision
	| publisher = The Royal Australasian College of Physicians
	}}
	</ref> It is recommended that, while there is no special age where the foreskin should be retractable, once the foreskin becomes retractable, the child should gently wash it with water. The use of soap to wash the foreskin and the glans can lead to ]. <ref>{{cite journal
	| last = Birley
	| initial = HDL
	| year = 1993
	| month = October
	| title = Clinical Features and management of recurrent balanitis; association with atopy and genital washing
	| journal = Genitourinary Medicine
	| volume = 69
	| issue = 5
	| pages = 400&ndash;403
	| doi = 10.1136/jme.2002.001313
	| id = PMID 15173354
	| url = http://www.cirp.org/library/disease/balanitis/birley/
	| accessdate = 2007-07-04
	}}
	</ref>
			Circumcision is prominent in the ].<ref>{{cite book | vauthors = McNutt PM |title=Reconstructing the Society of Ancient Israel |url=https://archive.org/details/reconstructingso0000mcnu |url-access=registration |page= |quote=Abraham patriarchal known history. |year=1999 |publisher=Westminster John Knox Press |isbn=978-0-664-22265-9 }}</ref> In addition to proposing that circumcision was adopted by the Israelites purely as a religious mandate, scholars have suggested that Judaism's patriarchs and their followers adopted circumcision to make penile hygiene easier in hot, sandy climates; as a rite of passage into adulthood; or as a form of blood sacrifice.<ref name="Doy2005" /><ref name="gollaher_2001_ch1" /><ref name="encyc_judaica_2006" />
	Smegma is a combination of exfoliated ], transudated skin oils, and moisture that can accumulate under the ] of males and within the female ] area. It is common to all ]—male and female. In rare cases, accumulating smegma may help cause balanitis.<ref>{{cite journal |first=C |last=Sonnex |coauthors=Croucher, PE; Dockerty WG |title=Balanoposthitis associated with the presence of subpreputial "smegma stones" |journal=Genitourin Med |year=1997 |month=Dec |volume=73 |issue=6 |pages=567}}</ref>
			Historical campaigns of ] frequently included bans on circumcision as a means of ].<ref name="Antisemitism">For sources, see:
	Hutson speculated that circumcision arose in peoples living in arid and sandy regions as a public health measure intended to prevent recurring irritation and infection caused by sand accumulating under the foreskin.<ref>{{cite journal
	| last = Hutson
	| first = J.M.
	| year = 2004
	| month = June
	| title = Circumcision: a surgeon’s perspective
	| journal = Journal of Medical Ethics
	| volume = 30
	| issue = 3
	| pages = 238&ndash;240
	| doi = 10.1136/jme.2002.001313
	| id = PMID 15173354
	| url = http://jme.bmjjournals.com/cgi/reprint/30/3/238.pdf
	| format = PDF
	| accessdate = 2006-07-09
	}}
	</ref> Darby, after checking the official war histories of Britain, Australia and New Zealand and other records, and finding no mention of ‘balanitis’ or ‘foreskin’ or ‘circumcision’, dismissed this idea as a “medical urban myth,” concluding that “‘sand under the foreskin,’ balanitis, and circumcision were not
	significant problems during either of the World Wars.”<ref>{{cite journal
	| last = Darby
	| first = Robert
	| year = 2005
	| month = July
	| title = The riddle of the sands: circumcision, history, and myth
	| journal = The New Zealand Medical Journal
	| volume = 118
	| issue = 1218
	| pages = 76&ndash;82
	| doi =
	| id = {{ISSN|11758716}} PMID 16027753
	| url = http://www.nzma.org.nz/journal/118-1218/1564/content.pdf
	| format = PDF
	| accessdate = 2006-07-09
	}}
	</ref>
			* {{Cite book | vauthors = Livingston M |title=Dreamworld or Dystopia: The Nordic Model and Its Influence in the 21st Century |publisher=] |year=2021 |isbn=978-1-108-75726-3 |pages=87 |quote=In Jewish history, the banning of circumcision (brit mila) has historically been a first step toward more extreme and violent forms of persecution. |author-link=Michael Livingston}}
	===Infectious and chronic conditions===
			* {{Cite book | vauthors = Wilson R |title=The Contested Place of Religion in Family Law |publisher=] |year=2018 |isbn=978-1-108-41760-0 |pages=174 |quote=Jews have a long history of suffering punishment at the hands of government authorities for engaging in circumcision. Muslims have also experienced suppression of their identities through suppression of this religious practice.}}
	Studies have found that boys with foreskins tend to have higher rates of various infections and inflammations of the penis than those who are circumcised.<ref name = "Ferg">{{cite journal
			* {{cite journal | vauthors = Miller GP |date=Spring 2002 |title=Circumcision: Cultural-Legal Analysis |journal=Virginia Journal of Social Policy & the Law |volume=9 |pages=497–585 |doi=10.2139/ssrn.201057 |ssrn=201057 <!-- | format = PDF (free download) -- can't list format or access-date without url--> |quote=Ritual circumcision of boys is a durable tradition. Jews of ancient times refused to abandon the practice despite enormous pressure to do so. In 167 BCE the Seleucid emperor Antiochus IV, as part of a campaign to Hellenise the Jews, condemned to death every Hebrew who allowed a son to be circumcised. The Jews responded with the Maccabean revolt, a campaign of ] which resulted in major victories for the rebels and, eventually, a peace treaty which restored Jewish ritual prerogatives.}}
	| last = Fergusson
			* {{Cite book | vauthors = Silverman E |title=From Abraham to America: A History of Jewish Circumcision |publisher=] |year=2006 |isbn=978-0-7425-1669-4 |pages=161–162 |chapter=Circumcision, Anti-Semitism, and Christ's Foreskin |quote=Ancient authors praised Jewish wisdom, courage, temperance, and justice. Still, they always denounced circumcision. The anonymous authors of Historiae Augustae, writing in the late fourth century, ttributed a Jewish revolt against Rome in 132-135, called the Bar Kokhba rebellion, to a ban on circumcision enacted by the emperor Hadrian... The prohibition was part of a broad campaign to "civilize" ethnic groups...}}
	| first = DM
			* {{Cite book | vauthors = Rosner F |title=Encyclopedia of Jewish Medical Ethics |publisher=] |year=2003 |isbn=978-1-58330-592-8 |pages=196 |quote=Several eras in subsequent Jewish history were associated with forced conversions and with prohibitions against ritual circumcision... Jews endangered their lives during such times and exerted strenuous efforts to nullify such edicts. When they succeeded, they celebrated by declaring a holiday. Throughout most of history, Jews never doubted their obligation to observe circumcision... voiders of the covenant of Abraham our father, and they have no portion in the World to Come.}}</ref> ] conquered the Middle East in the fourth century BCE, and in the following centuries ancient Greek cultures and values came to the Middle East. The Greeks abhorred circumcision, making life for circumcised Jews living among the Greeks and later the Romans very difficult.<ref name="Antisemitism" /> ] by European governments have occurred several times in world history, including the ] under ] and the ] under ], where it was used as a means of ].<ref name="Antisemitism" /> Antiochus IV's restriction on Jewish circumcision was a major factor in the ].<ref name="Antisemitism" /> ]'s prohibition has also been considered by some to have been a contributing cause of the ].<ref name="Antisemitism" /> According to Silverman (2006), these restrictions were part of a "broad campaign" by the Romans to "civilize" the Jewish people, viewing the practice as repulsive and analogous to ].<ref name="Antisemitism" /> His successor, ], altered the edict to permit {{transliteration|he|Brit Milah}}.<ref name="Antisemitism" /> During this period in history, Jewish circumcision called for the removal of only a part of the prepuce, and ] Jews often attempted to look uncircumcised by stretching the extant parts of their foreskins. This was considered by the Jewish leaders to be a serious problem, and during the second century CE they changed the requirements of Jewish circumcision to call for the complete removal of the foreskin,<ref>{{cite encyclopedia|vauthors=Hirsch EG, Kohler K, Jacobs J, Friedenwald A, Broydé I|date=1906|title=Circumcision|url=http://www.jewishencyclopedia.com/articles/4391-circumcision|encyclopedia=]|quote=In order to prevent the obliteration of the 'seal of the covenant' on the flesh, as circumcision was henceforth called, the Rabbis, probably after the ] (see Yeb. l.c.; Gen. R. xlvi.), instituted the 'peri'ah' (the laying bare of the glans), without which circumcision was declared to be of no value (Shab. xxx. 6).|access-date=8 March 2018|archive-date=4 August 2011|archive-url=https://web.archive.org/web/20110804221009/http://www.jewishencyclopedia.com/view.jsp?artid=514&letter=C&search=circumcision|url-status=live}}</ref> emphasizing the Jewish view of circumcision as intended to be not just the fulfillment of a Biblical commandment but also an essential and permanent mark of membership in a people.<ref name="gollaher_2001_ch1" /><ref name="encyc_judaica_2006" />
	| coauthors = JM Lawton and FT Shannon
	| year = 1988
	| month = April
	| title = Neonatal circumcision and penile problems: an 8-year longitudinal study
	| journal = Pediatrics
	| volume = 81
	| issue = 4
	| pages = 537&ndash;541
	| doi =
	| id = PMID 3353186
	| url = http://www.circs.org/library/fergusson/index.html
	| format =
	| accessdate = 2007-07-18
	}}</ref><ref>{{cite journal |last=Fakjian |first=N |coauthors=S Hunter, GW Cole and J Miller |year=1990 |month=August |title=An argument for circumcision. Prevention of balanitis in the adult |journal=Arch Dermatol |volume=126 |issue=8 |pages=1046&ndash;7 |id=PMID 2383029 }}</ref><ref>{{cite journal |last=Herzog |first=LW |coauthors=SR Alvarez |year=1986 |month=March |title=The frequency of foreskin problems in uncircumcised children |journal=Am J Dis Child |volume=140 |issue=3 |pages=254&ndash;6 |id=PMID 3946358}}</ref> The reasons are unclear, but several hypotheses have been suggested:
			]|left]]A narrative in the Christian ] makes a brief mention of the ], but physical circumcision is not part of the received teachings of Jesus. Circumcision has ] in ] and ]. ] reinterpreted circumcision as a spiritual concept, arguing literal circumcision to be unnecessary for Gentile converts to Christianity. The teaching that circumcision was unnecessary for membership in a divine covenant was instrumental to the separation of Christianity from Judaism.<ref name="Jacobs-2012">{{Cite book | vauthors = Jacobs A |title=Christ Circumcised: A Study in Early Christian History and Difference |publisher=] |year=2012 |isbn=978-0-8122-0651-7 |location=United States |pages=}}</ref><ref name="Bolnick-2012">{{Cite book | vauthors = Bolnick D, Koyle M, Yosha A |title=Surgical Guide to Circumcision |publisher=] |year=2012 |isbn=978-1-4471-2858-8 |location=United Kingdom |pages=290–298 |chapter=Circumcision in the Early Christian Church: The Controversy That Shaped a Continent |quote=In summary, circumcision has played a surprisingly important role in Western history. The circumcision debate forged a Gentile identity to the early Christian church which allowed it to survive the Jewish Diaspora and become the dominant religion of Western Europe. Circumcision continued to have a major cultural presence throughout Christendom even after the practice had all but vanished.... the circumcision of Jesus... celebrated as a religious holiday... examined by many of the greatest scholars and artists of the Western tradition.}}</ref> While the circumcision of Jesus is celebrated as ] in the ] of many ]s.<ref name="Bolnick-2012"/>
	*The foreskin may harbor bacteria and become infected if it is not cleaned properly.<ref>{{cite journal
	| last = O’Farrel
	| first = Nigel
	| coauthors = Maria Quigley and Paul Fox
	| year = 2005
	| month = August
	| title = Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study
	| journal = International Journal of STD & AIDS
	| volume = 16
	| issue = 8
	| pages = 556–588(4)
	| doi = 10.1258/0956462054679151
	| id = PMID 16105191
	| url = http://www.ingentaconnect.com/content/rsm/std/2005/00000016/00000008/art00008
	| format = Abstract
	| accessdate = 2006-08-20
	}}
	<small>'''Editor’s note: I cannot confirm that the article substantiates the claim as I cannot access the full article.</small></ref>
	*The foreskin may become inflamed if it is cleaned too often with soap.<ref name="birley">{{cite journal
	| last = Birley
	| first = HD
	| coauthors = MM Walker, GA Luzzi, R Bell, D Taylor-Robinson, M Byrne, and AM Renton
	| year = 1993
	| month = October
	| title = Clinical Features and management of recurrent balanitis; association with atopy and genital washing
	| journal = Genitourinary Medicine
	| volume = 69
	| issue = 5
	| pages = 400–403
	| doi =
	| id = PMID 8244363
	| url = http://www.cirp.org/library/disease/balanitis/birley/
	| format =
	| accessdate = 2006-08-20
	| quotes = A history of fluctuating episodes, with a rapid onset, as well as that of atopy and of zealous washing were predictive of a histological diagnosis of NSD . The proportion of NSD patients with a history of atopy (67%) was much larger than that in the general population. It is possible that the balanitis was due to hypersensitivity to a specific allergen, but we could ascribe it to nothing other than frequent soap washing.
	}}
	</ref>
	*The ] in boys can lead to infections.<ref name ="CMAJ" />
			Although it is not explicitly mentioned in the ] (early seventh century CE), circumcision is considered essential to Islam, and it is nearly universally performed among Muslims. The practice of circumcision spread across the Middle East, North Africa, and Southern Europe with Islam.<ref name="gollaher_2001_ch2" />
	The usual treatment for balanoposthitis is to use topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams.<ref>{{cite web
	| url = http://www.emedicine.com/derm/topic615.htm
	| title = Balanoposthitis
	| accessdate = 2006-11-20
	| last = Osipov
	| first = Vladimir O.
	| authorlink =
	| coauthors = Scott M. Acker
	| date = ], ]
	| work = Reactive and Inflammatory Dermatoses
	| publisher = ]
	}}
	</ref> There are less invasive treatments than circumcision for ].{{Fact|date=December 2006}}
			] and the following Yuan Emperors in China forbade Islamic practices such as ] butchering and circumcision.<ref name="Leslie-1998">{{cite web|url=http://www.islamicpopulation.com/asia/China/China_integration%20of%20religious%20minority.pdf |title=The Integration of Religious Minorities in China: The Case of Chinese Muslims | vauthors = Leslie DD |year=1998 |page=12 |publisher=The Fifty-ninth George Ernest Morrison Lecture in Ethnology |access-date=30 November 2010 |url-status=dead |archive-url=https://web.archive.org/web/20101217112014/http://islamicpopulation.com/asia/China/China_integration%20of%20religious%20minority.pdf |archive-date=17 December 2010 }}</ref><ref name="Elverskog-2010">{{cite book|url=https://archive.org/details/buddhismislamons0000elve|url-access=registration|title=Buddhism and Islam on the Silk Road| vauthors = Johan E |year=2010|publisher=University of Pennsylvania Press|edition=illustrated|pages=|isbn=978-0-8122-4237-9|access-date=28 June 2010}}</ref>
	====Balanitis====
	{{main|Balanitis}}
	], an inflammation of the ], has a variety of causes.<ref name = "HKhandbook">{{cite book
	| last = Au
	| first = T.S.
	| coauthors = K.H. Yeung
	| editor = Pedro Sá Cabral, Luís Leite, and José Pinto (eds.)
	| title = HANDBOOK OF DERMATOLOGY & VENEREOLOGY
	| origdate =
	| origyear =
	| origmonth =
	| url = http://www.hkmj.org.hk/skin/cover.htm
	| accessdate = 2006-09-04
	| edition = 2nd ed.
	| year = 2003
	| publisher = Department of Dermatology—Hospital Pulido Valente
	| location = ]
	| id = ISBN 978-962-334-030-4
	| chapter = Balanitis, Bacterial Vaginosis and Other Genital Conditions
	| chapterurl = http://www.hkmj.org.hk/skin/balaniti.htm
	}}
	</ref> Some of these, such as anaerobic infection, occur more frequently in uncircumcised men.<ref name = "EdwardsGU">{{cite journal
	| last = Edwards
	| first = Sarah
	| year = 1996
	| month = June
	| title = Balanitis and balanoposthitis: a review
	| journal = Genitourinary Medicine
	| volume = 72
	| issue = 3
	| pages = 155–159
	| doi =
	| id = PMID 8707315
	| url = http://www.cirp.org/library/disease/balanitis/edwards1/
	| accessdate = 2006-09-04
	}}
	</ref> There are less invasive treatments than circumcision that have been shown to be effective in treating most mild cases of balanitis.<ref name = "HKhandbook" /> Birley, et al, found that in 90% of their cases of chronic or recurring balanitis "use of emollient creams and restriction of soap washing alone controlled symptoms satisfactorily". They also state that circumcision “might be of benefit in a patient whose balanitis relapses despite these measures, and remains the principal treatment for specific conditions such as ] and plasma cell balanitis.”<ref name = "birley" /> The, less invasive procedures are not as successful in treating ], or '''BXO''',<ref>{{cite journal
	| last = Vincent
	| first = Michelle Valerie
	| coauthors = Ewan MacKinnon
	| year = 2005
	| month = April
	| title = The response of clinical balanitis xerotica obliterans to the application of topical steroid-based creams
	| journal = Journal of Pediatric Surgery
	| volume = 40
	| issue = 4
	| pages = 709–712
	| doi = 10.1016/j.jpedsurg.2004.12.001
	| id = PMID 15852285
	| url = http://www.jpedsurg.org/article/PIIS002234680400867X/abstract
	| format = Abstract
	| accessdate = 2006-09-21
	}}
	</ref><ref>{{cite journal
	| last = Wright
	| first = J.E.
	| year = 1994
	| month = May
	| title = The treatment of childhood phimosis with topical steroid
	| journal = The Australian and New Zealand journal of surgery
	| volume = 64
	| issue = 5
	| pages = 327–328
	| id = PMID 8179528
	| url = http://www.cirp.org/library/treatment/phimosis/wright/
	| accessdate = 2006-09-21
	}}
	</ref><ref>{{cite journal
	| last = Webster
	| first = T.M.
	| coauthors = M.P. Leonard
	| year = 2002
	| month = April
	| title = Topical steroid therapy for phimosis
	| journal = The Canadian journal of urology
	| volume = 9
	| issue = 2
	| pages = 1492–1495
	| id = PMID 12010594
	| url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12010594&query_hl=5
	| format = Abstract
	| accessdate = 2006-09-21
	}}
	</ref> which is much less common but harder to treat.<ref>{{cite web
	| url = http://www.emedicine.com/derm/topic46.htm
	| title = http://www.emedicine.com/derm/topic46.htm
	| accessdate = 2006-09-21
	| last = Scheinfeld
	| first = Noah S.
	| authorlink =
	| coauthors = George C. Keough, Daniel Lehman
	| date = ], ]
	| work = Diseases Of The Dermis
	| publisher = ]
	}}
	</ref>
			The practice of circumcision is thought to have been brought to the Bantu-speaking tribes of Africa by either the Jews after one of their many expulsions from European countries, or by Muslim Moors escaping after the 1492 ] of Spain. In the second half of the first millennium CE, inhabitants from the Northeast of Africa moved south and encountered groups from Arabia, the Middle East, and West Africa. These people moved south and formed what is known today as the Bantu. Bantu tribes were observed to be upholding what was described as Jewish law, including circumcision, in the 16th century. Circumcision and elements of Jewish dietary restrictions are still found among Bantu tribes.<ref name=Doy2005/>
	] ('''LSA''') produces a whitish-yellowish patch on the skin, and is not believed to be always harmful or painful, and may sometimes disappear without intervention. Some consider ] to be a form of LSA that happens to be on the foreskin, where it may cause pathological ]. Circumcision is believed to reliably reduce the threat of BXO.<ref>{{cite journal
	| last = Mattioli
	| first = G.
	| coauthors = P. Repetto, C. Carlini, C. Granata, C. Gambini, and V. Jasonni
	| year = 2002
	| month = May
	| title = Lichen sclerosus et atrophicus in children with phimosis and hypospadias
	| journal = Pediatric Surgery International
	| volume = 18
	| issue = 4
	| pages = 273–275
	| doi = 10.1007/s003830100699
	| id = PMID 12021978
	| url = http://www.springerlink.com/content/dy5cgm3h11prdy76/
	| format = Abstract
	| accessdate = 2006-09-21
	}}
	</ref>
			===Indigenous peoples of the Americas and Oceania===
	===Penile cancer===
			Circumcision is practiced by some groups amongst ] peoples, ], and ].<ref name=WHO_2007_GTDPSA/><ref name="Doy2005"/>
	{{main|Penile cancer}}
	] is cancer of the penis, i.e. on the glans or the foreskin. Most cases have been found to occur in men over the age of 70.<ref>{{cite web
	| url = http://www.cancerhelp.org.uk/help/default.asp?page=6833
	| title = Cancer of the penis (penile cancer)
	| accessdate = 2006-09-26
	| date = ], ]
	| work = Questions and Answers: Penis cancer questions
	| publisher = ]
	| quote = Penile cancer is more common in older men. Most cases are in men over 70. It is rare in men under 40.
	}}
	</ref> In 1979, Boczko and Freed remarked that since Wolbarst's 1932 review, "there have been only eight documented cases of penile carcinoma in an individual circumcised in infancy." They described the ninth reported case, concluding that "performing it in infancy continues to be the most effective prophylactic measure against penile carcinoma."<ref>{{cite journal |last=Boczko |first=S |coauthors=Freed, S |title=Penile carcinoma in circumcised males |journal=N Y State J Med |year=1979 |volume=79 |issue=12 |pages=1903-4}} </ref> The AMA remarked that in six case series published from 1932 and 1986, "all penile cancers occurred in uncircumcised individuals."<ref name = "CSA:I-99" /> Maden ''et al'' reported in 1993 that the risk of penile cancer was 3.2 times greater in men who were never circumcised and 3 times greater among those who were circumcised after the neonatal period;<ref>{{cite journal |title=History of circumcision, medical conditions, and sexual activity and risk of penile cancer |first=C |last=Maden |coauthors=''et al'' |journal=J Natl Cancer Inst |year=1993 |month=Jan |volume=85 |issue=1 |pages=19-24 |id=PMID 8380060}}</ref> this study was referenced in an editorial by Holly and Palefsky. They compliment the study for noting other risk factors for penile cancer, as well as for providing corroborating evidence as to the association between a lack of neonatal circumcision and the development of penile cancer. However, their criticisms include the study's combining data from invasive and ''in situ'' cancers. They concluded that as the new study reported circumcision at birth in 20% of the men with penile cancer, the recommendation of circumcision for medical indications remains somewhat controversial and the risks and benefits must be weighed.<ref>{{cite journal |url=http://jnci.oxfordjournals.org/cgi/reprint/85/1/2 |last=Holly |first=EA |coauthors=Palefsky, JM |title=Factors related to risk of penile cancer: new evidence from a study in the Pacific Northwest |journal=J Natl Cancer Inst |year=1993 |month=Jan |volume=85 |issue=1 |pages=2-4}}</ref> The American Academy of Pediatrics made similar criticism, also noting the possibly inaccurate use of self-report to determine circumcision status.<ref name = "AAP1999" /> Schoen ''et al'' studied the association between neonatal circumcision and invasive penile cancer in 2000, and found that the relative risk for uncircumcised men was 22 times that of circumcised men.<ref>{{cite journal |url=http://pediatrics.aappublications.org/cgi/content/full/105/3/e36 |title=The highly protective effect of newborn circumcision against invasive penile cancer |first=EJ |last=Schoen |coauthors=Oehrli, M; Colby, C; Machin, G | journal=Pediatrics |year=2000 |month=Mar |volume=105 |issue=3 |pages=e36}}</ref>
			For Aboriginal Australians and Polynesians, circumcision likely started as a blood sacrifice and a test of bravery and became an initiation rite with attendant instruction in manhood in more recent centuries. Often seashells were used to remove the foreskin, and the bleeding was stopped with ] smoke.<ref name=Doy2005/><ref name=gollaher_2001_ch3/>
	In 2005, the ] said that while studies suggest that circumcision may reduce the risk of more invasive forms of penile cancer, it is important to concentrate on the main risk factors: poor hygiene, having unprotected sex with multiple partners, and cigarette smoking.<ref>{{cite web
	| url = http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_penile_cancer_35.asp?sitearea=
	| title = What Are the Risk Factors for Penile Cancer?
	| accessdate = 2006-10-01
	| date = ], ]
	| work = Cancer Reference Information
	| publisher = ]
	}}
	</ref> They further state that the current consensus of most experts is that circumcision should not be recommended as a prevention strategy for penile cancer.<ref>{{cite web
	| url = http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_penile_cancer_be_prevented_35.asp
	| title = Can Penile Cancer Be Prevented?
	| accessdate = 2006-10-01
	| date = ], ]
	| work = Cancer Reference Information
	| publisher = ]
	}}
	</ref>
			] reported circumcision being practiced by Native Americans.<ref name=alanis_2004/> It probably started among South American tribes as a blood sacrifice or ritual to test bravery and endurance, and later evolved into a rite of initiation.<ref name=Doy2005/>
	The ] states that studies suggest that neonatal circumcision confers some protection from penile cancer, but circumcision at a later age does not seem to confer the same level of protection. Further, penile cancer is a rare disease and the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, remains low.<ref name = "AAP1999" /> Similarly, the ] states that although neonatal circumcision seems to lower the risk of contracting penile cancer, because it is rare and occurs later in life, the use of circumcision as a preventive practice is not justified.<ref name = "CSA:I-99" />
			=== Prophylactic circumcision ===
	Kochen and McCurdy performed a ] analysis on penile cancer rates. They assumed that these cancers occur exclusively in uncircumcised males and that age-specific rates calculated from older groups were applicable to the 1971 birth cohort.<ref name="Kochen">{{cite journal
	| last = Kochen
	| first = Mosze
	| coauthors = Stephen McCurdy
	| year = 1980
	| month = May
	| title = Circumcision and the risk of cancer of the penis. A life-table analysis
	| journal = American Journal of Diseases of Children
	| volume = 134
	| issue = 5
	| pages = 484–486
	| doi = 10.1001/archpedi.134.5.484
	| id = PMID 7377156
	| url = http://www.circs.org/library/kochen/index.html
	| accessdate = 2006-09-26
	}}
	</ref> Their overall analysis finds an estimated occurrence rate in uncircumcised males of 1 in 600, or 0.167%, with a median age of occurrence of 67 years old. However, they close their predictions section with the following “Since the uncircumcised male is uniquely susceptible, virtually all of these cancers are preventable by neo-natal circumcision. The number of lifetime incident cancers that could be prevented annually by circumcision can be estimated with birth statistics available for 1971. In that year, there were 1,822,910 recorded live male births. If none had been neonatally circumcised, our analysis predicts that one in 600, or more than 3,000 would have penile cancer in their lifetimes.”<ref name = "Kochen" />
			==== Anglophonic adoption (1855–1918) ====
	===Phimosis and paraphimosis===
			] physician ] in 1855. By the late 19th century, the belief that circumcision acted as an effective prophylactic against disease was held by a majority of the ]'s medical communities and doctors, such as the prominent ], president of the ], subsequently leading to its widespread adoption.<ref name="Al-Salem-2016">{{Cite book | vauthors = Al-Salem A |title=An Illustrated Guide to Pediatric Urology |publisher=] |year=2016 |isbn=978-3-319-44182-5 |pages=481}}</ref>]]
	It is normal for an infant's foreskin to be attached to the glans. Pathological ] is a condition when the foreskin remains so tight that retraction over the glans is painful or impossible. Dawson and Whitfield, say "True phimosis is rare but may cause appreciable problems in either childhood or adolescence." Rickwood suggested that the term 'phimosis' should be restricted to cases in which the prepuce loses suppleness and becomes scarred.<ref name = "Rickwood1">{{cite journal
			Circumcision began to be advocated as a means of ''prophylaxis'' in 1855, primarily as a means of preventing the transmission of sexually transmitted infections. At this time, ] physician ] published his findings that, among his venereal disease patients, Jews had a lower prevalence of ].<ref name="darby_2005" /><ref name="Hutchinson1855">{{cite journal | vauthors = Hutchinson J |title=On the influence of circumcision in preventing syphilis |journal=Medical Times and Gazette |date=1855 |volume=32 |pages=542–543}}</ref> Hutchinson suggested that circumcision lowers the risk of contracting syphilis.<ref name="Hutchinson1855"/> Pursuing a successful career as a general practitioner, Hutchinson went on to advocate circumcision for health reasons for the next fifty years,<ref name="darby_2005" /> eventually earned a ] for his contributions to medicine. His viewpoint that circumcision was prophylactic against disease was adopted by other medical professionals.<ref name="matthew_2004" />
	| last = Rickwood
	| first = AM.
	| coauthors = V. Hemalatha, G. Batcup, and L. Spitz
	| year = 1980
	| month = April
	| title = Phimosis in boys
	| journal = British Journal of Urology
	| volume = 52
	| issue = 2
	| pages = 147–150
	| id = PMID 7191744
	| url = http://www.cirp.org/library/treatment/phimosis/rickwood/
	| accessdate = 2006-10-10
	}}
	</ref>
	The AAP state that the true frequency of problems such as phimosis is unknown.<ref name = "AAP1999" /> Fergusson et al found phimosis in 16% of non-circumcised boys,<ref name = "Ferg" /> while Herzog and Alvarez found it in 2.6%. Rickwood and Walker raised concern that phimosis is frequently misdiagnosed by physicians confusing it with the developmentally non-retractable foreskin.<ref name = "Rickwood2">{{cite journal
	| last = Rickwood
	| first = AM.
	| coauthors = Jenny Walker
	| year = 1989
	| month = September
	| title = Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence?
	| journal = Annals of the Royal College of Surgeons of England
	| volume = 71
	| issue = 5
	| pages = 275–277
	| id = PMID 2802472
	| url = http://www.cirp.org/library/treatment/phimosis/rickwood2/
	| accessdate = 2006-10-10
	}}
	</ref>
	Several researchers have described less invasive treatments for phimosis than circumcision, and recommend that they be tried first.<ref name="dewan" /><ref name="beauge" />
			In 1870, orthopedic surgeon ], a founder of the ], introduced circumcision in the United States as a purported cure for several cases of young boys presenting with paralysis and other significant gross motor problems. He thought the procedure ameliorated such problems based on the then prominent "reflex neurosis" theory of disease, thinking that a tight foreskin inflamed the nerves and caused systemic problems.<ref name="Chubak-2013">{{Cite journal | vauthors = Chubak B |date=2013-04-01 |title=1101 the orthopedic origin of popular male circumcision in america |url= |journal=Journal of Urology |volume=189 |issue=4S |pages=e451 |doi=10.1016/j.juro.2013.02.693 |quote=Male circumcision was first popularized in late 19th-century America by Lewis Sayre, a renowned orthopedic surgeon, public-health activist, and creator of the Journal of the American Medical Association. On the basis of a few orthopedic case reports, Sayre used his influence to promote male circumcision as systemic therapy, rather than a local anatomic alteration. This redefinition was consistent with the contemporary reflex neurosis theory of disease, as well as the historic humoral-mechanical understanding of the human body.}}</ref> The use of circumcision to promote good health also fit the ], which saw validation during the same period: the foreskin was thought to harbor infection-causing ].<ref name="gollaher_2001_ch4"/>{{rp|106}} Sayre published works on the subject and promoted it in speeches.<ref name="Chubak-2013" /> Although later discredited, many contemporary physicians believed it could cure, reduce, or otherwise prevent a wide-ranging array of perceived medical problems and social ills, including that of ], ], ], ], ], ] and ]. Its popularity spread with publications such as Peter Charles Remondino's ''History of Circumcision''.<ref name="gollaher_2001_ch4" /><ref name="darby_2003" /><ref>{{cite journal | vauthors = Laumann EO, Masi CM, Zuckerman EW | title = Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice | journal = JAMA | volume = 277 | issue = 13 | pages = 1052–1057 | date = April 1997 | pmid = 9091693 | doi = 10.1001/jama.1997.03540370042034 | url = https://pubmed.ncbi.nlm.nih.gov/9091693 | access-date = 19 December 2021 | url-status = live | archive-url = https://web.archive.org/web/20211219170126/https://pubmed.ncbi.nlm.nih.gov/9091693/ | archive-date = 19 December 2021 }}</ref> By the late 19th century, circumcision had become common throughout the ]—Australia, Canada, the United States, and the United Kingdom—as well as the ]. In the United Kingdom and United States, it was universally recommended.<ref name="Al-Salem-2016" /><ref name="gollaher_2001_ch4" />
	Several studies have identified phimosis as a risk factor for penile cancer. The British Medical Journal published one letter that stated it would be irresponsible to expose a patient to risk for longer than necessary.<ref>Robin J Willcourt, "Re: Circumcision is a last resort - to be avoided, whenever possible" - letters to the editor, ''British Medical Journal'' </ref>
			Historian ] proposes that "Americans found circumcision appealing not merely on medical grounds, but also for its connotations of science, health, and cleanliness—newly important class distinctions" in a country where 17 million immigrants arrived between 1890 and 1914.<ref name="gollaher_2001_ch4"/>{{rp|106}}
	] is an acute condition when a tight foreskin is stuck behind the glans and cannot be returned to its original position, curbing the blood flow to the glans. In children, it is sometimes caused by a caregiver trying to ].<ref name = "Gairdner" />
			==== Interwar period and World War II (1918–1945) ====
	===Urinary tract infections===
			During the ], medical organizations and doctors in ] experimented with the idea of routine circumcision for prophylactic reasons as well, alongside developments in the Anglophonic world. In France, the medical profession went so far as to recommend universal routine circumcision. However, prevalence in France and mainland Europe remained low.<ref name="Bolnick_2012_ch1" /> There is a lack of consensus in the academic literature on why this occurred.<ref name="Bolnick_2012_ch1" />
	Twelve studies have indicated that neonatal circumcision reduces the occurrence rate of ] in male infants by a factor of about 10.<ref name="singhgrewal2005">{{cite journal
	| last = Singh-Grewal
	| first = D.
	| coauthors = J. Macdessi, and J. Craig
	| date = ], ]
	| title = Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies
	| journal = Archives of Disease in Childhood
	| volume = 90
	| issue = 8
	| pages = 853-858
	| doi = 10.1136/adc.2004.049353
	| id = PMID 15890696
	| url = http://adc.bmjjournals.com/cgi/reprint/90/8/853.pdf
	| format = PDF
	| accessdate = 2006-09-21
	}}
	</ref> The March 1999 AAP statement notes that premature infants are usually not circumcised because of their fragile health status.<ref name = "AAP1999" /> Studies have found that 1 in 10 premature infants will have a urinary tract infection during the first month of life. Some of the UTI studies have been criticised for not taking these and other factors into account. A Swedish study found that the cumulative incidence of UTIs in boys under 2 years of age was 2.2%.<ref name="jakobsson1999">Jakobsson 1999, ''et al''. Minimum incidence and diagnostic rate of first urinary tract infection. ''Pediatrics.'' 1999 August;104 (2 Pt 1):222–6. ()</ref> The AMA cites evidence that the incidence of UTI’s is “small (0.4%–1%)” in uncircumcised infants, and “depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI…One model of decision analysis concluded that the incidence of UTI would have to be substantially higher in uncircumcised males to justify circumcision as a preventive measure against this condition.”<ref name = "CSA:I-99" />
			''Yosha & Bolnick & Koyle'' (2012) have suggested that a factor in its Anglophonic adoption and dismissal in mainland Europe relates to attitudes towards Judaism and Jewish practices. While many of these Anglophonic polities would not be considered tolerant by modern standards: the United Kingdom had ]—a Jew—as ]; ] were prominent and generally well-respected; while in Australia "the racial issues of the time ], and Jews were essentially below the radar". They argue that once "a substantial proportion of the male population circumcised, the idea that it a Jewish practice no longer relevant. In Britain this was aided by the fact that circumcision was well known to be as much a practice of the nobility as a Jewish religious rite, so that the racial-religious nexus was broken." These factors were absent in ].<ref name="Bolnick_2012_ch1" />
	The ] poses the question of whether increased ] and ] rates in non-circumcised male infants may be caused by ].<ref name = "CMAJ" /> According to the Lerman and Liao, aside from its effects on UTI infection rates, "Most of the other medical benefits of circumcision probably can be realized without circumcision as long as access to clean water and proper penile hygiene are achieved."<ref name="lerman2001">Lerman SE, Liao JC. Neonatal circumcision. ''Pediatr Clin North Am.'' 2001 December;48(6):1539-57. PMID 11732129</ref>
			Rates in the Anglophonic world began to sharply diverge after 1945.<ref name="alanis_2004" /> ] recommended circumcision in his influential work '']'', one of the best-selling books of the twentieth century.<ref name="Paige 2021 263">{{Cite book | vauthors = Paige J, Paige K |title=The Politics of Reproductive Ritual |publisher=] |year=2021 |isbn=978-0-520-30674-5 |pages=263 |chapter=Summary and Implications for Complex Societies}}</ref> ]]
	===Policies of various national medical associations===
	====United States====
	The ] recommends that physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering circumcision for newborn boys.<ref name = "AAFP2">{{cite web
	| url = http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html
	| title = Circumcision: Position Paper on Neonatal Circumcision
	| accessdate = 2007-01-30
	| year = 2007
	| publisher = ]
	| quote = <small>Considerable controversy surrounds neonatal circumcision. Putative indications for neonatal circumcision have included preventing UTIs and their sequelae, preventing the contraction of STDs including HIV, and preventing penile cancer as well as other reasons for adult circumcision. Circumcision is not without risks. Bleeding, infection, and failure to remove enough foreskin occur in less than 1% of circumcisions. Evidence-based complications from circumcision include pain, bruising, and meatitis. More serious complications have also occurred. Although numerous studies have been conducted to evaluate these postulates, only a few used the quality of methodology necessary to consider the results as high level evidence.<br />
	<br />
	The evidence indicates that neonatal circumcision prevents UTIs in the first year of life with an absolute risk reduction of about 1% and prevents the development of penile cancer with an absolute risk reduction of less than 0.2%. The evidence suggests that circumcision reduces the rate of acquiring an STD, but careful sexual practices and hygiene may be as effective. Circumcision appears to decrease the transmission of HIV in underdeveloped areas where the virus is highly prevalent. No study has systematically evaluated the utility of routine neonatal circumcision for preventing all medically-indicated circumcisions in later life. Evidence regarding the association between cervical cancer and a woman’s partner being circumcised or uncircumcised, and evidence regarding the effect of circumcision on sexual functioning is inconclusive. If the decision is made to circumcise, anesthesia should be used.<br />
	<br />
	The American Academy of Family Physicians recommends physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering this procedure for their newborn son.</small>
	}}
	</ref>
			==== Mid-20th century (1945–1985) ====
	The ] finds both potential benefits and risks in infant circumcision. At current it feels that there is insufficient data to recommend routine neonatal circumcision, and recommends that parental decisions on elective circumcision should be made with as much accurate and unbiased information as possible, taking medical, cultural, ethnic, traditional, and religious factors into account. The AAP also recommends using analgesia as a safe and effective method for reducing procedural pain associated with circumcision, and that circumcision on newborns only be performed on infants who are stable and healthy.<ref name = "AAP19992">{{cite journal
			After the end of ], Britain implemented a ]. ]'s 1949 article "The Fate of the Foreskin" argued that the evidence showed that the risks outweighed the benefits, leading to a significant reduction in circumcision incidence within the United Kingdom.<ref>{{cite journal | vauthors = Gairdner D | title = The fate of the foreskin, a study of circumcision | journal = British Medical Journal | volume = 2 | issue = 4642 | pages = 1433–7, illust | date = December 1949 | pmid = 15408299 | pmc = 2051968 | doi = 10.1136/bmj.2.4642.1433 }}</ref>
	| last = Task Force on Circumcision
	| coauthors =
	| year = 1999
	| month = ],
	| title = Circumcision Policy Statement
	| journal = Pediatrics
	| volume = 103
	| issue = 3
	| pages = 686&ndash;693
	| doi = 10.1542/peds.103.3.686
	| id = {{ISSN|0031-4005}} PMID 10049981
	| url = http://pediatrics.aappublications.org/cgi/reprint/pediatrics;103/3/686.pdf
	| format = PDF
	| accessdate = 2006-07-01
	}}
	<small>“Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided. If circumcision is performed in the newborn period, it should only be done on infants who are stable and healthy.”</small>
	</ref>
			In contrast to Gairdner, American pediatrician ] argued in favor of circumcision in his popular '']'' which led to rates in the United States significantly rising. In the 1970s, national medical associations in Australia and Canada issued recommendations against routine infant circumcision, leading to drops in the rates of both of those countries. The United States made similar statements in the 1970s but stopped short of recommending against it.<ref name="alanis_2004" />
	The American Medical Association supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics.<ref name = "CSA:I-99" />
	====Canada====		==== Modernity (since 1985) ====
			An association between circumcision and reduced heterosexual HIV infection rates was first suggested in 1986.<ref name="alanis_2004" />
	The Fetus and Newborn Committee of the ] posted "Circumcision: Information for Parents" in November 2004,<ref name = "CPSIFP2">{{cite web
	| url = http://www.caringforkids.cps.ca/babies/Circumcision.htm
	| title = Circumcision: Information for parents
	| accessdate = 2006-10-24
	| year = 2004
	| month = November
	| work = Caring for kids
	| publisher = ]
	| quote = <small>Circumcision is a “non-therapeutic” procedure, which means it is not medically necessary. Parents who decide to circumcise their newborns often do so for religious, social or cultural reasons. To help make the decision about circumcision, parents should have information about risks and benefits. It is helpful to speak with your baby’s doctor. After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.</small>
	}}
	</ref> as well as "Neonatal circumcision revisited" in 1996. The 2004 statement said it "does not recommend circumcision for newborn boys. Many
	paediatricians no longer perform circumcisions." <ref name = "CMAJ2">
	{{cite journal
	| last = Fetus and Newborn Committee
	| year = 1996
	| month = March
	| title = Neonatal circumcision revisited
	| journal = Canadian Medical Association Journal
	| volume = 154
	| issue = 6
	| pages = 769&ndash;780
	| doi =
	| id =
	| url = http://www.cps.ca/english/statements/FN/fn96-01.htm
	| format =
	| accessdate = 2006-07-02
	}}
	<small>“We undertook this literature review to consider whether the CPS should change its position on routine neonatal circumcision from that stated in 1982. The review led us to conclude the following. There is evidence that circumcision results in an approximately 12-fold reduction in the incidence of UTI during infancy. The overall incidence of UTI in male infants appears to be 1% to 2%. The incidence rate of the complications of circumcision reported in published articles varies, but it is generally in the order of 0.2% to 2%. Most complications are minor, but occasionally serious complications occur. There is a need for good epidemiological data on the incidence of the surgical complications of circumcision, of the later complications of circumcision and of problems associated with lack of circumcision. Evaluation of alternative methods of preventing UTI in infancy is required. More information on the effect of simple hygienic interventions is needed. Information is required on the incidence of circumcision that is truly needed in later childhood. There is evidence that circumcision results in a reduction in the incidence of penile cancer and of HIV transmission. However, there is inadequate information to recommend circumcision as a public health measure to prevent these diseases. When circumcision is performed, appropriate attention needs to be paid to pain relief. The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns. There is therefore no indication that the position taken by the CPS in 1982 should be changed. When parents are making a decision about circumcision, they should be advised of the present state of medical knowledge about its benefits and harms. Their decision may ultimately be based on personal, religious or cultural factors.</small>
	</ref>
			Experimental evidence was needed to establish a causal relationship, so three ]s were commissioned to exclude other ].<ref name="siegfried_Cochrane_2009" /> Trials took place in South Africa, Kenya and Uganda.<ref name="siegfried_Cochrane_2009" /> All three trials were stopped early by their monitoring boards because those in the circumcised group had a substantially lower rate of HIV contraction than the control group, so it was considered unethical to withhold the procedure, in light of strong evidence of prophylactic efficacy.<ref name="siegfried_Cochrane_2009" /><ref>{{cite journal | vauthors = Hankins C, Forsythe S, Njeuhmeli E | title = Voluntary medical male circumcision: an introduction to the cost, impact, and challenges of accelerated scaling up | journal = PLOS Medicine | volume = 8 | issue = 11 | pages = e1001127 | date = November 2011 | pmid = 22140362 | pmc = 3226452 | doi = 10.1371/journal.pmed.1001127 | doi-access = free }}</ref> WHO assessed these as "gold standard" studies and found "strong and consistent" evidence from later studies that confirmed the results of the studies.<ref name="WHO-PrevHIV" /> A scientific consensus subsequently developed that circumcision reduces heterosexual HIV infection rates in high-risk populations;<ref name="Merson-2017" /><ref name="Chikutsa-2015" /><ref name="Bell-2016">{{Cite book | vauthors = Bell K |title=Health and Other Unassailable Values: Reconfigurations of Health, Evidence and Ethics |publisher=Taylor & Francis |year=2016 |isbn=978-1-317-48203-1 |pages=106 |quote=...defending the casual relation between male circumcision and reduced HIV transmission has become essentially hegemonic in the academic literature.}}</ref> the WHO, along with other major medical organizations, have since promoted circumcision of high-risk populations as part of the program to reduce the spread of HIV.<ref name="WHO-PrevHIV" /> The ''Male Circumcision Clearinghouse'' website was created in 2009 by WHO, UNAIDS, FHI and AVAC to provide evidence-based guidance, information, and resources to support the delivery of safe male circumcision services in countries that choose to scale up the procedure as one component of comprehensive HIV prevention services.<ref name="NYTimes_2009" /><ref name="AVAC_2015" />
	====United Kingdom====
	As of June of 2006, the British Medical Association's position was that male circumcision for medical purposes should only be used where less invasive procedures are either unavailable or not as effective. The BMA specifically refrained from issuing a policy regarding “non-therapeutic circumcision,” stating that as a general rule, it “believes that parents should be entitled to make choices about how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices.”<ref name = "BMAGuide2">
	{{cite web
	| url = http://www.bma.org.uk/ap.nsf/Content/malecircumcision2006?OpenDocument&Highlight=2,circumcision
	| title = The law and ethics of male circumcision - guidance for doctors
	| accessdate = 2006-07-01
	| author = Medical Ethics Committee
	| year = 2006
	| month = June
	| publisher = ]
	| quote = <small>'''Circumcision for medical purposes'''<br />
	Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.
			==Society and culture==
	Male circumcision in cases where there is a clear clinical need is not normally controversial. Nevertheless, normal anatomical and physiological characteristics of the infant foreskin have in the past been misinterpreted as being abnormal. The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision. Doctors should be aware of this and reassure parents accordingly.<br />
			]
	<br />
	'''Non-therapeutic circumcision'''<br />
	Male circumcision that is performed for any reason other than physical clinical need is termed non-therapeutic (or sometimes “ritual”) circumcision. Some people ask for non-therapeutic circumcision for religious reasons, some to incorporate a child into a community, and some want their sons to be like their fathers. Circumcision is a defining feature of some faiths.<br />
	<br />
	There is a spectrum of views within the BMA’s membership about whether non-therapeutic male circumcision is a beneficial, neutral or harmful procedure or whether it is superfluous, and whether it should ever be done on a child who is not capable of deciding for himself. The medical harms or benefits have not been unequivocally proven except to the extent that there are clear risks of harm if the procedure is done inexpertly. The Association has no policy on these issues. Indeed, it would be difficult to formulate a policy in the absence of unambiguously clear and consistent medical data on the implications of the intervention. As a general rule, however, the BMA believes that parents should be entitled to make choices about how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices.</small>
	}}
	</ref>
			The word ] is from Latin {{Lang|la|circumcidere}}, meaning "to cut around".<ref name="WHO_2007_GTDPSA" />
	====Australasia====
	The ] states '''there is no medical indication for routine neonatal circumcision''' (emphasis as in the original). It states, "If the operation is to be performed, the medical attendant should ensure this is done by a competent operator, using appropriate anaesthesia and in a safe child-friendly environment"<ref name = "RACPSumm" />
			===Cultures and religions {{Anchor|Cultures and religions}}===
	==History of circumcision==
	{{main|History of male circumcision}}		{{See also|Cultural views on circumcision|Religious male circumcision}}
			{{Undue weight section|date=November 2023}}
	It has been variously proposed that circumcision began as a religious ], as a ] marking a boy's entrance into adulthood, as a form of ] to ensure virility, as a means of suppressing (or enhancing) sexual pleasure, as an aid to ] where regular ] was impractical, as a means of marking those of lower (or higher) social status, as a means of differentiating a circumcising group from their non-circumcising neighbors, as a means of discouraging ] or other socially proscribed sexual behaviors, to remove "excess" pleasure, to increase a man's attractiveness to women, as a symbolic ], as a demonstration of one's ability to endure pain, or as a male counterpart to ] or the breaking of the ]. It has been suggested that the custom of circumcision gave advantages to tribes that practiced it and thus led to its spread regardless of whether the people understood this.<ref>{{cite journal
	| author = ] and ]
	| year = 1997
	| title = A Biocultural Analysis of Circumcision
	| journal = ]
	| volume = 44
	| pages = 265-275
	| url = http://www.cirp.org/library/psych/immerman2/
	}}</ref>
	It is possible that circumcision arose independently in different cultures for different reasons.
			Many societies hold ], with perspectives ranging widely. In some cultures, males are generally required to be circumcised shortly after birth, during childhood or around puberty as part of a rite of passage. Circumcision is commonly practiced in the Jewish and Islamic and ] faiths and in ] and the ] and the ].<ref name="Bolnick_2012_ch1" /><ref name="glass_1999">{{cite journal | vauthors = Glass JM | title = Religious circumcision: a Jewish view | journal = BJU International | volume = 83 | issue = Suppl 1 | pages = 17–21 | date = January 1999 | pmid = 10349410 | doi = 10.1046/j.1464-410x.1999.0830s1017.x | s2cid = 2888024 }}</ref><ref name="Columbia_encyc_2011_circ">{{cite encyclopedia |year=2011 |title=Circumcision |encyclopedia=Columbia Encyclopedia |publisher=Columbia University Press |url=http://www.infoplease.com/encyclopedia/science/circumcision.html |archive-url=https://web.archive.org/web/20150924051012/http://www.infoplease.com/encyclopedia/science/circumcision.html |archive-date=24 September 2015 |url-status=live}}</ref><ref name="clark_2011">{{cite book |author=Clark M |url=https://books.google.com/books?id=zPXu561ZpvgC&pg=PA178 |title=Islam For Dummies |date=10 March 2011 |publisher=John Wiley & Sons |isbn=978-1-118-05396-6 |page=170 |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=zPXu561ZpvgC&pg=PA178 |archive-date=18 January 2016 |url-status=live}}</ref><ref name="alsabbagh_1996" /><ref name="encyc_religion_2005" /><ref name="riggs_2006" /> In contrast, some religions, such as ] and ] and ], strongly prohibit the practice of routine circumcision.<ref name="Drower" /><ref name = "Clarence-Smith_2008" /><ref name="Cherry-2013" />
	] at the ], ], Egypt. ], ], c. 1360 BC.]]
			====Judaism====
	] at a fair'''<br>Köçek troupe dancing at Sultan ]'s 14-day celebration of his sons' circumcision in 1720. Miniature from the ''Surname-i Vehbi'', ], ].]]
			{{Main|Brit milah}}Circumcision is near-universal among Jews.<ref name="Cohen-Almagor-2020">{{Cite journal | vauthors = Cohen-Almagor R |date=9 November 2020 |title=Should liberal government regulate male circumcision performed in the name of Jewish tradition? |journal=SN Social Sciences |language=en |volume=1 |issue=1 |pages=8 |doi=10.1007/s43545-020-00011-7 |issn=2662-9283 |quote=Protagonists and critics of male circumcision agree on some things and disagree on many others... They also do not underestimate the importance of male circumcision for the relevant communities.... Even the most critical voices of male circumcision do not suggest putting a blanket ban on the practice as they understand that such a ban, very much like the 1920–1933 prohibition laws in the United States, would not be effective... Protagonists and critics of male circumcision debate whether the practice is morally acceptable... They assign different weights to harm as well as to medical risks and to non-medical benefits. The different weights to risks and benefits conform to their underlying views about the practices... Protagonists and critics disagree about the significance of medical reasons for circumcision... |s2cid=228911544|doi-access=free }}</ref> The '']'' of circumcision on the eighth day of life is considered among the ]. Barring extraordinary circumstances, failure to undergo the rite is seen by followers of ] as leading to a state of '']'': the extinction of the ] and denial of a share in the ].<ref name="Mark-2003a" /><ref name="Hamilton-1990" /><ref name="Antisemitism" /> Reasons for biblical circumcision include to show off "patrilineal descent, sexual fertility, male initiation, cleansing of birth impurity, and dedication to God".<ref name=":92">{{Cite book |last=Hendel |first=Ronald |url=https://academic.oup.com/book/10720/chapter/158788296?login=true#313433798 |title=Remembering Abraham: Culture, Memory, and History in the Hebrew Bible |date=2005 |publisher=Oxford University Press |isbn=9780199784622 |pages=3–30}}</ref>
			]
	===Circumcision in the ancient world===
			The basis for its observance is found in the ] of the Hebrew Bible, in ], in which a covenant of circumcision is made with Abraham and his descendants. Jewish circumcision is part of the {{transliteration|he|]}} ritual, to be performed by a specialist ritual circumciser, a {{transliteration|he|]}}, on the eighth day of a newborn son's life, with certain exceptions for poor health. Jewish law requires that the circumcision leaves the glans bare when the penis is flaccid. Converts to Conservative and Orthodox Judaism must also be circumcised; those who are already circumcised undergo a symbolic circumcision ritual. Circumcision is not required by Judaism for one to be considered Jewish, but mainstream Judaism foresees serious negative spiritual consequences if it is neglected.<ref name="glass_1999" /><ref name="Bolnick_2012_ch23" /> Circumcision is not considered a ] within Judaism. Rather, the commandment to circumcise is seen as only applying to Jewish people. Those who are Gentiles are believed to have a portion in the "World to Come" as long as they follow the tenets of the ].<ref>{{Cite journal |vauthors = Oliver IW |date=2013-05-14 |title=Forming Jewish Identity by Formulating Legislation for Gentiles |url=http://dx.doi.org/10.30965/21967954-00401005 |journal=Journal of Ancient Judaism |volume=4 |issue=1 |pages=105–132 |doi=10.30965/21967954-00401005 |issn=1869-3296 |access-date=22 December 2022 |archive-date=14 September 2023 |archive-url=https://web.archive.org/web/20230914230852/https://brill.com/view/journals/jaj/4/1/article-p105_5.xml |url-status=live }}</ref> There are also certain exceptions for Jews with poor health.<ref>{{Cite book | vauthors = Levine A, Zvi Brettler M |title=The Jewish Annotated New Testament |publisher=] |year=2017 |pages=673 |quote=With rare exceptions (e.g. matters of health), Judaism requires circumcision for all male children on their eighth day of birth. |author-link=Amy-Jill Levine |author-link2=Marc Zvi Brettler}}</ref>
	The oldest documentary evidence for circumcision comes from ]. Tomb artwork from the ] (2345-2181 BCE) shows men with circumcised penises, and one ] from this period shows the rite being performed on a standing adult male. The ] for "penis" depicts either a circumcised or an erect organ. The examination of Egyptian mummies has found some with foreskins and others who were circumcised.
			According to traditional Jewish law, in the absence of an adult free Jewish male expert, a woman, a slave, or a child who has the required skills is also authorized to perform the circumcision, provided that they are Jewish.<ref>Talmud Avodah Zarah 26b; Menachot 42a; Maimonides' Mishneh Torah, Milah, ii. 1; ], Yoreh De'ah, l.c.</ref> However, most streams of non-Orthodox Judaism allow female {{transliteration|he|mohels}}, called {{transliteration|he|mohalot}} ({{langx|he|מוֹהֲלוֹת}}, the plural of {{lang|he|מוֹהֶלֶת}} {{transliteration|he|mohelet}}, feminine of {{transliteration|he|mohel}}), without restriction. In 1984 Deborah Cohen became the first certified Reform {{transliteration|he|mohelet}}; she was certified by the Berit Mila program of Reform Judaism.<ref>{{Cite web|date=2013-10-07|title=Berit Mila Program of Reform Judaism|url=http://beritmila.org/|access-date=2022-07-20|archive-url=https://web.archive.org/web/20131007073323/http://beritmila.org/ |archive-date=7 October 2013 }}</ref> An increasing number of Jews in the United States have chosen not to circumcise their sons.<ref>{{cite news |url= https://www.reuters.com/article/domesticNews/idUSN22970720071003?pageNumber=1 |title= Jewish "intactivists" in U.S. stop circumcising |access-date= 3 November 2007 | vauthors = Chernikoff H |date= 3 October 2007 |newspaper= Reuters |url-status= live |archive-url= https://web.archive.org/web/20081227025338/http://www.reuters.com/article/domesticNews/idUSN22970720071003?pageNumber=1 |archive-date= 27 December 2008 }}</ref>
	Circumcision was common, although not universal, among ancient ] peoples. The ], written in the sixth century BCE, lists the Egyptians, Jews, ], ], and ] as circumcising cultures. ], writing in the fifth century BCE, would add the ], ]ns, ], and ]ns to that list.
			All major rabbinical organizations make the recommendation that male infants should be circumcised. The issue of converts remains controversial in Reform and Reconstructionist Judaism;<ref>{{cite web| url = http://www.reformjudaism.org/learning/torah-study/lech-lcha/brit-milah-jewish-answer-modernity| title = B'rit Milah: A Jewish Answer to Modernity| access-date = 11 March 2017| vauthors = Glickman M | date = 12 November 2005| publisher = ]| url-status = live| archive-url = https://web.archive.org/web/20170312052827/http://www.reformjudaism.org/learning/torah-study/lech-lcha/brit-milah-jewish-answer-modernity| archive-date = 12 March 2017}}</ref><ref>{{cite web|url=http://www4.jrf.org/showdt&rid=322&pid=15 |title=Bo: Defining Boundaries |access-date=3 November 2007 | vauthors = Cohen H |date=20 May 2002 |publisher=Jewish Reconstructionist Federation |url-status=dead |archive-url=https://web.archive.org/web/20071009173021/http://www4.jrf.org/showdt%26rid%3D322%26pid%3D15 |archive-date=9 October 2007 }}</ref> circumcision of converts is not mandatory in either.<ref>{{cite web|url=http://www.jewishcalgary.org/page.html?ArticleID=63645 |title=The Conversion Process |access-date=3 November 2007 | vauthors = Epstein L |year=2007 |publisher=Calgary Jewish Community Council |url-status=dead |archive-url=https://web.archive.org/web/20081227065531/http://www.jewishcalgary.org/page.html?ArticleID=63645 |archive-date=27 December 2008 }}</ref>
	In the aftermath of the conquests of ], Greek dislike of circumcision led to a decline in its incidence among many peoples that had previously practised it. The writer of the ] wrote that under the ]s, many Jewish men attempted to hide or reverse their circumcision so they could exercise in Greek ], where nudity was the norm. First Maccabees also relates that the Seleucids forbade the practice of ] (Jewish circumcision), and punished those who performed it&ndash;as well as the infants who underwent it&ndash;with death.
			====Islam====
	===Medical circumcision in the 19th century and early 20th century===
			{{Main|Khitan (circumcision)}}
	Several hypotheses have been raised to explain the acceptance of infant circumcision in the United States about the turn of the Twentieth Century. The success of the ] made surgery safer, and made the public deeply suspicious of dirt and bodily secretions. So ] was viewed as unhealthy, and circumcision was seen as good penile hygiene. At that time when people regarded ] as both ]ful, and physically and mentally unhealthy, circumcision was promoted as a way of discouraging it. ''All About the Baby'', a popular parenting book of the 1890s, recommended infant circumcision for this purpose. (However, a survey of 1410 men in the United States in 1992, found that circumcised men were ''more'' likely to report masturbating at least once a month.)
			]
			] market, just after circumcision, Mali, 1990]]
			Islamic scholars have diverse opinions on the obligatory nature of male circumcision, with some considering it mandatory ('']''), while others view it as only being recommended (''sunnah'').<ref name="pmid36006531">{{cite journal | vauthors = Dabbagh H | title = Is Circumcision "Necessary" in Islam? A Philosophical Argument Based on Peer Disagreement | journal = Journal of Religion and Health | volume = 61 | issue = 6 | pages = 4871–4886 | date = December 2022 | pmid = 36006531 | pmc = 9569283 | doi = 10.1007/s10943-022-01635-0 }}</ref> According to ] and scholars of ], the Islamic tradition of circumcision was derived from the ] of ].<ref>{{cite journal | vauthors = Abu-Sahlieh SA | title = To mutilate in the name of Jehovah or Allah: legitimization of male and female circumcision | journal = Medicine and Law | volume = 13 | issue = 7–8 | pages = 575–622 | date = 1994 | pmid = 7731348 | publisher = ] | author-link = Sami Aldeeb }}; {{cite journal | vauthors = Aldeeb Abu-Sahlieh SA |date=1995 |url=https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1036&context=twls |title=Islamic Law and the Issue of Male and Female Circumcision |journal=Third World Legal Studies |volume=13 |pages=73–101 |publisher=] |access-date=13 February 2020 |archive-url=https://web.archive.org/web/20191112162823/https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1036&context=twls |archive-date=12 November 2019 |url-status=live }}</ref> Although there is some debate within Islam over whether it is a religious requirement or mere recommendation, circumcision (called ''khitan'') is practiced nearly universally by Muslim males. Islam bases its practice of circumcision on the Genesis 17 narrative, the same Biblical chapter referred to by Jews. The procedure is not explicitly mentioned in the Quran, however, it is a tradition established by Islam's prophet ] directly (following Abraham), and so its practice is considered a '']'' (prophet's tradition) and is very important in Islam. For Muslims, circumcision is also a matter of cleanliness, purification and control over one's baser self ('']'').<ref name=clark_2011/><ref name=alsabbagh_1996/><ref name=Bolnick_2012_ch24/>
	In 1855, the ] surgeon, Jonathan Hutchinson, observed that circumcision appeared to protect against ].<ref>{{cite journal | Hutchinson J | title=On the influence of circumcision in preventing syphilis | journal=Medical Times and Gazette | volume=NS Vol II | year=1855 | pages=542&ndash;3 }}</ref> Although this observation was challenged (the protection that Jews appear to have are more likely due to cultural factors<ref>{{cite journal | author=Epstein E | title=Have the Jews any Immunity from Certain Diseases? | journal=Medical and Surgical Reporter (Philadelphia) | volume=XXX | year=1874 | pages=40&ndash;41 }}</ref>), a 2006 systematic review concluded that the evidence "strongly indicates that circumcised men are at lower risk ... syphilis."<ref>{{cite journal |title=Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis |first=HA |last=Weiss |coauthors=Thomas, SL; Munabi SK; Hayes RJ |journal=Sex Transm Infect |year=2006 |month=Apr |volume=82 |issue=2 |pages=101-9 |id=PMID 16581731 |url=http://sti.bmj.com/cgi/content/full/82/2/101}}</ref>
			There is no agreement across the many Islamic communities about the age at which circumcision should be performed. It may be done from soon after birth up to about age 15; most often it is performed at around six to seven years of age. The timing can correspond with the boy's completion of his recitation of the whole Quran, with a coming-of-age event such as taking on the responsibility of daily prayer or betrothal. Circumcision may be celebrated with an associated family or community event. Circumcision is recommended for, but is not required of, converts to Islam.<ref name=clark_2011/><ref name=alsabbagh_1996/><ref name=Bolnick_2012_ch24/>
	As ]s proliferated in urban areas, ], at least among the upper and middle classes, was increasingly under the care of physicians in hospitals rather than with ] in the home. It has been suggested that once a critical mass of infants were being circumcised in the hospital, circumcision became a class marker of those wealthy enough to afford a hospital birth.<ref>{{cite journal |url=http://www.law.uc.edu/lawreview/uclaw72pdf/0455waldeck.pdf |title=Using Male Circumcision to Understand Social Norms as Multipliers |journal=UNIVERSITY OF CINCINNATI LAW REVIEW |first=S.E. |last=Waldeck |year=2003 |volume=72 |issue=2 |pages=455-526}}</ref>
			====Christianity====
	By the 1920s, advances in the understanding of disease had undermined much of the original medical basis for preventive circumcision but doctors continued to promote it as good penile hygiene and as a preventive for balanitis, phimosis, and penile cancer. {{Fact|date=March 2007}}
			{{Main|Religious male circumcision#In Christianity}}
			Traditionally, circumcision has not been practiced by Christians for religious reasons, with the practice being viewed as succeeded by ], with the ] chapter ] recording that Christianity did not require circumcision from new converts.<ref>{{Cite book | vauthors = Mark E |title=The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite |publisher=] |year=2003 |isbn=978-1-58465-307-3 |pages=xxiii}}</ref> Christian denominations generally hold a neutral position on circumcision for prophylactic, cultural, and social reasons, while strongly opposing it for religious reasons. This includes the ], which explicitly banned the practice of religious circumcision in the ],<ref name = "CoF">{{cite book| author = Pope Eugenius IV| author-link = Pope Eugene IV| veditors = Tanner NP | title = Decrees of the ecumenical councils| orig-date = 1442| access-date = 25 April 2007| series = 2 volumes| year = 1990| publisher = ]| location = ]| isbn = 978-0-87840-490-2| language = el, la| chapter = Ecumenical Council of Florence (1438–1445): Session 11—4 February 1442; Bull of union with the Copts| chapter-url = http://www.ewtn.com/library/COUNCILS/FLORENCE.HTM#5| quote = it denounces all who after that time observe circumcision| lccn = 90003209| archive-date = 25 April 2009| archive-url = https://web.archive.org/web/20090425150516/http://www.ewtn.com/library/COUNCILS/FLORENCE.HTM#5| url-status = live}}</ref> and maintains a neutral position on the practice of circumcision for other reasons.<ref name=Slosar>{{cite journal | vauthors = Slosar JP, O'Brien D | title = The ethics of neonatal male circumcision: a Catholic perspective | journal = The American Journal of Bioethics | volume = 3 | issue = 2 | pages = 62–64 | year = 2003 | pmid = 12859824 | doi = 10.1162/152651603766436306 | s2cid = 38064474 }}</ref> A majority of other ] take a similar position on circumcision, prohibiting it for religious observance, but neither explicitly supporting or forbidding it for other reasons.<ref name=Slosar/>
			] Children wearing traditional circumcision costumes]]
			Thus, circumcision rates of Christians are predominately determined by the surrounding cultures which they live in. In some ] and ] circumcision is an established practice,<ref name="N. Stearns 2008 179">{{Cite book | vauthors = Stearns PN |title=The Oxford Encyclopedia of the Modern World |publisher=] |year=2008 |isbn=978-0-19-517632-2 |pages=179 |quote=Uniformly practiced by Jews, Muslims, and the members of Coptic, Ethiopian, and Eritrean Orthodox Churches, male circumcision remains prevalent in many regions of the world, particularly Africa, South and East Asia, Oceania, and Anglosphere countries.}}</ref><ref>{{cite book|title=Cultural Encyclopedia of the Body | vauthors = Pitts-Taylor V |year= 2008| isbn= 978-1-56720-691-3| page =394|publisher=ABC-CLIO|quote=For most part, Christianity does not require circumcision of its followers. Yet, some Orthodox and African Christian groups do require circumcision. These circumcisions take place at any point between birth and puberty.}}</ref> and generally boys undergo circumcision shortly after birth as part of a ].<ref name="N. Stearns 2008 179" /> Circumcision is near-universal among ],<ref>{{cite book|title= American Evangelicals in Egypt: Missionary Encounters in an Age of Empire| vauthors = Sharkey HJ |year= 2015| isbn=978-0-691-16810-4 | page =30|publisher=Princeton University Press}}</ref> and they practice circumcision as a rite of passage.<ref name=WHO_2007_GTDPSA/><ref name=Columbia_encyc_2011_circ/><ref name=riggs_2006/><ref name=Bolnick_2012_ch26/> The ] calls for circumcision, with near-universal prevalence among Orthodox men in Ethiopia.<ref name=WHO_2007_GTDPSA/> ] practice circumcision as a rite of passage, and they circumcise their sons "anywhere from the first week of life to the first few year".<ref>{{Cite book| vauthors = DeMello M |title=Encyclopedia of Body Adornment|publisher=]|year=2007|isbn=978-0-313-33695-9 |pages=66|quote=Coptic Christians, Ethiopian Orthodox, and Eritrean Orthodox churches on the other hand, do observe the ordainment, and circumcise their sons anywhere from the first week of life to the first few years.}}</ref> Some Christian churches in South Africa disapprove of the practice, while others require it of their members.<ref name=WHO_2007_GTDPSA/>
			Circumcision is practiced in many predominantly ] and Christian communities.<ref name="Gruenbaum 2015 61">{{cite book | vauthors = Gruenbaum E |title=The Female Circumcision Controversy: An Anthropological Perspective |publisher=University of Pennsylvania Press |year=2015 |isbn=978-0-8122-9251-0 |page=61 |quote=Christian theology generally interprets male circumcision to be an Old Testament rule that is no longer an obligation ... though in many countries (especially the United States and Sub-Saharan Africa, but not so much in Europe) it is widely practiced among Christians}}</ref><ref>{{cite book|title=Essential Case Studies in Public Health: Putting Public Health Into Practice| vauthors = Hunting K |year= 2012| isbn=978-1-4496-4875-6| pages =23–24 |publisher=Jones & Bartlett Publishers|quote= Neonatal circumcision is the general practice among Jews, Christians, and many, but not all Muslims.}}</ref><ref name="R. Wylie 2015 101">{{cite book | vauthors = Wylie KR |title=ABC of Sexual Health |publisher=John Wiley & Sons |year=2015 |isbn=978-1-118-66569-5 |page=101 |quote=Although it is mostly common and required in male newborns with Moslem or Jewish backgrounds, certain Christian-dominant countries such as the United States also practice it commonly.}}</ref> ] in ],<ref>{{cite book | vauthors = Creighton S, Liao LM |title=Female Genital Cosmetic Surgery: Solution to What Problem? |date=2019 |publisher=Cambridge University Press|isbn=978-1-108-43552-9 |page=63 |language=English |quote=Christians in Africa, for instance, often practise infant male circumcision.}}</ref><ref>{{cite web |first =Armelle |last =Nga |url =https://www.africanews.com/2019/12/30/the-ritual-of-circumcision-in-africa-the-case-of-south-africa/ |title =The Ritual of Circumcision in Africa: The Case of South Africa |date =30 December 2019 |publisher =Africanews |quote =This practice is old and widespread among African Christians with very close links to their beliefs. It can be executed traditionally or in hospital. |access-date =8 November 2022 |archive-date =6 December 2022 |archive-url =https://web.archive.org/web/20221206235611/http://www.africanews.com/2019/12/30/the-ritual-of-circumcision-in-africa-the-case-of-south-africa/ |url-status =live }}</ref> some ], the Philippines, the Middle East,<ref>{{cite book | vauthors = Bakos GT |title=On Faith, Rationality, and the Other in the Late Middle Ages:: A Study of Nicholas of Cusa's Manuductive Approach to Islam |date=2011 |publisher=Wipf and Stock Publishers|isbn= 978-1-60608-342-0|page=228 |language=English |quote=Although it is stated that circumcision is not a sacrament necessary for salvation, this rite is accepted for the Ethiopian Jacobites and other Middle Eastern Christians.}}</ref><ref>{{cite book | vauthors =Sharkey HJ |title=A History of Muslims, Christians, and Jews in the Middle East|date=2017 |publisher=Cambridge University Press|isbn=978-0-521-76937-2|page=63 |language=English |quote= On the Coptic Christian practice of male circumcision in Egypt, and on its practice by other Christians in western Asia.}}</ref> South Korea and ] have high circumcision rates,<ref name="Associated Press">{{cite web |date=March 30, 2008 |title=Circumcision protest brought to Florence |url=https://apnews.com/article/19456997e17c4a12a24abb9d11c01dba |publisher=] |quote=However, the practice is still common among Christians in the United States, Oceania, South Korea, the Philippines, the Middle East and Africa. Some Middle Eastern Christians actually view the procedure as a rite of passage. |access-date=2 August 2022 |archive-date=26 March 2023 |archive-url=https://web.archive.org/web/20230326234939/https://apnews.com/article/19456997e17c4a12a24abb9d11c01dba |url-status=live }}</ref><ref>{{cite book |title= Religion and Violence: An Encyclopedia of Faith and Conflict from Antiquity to the Present | vauthors = Ross JI |year= 2015| isbn=978-1-317-46109-8| page =169|publisher=Routledge|quote=For instance, the majority of South Koreans, Americans, and Filipinos, as well as African Christians, practice circumcision.}}</ref> while Christian communities in ] and ] have low circumcision rates, although none of these are performed out of perceived religious obligation.<ref name="N. Stearns 2008 179" /><ref name="R. Peteet 2017 97–101">{{cite book | vauthors = Peteet JR |title=Spirituality and Religion Within the Culture of Medicine: From Evidence to Practice |publisher=Oxford University Press |year=2017 |isbn=978-0-19-027243-2 |pages=97–101 |quote=male circumcision is still observed among Ethiopian and Coptic Christians, and circumcision rates are also high today in the Philippines and the US.}}</ref> Scholar Heather L. Armstrong writes that, {{as of|lc=y|2021|post=,}} about half of Christian males worldwide are circumcised, with most of them being located in Africa, Anglosphere countries, and the Philippines.<ref name="Armstrong">{{cite book | vauthors = Armstrong HL |title=Encyclopedia of Sex and Sexuality: Understanding Biology, Psychology, and Culture |publisher=ABC-CLIO |year=2021 |isbn=978-1-61069-875-7 |pages=115–117}}</ref>
	Routine infant circumcision was taken up in the English-speaking parts of ], the ] and ], and to a lesser extent in ] and the ] In England, the Royal House had a long tradition requiring that all male children be circumcised” (Alfred J. Kolatach’s The Jewish Book of Why, Middle Village, New York; Jonathan David, 1981). Although it is difficult to determine historical circumcision rates, one estimate of infant circumcision rates in the United States holds that 30% of newborn American boys were being circumcised in 1900, 55% in 1925, and 72% in 1950.
	===Circumcision since 1950===		====Druze faith====
			] child]]
	In 1949, the United Kingdom's newly-formed ] removed infant circumcision from its list of covered services. One reason may have been Douglas Gairdner’s famous study, ''The fate of the foreskin'', which revealed that for the years 1942&ndash;1947, about 16 children per year in England and Wales had died because of circumcision, a rate of about 1 per 6000 circumcisions.<ref name = "Gairdner" /> Since then, circumcision has been an ] to parents, and the proportion of newborns circumcised in England and Wales has fallen to less than one percent.
			Circumcision is widely practiced by the ];<ref name="Ubayd-2006a">{{cite book|title=The Druze and Their Faith in Tawhid| vauthors = Ubayd A |year= 2006| isbn=978-0-8156-3097-5| page =150|publisher=Syracuse University Press|quote=Male circumcision is standard practice, by tradition, among the Druze}}</ref> Druze practice Druzism, an ],<ref name="BritishLibrary">{{cite web | vauthors = Abulafia AS |author-link=Anna Abulafia |date=23 September 2019 |url=https://www.bl.uk/sacred-texts/articles/the-abrahamic-religions |title=The Abrahamic religions |website=www.bl.uk |publisher=] |location=] |access-date=9 March 2021 |url-status=live |archive-url=https://web.archive.org/web/20200712150432/https://www.bl.uk/sacred-texts/articles/the-abrahamic-religions |archive-date=12 July 2020}}</ref><ref name="TheDruze">{{cite book| vauthors = Obeid A |title=The Druze & Their Faith in Tawhid|url=https://books.google.com/books?id=FejqBQAAQBAJ&pg=PT1|year=2006|publisher=Syracuse University Press|isbn=978-0-8156-5257-1|page=1}}</ref> ], ], and ]. The procedure is practiced as a cultural tradition, and has no religious significance in the Druze faith.<ref>{{cite book|title=Israel and the Palestinian Territories: The Rough Guide| vauthors = Jacobs D |year= 1998| isbn=978-1-85828-248-0| page =147|publisher=Rough Guides|quote=Circumcision is not compulsory and has no religious significance.}}</ref><ref>{{cite book|title=The History of Galilee, 1538–1949: Mysticism, Modernization, and War| vauthors = Silver MM |year= 2022| isbn= 978-1-7936-4943-0 | page =97|publisher=Rowman & Littlefield|quote=Muslim men are circumcised, whereas this is not a religious obligation among the Druze}}</ref> There is no special date for this act in the ]: male Druze infants are usually circumcised shortly after birth,<ref name = "Dana_2003" /> however some remain uncircumcised until the age of ten or older.<ref name = "Dana_2003" />
			Some Druses do not circumcise their male children and refuse to observe this "common Muslim practice".<ref>{{cite book|title=The Sunni-Shi'a Divide: Islam's Internal Divisions and Their Global Consequences | vauthors = Brenton RB |year= 2013| isbn=978-1-61234-523-9| page =56|publisher=Potomac Books, Inc.|quote=There are many references to the Druze refusal to observe this common Muslim practice, one of the earliest being the rediscoverer of the ruins of Petra, John Burckhardt. "The Druses do not circumcise their children}}</ref>
	In Canada (where public medical insurance is universal, and where private insurance does not replicate services already paid from the public purse), individual provincial health services began delisting circumcision in the 1980s. <!--Commenting out pending a reliable source: The infant circumcision rate in Canada has fallen from roughly 50% in the 1970s to 13.9% in 2003. However, the figures varied from 29.5% on Prince Edward Island to zero in Newfoundland and Labrador. -->
			====Samaritanism====
	In ], circumcision grew in popularity following the establishment of the United States trusteeship in 1945 and the spread of American influence. More than 90% of South Korean high school boys are now circumcised, but the average age of circumcision is 12 years.<ref>{{cite journal |url=http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410X.2002.02545.x |first=MG |last=Pang |coauthors=Kim DS |title=Extraordinarily high rates of male circumcision in South Korea: history and underlying causes |journal=BJU Int |year=2002 |volume=89 |issue=1 |pages=48-54}}</ref>
			Like Judaism, the religion of ] requires ritual circumcision on the eighth day of life.<ref name="Mark-2003">{{Cite book | vauthors = Mark E |title=The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite |publisher=] |year=2003 |isbn=978-1-58465-307-3 |pages=94–95}}</ref>
	In some ]n ethnic groups, circumcision has roots in several belief systems, and is performed most of the time on teenage boys:
	:''"...The young men in the eastern Cape belong to the Xhosa ethnic group for whom circumcision is considered part of the passage into manhood... A law was recently introduced requiring initiation schools to be licensed and only allowing circumcisions to be performed on youths aged 18 and older. But Eastern Cape provincial Health Department spokesman Sizwe Kupelo told Reuters news agency that boys as young as 11 had died. Each year thousands of young men go into the bush alone, without water, to attend initiation schools. Many do not survive the ordeal..."'' .
			====Mandaeism====
	Prior to 1989, the American Academy of Pediatrics had a long-standing opinion that medical indications for routine circumcision were lacking. This stance, according to the AMA, was reversed in 1989, following new evidence of reduction in risk of urinary tract infection.<ref name = "CSA:I-99" /> A study in 1987 found that the prominent reasons for parents choosing circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns. A 1999 study reported that reasons for circumcision included "ease of hygiene (67 percent), ease of infant circumcision compared with adult circumcision (63 percent), medical benefit (41 percent), and father circumcised (37 percent)." The authors commented that "Medical benefits were cited more frequently in this study than in past studies, although medical issues remain secondary to hygience and convenience." A 2001 study reported that "The most important reason to circumcise or not circumcise the child was health reasons."<ref name="adler">{{cite journal |url=http://pediatrics.aappublications.org/cgi/content/full/107/2/e20 |title=Circumcision: we have heard from the experts; now let's hear from the parents |first=R |last=Adler |coauthors=''et al'' |journal=Pediatrics |year=2001 |volume=107 |issue=2 |pages=E20}}</ref> A 2005 study speculated that increased recognition of the potential benefits may be responsible for an observed increase in the rate of neonatal circumcision in the USA between 1988 and 2000.
			Circumcision is forbidden in ],<ref name="Drower">{{cite book| vauthors = Drower ES |title=The Mandaeans of Iraq and Iran|publisher=Oxford At The Clarendon Press|year=1937}}</ref><ref>{{cite book| vauthors = Lupieri E |title=The Mandaeans: The Last Gnostics|date=2001|publisher=Wm. B. Eerdmans Publishing|isbn=978-0-8028-3350-1 |url=https://books.google.com/books?id=zJ73YfrZ2T4C&q=Nicolas%20Siouffi%20christian&pg=PA12|page=60|access-date=6 August 2022|archive-date=14 September 2023|archive-url=https://web.archive.org/web/20230914230849/https://books.google.com/books?id=zJ73YfrZ2T4C&q=Nicolas%20Siouffi%20christian&pg=PA12|url-status=live}}</ref> and the sign of the Jews given to ] by God, circumcision, is considered abhorrent by the ].<ref>{{cite book|title=Beyond ISIS: History and Future of Religious Minorities in Iraq| vauthors = Schmidinger T |year= 2019| isbn=978-1-912997-15-2| page =82|publisher=Transnational Press London|quote=}}</ref> According to Mandaean doctrine, a circumcised man cannot serve as a ].<ref>{{cite book|title=Guardians of the Gate: Angelic Vice-regency in the Late Antiquity| vauthors = Deutsch N |year= 1999| isbn=978-90-04-10909-4| page =105|publisher=BRILL|quote=}}</ref>
	In a 2001 survey, 86.6% of parents felt respected by their medical provider, and parents who did not circumcise "felt less respected by their medical provider".<ref name="adler" />
			====Yazidism====
	The major medical societies in Britain, Canada, Australia and New Zealand do not support routine non-therapeutic infant circumcision. Major medical organizations in the United States do not recommend routine circumcision, but instead state that parents should decide what is in their child's best interests.
			Circumcision is not required in ], but is practised by some ] due to regional customs.<ref>{{cite web | vauthors = Parry OH |title=Six months in a Syrian monastery; being the record of a visit to the head quarters of the Syrian church in Mesopotamia, with some account of the Yazidis or devil worshippers of Mosul and El Jilwah, their sacred book |url=https://archive.org/stream/sixmonthsinasyr00parrgoog/sixmonthsinasyr00parrgoog_djvu.txt |publisher=London : H. Cox |date=1895}}</ref> The ritual is usually performed soon after birth, it takes place on the knees of the kerîf (approximately "godfather"), with whom the child will have a life-long formal relationship.<ref>{{Cite book| vauthors = Kreyenbroek PG |title=Yezidism in Europe: Different Generations Speak about Their Religion|date=2009|publisher=Otto Harrassowitz Verlag|isbn=978-3-447-06060-8|language=en}}</ref>
			====Sikhism====
	The AMA remarked that, in one study, physicians in "nearly half" of neonatal circumcisions "did not discuss the potential medical risks and benefits of elective circumcision prior to delivery of the infant son. Deferral of discussion until after birth, combined with the fact that many parents' decisions about circumcision are preconceived, contribute to the high rate of elective circumcision."<ref name="CSA:I-99" />
			] does not require the elective circumcision of its followers and strongly criticizes the practice.<ref name="Cherry-2013">{{Cite book| vauthors = Cherry M |title=Religious Perspectives on Bioethics|publisher=]|year=2013|isbn=978-90-265-1967-3|pages=213}}</ref><ref>{{cite book | vauthors = Cole WO, Sambhi PS |date=1995 |title=The Sikhs: Their Religious Beliefs and Practices |publisher=Sussex Academic Press |isbn=978-1-898723-13-4 |pages=155–156}}</ref>
			For example, ] criticizes the practise of circumcision in the hymn of ].<ref>{{Cite web|url=http://www.srigranth.org/servlet/gurbani.gurbani?Action=Page&Param=477|title=Sri Granth: Sri Guru Granth Sahib|website=www.srigranth.org}}</ref>
	{| border="2" cellpadding="4" cellspacing="0" style="margin-left:auto; margin-right:auto; border-collapse: collapse; border:1px solid #999"
	|+'''Table 1: International circumcision rates'''
	|- bgcolor="#f2f2f2"
	! Country
	! Year
	! Neonatal circumcisions (%)
	|-
	| United States
	| 2003
	| 55.9%*
	|-
	| Canada
	| 2005
	| &lt; 14%
	|-
	| Australia
	| 2004
	| 10%-20%
	|-
	| New Zealand
	| 1995
	| 10%-20%
	|-
	|- style="border-top:1px solid #999; border-bottom: hidden; border-left: hidden; border-right: hidden;"
	| colspan="3" | <small>*The percentage refers to infants born in non-Federal hospitals; see p 52, Table 44 of the reference.</small>
	|- style="border-top: hidden; border-bottom: hidden; border-left: hidden; border-right: hidden;"
	| colspan="3" | <small>**Samoans, Tongans and Niueans in New Zealand continue to practice circumcision, but not in public hospitals, to which these data refer.</small>
	|}
			====African cultures====
	==Prevalence of circumcision==
	{{main|Circumcision worldwide}}		{{excerpt|Circumcision in Africa|paragraphs=1}}
	Estimates of the proportion of males that are circumcised worldwide vary from one sixth (12.5%)<ref name="williams1993">Williams N, Kapila L. Complications of circumcision. ''Brit J Surg.'' 1993;80:1231-6. ()</ref> to one third (33.3%).<ref name="crawford2002">Crawford DA. Circumcision: a consideration of some of the controversy. ''J Child Health Care.'' 2002 December;6(4):259-70. PMID 12503896</ref> According to one author, the practice is "a falling trend internationally",<ref>{{cite journal
	| last = StanWisniewski
	| first = Z.
	| year = 2004
	| title = Circumcision in Western Australia
	| journal = ANZ Journal of Surgery
	| volume = 74
	| issue = 5
	| pages = 387-388
	| doi = 10.1111
	| url = http://pt.wkhealth.com/pt/re/aunz/fulltext.00130494-200405000-00028.htm
	| accessdate = 2007-03-31
	</ref>{{Verify source|date=April 2007}} although another notes indications of increasing demand in Southern Africa.<ref>{{cite journal |title=Demand for male circumcision rises in a bid to prevent HIV |journal=Bulletin of the World Health Organization |volume=84 |issue=7 |year=2006 |pages=505-588 |url=http://www.scielosp.org/pdf/bwho/v84n7/v84n7a05.pdf |quote=As a result, there are already indications of increasing demand for male circumcision in traditionally non-circumcising societies in southern Africa.}}</ref>
	===Australia===		====Australian cultures====
			Some ] use circumcision as a test of bravery and self-control as a part of a rite of passage into manhood, which results in full societal and ceremonial membership. It may be accompanied by body ] and the removal of teeth, and may be followed later by ]. Circumcision is one of many trials and ceremonies required before a youth is considered to have become knowledgeable enough to maintain and pass on the cultural traditions. During these trials, the maturing youth bonds in solidarity with the men. Circumcision is also strongly associated with a man's family, and it is part of the process required to prepare a man to take a wife and produce his own family.<ref name=encyc_religion_2005/>
	According to the Sydney Morning Herald, the infant circumcision rate in Australia was 12.9% as of 2003. However, rates in the states varied, with highest rates in Queensland (19.3%), New South Wales (16.3%) and South Australia (14.3%), and the lowest in Tasmania (1.6%).<ref>{{cite web |first=Judy |last=Skatssoon |month=July |year=2004 |title=Circumcision rates rise for some |publisher=Sydney Morning Herald (reprint: CIRP.org) |location=Sydney, New South Wales, Australia |url=http://www.cirp.org/news/smh07-01-04/}}</ref>
	===Denmark===		====Filipino culture====
			{{Main|Tuli (rite)}}
	In 1986, only 511 out of approximately 478,000 Danish boys aged 0-14 years were circumcised. This corresponds to a cumulative national circumcision rate of around 1.6% by the age of 15 years.
			In the Philippines, circumcision is known as "tuli" and is generally viewed as a rite of passage.<ref name=Tuli2011/> An overwhelming majority of Filipino men are circumcised.<ref name="Tuli2011">{{cite web|title=Tuli a rite of passage for Filipino boys|url=http://www.gmanetwork.com/news/story/219779/news/nation/tuli-a-rite-of-passage-for-filipino-boys|access-date=6 December 2015|date=6 May 2011|url-status=live|archive-url=https://web.archive.org/web/20151208183045/http://www.gmanetwork.com/news/story/219779/news/nation/tuli-a-rite-of-passage-for-filipino-boys|archive-date=8 December 2015}}</ref>{{efn| The most commonly-done procedure is in actuality not a ''circumcision'' but a ], where no foreskin is actually removed. When the foreskin is removed, it is commonly known locally as a "German cut" in reference to the introduction of the modern surgical technique by the founder of plastic and reconstructive surgery, ].<ref> {{Webarchive|url=https://web.archive.org/web/20220902032825/https://books.google.com/books?id=hpNlnylhRKsC&pg=PA435 |date=2022-09-02 }} (vgl. Schumpelick u.&nbsp;a., S. 434 ff.)</ref>}} Often this occurs, in April and May, when Filipino boys are taken by their parents. The practice dates back to the arrival of ] in 1450. Pressure to be circumcised is even in the language: one ] for 'uncircumcised' is ''supot'', meaning 'coward' literally. A circumcised eight or ten year-old is no longer considered a boy and is given more adult roles in the family and society.<ref>{{cite news |title='Circumcision season': Philippine rite puts boys under pressure |url=https://www.channelnewsasia.com/news/asia/-circumcision-season---philippine-rite-puts-boys-under-pressure--11640442 |access-date=20 June 2019 |work=Channel News Asia |agency=Agence France-Presse |date=19 June 2019 |archive-date=20 June 2019 |archive-url=https://web.archive.org/web/20190620140705/https://www.channelnewsasia.com/news/asia/-circumcision-season---philippine-rite-puts-boys-under-pressure--11640442 |url-status=dead }}</ref>
	===South Korea===
	It has been estimated on the basis of an academic medical survey that some 78% of South Korean men may be circumcised and it has been stated that "South Korea has possibly the largest absolute number of teenage or adult circumcisions anywhere in the world. Because circumcision started through contact with the American military during the Korean War, South Korea has an unusual history of circumcision."<ref>J.H. Ku1, M.E. Kim, N.K. Lee and Y.H. Park, "Circumcision practice patterns in South Korea: community based survey" (Sex Transm Inf 2003;79:65-67 http://sti.bmjjournals.com/cgi/content/full/79/1/65 retrieved ] ]</ref>
	===United Kingdom===		===Ethical and legal issues===
			{{Main|Ethics of circumcision}}
	A national survey on sexual attitudes in 2000 found that 11.7% of 16-19 year olds, and 19.6% of 40-44 year olds said they had been circumcised. It also found that, apart from black Caribbeans, overseas born men were more likely to be circumcised.<ref>{{cite journal |title=Male circumcision in Britain:
			{{See also|Circumcision controversies|Circumcision and law}}
	findings from a national probability sample survey |url=http://sti.bmj.com/cgi/content/full/79/6/499 |first=SS |last=Dave |coauthors=''et al'' |journal=Sex Transm Infect |year=2003 |volume=79 |issue=6 |pages=499-500}}</ref> Rickwood ''et al'' reported that the proportion of English boys circumcised for medical reasons had fallen from 35% in the early 1930s to 6.5% by the mid-1980s. An estimated 3.8% of male children in the UK in 2000 were being circumcised by the age of 15 . The researchers stated that too many boys, especially under the age of 5, were still being circumcised because of a misdiagnosis of phimosis. They called for a target to reduce the percentage to 2%.
	===United States===		==== Ethics ====
			{{excerpt|Ethics of circumcision|paragraphs=2}}
	Statistics from different sources give widely varying estimates of infant circumcision rates in the United States.
			==== Legal ====
	Nelson, 2005 used data from the Nationwide Inpatient Sample (a sample of 5-7 million of the nation's total inpatient stays, and representing a 20% sample taken from 8 states in 1988 and 28 in 2000), stated that circumcisions rose from 48.3% in 1988 to 61.1% in 1997.<ref>{{cite journal
			Worldwide, the large majority of polities do not have specific laws concerning the circumcision of males,<ref name=WHO_2007_GTDPSA/> with religious infant circumcision being legal in every country.<ref name="Cohen-Almagor-2020" /><ref name=RACP_2010/> A few countries have passed legislation on the procedure: Germany allows routine circumcision,<ref name=DW_2012/> while non-religious routine circumcision is illegal in South Africa and Sweden.<ref name=WHO_2007_GTDPSA/><ref name=RACP_2010/> No major medical organization recommends circumcising all males, and no major medical organization recommends banning the procedure.<ref name="Bolnick_2012_ch1" /><ref name="Basaran-2023">{{Cite book | vauthors = Basaran O |title=Circumcision and Medicine in Modern Turkey |publisher=] |year=2023 |isbn=978-1-4773-2702-9 |pages=156–157 |quote=Regardless of their ethical stances, scholars of both camps tend to agree that a blanket criminalization of male circumcision would be unhelpful and harmful to boys...}}</ref><ref name="Cohen-Almagor-2020" />
	| last = Nelson
	| first = CP.
	| coauthors = R. Dunn, J. Wan, JT. Wei
	| year = 2005
	| month = March
	| title = The increasing incidence of newborn circumcision: data from the nationwide inpatient sample
	| journal = Journal of Urology
	| volume = 173
	| issue = 3
	| pages = 978–981
	| id = {{ISSN|0022-5347}} PMID 15711354
	| url = http://www.jurology.com/article/PIIS0022534705604193/abstract
	| format = Abstract
	| doi = 10.1097/01.ju.0000145758.80937.7d
	| accessdate = 2006-09-21
	}}
	</ref>
			In the academic literature, there is general agreement among both supporters and opponents of the practice that an outright ban would be predominately ineffective and "harmful".<ref name="Bolnick_2012_ch1" /><ref name="Cohen-Almagor-2020" /><ref name="knmg.nl">{{cite web |title=Non-therapeutic circumcision of male minors | work = KNMG Viewpoint | location = Utrecht, The Netherlands | publisher = Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst (KNMG) (Royal Dutch Society for the Promotion of Medicine)| date = May 2010 |url=https://www.knmg.nl/advies-richtlijnen/knmg-publicaties/publications-in-english.htm |access-date=7 March 2018 |archive-date=8 March 2018 |archive-url=https://web.archive.org/web/20180308231353/https://www.knmg.nl/advies-richtlijnen/knmg-publicaties/publications-in-english.htm |url-status=live }}</ref><ref name="Basaran-2023" /> A consensus to keep the procedure within the purview of medical professionals is found across all major medical organizations, who advise medical professionals to yield to some degree to parental preferences in their decision to agree to circumcise.<ref name="Bolnick_2012_ch1" /><ref name="Cohen-Almagor-2020" /> The Royal Dutch Medical Association, which expresses some of the strongest opposition to routine neonatal circumcision, argues that while there are valid reasons for banning it, doing so could lead parents who insist on the procedure to turn to poorly trained practitioners instead of medical professionals.<ref name="Bolnick_2012_ch1" /><ref name=RACP_2010/>
	The 2003 Nationwide Hospital Discharge Survey stated that circumcision rates declined from 64.7% in 1980 to 59.0% in 1990, rose to 64.1% in 1995, and fell again to 55.9% in 2003.<ref name = "NHDS">{{cite journal
	| last = Kozak
	| first = LJ
	| coauthors = KA Lees, and CJ DeFrances
	| year = 2006
	| title = National Hospital Discharge Survey: 2003 annual summary with detailed diagnosis and procedure data.
	| journal = Vital Health Statistics
	| volume = 13
	| issue = 160
	| pages =
	| doi =
	| id =
	| url = http://www.cdc.gov/nchs/data/series/sr_13/sr13_160.pdf
	| format = PDF
	| accessdate = 2007-01-30
	}}</ref> On page 52, it is shown that the western region of the United States has seen the most significant change, declining from 61.8% in 1980 to 31.4% in 2003.<ref name = "NHDS" /> The decline in the western region has been partly attributed to increasing births among ]s, who usually do not circumcise.<ref>{{cite web
	| url = http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions.htm
	| title = Trends in circumcisions among newborns
	| accessdate = 2007-01-30
	| date = ], ]
	| work = Health E-Stats
	| publisher = ]
	| quote = <small>However, the most notable change occurred in the West where newborn circumcisions dropped from 62 percent in 1980 to 37 percent in 1999. This latest available figure for the West represents over a two-fold difference when compared with circumcision estimates for the Midwest. This dramatic decline, in part, reflects the increased birth rate among Hispanics who have been shown in several other studies to be less likely to receive circumcisions than other white and black infants.</small>
	}}
	</ref>
			During the 2010s, several ] parties prominently called for the banning of circumcision.<ref>{{Cite book | vauthors = Bruns A, Bu Y, Merkt H |title=Legal Theory and Interpretation in a Dynamic Society |publisher=Nomos Verlagsgesellschaft |year=2021 |isbn=978-3-7489-2584-2 |pages=352}}</ref> Gressgård argued that politicians that supported Norway's proposed circumcision ban debated circumcision in a manner which constituted "]".<ref>{{Cite book | vauthors = Gressgård R |title=Multicultural Dialogue: Dilemmas, Paradoxes, Conflicts |publisher=] |year=2012 |isbn=978-0-85745-648-9 |pages=7, 94}}</ref>
	A national survey of adult men found that 91% of men born in the 1970s, and 83% of men born in the 1980s were circumcised.<ref>{{cite paper
	| author = Xu, F, L Markowitz, M Sternberg, and S Aral
	| title = Prevalence of circumcision in men in the United States: data from the National Health and Nutrition Examination Survey (NHANES), 1999-2002
	| publisher = XVI International AIDS Conference
	| date = 2006
	| url = http://www.iasociety.org/abstract/show.asp?abstract_id=2183186
	| accessdate = 2006-09-21
	}}
	</ref>
			===Economic considerations===
	Schoen, 2006, claimed that "the published results of national statistical surveys represent only coded diagnoses obtained from birth centers; the reported figures do not include males who are circumcised at a later date for religious, medical, or personal reasons or who received newborn circumcision that was not coded."<ref>{{cite journal
			The cost-effectiveness of circumcision has been studied to determine whether a policy of circumcising all newborns or a policy of promoting and providing inexpensive or free access to circumcision for all adult men who choose it would result in lower overall societal healthcare costs. As ] is an incurable disease that is expensive to manage, significant effort has been spent studying the cost-effectiveness of circumcision to reduce its spread in parts of Africa that have a relatively high infection rate and low circumcision prevalence.<ref name=doyle_2010/> Several analyses have concluded that circumcision programs for adult men in Africa are cost-effective and in some cases are cost-saving.<ref name=uthman_2010/><ref>{{cite journal | vauthors = Grimes CE, Henry JA, Maraka J, Mkandawire NC, Cotton M | title = Cost-effectiveness of surgery in low- and middle-income countries: a systematic review | journal = World Journal of Surgery | volume = 38 | issue = 1 | pages = 252–263 | date = January 2014 | pmid = 24101020 | doi = 10.1007/s00268-013-2243-y | s2cid = 2166354 }}</ref> In Rwanda, circumcision has been found to be cost-effective across a wide range of age groups from newborn to adult,<ref name=albero_2012/><ref name=binagwaho_2010/> with the greatest savings achieved when the procedure is performed in the newborn period due to the lower cost per procedure and greater timeframe for HIV infection protection.<ref name="kim_2010">{{cite journal | vauthors = Kim HH, Li PS, Goldstein M | title = Male circumcision: Africa and beyond? | journal = Current Opinion in Urology | volume = 20 | issue = 6 | pages = 515–519 | date = November 2010 | pmid = 20844437 | doi = 10.1097/MOU.0b013e32833f1b21 | s2cid = 2158164 }}</ref><ref name=binagwaho_2010/> Circumcision for the prevention of HIV transmission in adults has also been found to be cost-effective in South Africa, Kenya, and Uganda, with cost savings estimated in the billions of US dollars over 20 years.<ref name=doyle_2010/> Hankins ''et al.'' (2011) estimated that a $1.5 billion investment in circumcision for adults in 13 high-priority African countries would yield $16.5 billion in savings.<ref name=hankins_2011/>
	| last = Schoen
	| first = Edgar J.
	| year = 2006
	| month = July
	| title = Ignoring evidence of circumcision benefits
	| journal = Pediatrics
	| volume = 118
	| issue = 1
	| pages = 385&ndash;387
	| id = {{ISSN|0031-4005}} PMID 16818586
	| url = http://pediatrics.aappublications.org/cgi/content/extract/118/1/385
	| accessdate = 2006-09-21
	}}
	</ref>
			The overall cost-effectiveness of neonatal circumcision has also been studied in the United States, which has a different cost setting from Africa in areas such as public health infrastructure, availability of medications, and medical technology and the willingness to use it.<ref name=xu_2009/> A study by the CDC suggests that newborn circumcision would be societally cost-effective in the United States based on circumcision's efficacy against the transmission of HIV alone during ], without considering any other cost benefits.<ref name=AAP_2012/><!-- Quote = "The CDC study suggests that newborn circumcision performed in the United States to prevent HIV infection is cost-effective without consideration of other health benefits." --> The American Academy of Pediatrics (2012) recommends that neonatal circumcision in the United States be covered by third-party payers such as ] and insurance.<ref name=AAP_2012/> A 2014 review that considered reported benefits of circumcision such as reduced risks from HIV, HPV, and HSV-2 stated that circumcision is cost-effective in both the United States and Africa and may result in health care savings.<ref>{{cite journal | vauthors = Tobian AA, Kacker S, Quinn TC | title = Male circumcision: a globally relevant but under-utilized method for the prevention of HIV and other sexually transmitted infections | journal = Annual Review of Medicine | volume = 65 | pages = 293–306 | date = 2014 | pmid = 24111891 | pmc = 4539243 | doi = 10.1146/annurev-med-092412-090539 }}</ref> A 2014 literature review found that there are significant gaps in the current literature on male and female sexual health that need to be addressed for the literature to be applicable to North American populations.<ref name = bossio_2014/>
	There are various explanations why the infant circumcision rate in the United States are different from comparable countries. Some obstetricians have been accused of using circumcision as a quick and easy way of making money.<ref>{{cite news
	| first = Lehman
	| last = Betsy A.
	| title = The Age-old Question of Circumcision
	| url = http://www.cirp.org/news/bostonglobe06-22-87
	| format = CIRP (CIRP has modified text display)
	| publisher = ]
	| pages = 41 & 43
	| date = ], ]
	| accessdate = 2007-04-06
	}}
	</ref> Many parents’ decisions about circumcision are preconceived, and this may contribute to the high rate of elective circumcision.<ref name = "CSA:I-99" />
			== References ==
	] funding for infant circumcision used to be universal in the United States; however, sixteen states no longer pay for the procedure under ] . One study in the Midwest of the U.S. found that this had no effect on the newborn circumcision rate but it did affect the demand for circumcision at a later time.<ref>{{cite journal
			{{Reflist|refs=
	| last = Quayle
			<!-- A -->
	| first = SS.
			<ref name=AAFP_2013>{{cite web |title=Neonatal Circumcision |access-date=3 August 2015 |year=2013 |publisher=American Academy of Family Physicians |url=http://www.aafp.org/about/policies/all/neonatal-circumcision.html |url-status=live |archive-url=https://web.archive.org/web/20150721022442/http://www.aafp.org/about/policies/all/neonatal-circumcision.html |archive-date=21 July 2015 }}</ref>
	| coauthors = DE. Coplen, PF. Austin
	| year = 2003
	| month = October
	| title = The effect of health care coverage on circumcision rates among newborns
	| journal = Journal of Urology
	| volume = 170
	| issue = 4 Pt 2
	| pages = 1533&ndash;1536
	| id = {{ISSN|0022-5347}} PMID 14501653
	| accessdate = 2006-09-21
	}}
	</ref>
			<ref name=AAP_2012>{{cite journal | vauthors = ((American Academy of Pediatrics Task Force on Circumcision)) | title = Male circumcision | journal = Pediatrics | volume = 130 | issue = 3 | pages = e756–e785 | date = September 2012 | pmid = 22926175 | doi = 10.1542/peds.2012-1990 | url = http://pediatrics.aappublications.org/content/130/3/e756.full | url-status = live | doi-access = free | archive-url = https://web.archive.org/web/20120920054623/http://pediatrics.aappublications.org/content/130/3/e756.full | archive-date = 20 September 2012 }}</ref>
	==See also==
	*]
	*]
	*]
	*]
	*]
	*]
	*]
	*]
			<ref name = "Afshar_2018">{{Cite book | vauthors = Afshar K, Kazemi B, MacNeily A |title=Diagnostics to Pathogenomics of Sexually Transmitted Infections |publisher=] |year=2018 |isbn=978-1-119-38084-9 | veditors = Singh S |pages=28–34 |chapter=The Role of Circumcision in Preventing Sexually Transmitted Infections}}</ref>
	==References==
	{| class="messagebox" style="background: {{{#666666}}};"
	|-
	||Some referenced articles are available on-line only in the Circumcision Information and Resource Page’s (CIRP) library or in The Circumcision Reference Library (CIRCS). CIRP articles are chosen from an anti-circumcision point of view, and text in support of this position is often highlighted on-screen using ]. CIRCS articles are chosen from a pro-circumcision point of view. If documents are not freely available on-line elsewhere, links to articles in one or other of these two websites may be provided.
	|}
	<div class="references-small" style="-moz-column-count:2; column-count:2;">
	<references />
	</div>
			<ref name=albero_2012>{{cite journal | vauthors = Albero G, Castellsagué X, Giuliano AR, Bosch FX | title = Male circumcision and genital human papillomavirus: a systematic review and meta-analysis | journal = Sexually Transmitted Diseases | volume = 39 | issue = 2 | pages = 104–113 | date = February 2012 | pmid = 22249298 | doi = 10.1097/OLQ.0b013e3182387abd | s2cid = 26859788 | doi-access = free }}</ref>
	==External links==
	===Circumcision opposition===
			<ref name="alanis_2004">{{cite journal | vauthors = Alanis MC, Lucidi RS | title = Neonatal circumcision: a review of the world's oldest and most controversial operation | journal = Obstetrical & Gynecological Survey | volume = 59 | issue = 5 | pages = 379–395 | date = May 2004 | pmid = 15097799 | doi = 10.1097/00006254-200405000-00026 | s2cid = 25226185 }}</ref>
	* by Geoffrey T. Falk
	* presided by George C. Denniston, MD, MPH
			<ref name=alsabbagh_1996>{{cite book |author=al-Sabbagh, Muhammad Lutfi |title=Islamic ruling on male and female circumcision |page= |year=1996 |publisher=World Health Organization |isbn=978-92-9021-216-4 |url=https://archive.org/details/islamicrulingonm0000alsa/page/16 }}</ref>
	* by Marilyn Milos, RN
			<ref name=aridogan_2011>{{cite journal | vauthors = Aridogan IA, Izol V, Ilkit M | title = Superficial fungal infections of the male genitalia: a review | journal = Critical Reviews in Microbiology | volume = 37 | issue = 3 | pages = 237–244 | date = August 2011 | pmid = 21668404 | doi = 10.3109/1040841X.2011.572862 | s2cid = 31957918 }}</ref>
			<ref name=AUA_2007>{{cite web|url=http://www.auanet.org/about/policy-statements/circumcision.cfm|title=Circumcision|access-date=2 November 2008|author=American Urological Association|url-status=dead|archive-url=https://web.archive.org/web/20130825011022/http://www.auanet.org/about/policy-statements/circumcision.cfm|archive-date=25 August 2013}}</ref>
			<ref name=AVAC_2015>{{cite web|title=Clearinghouse on Male Circumcision for HIV Prevention Redesigned|url=http://www.avac.org/blog/clearinghouse-male-circumcision-hiv-prevention-redesigned|website=AVAC|date=May 2015|access-date=11 March 2017|url-status=live|archive-url=https://web.archive.org/web/20170312065747/http://www.avac.org/blog/clearinghouse-male-circumcision-hiv-prevention-redesigned|archive-date=12 March 2017}}</ref>
			<!-- B -->
			<ref name=becker_2011>{{cite journal | vauthors = Becker K | title = Lichen sclerosus in boys | journal = Deutsches Ärzteblatt International | volume = 108 | issue = 4 | pages = 53–58 | date = January 2011 | pmid = 21307992 | pmc = 3036008 | doi = 10.3238/arztebl.2011.0053 }}</ref>
			<ref name=binagwaho_2010>{{cite journal | vauthors = Binagwaho A, Pegurri E, Muita J, Bertozzi S | title = Male circumcision at different ages in Rwanda: a cost-effectiveness study | journal = PLOS Medicine | volume = 7 | issue = 1 | pages = e1000211 | date = January 2010 | pmid = 20098721 | pmc = 2808207 | doi = 10.1371/journal.pmed.1000211 | veditors = Kalichman SC | doi-access = free }}</ref>
			<ref name="Bolnick_2012_ch1">{{cite book |title=Surgical Guide to Circumcision |vauthors=Jacobs M, Grady R, Bolnick DA |publisher=Springer |year=2012 |isbn=978-1-4471-2857-1 |veditors=Bolnick DA, Koyle M, Yosha A |location=London |pages=3–8, 255–257 |chapter=Current Circumcision Trends and Guidelines |doi=10.1007/978-1-4471-2858-8_1 |quote=Outside of strategic regions in sub-Saharan Africa, no call for routine circumcision has been made by any established medical organizations or governmental bodies. Positions on circumcision include "some medical benefit/parental choice" in the United States, "no medical benefit/parental choice" in Great Britain, and "no medical benefit/physical and psychological trauma/parental choice" in the Netherlands. |author2-link=<!--Not the Olympic athlete. Do not link-->}}</ref>
			<ref name=Bolnick_2012_ch23>{{cite book | vauthors = Bolnick DA, Katz KE |year= 2012 |chapter= Jewish Ritual Circumcision| veditors = Bolnick DA, Koyle M, Yosha A |title=Surgical Guide to Circumcision |location= London |publisher=Springer |pages=265–274 |doi=10.1007/978-1-4471-2858-8_23 |isbn=978-1-4471-2857-1 }}</ref>
			<ref name=Bolnick_2012_ch24>{{cite book | vauthors = El-Sheemy MS, Ziada AM |year= 2012 |chapter= Islam and Circumcision| veditors = Bolnick DA, Koyle M, Yosha A |title=Surgical Guide to Circumcision |location= London |publisher=Springer |pages=275–280 |doi=10.1007/978-1-4471-2858-8_24 |isbn=978-1-4471-2857-1 }}</ref>
			<ref name=Bolnick_2012_ch26>{{cite book | vauthors = Adams G, Adams K |year= 2012 |chapter= Circumcision in the Early Christian Church: The Controversy That Shaped a Continent| veditors = Bolnick DA, Koyle M, Yosha A |title=Surgical Guide to Circumcision |location= London |publisher=Springer |pages=291–298 |doi=10.1007/978-1-4471-2858-8_26 |isbn=978-1-4471-2857-1 }}</ref>
			<ref name=bossio_2014>{{cite journal | vauthors = Bossio JA, Pukall CF, Steele S | title = A review of the current state of the male circumcision literature | journal = The Journal of Sexual Medicine | volume = 11 | issue = 12 | pages = 2847–2864 | date = December 2014 | pmid = 25284631 | doi = 10.1111/jsm.12703 }}</ref>
			<!-- C -->
			<ref name=CDC_HPV>{{cite web |url=https://www.cdc.gov/std/HPV/STDFact-HPV.htm |title=STD facts&nbsp;– Human papillomavirus (HPV) |publisher=CDC |access-date=12 September 2012 |url-status=live |archive-url=https://web.archive.org/web/20120911095019/http://www.cdc.gov/STD/HPV/STDFact-HPV.htm |archive-date=11 September 2012 }}</ref>
			<ref name=CPSBC_2009>{{cite report |title=Professional Standards and Guidelines – Circumcision (Infant Male) |work=College of Physicians and Surgeons of British Columbia |date=September 2009 }}</ref>
			<ref name="caga-anan_2011">{{cite book |url=https://books.google.com/books?id=C1T6NrSPD_AC&pg=PA43 |title=Clinical Ethics in Pediatrics: A Case-Based Textbook |vauthors=Caga-anan EC, Thomas AJ, Diekema DS, Mercurio MR, Adam MR |date=8 September 2011 |publisher=Cambridge University Press |isbn=978-0-521-17361-2 |page=43 |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=C1T6NrSPD_AC&pg=PA43 |archive-date=18 January 2016 |url-status=live}}</ref>
			<ref name = "Clarence-Smith_2008">{{cite journal | vauthors = Clarence-Smith WG |date=2008 |title=Islam and Female Genital Cutting in Southeast Asia: The Weight of the Past |url= http://www.etmu.fi/fjem/pdf/FJEM_2_2008.pdf |archive-url=https://web.archive.org/web/20090306050235/http://www.etmu.fi/fjem/pdf/FJEM_2_2008.pdf |archive-date=6 March 2009 |journal=Finnish Journal of Ethnicity and Migration |volume=3 |issue=2: Special Issue: Female Genital Cutting in the Past and Today |pages=14–22 }}</ref>
			<!-- D -->
			<ref name = "Dana_2003">{{cite book | vauthors = Dana N |year=2003 |title=The Druze in the Middle East: Their Faith, Leadership, Identity and Status| isbn=978-1-903900-36-9| page =56|publisher=University of Michigan Press|quote=}}</ref>
			<ref name=darby_2003>{{cite journal| vauthors = Darby R |title=The Masturbation Taboo and the Rise of Routine Male Circumcision: A Review of the Historiography|journal=Journal of Social History|date=Spring 2003|volume=36|issue=3|pages=737–757|doi=10.1353/jsh.2003.0047|s2cid=72536074}}</ref>
			<ref name=darby_2005>{{cite book| vauthors = Darby R |title=A surgical temptation: the demonization of the foreskin and the rise of circumcision in Britain|publisher=University of Chicago Press|location=Chicago|year=2005|isbn=978-0-226-13645-5|pages=262–}}</ref>
			<ref name="Doy2005">{{cite journal | vauthors = Doyle D | title = Ritual male circumcision: a brief history | journal = The Journal of the Royal College of Physicians of Edinburgh | volume = 35 | issue = 3 | pages = 279–285 | date = October 2005 | pmid = 16402509 | url = https://www.rcpe.ac.uk/sites/default/files/doyle_circumcision.pdf | access-date = 16 January 2023 | url-status = live | archive-url = https://web.archive.org/web/20230314204243/https://www.rcpe.ac.uk/sites/default/files/doyle_circumcision.pdf | archive-date = 14 March 2023 }}</ref>
			<ref name=doyle_2010>{{cite journal | vauthors = Doyle SM, Kahn JG, Hosang N, Carroll PR | title = The impact of male circumcision on HIV transmission | journal = The Journal of Urology | volume = 183 | issue = 1 | pages = 21–26 | date = January 2010 | pmid = 19913816 | doi = 10.1016/j.juro.2009.09.030 }}</ref>
			<ref name=DW_2012>{{cite news | url=http://www.dw.de/circumcision-remains-legal-in-germany/a-16399336 | title=Circumcision remains legal in Germany | work=Deutsche Welle | date=12 December 2012 | access-date=11 September 2013 | url-status=live | archive-url=https://web.archive.org/web/20131026154156/http://www.dw.de/circumcision-remains-legal-in-germany/a-16399336 | archive-date=26 October 2013 }}</ref>
			<!-- E -->
			<ref name=encyc_religion_2005>{{cite encyclopedia |year=2005 |title=Circumcision |encyclopedia=Encyclopedia of Religion |edition=2 |publisher=Gale}}</ref>
			<ref name=encyc_judaica_2006>{{cite encyclopedia | veditors = Skolnik F, Berenbaum M |year=2006 |title=Circumcision |encyclopedia=Encyclopaedia Judaica |edition=2nd |publisher=Macmillan Reference |location=USA |isbn=978-0-02-865928-2}}</ref>
			<!-- F -->
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			<ref name="Gable-2007">{{Cite book| vauthors = Gable L, Gamharter K, Gostin L, Hodge Jr J, Puymbroeck R |title=Legal Aspects of HIV/AIDS: A Guide for Policy and Law Reform |publisher=World Bank Publications|year=2007|isbn=978-0-8213-7105-3|pages=38–39|chapter=1.12 Male Circumcision}}</ref>
			<ref name=gollaher_2001_ch1>{{cite book |vauthors=Gollaher D | chapter = Chapter 1: The Jewish Tradition | pages = 1–30 |title=Circumcision: A History of the World's Most Controversial Surgery |date=February 2001 |publisher=Basic Books |isbn=978-0-465-02653-1 |url=https://books.google.com/books?id=usEzSffvPBMC |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=usEzSffvPBMC |url-status=dead |archive-date=18 January 2016 }}</ref>
			<ref name=gollaher_2001_ch2>{{cite book |vauthors=Gollaher D | chapter = Chapter 2: Christians and Muslims | pages = 31–52 |title=Circumcision: A History of the World's Most Controversial Surgery |date=February 2001 |publisher=Basic Books |isbn=978-0-465-02653-1 |url=https://books.google.com/books?id=usEzSffvPBMC |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=usEzSffvPBMC |url-status=dead |archive-date=18 January 2016 }}</ref>
			<ref name=gollaher_2001_ch3>{{cite book |vauthors=Gollaher D | chapter = Chapter 3: Symbolic Wounds | pages = 53–72 |title=Circumcision: A History of the World's Most Controversial Surgery |date=February 2001 |publisher=Basic Books |isbn=978-0-465-02653-1 |url=https://books.google.com/books?id=usEzSffvPBMC |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=usEzSffvPBMC |url-status=dead |archive-date=18 January 2016 }}</ref>
			<ref name=gollaher_2001_ch4>{{cite book |vauthors=Gollaher D | chapter = Chapter 4: From Ritual to Science | pages = 73–108 |title=Circumcision: A History of the World's Most Controversial Surgery |date=February 2001 |publisher=Basic Books |isbn=978-0-465-02653-1 |url=https://books.google.com/books?id=usEzSffvPBMC |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=usEzSffvPBMC |url-status=dead |archive-date=18 January 2016 }}</ref>
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			<ref name="Hamilton-1990">{{Cite book | vauthors = Hamilton V |title=The Book of Genesis, Chapters 1-17 |publisher=] |year=1990 |isbn=978-0-8028-2521-6 |pages=473 |quote=In fact, circumcision is only one of two performative commands, the neglect of which bring the kareth penalty. (The other is the failure to be cleansed from corpse contamination, umb. 19:11-22.) |author-link=Victor P. Hamilton}}</ref>
			<ref name=hankins_2011>{{cite journal | vauthors = Hankins C, Forsythe S, Njeuhmeli E | title = Voluntary medical male circumcision: an introduction to the cost, impact, and challenges of accelerated scaling up | journal = PLOS Medicine | volume = 8 | issue = 11 | pages = e1001127 | date = November 2011 | pmid = 22140362 | pmc = 3226452 | doi = 10.1371/journal.pmed.1001127 | veditors = Sansom SL | doi-access = free }}</ref>
			<ref name="hay_2012">{{cite book |vauthors=Hay W, Levin M |title=Current Diagnosis and Treatment Pediatrics 21/E |pages=18–19 |date=25 June 2012 |publisher=McGraw Hill Professional |isbn=978-0-07-177971-5 |url=https://books.google.com/books?id=V8lMJniWK_QC |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=V8lMJniWK_QC |archive-date=18 January 2016 }}</ref>
			<ref name=hpv_prevalence_ref_bundle>See: Larke ''et al.'' "Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis" (2011), Albero ''et al.'' "Male Circumcision and Genital Human Papillomavirus: A Systematic Review and Meta-Analysis" (2012), Rehmeyer "Male Circumcision and Human Papillomavirus Studies Reviewed by Infection Stage and Virus Type" (2011).</ref>
			<!-- I -->
			<!-- J -->
			<ref name=jagannath_2012>{{cite journal | vauthors = Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S | title = Routine neonatal circumcision for the prevention of urinary tract infections in infancy | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 5 | pages = CD009129 | date = November 2012 | pmid = 23152269 | doi = 10.1002/14651858.CD009129.pub2 | veditors = Fedorowicz Z }}</ref>
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			<ref name=larke_penile_cancer_2011>{{cite journal | vauthors = Larke NL, Thomas SL, dos Santos Silva I, Weiss HA | title = Male circumcision and penile cancer: a systematic review and meta-analysis | journal = Cancer Causes & Control | volume = 22 | issue = 8 | pages = 1097–1110 | date = August 2011 | pmid = 21695385 | pmc = 3139859 | doi = 10.1007/s10552-011-9785-9 }}</ref>
			<ref name="larke_HPV_2011">{{cite journal | vauthors = Larke N, Thomas SL, Dos Santos Silva I, Weiss HA | title = Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis | journal = The Journal of Infectious Diseases | volume = 204 | issue = 9 | pages = 1375–1390 | date = November 2011 | pmid = 21965090 | doi = 10.1093/infdis/jir523 | doi-access = free }}</ref>
			<ref name=leber_2006>{{cite web |url=http://www.emedicine.com/derm/topic615.htm |title=Balanitis |access-date=14 October 2008 |vauthors=Leber M, Tirumani A |date=8 June 2006 |publisher=EMedicine |url-status=live |archive-url=https://web.archive.org/web/20081007002704/http://www.emedicine.com/DERM/topic615.htm |archive-date=7 October 2008 }}</ref>
			<ref name="lissauer_2012">{{cite book|title=Illustrated Textbook of Paediatrics, Fourth edition|vauthors=Lissauer T, Clayden G|date=October 2011|publisher=Elsevier|isbn=978-0-7234-3565-5|pages=352–353|quote=}}</ref>
			<ref name=lonngvist_2010>{{cite journal | vauthors = Lönnqvist PA | title = Regional anaesthesia and analgesia in the neonate | journal = Best Practice & Research. Clinical Anaesthesiology | volume = 24 | issue = 3 | pages = 309–321 | date = September 2010 | pmid = 21033009 | doi = 10.1016/j.bpa.2010.02.012 }}</ref>
			<!-- M -->
			<ref name="Mark-2003a">{{Cite book | vauthors = Mark E |title=The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite |publisher=] |year=2003 |isbn=978-1-58465-307-3 |pages=141 |chapter=Frojmovic/Travelers to the Circumcision |quote=Circumcision became the single most important commandment... the one without which... no Jew could attain the world to come.}}</ref>
			<ref name = "Marrazzo et al. 2014">{{cite journal | vauthors = Marrazzo JM, del Rio C, Holtgrave DR, Cohen MS, Kalichman SC, Mayer KH, Montaner JS, Wheeler DP, Grant RM, Grinsztejn B, Kumarasamy N, Shoptaw S, Walensky RP, Dabis F, Sugarman J, Benson CA | title = HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel | journal = JAMA | volume = 312 | issue = 4 | pages = 390–409 | date = 23–30 Jul 2014 | pmid = 25038358 | pmc = 6309682 | doi = 10.1001/jama.2014.7999 }}</ref>
			<ref name=matthew_2004>{{cite book| vauthors = Matthew HC |title=Oxford dictionary of national biography: in association with the British Academy: from the earliest times to the year 2000|url=https://archive.org/details/isbn_0198613644|url-access=registration|publisher=Oxford University Press|location=Oxford New York|year=2004|isbn=978-0-19-861411-1}}</ref>
			<ref name="Merson-2017">{{Cite book | vauthors = Merson M, Inrig S |title=The AIDS Pandemic: Searching for a Global Response |publisher=] |year=2017 |isbn=978-3-319-47133-4 |pages=379 |quote=This led to a consensus that male circumcision should be a priority for HIV prevention in countries and regions with heterosexual epidemics and high HIV and low male circumcision prevalence.}}</ref>
			<!-- N -->
			<ref name=NYTimes_2009>{{cite news |title=AIDS: New Web Site Seeks to Fight Myths About Circumcision and H.I.V. | vauthors = McNeil Jr DG |author-link=Donald McNeil, Jr. |url=https://www.nytimes.com/2009/03/03/health/03glob.html |newspaper=The New York Times |date=3 March 2009 |page=D6 |access-date=1 February 2012 |url-status=live |archive-url=https://web.archive.org/web/20140108150300/http://www.nytimes.com/2009/03/03/health/03glob.html |archive-date=8 January 2014 }}</ref>
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			<ref name=osipov_2006>{{cite web |url=http://www.emedicine.com/derm/topic615.htm |title=Balanoposthitis |access-date=20 November 2006 |vauthors=Osipov V, Acker S |date=November 2006 |website=Reactive and Inflammatory Dermatoses |publisher=EMedicine |url-status=live |archive-url=https://web.archive.org/web/20061211115857/http://emedicine.com/DERM/topic615.htm |archive-date=11 December 2006 }}</ref>
			<!-- P -->
			<ref name=perera_2010>{{cite journal | vauthors = Perera CL, Bridgewater FH, Thavaneswaran P, Maddern GJ | title = Safety and efficacy of nontherapeutic male circumcision: a systematic review | journal = Annals of Family Medicine | volume = 8 | issue = 1 | pages = 64–72 | year = 2010 | pmid = 20065281 | pmc = 2807391 | doi = 10.1370/afm.1073 }}</ref>
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			<ref name=RACP_2010>{{cite web | url=https://www.racp.edu.au/docs/default-source/advocacy-library/circumcision-of-infant-males.pdf | title=Circumcision of Infant Males | publisher=The Royal Australasian College of Physicians | date=Sep 2010 | access-date=11 September 2013 | url-status=live | archive-url=https://web.archive.org/web/20150812092333/http://www.racp.edu.au/docs/default-source/advocacy-library/circumcision-of-infant-males.pdf | archive-date=12 August 2015 }}</ref>
			<ref name="rehmeyer_2011">{{cite journal | vauthors = Rehmeyer CJ | title = Male circumcision and human papillomavirus studies reviewed by infection stage and virus type | journal = The Journal of the American Osteopathic Association | volume = 111 | issue = 3 Suppl 2 | pages = S11–S18 | date = March 2011 | pmid = 21415373 }}</ref>
			<ref name=riggs_2006>{{cite book | vauthors = Riggs T |title=Worldmark Encyclopedia of Religious Practices: Religions and denominations |chapter=Christianity: Coptic Christianity |year=2006 |publisher=Thomson Gale |isbn=978-0-7876-6612-5 |chapter-url=https://books.google.com/books?id=uTMOAQAAMAAJ |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=uTMOAQAAMAAJ |archive-date=18 January 2016 }}</ref>
			<ref name=rudolph_2011>{{cite book |vauthors=Rudolph C, Rudolph A, Lister G, First L, Gershon A |title=Rudolph's Pediatrics | edition = 22nd |page=188 |date=18 March 2011 |publisher=McGraw-Hill Companies, Incorporated |isbn=978-0-07-149723-7 |url=https://books.google.com/books?id=or15PgAACAAJ |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=or15PgAACAAJ |archive-date=18 January 2016 }}</ref>
			<!-- S -->
			<ref name="Selekman-2020">{{Cite book| vauthors = Selekman R, Copp H |title=Campbell Walsh Wein Urology|publisher=Elsevier|year=2020|isbn=978-0-323-67227-6| veditors = Partin A |edition=12th |pages=388–402 |chapter=Urologic Evaluation of the Child}}</ref>
			<ref name="siegfried_Cochrane_2009">{{cite journal | vauthors = Siegfried N, Muller M, Deeks JJ, Volmink J | title = Male circumcision for prevention of heterosexual acquisition of HIV in men | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD003362 | date = April 2009 | pmid = 19370585 | doi = 10.1002/14651858.CD003362.pub2 | veditors = Siegfried N }}</ref>
			<ref name=shockley_2011>{{cite journal | vauthors = Shockley RA, Rickett K | title = Clinical inquiries. What's the best way to control circumcision pain in newborns? | journal = The Journal of Family Practice | volume = 60 | issue = 4 | pages = 233a–233b | date = April 2011 | pmid = 21472156 }}</ref>
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			<ref name=templeton_2010>{{cite journal | vauthors = Templeton DJ, Millett GA, Grulich AE | title = Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men | journal = Current Opinion in Infectious Diseases | volume = 23 | issue = 1 | pages = 45–52 | date = February 2010 | pmid = 19935420 | doi = 10.1097/QCO.0b013e328334e54d | s2cid = 43878584 }}</ref>
			<ref name="Thomas_2021">{{cite journal | vauthors = Thomas A, Necchi A, Muneer A, Tobias-Machado M, Tran AT, Van Rompuy AS, Spiess PE, Albersen M | title = Penile cancer | journal = Nature Reviews. Disease Primers | volume = 7 | issue = 1 | pages = 11 | date = February 2021 | pmid = 33574340 | doi = 10.1038/s41572-021-00246-5 | type = Review | s2cid = 231877615 }}</ref>
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			<ref name=uthman_2010>{{cite journal | vauthors = Uthman OA, Popoola TA, Uthman MM, Aremu O | title = Economic evaluations of adult male circumcision for prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa: a systematic review | journal = PLOS ONE | volume = 5 | issue = 3 | pages = e9628 | date = March 2010 | pmid = 20224784 | pmc = 2835757 | doi = 10.1371/journal.pone.0009628 | veditors = Van Baal PH | doi-access = free | bibcode = 2010PLoSO...5.9628U }}</ref>
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			<ref name=weiss_2006_syphilis>{{cite journal | vauthors = Weiss HA, Thomas SL, Munabi SK, Hayes RJ | title = Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis | journal = Sexually Transmitted Infections | volume = 82 | issue = 2 | pages = 101–9; discussion 110 | date = April 2006 | pmid = 16581731 | pmc = 2653870 | doi = 10.1136/sti.2005.017442 }}</ref>
			<ref name="weiss_2010_complications">{{cite journal | vauthors = Weiss HA, Larke N, Halperin D, Schenker I | title = Complications of circumcision in male neonates, infants and children: a systematic review | journal = BMC Urology | volume = 10 | pages = 2 | date = February 2010 | pmid = 20158883 | pmc = 2835667 | doi = 10.1186/1471-2490-10-2 | doi-access = free }}</ref>
			<ref name=wetmore_2010>{{cite journal | vauthors = Wetmore CM, Manhart LE, Wasserheit JN | title = Randomized controlled trials of interventions to prevent sexually transmitted infections: learning from the past to plan for the future | journal = Epidemiologic Reviews | volume = 32 | issue = 1 | pages = 121–136 | date = April 2010 | pmid = 20519264 | pmc = 2912604 | doi = 10.1093/epirev/mxq010 }}</ref>
			<ref name=WHO_2007_GTDPSA>{{cite book |vauthors=Weiss H, Polonsky J, Bailey R, Hankins C, Halperin D, Schmid G |title=Male circumcision: global trends and determinants of prevalence, safety, and acceptability. |publisher=World Health Organization |publication-place=Geneva |date=2007 |isbn=978-92-4-159616-9 |oclc=425961131 |url=http://www.unaids.org/sites/default/files/media_asset/jc1360_male_circumcision_en_0.pdf |url-status=live |archive-url=https://web.archive.org/web/20151222194858/http://www.unaids.org/sites/default/files/media_asset/jc1360_male_circumcision_en_0.pdf |archive-date=22 December 2015 }}</ref>
			<ref name="WHO-2010a">{{Cite book|title=Manual for early infant male circumcision under local anaesthesia|publisher=]|year=2010|url=http://apps.who.int/iris/bitstream/handle/10665/44478/9789241500753_eng.pdf;jsessionid=53B12CB197A3AE365211417D2C812B5F?sequence=1|location=Geneva|language=English|quote=There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men.|access-date=14 April 2022|archive-date=14 April 2022|archive-url=https://web.archive.org/web/20220414143741/http://apps.who.int/iris/bitstream/handle/10665/44478/9789241500753_eng.pdf;jsessionid=53B12CB197A3AE365211417D2C812B5F?sequence=1|url-status=live}}</ref>
			<ref name="WHO-2010b">{{Cite book |url=http://apps.who.int/iris/bitstream/handle/10665/44478/9789241500753_eng.pdf;jsessionid=53B12CB197A3AE365211417D2C812B5F?sequence=1 |title=Manual for early infant male circumcision under local anaesthesia |publisher=] |year=2010 |location=Geneva |language=English |quote=There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men. |access-date=14 April 2022 |archive-date=14 April 2022 |archive-url=https://web.archive.org/web/20220414143741/http://apps.who.int/iris/bitstream/handle/10665/44478/9789241500753_eng.pdf;jsessionid=53B12CB197A3AE365211417D2C812B5F?sequence=1 |url-status=live }}</ref>
			<ref name=WHO_adult_devices_2012>{{cite web |year=2012 |title=Use of devices for adult male circumcision in public health HIV prevention programmes: Conclusions of the Technical Advisory Group on Innovations in Male Circumcision |website=World Health Organization |url=http://whqlibdoc.who.int/hq/2012/WHO_HIV_2012.7_eng.pdf |url-status=live |archive-url=https://web.archive.org/web/20130312062922/http://whqlibdoc.who.int/hq/2012/WHO_HIV_2012.7_eng.pdf |archive-date=12 March 2013 }}</ref>
			<ref name=wolter_2008>{{cite book |vauthors=Wolter C, Dmochowski R |title=Handbook of Office Urological Procedures |chapter=Circumcision |pages=88– |year=2008 |publisher=Springer |isbn=978-1-84628-523-3 |chapter-url=https://books.google.com/books?id=-ek1wPWaUKkC&pg=PA88 |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=-ek1wPWaUKkC&pg=PA88 |archive-date=18 January 2016 }}</ref>
			<!-- X -->
			<ref name=xu_2009>{{cite journal | vauthors = Xu X, Patel DA, Dalton VK, Pearlman MD, Johnson TR | title = Can routine neonatal circumcision help prevent human immunodeficiency virus transmission in the United States? | journal = American Journal of Men's Health | volume = 3 | issue = 1 | pages = 79–84 | date = March 2009 | pmid = 19430583 | pmc = 2678848 | doi = 10.1177/1557988308323616 }}</ref>
			<!-- Y -->
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			== Notes ==
	===Circumcision promotion===
			{{notelist}}
	* by Professor Brian Morris
	* by Edgar Schoen, BSc., M.D.
	* by Gerald N. Weiss, M.D.
			== External links ==
	===Circumcision techniques===
			{{Commons category}}
	* from the ].
			{{Wikinews category}}
	* from the Medical College of Georgia.
			* Videos of infant circumcision: using a , a and a (all from Stanford Medical School)
			* A from National Geographic
			{{Circumcision series}}
	==Further reading==
			{{Male genital procedures}}
	<!-- The following references should be moved into cite tags as in ], above. -->
			{{Infants and their care}}
	* Billy Ray Boyd. ''Circumcision Exposed: Rethinking a Medical and Cultural Tradition.'' Freedom, CA: The Crossing Press, 1998. (ISBN 978-0-89594-939-4)
			{{Authority control}}
	* Anne Briggs. ''Circumcision: What Every Parent Should Know.'' Charlottesville, VA: Birth & Parenting Publications, 1985. (ISBN 978-0-9615484-0-7)
	* Robert Darby. ''A surgical temptation: The demonization of the foreskin and the rise of circumcision in Britain.'' Chicago: University of Chicago Press, 2005. (ISBN 978-0-226-13645-5)
	* Aaron J. Fink, M.D. ''Circumcision: A Parent's Decision for Life''. Kavanah Publishing Company, Inc., 1988. (ISBN 978-0-9621347-0-8)
	* Paul M. Fleiss, M.D. and Frederick Hodges, D. Phil. ''What Your Doctor May'' Not ''Tell You About Circumcision.'' New York: Warner Books, 2002. (ISBN 978-0-446-67880-3)
	* Leonard B. Glick. ''Marked in Your Flesh: Circumcision from Ancient Judea to Modern America.'' New York: Oxford University Press, 2005. (ISBN 978-0-19-517674-2)
	* David L. Gollaher. ''Circumcision: A History of the World's Most Controversial Surgery.'' New York: Basic Books, 2000. (ISBN 0465026532
	* Ronald Goldman, Ph.D. ''Circumcision: The Hidden Trauma.'' Boston: Vanguard, 1996. (ISBN 978-0-9644895-3-0)
	* Brian J. Morris, Ph.D., D.Sc. ''In Favour of Circumcision.'' Sydney: UNSW Press, 1999. (ISBN 978-0-86840-537-7)
	* Rosemary Romberg. ''Circumcision: The Painful Dilemma.'' South Hadley, MA Bergan & Garvey, 1985. (ISBN 978-0-89789-073-1)
	* Edgar J Schoen, M.D. ''Ed Schoen, MD on Circumcision.'' Berkeley, CA: RDR Books, 2005. (ISBN 978-1-57143-123-3)
	* Edward Wallerstein. ''Circumcision: An American 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)
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Latest revision as of 12:53, 24 December 2024

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

Medical intervention

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

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

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

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

Uses

Elective

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

Prophylactic usage in high-risk populations

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

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

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

Prophylactic usage in developed countries

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

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

The World Health Organization in 2010 stated:

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

Pathologies

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

Contraindications

Circumcision is contraindicated in certain cases.

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

Technique

Main article: Circumcision surgical procedure

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

Removal of the foreskin

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

Pain management

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

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

Effects

Sexually transmitted infections

Human immunodeficiency virus

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

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

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

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

Human papillomavirus

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

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

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

Other infections

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

Phimosis, balanitis and balanoposthitis

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

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

Urinary tract infections

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

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

Cancers

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

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

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

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

Women's health

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

Sexual effects

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

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

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

Adverse effects

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

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

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

History

Main article: History of circumcision

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

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

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

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

Middle East, Africa and Europe

Further information: Circumcision in Africa

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

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

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

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

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

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

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

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

Indigenous peoples of the Americas and Oceania

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

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

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

Prophylactic circumcision

Anglophonic adoption (1855–1918)

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

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

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

Interwar period and World War II (1918–1945)

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

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

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

Mid-20th century (1945–1985)

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

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

Modernity (since 1985)

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

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

Society and culture

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

Cultures and religions

See also: Cultural views on circumcision and Religious male circumcision

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

Judaism

Main article: Brit milah

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

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

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

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

Islam

Main article: Khitan (circumcision)

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

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

Christianity

Main article: Religious male circumcision § In Christianity

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

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

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

Druze faith

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

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

Samaritanism

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

Mandaeism

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

Yazidism

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

Sikhism

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

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

African cultures

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

Australian cultures

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

Filipino culture

Main article: Tuli (rite)

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

Ethical and legal issues

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

Ethics

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

Legal

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

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

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

Economic considerations

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

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

References

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144. Hunting K (2012). Essential Case Studies in Public Health: Putting Public Health Into Practice. Jones & Bartlett Publishers. pp. 23–24. ISBN 978-1-4496-4875-6. Neonatal circumcision is the general practice among Jews, Christians, and many, but not all Muslims.
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Notes

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

External links

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

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Category	Circumcision

v t e Tests and procedures involving the male reproductive system
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Other tests	Semen analysis Scrotal ultrasound

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Categories:

• Circumcision
• Human penis
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• Pediatric surgery
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