Circumcision

Not to be confused with female circumcision.

For the paintings, see The Circumcision.

Circumcision is a procedure that removes the foreskin from the human penis.^[1][2][3] 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.^[4] Circumcision is generally electively performed, most commonly done as a form of preventive healthcare, as a religious obligation, or as a cultural practice.^{[5][6][7][8][9][1]} It is also an option for cases of phimosis, other pathologies that do not resolve with other treatments, and chronic urinary tract infections (UTIs).^[10][11] The procedure is contraindicated in cases of certain genital structure abnormalities or poor general health.^[2][11]

Circumcision
A circumcision being performed in Central Asia c. 1865–1872
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 associated with reduced rates of sexually transmitted infections and urinary tract infections.^{[4][12][13][14]} This includes decreasing the incidence of cancer-causing forms of human papillomavirus (HPV) and significantly reducing HIV transmission among heterosexual men within high risk populations. The World Health Organization (WHO) and UNAIDS recommend circumcision as part of a comprehensive HIV transmission program in areas with high endemic rates of HIV. The WHO does not recommend circumcision for HIV prevention in men who have sex with men; effectiveness of using circumcision to prevent HIV in the developed world is unclear.^{[15][16][17][18][19][20]} Neonatal circumcision also decreases the risk of penile cancer.^[a][21] Complication rates are higher when the procedure is performed on older people.^[22] A 2010 review found circumcisions performed by medical providers to have a typical complication rate of 1.5% for babies and 6% for older children, with few cases of severe complications.^[22] Bleeding, infection, and the removal of either too much or too little foreskin are the most common acute complications. Meatal stenosis is the most common long term complication.^[23] Major medical organizations hold variant perspectives on the prophylactic efficacy of the elective circumcision of minors. The WHO, UNAIDS, and American medical organizations take the position that it carries prophylactic health benefits which outweigh small risks, while European medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk.^{[24][25][26][27]}

Prophylactic circumcision originated in England during the 1850s, becoming established as a way to prevent sexually transmitted infections.^[28][29] 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.^[30][31] Historically, campaigns of Jewish persecution have included bans on the practice as a means of forceful assimilation, conversion, and ethnocide.^[32] Variant medical, cultural, religious, and ethical views have led to a widely diverging incidence and prevalence within polities. It is widespread in Australia, Canada, the United States, South Korea, New Zealand, most of Africa, and parts of Asia.^{[1][6][7][33][34][35][36][37][38]} It is relatively rare for non-religious reasons in parts of Southern Africa, Latin America, Europe, and parts of Asia.^[1] The origin of circumcision is not known with certainty; the oldest documentation comes from ancient Egypt.^[1][39][40]

Uses

Elective

Around half of all circumcisions worldwide are performed for reasons of prophylactic healthcare.^[11]

Prophylactic usage in high-risk populations

 

Actor Melusi Yeni became the 1 millionth VMMC against HIV/AIDS transmission in the province of KwaZulu-Natal, South Africa.^[41]

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.^{[18][19][42][43][44]}

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.^[18] In 2010, this was expanded to routine neonatal circumcision, as long as those undergoing the procedure received assent from their parents.^[25] 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.^[18][25]

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.^[45] There is evidence that circumcision is associated with a reduced risk of HIV infection for such men, particularly in low-income countries.^[14]

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.^[26]

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.^[26] 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.^[27][46][47]

The World Health Organization (WHO), UNAIDS, and American medical organizations take the position that it carries prophylactic health benefits which outweigh small risks, while European medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk.^{[24][25][26][27]} Public health advocates of circumcision consider it to have a net health benefit, and therefore feel that increasing the circumcision rate is "imperative".^[48] They recommend performing it during the neonatal period when it is less expensive and has a lower risk of complications.^[46] The American Academy of Pediatrics and Centers for Disease Control and Prevention stated that the benefits of circumcision outweigh the risks.^{[4][49][conflicted source]}

Similarly, the World Health Organization in 2010 stated:^[25]

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.^[25]

Religious, cultural, and ethnic circumcision

 

Religious Physician, Galilee, 1924

Worldwide, around half of all circumcisions are performed for religious or cultural reasons.^[11] Circumcision plays a major role in many of the world's cultures and religions. When performed for religious reasons, it is most common among Muslims and Jews, among whom it is near-universal.^[6][8][50] Circumcision is an integral or established practice for members of these faiths, as well as among the Samaritans and Druze.^[37][51]

In some African and Eastern Christian denominations male circumcision is an established practice, and require that their male members undergo circumcision.^[52] It is commonly performed among members of the Coptic, Ethiopian, and Eritrean Orthodox Churches.^[6][8][50]

Pathologies

Circumcision is also used to treat various pathologies. These include pathological phimosis, refractory balanoposthitis and chronic or recurrent urinary tract infections (UTIs).^[10][11]

Contraindications

Circumcision is contraindicated in certain cases.^[2][11][53] 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.^[2][11][53] 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.^[11][53]

Technique

Main article: Circumcision surgical procedure

 

Circumcision surgery with hemostats and scissors

 

Before (left) and after (right) an adult circumcision that was undertaken to treat phimosis. After the operation, the glans is exposed even when the penis is flaccid.

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.^[1] 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.^[53]

Removal of the foreskin

For infant circumcision, devices such as the Gomco clamp, Plastibell and Mogen clamp are commonly used in the USA.^[4] 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.^[4] For older babies and adults, circumcision is often performed surgically without specialized instruments,^[53] and alternatives such as Unicirc or the Shang ring are available.^[54]

Pain management

The circumcision procedure causes pain, and for neonates this pain may interfere with mother-infant interaction or cause other behavioral changes,^[55] so the use of analgesia is advocated.^[4][56] 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.^[4][57][58] 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.^[57][58] Topical creams have been found to irritate the skin of low birth weight infants, so penile nerve block techniques are recommended in this group.^[4]

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,^[58] but the American Academy of Pediatrics (AAP) states that such methods are insufficient alone and should be used to supplement more effective techniques.^[4] 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.^[58] The available evidence does not indicate that post-procedure pain management is needed.^[4] For adults, topical anesthesia, ring block, dorsal penile nerve block (DPNB) and general anesthesia are all options,^[59] and the procedure requires four to six weeks of abstinence from masturbation or intercourse to allow the wound to heal.^[53]

Effects

Sexually transmitted diseases

Human immunodeficiency virus

Main article: Circumcision and HIV

See also: Circumcision in Africa § Circumcision to prevent the spread of human immunodeficiency virus in Africa

There is strong evidence that circumcision reduces the risk of men acquiring HIV infection in areas of the world with high rates of HIV. This evidence is principally derived from three randomized controlled studies conducted in Africa in 2002.^[19][60] Evidence among heterosexual men in sub-Saharan Africa shows an absolute decrease in risk of 1.8% which is a relative decrease of between 38% and 66% over two years,^[19] and in this population studies rate it cost-effective.^[61] Whether it is of benefit in developed countries is undetermined.^[15]

There are plausible explanations based on human biology for how circumcision can decrease the likelihood of female-to-male HIV transmission. The superficial skin layers of the penis contain Langerhans cells, which are targeted by HIV; removing the foreskin reduces the number of these cells. When an uncircumcised penis is erect during intercourse, any small tears on the inner surface of the foreskin come into direct contact with the vaginal walls, providing a pathway for transmission. When an uncircumcised penis is flaccid, the pocket between the inside of the foreskin and the head of the penis provides an environment conducive to pathogen survival; circumcision eliminates this pocket. Some experimental evidence has been provided to support these theories.^[62]

The WHO and the UNAIDS state that male circumcision is an efficacious intervention for HIV prevention, but should be carried out by well-trained medical professionals and under conditions of informed consent (parents' consent for their infant boys).^[1][18][63] The WHO has judged circumcision to be a cost-effective public health intervention against the spread of HIV in Africa, although not necessarily more cost-effective than condoms.^[1] The joint WHO/UNAIDS recommendation also notes that circumcision only provides partial protection from HIV and should not replace known methods of HIV prevention.^[18]

Male circumcision provides only indirect HIV protection for heterosexual women.^[4][64][65] The WHO does not recommend circumcision as a protection for male-to-male HIV transmission. Evidence is lacking with regards to circumcision reducing HIV risk for receptive anal intercourse.^[18]

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.^[66]

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.^[67][68] It also decreases the likelihood of multiple infections.^[12] As of 2012^[update] there was no strong evidence that it reduces the rate of new HPV infection,^[13][12][69] but the procedure is associated with increased clearance of the virus by the body,^[13][12] which can account for the finding of reduced prevalence.^[12]

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.^[13][68][69]

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.^[70] A 2010 review found that circumcision reduced the incidence of HSV-2 (herpes simplex virus, type 2) infections by 28%.^[71] The researchers found mixed results for protection against trichomonas vaginalis and chlamydia trachomatis, and no evidence of protection against gonorrhea or syphilis.^[71] It may also possibly protect against syphilis in MSM.^[72]

Phimosis, balanitis and balanoposthitis

Phimosis is the inability to retract the foreskin over the glans penis.^[73] At birth, the foreskin cannot be retracted due to adhesions between the foreskin and glans, and this is considered normal (physiological phimosis).^[73] Over time the foreskin naturally separates from the glans, and a majority of boys are able to retract the foreskin by age three.^[73] Less than one percent are still having problems at age 18.^[73] If the inability to do so becomes problematic (pathological phimosis) circumcision is a treatment option.^[10][74] 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.^[75] Steroid creams are also a reasonable option and may prevent the need for surgery including in those with mild BXO.^[75][76] The procedure may also be used to prevent the development of phimosis.^[11] Phimosis is also a complication that can result from circumcision.^[77]

An inflammation of the glans penis and foreskin is called balanoposthitis, and the condition affecting the glans alone is called balanitis.^[78][79] Most cases of these conditions occur in uncircumcised males,^[80] affecting 4–11% of that group.^[73] 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.^[80] Both conditions are usually treated with topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams.^[78][79] 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.^[78][79]

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).^{[4][81][conflicted source][82]} Circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects,^[4] and may be used to treat recurrent UTIs.^[10]

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.^[4][82]

Cancers

Being uncircumcised is a risk factor for penile cancer.^[83]

Penile cancer is a rare disease in the developed world but much more prevalent in the developing world.^[21] The penile tissue removed during circumcision is a potential origin for penile cancer.^[84] Childhood circumcision has a strong protective effect against penile cancer in later life.^[21]

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.^[4] 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.^[85] Penile cancer has been observed to be nearly eliminated in populations of males circumcised neonatally.^[73]

Important risk factors for penile cancer include phimosis and HPV infection, both of which are mitigated by circumcision.^[85] 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.^[4][85] Circumcision is also associated with a reduced prevalence of cancer-causing types of HPV in men^[12] and a reduced risk of cervical cancer (which is caused by a type of HPV) in female partners of men.^[11]

There is some evidence that circumcision is associated with lower risk of prostate cancer. A 2015 meta-analysis found a reduced risk of prostate cancer associated with circumcision in black men.^[86] A 2016 meta-analysis found that men with prostate cancer were less likely to be circumcised.^[87]

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.^[88]

Sexual effects

Circumcision does not affect sexual function, sensation, desire, or pleasure.^{[disputed ][89]} A 2013 systematic review published in the Asian Journal of Andrology found that circumcision did not appear to adversely affect or prevent pain with intercourse, premature ejaculation, time until ejaculation, erectile dysfunction or difficulties with orgasm.^[90] However, the study found that the existing evidence is insufficient to make conclusive determinations.^[90] The effect of circumcision on sexual partners' experiences is unclear as this has not been well studied.^[91]

There are popular misconceptions that circumcision benefits or adversely impacts sexual pleasure.^[89]

Adverse effects

Neonatal circumcision is generally a safe, low-risk procedure when done by an experienced practitioner.^[92][93][94]

The most common acute complications are bleeding, infection and the removal of either too much or too little foreskin.^[4][95] These complications occur in approximately 0.13% of procedures, with bleeding being the most common acute complication in the United States.^[95] Minor complications are reported to occur in three percent of procedures.^[93] Severe complications are rare.^[77] A specific complication rate is difficult to determine due to scant data on complications and inconsistencies in their classification.^[4] 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.^[22] Significant acute complications happen rarely,^[4][22] occurring in about 1 in 500 newborn procedures in the United States.^[4] Severe to catastrophic complications, including death, are so rare that they are reported only as individual case reports.^[4][94] Where a Plastibell device is used, the most common complication is the retention of the device occurring in around 3.5% of procedures.^[23] Other possible complications include buried penis, chordee, phimosis, skin bridges, urethral fistulas, and meatal stenosis.^{[94][96][conflicted source]} These complications may be partly avoided with proper technique, and are often treatable without requiring surgical revision.^[94] 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.^[23] It can be treated by meatotomy.^[23]

Effective pain management should be used during the procedure.^[4] Inadequate pain relief may carry the risks of heightened pain response for newborns.^[55] Newborns that experience pain due to being circumcised have different responses to vaccines given afterwards, with higher pain scores observed.^[97] For adult men who have been circumcised, there is a risk that the circumcision scar may be tender.^{[98][conflicted source]}

It is unclear what the psychological outcomes of circumcision are. Studies have shown positive, neutral, or negative effects. There is debate in the literature over whether the pain of circumcision has lasting psychological impact, with only weak underlying data available.^{[98][conflicted source]} There is no good evidence that circumcision affects cognitive abilities.^[99]

Prevalence

Main article: Prevalence of circumcision

Circumcision is one of the world's most widely performed medical procedures.^[39]

Present

Approximately 38% of males worldwide are circumcised as of 2016. Around half are performed for reasons of prophylactic healthcare and half for religious or cultural reasons.^{[100][conflicted source]} It is most often practiced between infancy and the early twenties.^[1] This is an increase from 2007, when WHO estimated that 664,500,000 males aged 15 and over were circumcised (30–33% global prevalence), and that 70% of circumcised men were Muslim.^[1] A study on male circumcision prevalence in 118 developing countries found that 69% of circumcised men were Muslim.^[101][102]

Circumcision is most common in Australia, Canada, Israel, New Zealand, the Muslim world, South Korea, the United States, and parts of Southeast Asia and Africa. It is relatively rare for non-religious reasons in Europe, Latin America, parts of Southern Africa and Oceania and most of non-Muslim Asia. Prevalence is near-universal in the Middle East and Central Asia.^[1][103] Non-religious circumcision in Asia, outside the Republic of Korea and the Philippines, is fairly rare,^[1] and prevalence is generally low (less than 20%) across Europe.^[1][104] Estimates for individual countries include Taiwan at 9%^[105] and Australia 58.7%.^[106] Prevalence in the United States and Canada is estimated at 75% and 30% respectively.^[1] Prevalence in Africa varies from less than 20% in some southern African countries to near universal in North and West Africa.^[103]

Rates of circumcision over time have varied by country. As of 2021, Wolters Kluwer Health estimates that present circumcision incidence in the United States is 80%, and most are performed in the neonatal period for prophylactic reasons. Circumcision incidence in the U.S. has likely risen since 2012, when the AAP released a policy statement that was more positive on the topic.^{[107][108][109][conflicted source]} Hospital discharge surveys in the U.S. show lower numbers,^[110] although this is likely due to miscoding, circumcisions performed after hospital discharge, and those performed later in life.^[107][111] Canada has seen a slow decline since the early 1970s, possibly influenced by past statements from the AAP and the Canadian Pediatric Society in the 1970s that stated it was not medically necessary.^[1] In Australia, the rate declined in the 1970s and 80s, but has been increasing slowly as of 2004.^[1] In the United Kingdom, prevalence was likely to have been 20–30% in the 1940s but declined at the end of that decade. One possible reason may have been a 1949 British Medical Journal article which argued that there was no good medical reason for routine circumcision.^[1] The overall prevalence of circumcision in South Korea has increased markedly in the second half of the 20th century, rising from near zero around 1950 to about 60% in 2000, with the most significant jumps in the last two decades of that time period.^[1]

Medical organizations can affect the neonatal circumcision rate of a country by influencing whether the costs of the procedure are borne by the parents or are covered by insurance or a national health care system.^[26] Policies that require the costs to be paid by the parents yield lower circumcision rates.^[26] The decline in the rates in the UK is one example; another is that in United States, with states where insurance or Medicaid covers the costs having higher rates.^[26] Changes to policy are driven by the results of new research, and moderated by the politics, demographics, and culture of the communities.^[26]

History

Main article: History of circumcision

 

Circumcision knife from the Congo; wood, iron; late 19th/early 20th century

Circumcision is the world's oldest planned surgical procedure, suggested by anatomist and hyperdiffusionist historian Grafton Elliot Smith to be over 15,000 years old, pre-dating recorded history. There is no firm consensus as to how it came to be practiced worldwide. One theory is that it began in one geographic area and spread from there; another is that several different cultural groups began its practice independently. In his 1891 work History of Circumcision, physician Peter Charles Remondino suggested that it began as a less severe form of emasculating a captured enemy: penectomy or castration would likely have been fatal, while some form of circumcision would permanently mark the defeated yet leave him alive to serve as a slave.^[40][112] Other explanations for its origin include it acting as a religious sacrifice or a rite of passage marking a boy's entrance into adulthood.^[40]

The history of the migration and evolution of the practice of circumcision is followed mainly through the cultures and peoples in two separate regions. In the lands south and east of the Mediterranean, starting with Sudan and Ethiopia, the procedure was practiced by the ancient Egyptians and the Semites, and then by the Jews and Muslims, with whom the practice travelled to and was adopted by the Bantu Africans. In Oceania, circumcision is practiced by the Australian Aboriginals and Polynesians.^[112] There is also evidence that circumcision was practiced among the Aztec and Mayan civilizations in the Americas,^[1] but little detail is available about its history.^[39][40]

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;^[113] 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.^[114] 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.^[113] 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.^[115] Some ancient Egyptian mummies, which have been dated as early as 4000 BCE, show evidence of having undergone circumcision.^[116][117]

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.^[39] 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 done by the Egyptians possibly 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 into adulthood, 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.^[40][112]

 

Detail of the Artemision Bronze; the Greeks abhorred circumcision, making life difficult for circumcised Jews living among the Greeks.

Circumcision features prominently in the Hebrew Bible.^[118] The narrative in Genesis chapter 17 describes the circumcision of Abraham and his relatives and slaves. In the same chapter, Abraham's descendants are commanded to circumcise their sons on the eighth day of life as part of a covenant with God. In addition to proposing that circumcision was taken up 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.^{[39][112][119]}

Genesis 17:9–14 (English Standard Version)

And God said to Abraham,

"As for you, you shall keep my covenant, you and your offspring after you throughout their generations. This is my covenant, which you shall keep, between me and you and your offspring after you: Every male among you shall be circumcised. You shall be circumcised in the flesh of your foreskins, and it shall be a sign of the covenant between me and you. He who is eight days old among you shall be circumcised. Every male throughout your generations, whether born in your house or bought with your money from any foreigner who is not of your offspring, both he who is born in your house and he who is bought with your money, shall surely be circumcised. So shall my covenant be in your flesh an everlasting covenant. Any uncircumcised male who is not circumcised in the flesh of his foreskin shall be cut off from his people; he has broken my covenant."

Historical campaigns of ethnic, cultural, and religious persecution frequently included bans on the practice as a means of forceful assimilation, conversion, and ethnocide.^[32] 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.^[32] 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.^[32] Antiochus IV's restriction on Jewish circumcision was a major factor in the Maccabean Revolt.^[32] Hadrian's prohibition has also been considered by some to have been a contributing cause of the Bar Kokhba revolt.^[32] According to Silverman (2006), these restrictions were part of a "broad campaign" by the Romans to "civilize" the Jewish people, viewing the practice as replusive and analogous to castration.^[32] His successor, Antoninus Pius, altered the edict to permit Brit Milah.^[32] 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,^[120] 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.^[112][119]

 

The Circumcision of Jesus Christ, by Ludovico Mazzolino

A narrative in the Christian Gospel of Luke makes a brief mention of the circumcision of Jesus, but the subject of physical circumcision itself 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 the physical one to be unnecessary for Gentile converts to Christianity. The teaching that physical circumcision was unnecessary for membership in a divine covenant was instrumental in the separation of Christianity from Judaism.^[121][122] While the circumcision of Jesus is celebrated as a feast day in the liturgical calendar of many Christian denominations.^[122]

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.^[123]

Genghis Khan and the following Yuan Emperors in China forbade Islamic practices such as halal butchering and circumcision.^[124][125]

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 North East 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.^[39]

Indigenous peoples of the Americas and Oceania

Circumcision is practiced by some groups amongst Australian Aboriginal peoples, Polynesians, and Native Americans.^[1][39] Little information is available about the origins and history of circumcision among these peoples, compared to circumcision in the Middle East.^{[citation needed]}

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.^[39][126]

Christopher Columbus reported circumcision being practiced by Native Americans.^[40] It probably started among South American tribes as a blood sacrifice or ritual to test bravery and endurance, and its use later evolved into a rite of initiation.^[39]

Prophylactic circumcision

Anglophonic adoption (1855–1918)

 

The first medical professional to recommend circumcision as a prophylaxis against disease was the British physician Jonathan Hutchinson 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 core Anglosphere's medical communities and doctors, such as the prominent Lewis Sayre, president of the American Medical Association, subsequently leading to its widespread adoption.^[28]

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.^[127][128] Hutchinson suggested that circumcision lowers the risk of contracting syphilis.^[128] Pursuing a successful career as a general practitioner, Hutchinson went on to advocate circumcision for health reasons for the next fifty years,^[127] eventually earned a knighthood for his overall contributions to medicine. His viewpoint that circumcision was prophylactic against disease was adopted by other medical professionals of the time.^[129]

In 1870, the influential 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, with the understanding that a tight foreskin inflamed the nerves and caused systemic problems.^[130] The use of circumcision to promote good health also fit in with the germ theory of disease, which saw validation during the same time period: the foreskin was seen as harboring infection-causing smegma.^[131] Sayre published works on the subject and promoted it energetically in speeches.^[130] 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.^{[132][133][134]} By the late 19th century, circumcision had become a common medical procedure throughout a majority of the core 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.^[28][132]

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.^[135]

Interwar Period and World War II (1918-1945)

During the interwar period, medical organizations and doctors in mainland Europe experimented with the idea of introducing routine circumcision for prophylactic reasons as well, in lieu of the-then ongoing developments in the Anglophonic world. In France, the medical profession went so far as to recommended universal routine circumcision. However, prevalence in France and mainland Europe remained low.^[26] There is a lack of consensus in the academic literature on why this occurred.^[26]

Yosha & Bolnick & Koyle (2012) have suggested that a factor in its Anglophonic adoption and dismissal in mainland Europe relate to attitudes towards Judaism and Jewish practices. While many of these Anglophonic polities would not considered tolerant by modern standards: the United Kingdom had Benjamin Disraeli—a Jew—as Prime Minister; Jews in the United States were a prominent and generally well-respected part of American life; 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 [was] circumcised, the idea that it [was] a Jewish practice [became] 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.^[26]

Rates in the Anglophonic world began to sharply diverge after 1945.^[40]

 

Pediatrician and political activist Benjamin Spock recommended circumcision in his influential work The Common Sense Book of Baby and Child Care, one of the best-selling books of the twentieth century.^[136]

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 available at that time showed that the risks outweighed the known benefits, leading to a significant reduction in circumcision incidence within the United Kingdom.^[137]

In contrast to Gairdner, the influential American pediatrician Benjamin Spock argued in favor of circumcision in his work The Common Sense Book of Baby and Child Care. This 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.^[40]

Modernity (1985–present)

An association between circumcision and reduced heterosexual HIV infection rates was first suggested in 1986.^[40]

Experimental evidence was needed to establish a causal relationship, so three randomized controlled trials were commissioned as a means to reduce the effect of any confounding factors.^[19] Trials took place in South Africa, Kenya and Uganda.^[19] 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, and hence it was seen as unethical to withhold the procedure, in light of strong evidence of prophylactic efficacy.^{[19][138][conflicted source][139]} WHO assessed these as "gold standard" studies and found "strong and consistent" evidence from later studies that confirmed the results of the studies.^[18] A scientific consensus subsequently developed that circumcision reduces heterosexual HIV infection rates in high-risk populations;^[20][42][43] the WHO, along with other major medical organizations, have since promoted the widespread adoption of circumcision in high-risk populations as part of an overall program to reduce the spread of HIV.^[18] The Male Circumcision Clearinghouse website was formed in 2009 by WHO, UNAIDS, FHI and AVAC to provide current 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.^[140][141]

Society and culture

The word circumcision is from Latin circumcidere, meaning "to cut around".^[1]

Cultures and religions

See also: Cultural views on circumcision and Religious male circumcision

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.^{[26][36][34][35][142][143][144]} In contrast, some religions, such as Mandaeism and Hinduism and Sikhism, strongly prohibit the practice of routine circumcision.^{[145][146][147]}

Judaism

Main article: Brit milah

Circumcision is near-universal among Jews.^[148] 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.^[30][31][32]

 

Preparing for a Jewish ritual circumcision

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.^[36][149] 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.^[150] There are also certain exceptions for Jews with poor health.^[151]

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.^[152] 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.^[153] A small minority of Jews in the United States have chosen not to circumcise their sons.^[154]

All major rabbinical organizations make the recommendation that male infants should be circumcised. The issue of converts remains controversial in Reform and Reconstructionist Judaism;^[155][156] circumcision of converts is not mandatory in either.^[157]

Islam

Main article: Khitan (circumcision)

 

Children in Turkey wearing traditional circumcision costumes

 

Boys in white clothing with bonnets at Tireli market, just after circumcision, Mali 1990

Despite its common practice in Muslim-majority nations, circumcision is considered to be sunnah (tradition) and not required for a life directed by Allah.^[158] 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.^[159] 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).^{[35][142][160]}

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.^{[35][142][160]}

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.^[161] 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,^[162] and maintains a neutral position on the practice of circumcision for other reasons.^[163] 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.^[163]

 

Coptic Children wearing traditional circumcision costumes

Thus, circumcision rates of Christians are predominately determined by the surrounding cultures in which they live in. In some African and Eastern Christian denominations circumcision is an established practice,^[6][164] and generally men undergo circumcision shortly after birth as part of a rite of passage.^[6] Circumcision is near-universal among Coptic Christians,^[165] and they practice circumcision as a rite of passage.^{[1][34][144][166]} The Ethiopian Orthodox Church calls for circumcision, with near-universal prevalence among Orthodox men in Ethiopia.^[1] 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".^[167] Some Christian churches in South Africa disapprove of the practice, while others require it of their members.^[1]

Circumcision is practiced in some predominantly Christian countries and Christian communities.^{[168][169][7]} Christian communities in Africa,^[170][171] the Anglosphere countries, the Philippines, the Middle East,^[172][173] South Korea and Oceania have high circumcision rates,^[174][175] while Christian communities in Europe and South America have low circumcision rates, although none of these are performed out of perceived religious obligation.^[6][8] 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.^[176]

Druze faith

 

Preparing for a ritual circumcision to a Druze child

Circumcision is widely practiced by the Druze;^[51] Druze practice Druzism, an Abrahamic,^[177][178] monotheistic, syncretic, and ethnic religion. The procedure is practiced as a cultural tradition, and has no religious significance in the Druze faith.^[179][180] There is no special date for this act in the Druze faith: male Druze infants are usually circumcised shortly after birth,^[181] however some remain uncircumcised until the age of ten or older.^[181]

Some Druses do not circumcise their male children, and refuse to observe this "common Muslim practice".^[182]

Samaritanism

Like Judaism, the religion of Samaritanism requires ritual circumcision on the eighth day of life.^[183]

Mandaeism

Circumcision is forbidden in Mandaeism,^[145][184] and the sign of the Jews given to Abraham by God, circumcision, is considered abhorrent by the Mandaeans.^[185] According to the Mandaean doctrine a circumcised man cannot serve as a Mandaean priest.^[186]

Yazidism

Circumcision is not required in Yazidism, but is practised by some Yazidis due to regional customs.^[187] 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.^[188]

Sikhism

Sikhism does not require the elective circumcision of its followers and strongly criticizes the practice.^[147][189]

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

Because of the love of woman, circumcision is done; I don't believe in it, O Siblings of Destiny. If God wished me to be a Muslim, it would be cut off by itself. If circumcision makes one a Muslim, then what about a woman? She is the other half of a man's body, and she does not leave him, so he remains a Hindu. Give up your holy books, and remember the Lord, you fool, and stop oppressing others so badly. Kabeer has grasped hold of the Lord's Support, and the Muslims have utterly failed.

— Bhagat Kabir, Guru Granth Sahib 477^[190]

African cultures

Main article: Circumcision in Africa

 

9–10-year-old boys of the Yao tribe in Malawi participating in circumcision and initiation rites

Circumcision is prevalent among 92% of men in North Africa and around 62% in Sub-Saharan Africa. In western and northern parts of Africa it is mainly performed for religious reasons, whereas in southern parts of Africa it rarely performed in neonates, instead being a rite of passage into manhood.^[191] Certain African cultural groups, such as the Yoruba and the Igbo of Nigeria, customarily circumcise their infant sons. The procedure is also practiced by some cultural groups or individual family lines in Sudan, Democratic Republic of the Congo, Uganda and in southern Africa. For some of these groups, circumcision appears to be purely cultural, done with no particular religious significance or intention to distinguish members of a group. For others, circumcision might be done for purification, or it may be interpreted as a mark of subjugation. Among these groups, even when circumcision is done for reasons of tradition, it is often done in hospitals.^[143]

The Maasai people, who live predominantly in Kenya and Tanzania, use circumcision as a rite of passage. It is also used for distinguished age groups. This is usually done after every fifteen years where a new "age set" are formed. The new members are to undergo initiation at the same time. Whenever new age groups are initiated, they will become novice warriors and replace the previous group. The new initiates will be given a unique name that will be an important marker of the history of the Maasai. No anesthesia is used, and initiates have to endure the pain or be called flinchers.^[192]

The Xhosa community practice circumcision as a sacrifice. In doing so, young boys will announce to their family members when they are ready for circumcision by singing. The sacrifice is the blood spilt during the initiation procedure. Young boys will be considered an "outsiders" unless they undergo circumcision.^[193] It is not clear how many deaths and injuries result from non-clinical circumcisions.^[194]

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.^[143]

Filipino culture

Main article: Tuli (rite)

In the Philippines, circumcision is known as "tuli" and is generally viewed as a rite of passage.^[195] An overwhelming majority of Filipino men are circumcised.^[195] 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 word 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.^[196]

Ethical and legal issues

Main article: Ethics of circumcision

See also: Circumcision controversies and Circumcision and law

 

A protest against infant circumcision

Ethics

There is a long-running and vigorous debate over ethical concerns regarding circumcision, particularly neonatal circumcision for reasons other than intended direct medical benefit. There are three parties involved in the decision to circumcise a minor: the minor as the patient, the parents (or other guardians) and the physician. The physician is bound under the ethical principles of beneficence (promoting well-being) and non-maleficence ("first, do no harm"), and so is charged with the responsibility to promote the best interests of the patient while minimizing unnecessary harms. Those involved must weigh the factors of what is in the best interest of the minor against the potential harms of the procedure.^[27]

With a newborn involved, the decision is made more complex due to the principles of respect for autonomy and consent, as a newborn cannot understand or engage in a logical discussion of his own values and best interests.^[27][46] A mentally more mature child can understand the issues involved to some degree, and the physician and parents may elicit input from the child and weigh it appropriately in the decision-making process, although the law may not treat such input as legally informative. Ethicists and legal theorists also state that it is questionable for parents to make a decision for the child that precludes the child from making a different decision for himself later. Such a question can be raised for the decision by the parents either to circumcise or not to circumcise the child.^[27]

Parents are assumed to have the child's best interests in mind. Ethically, it is imperative that the medical practitioner inform the parents about the benefits and risks of the procedure and obtain informed consent before performing it. Practically, however, many parents come to a decision about circumcising the child before he is born, and a discussion of the benefits and risks of the procedure with a physician has not been shown to have a significant effect on the decision. Some parents request to have their newborn or older child circumcised for non-therapeutic reasons, such as the parents' desires to adhere to family tradition, cultural norms or religious beliefs. In considering such a request, the physician may consider (in addition to any potential medical benefits and harms) such non-medical factors in determining the child's best interests and may ethically perform the procedure. Equally, without a clear medical benefit relative to the potential harms, a physician may take the ethical position that non-medical factors do not contribute enough as benefits to outweigh the potential harms and refuse to perform the procedure. Medical organizations such as the British Medical Association state that their member physicians are not obliged to perform the procedure in such situations.^[27][46]

The German Academy for Pediatric and Adolescent Medicine (Deutsche Akademie für Kinder- und Jugendmedizin e.V., DAKJ) recommend against routine non-medical infant circumcision.^[197] The Royal Dutch Medical Association questions why the ethics regarding male genital alterations should be viewed any differently from female genital alterations.^[198]

The procedure's relationship to other prophylactic procedures, along with the concepts of group rights, consent, and religious freedom, have been discussed in academic literature.^{[5][24][27][46][148]} Opponents have argued that ethical or legal opposition to circumcision is a form of ethnocentrism intended to privilege the rights of Christians over religious minorities, particularly Jews and Muslims.^[199]

Legal

Generally, circumcision on a minor is not ethically controversial or legally questionable when there is a clear and pressing medical indication for which it is the accepted best practice to resolve. Where circumcision is the chosen intervention, the physician has an ethical responsibility to ensure the procedure is performed competently and safely to minimize potential harms.^[27][46] Worldwide, most legal jurisdictions do not have specific laws concerning the circumcision of males,^[1] but infant circumcision is not illegal in many countries.^[200] A few countries have passed legislation on the procedure: Germany allows routine circumcision,^[201] while non-religious routine circumcision is illegal in South Africa and Sweden.^[1][200] The religious circumcision of minors is legal in every polity.^[148]

No major medical organization recommends circumcising all males, and no major medical organization recommends banning the procedure.^{[26][202][148]} In the academic literature, there is general agreement among both supporters and opponents of the practice that an outright ban would be predominately ineffective.^{[26][148][198][202]} 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.^[26][148] 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.^[26][200]

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.^[203] Several analyses have concluded that circumcision programs for adult men in Africa are cost-effective and in some cases are cost-saving.^[61][204] In Rwanda, circumcision has been found to be cost-effective across a wide range of age groups from newborn to adult,^[69][205] 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.^[15][205] 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.^[203] 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.^[206]

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.^[207] 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.^[4] 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.^[4] 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.^[208] 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.^[91]

References

1. Weiss H, Polonsky J, Bailey R, Hankins C, Halperin D, Schmid G (2007). Male circumcision: global trends and determinants of prevalence, safety, and acceptability (PDF). Geneva: World Health Organization. ISBN 978-92-4-159616-9. OCLC 425961131. (PDF) from the original on 22 December 2015.
2. Rudolph C, Rudolph A, Lister G, First L, Gershon A (18 March 2011). Rudolph's Pediatrics, 22nd Edition. McGraw-Hill Companies, Incorporated. p. 188. ISBN 978-0-07-149723-7. from the original on 18 January 2016.
3. Sawyer S (November 2011). Pediatric Physical Examination & Health Assessment. Jones & Bartlett Publishers. pp. 555–556. ISBN 978-1-4496-7600-1. from the original on 18 January 2016.
4. American Academy of Pediatrics Task Force on Circumcision (September 2012). "Male circumcision". Pediatrics. 130 (3): e756–e785. doi:10.1542/peds.2012-1990. PMID 22926175. from the original on 20 September 2012.
5. Calcagno C (April 2007). "[Circumcision: what do we cut when we are cutting?]". Urologia. 74 (2): 73–79. doi:10.5301/ru.2010.5865. PMID 21086403.
6. N. Stearns, Peter (2008). The Oxford Encyclopedia of the Modern World. Oxford University Press. p. 179. ISBN 9780195176322. 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.
7. R. Wylie, Kevan (2015). ABC of Sexual Health. John Wiley & Sons. p. 101. ISBN 9781118665695. 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.
8. R. Peteet, John (2017). Spirituality and Religion Within the Culture of Medicine: From Evidence to Practice. Oxford University Press. pp. 97–101. ISBN 9780190272432. male circumcision is still observed among Ethiopian and Coptic Christians, and circumcision rates are also high today in the Philippines and the US.
9. Wise J (July 2006). "Demand for male circumcision rises in a bid to prevent HIV". Bulletin of the World Health Organization. 84 (7): 509–511. PMC 2627386. PMID 16878217. As a result, there are already indications of increasing demand for male circumcision in traditionally non-circumcising societies in Southern Africa.
10. Lissauer T, Clayden G (October 2011). Illustrated Textbook of Paediatrics, Fourth edition. Elsevier. pp. 352–353. ISBN 978-0-7234-3565-5.
11. Hay W, Levin M (25 June 2012). Current Diagnosis and Treatment Pediatrics 21/E. McGraw Hill Professional. pp. 18–19. ISBN 978-0-07-177971-5. from the original on 18 January 2016.
12. Rehmeyer CJ (March 2011). "Male circumcision and human papillomavirus studies reviewed by infection stage and virus type". The Journal of the American Osteopathic Association. 111 (3 Suppl 2): S11–S18. PMID 21415373.
13. Larke N, Thomas SL, Dos Santos Silva I, Weiss HA (November 2011). "Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis". The Journal of Infectious Diseases. 204 (9): 1375–1390. doi:10.1093/infdis/jir523. PMID 21965090.
14. 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 (April 2019). "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". Lancet Glob Health (Mata-analysis). 7 (4): e436–e447. doi:10.1016/S2214-109X(18)30567-9. PMC 7779827. PMID 30879508.
15. Kim HH, Li PS, Goldstein M (November 2010). "Male circumcision: Africa and beyond?". Current Opinion in Urology. 20 (6): 515–519. doi:10.1097/MOU.0b013e32833f1b21. PMID 20844437. S2CID 2158164.
16. "Preventing HIV Through Safe Voluntary Medical Male Circumcision For Adolescent Boys And Men In Generalized HIV Epidemics". World Health Organization. 2020. Retrieved 24 May 2021.
17. Manual for early infant male circumcision under local anaesthesia. Geneva: World Health Organization. 2010. 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.
18. "Preventing HIV Through Safe Voluntary Medical Male Circumcision For Adolescent Boys And Men In Generalized HIV Epidemics". World Health Organization. 2020. Retrieved 24 May 2021.
19. Siegfried N, Muller M, Deeks JJ, Volmink J (April 2009). Siegfried N (ed.). "Male circumcision for prevention of heterosexual acquisition of HIV in men". The Cochrane Database of Systematic Reviews (2): CD003362. doi:10.1002/14651858.CD003362.pub2. PMID 19370585.
20. Merson, Michael; Inrig, Stephen (2017). The AIDS Pandemic: Searching for a Global Response. Springer Publishing. p. 379. ISBN 9783319471334. This led to a [medical] 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.
21. Thomas A, Necchi A, Muneer A, Tobias-Machado M, Tran AT, et al. (February 2021). "Penile cancer". Nat Rev Dis Primers (Review). 7 (1): 11. doi:10.1038/s41572-021-00246-5. PMID 33574340. S2CID 231877615.
22. Weiss HA, Larke N, Halperin D, Schenker I (February 2010). "Complications of circumcision in male neonates, infants and children: a systematic review". BMC Urology. 10: 2. doi:10.1186/1471-2490-10-2. PMC 2835667. PMID 20158883.
23. Selekman R, Copp H (2020). "Urologic Evaluation of the Child". In Partin A (ed.). Campbell Walsh Wein Urology (12th ed.). Elsevier. pp. 388–402. ISBN 9780323672276.
24. Gable, Lance; Gamharter, Katharina; Gostin, Lawrence; Hodge Jr., James; Puymbroeck, Rudolf (2007). "1.12 Male Circumcision". Legal Aspects of HIV/AIDS: A Guide for Policy and Law Reform. World Bank Publications. pp. 38–39. ISBN 978-0821371053.
25. Manual for early infant male circumcision under local anaesthesia. Geneva: World Health Organization. 2010. 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.
26. Jacobs M, Grady R, Bolnick DA (2012). "Current Circumcision Trends and Guidelines". In Bolnick DA, Koyle M, Yosha A (eds.). Surgical Guide to Circumcision. London: Springer. pp. 3–8, 255–257. doi:10.1007/978-1-4471-2858-8_1. ISBN 978-1-4471-2857-1. 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.
27. Caga-anan EC, Thomas AJ, Diekema DS, Mercurio MR, Adam MR (8 September 2011). Clinical Ethics in Pediatrics: A Case-Based Textbook. Cambridge University Press. p. 43. ISBN 978-0-521-17361-2. from the original on 18 January 2016.
28. Al-Salem, Ahmed (2016). An Illustrated Guide to Pediatric Urology. Springer Publishing. p. 481. ISBN 9783319441825.
29. Afshar, Kourosh; Kazemi, Behnam; MacNeily, Andrew (2018). "The Role of Circumcision in Preventing Sexually Transmitted Infections". In Singh, Sunit (ed.). Diagnostics to Pathogenomics of Sexually Transmitted Infections. Wiley. pp. 28–34. ISBN 9781119380849.
30. Mark, Elizabeth (2003). "Frojmovic/Travelers to the Circumcision". The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite. Brandeis University Press. p. 141. ISBN 9781584653073. Circumcision became the single most important commandment... the one without which... no Jew could attain the world to come.
31. Hamilton, Victor (1990). The Book of Genesis, Chapters 1-17. Eerdmans Publishing Company. p. 473. ISBN 9780802825216. 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.)
32. For sources surrounding this, see:
    • Livingston, Michael (2021). Dreamworld or Dystopia: The Nordic Model and Its Influence in the 21st Century. Cambridge University Press. p. 87. ISBN 9781108757263. In Jewish history, the banning of circumcision (brit mila) has historically been a first step toward more extreme and violent forms of persecution.
    • Livingston, Michael (2021). Dreamworld or Dystopia: The Nordic Model and Its Influence in the 21st Century. Cambridge University Press. p. 87. ISBN 9781108757263. In Jewish history, the banning of circumcision (brit mila) has historically been a first step toward more extreme and violent forms of persecution.
    • Wilson, Robin (2018). The Contested Place of Religion in Family Law. Cambridge University Press. p. 174. ISBN 9781108417600. 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.
    • Miller, Geoffrey P. (Spring 2002). "Circumcision: Cultural-Legal Analysis". Virginia Journal of Social Policy & the Law. 9: 497–585. doi:10.2139/ssrn.201057. SSRN 201057. 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 guerrilla warfare which resulted in major victories for the rebels and, eventually, a peace treaty which restored Jewish ritual prerogatives.
    • Silverman, Eric (2006). "Circumcision, Anti-Semitism, and Christ's Foreskin". From Abraham to America: A History of Jewish Circumcision. Rowman & Littlefield. pp. 161–162. ISBN 9780742516694. Ancient [Greek and Roman] 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...
    • Rosner, Fred (2003). Encyclopedia of Jewish Medical Ethics. Feldheim Publishers. p. 196. ISBN 9781583305928. 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... [those who attempted to reverse it or failed to perform the ritual were called] voiders of the covenant of Abraham our father, and they have no portion in the World to Come.
33. Owings M. "Products – Health E Stats – Trends in Circumcision Among Male Newborns Born in U.S. Hospitals: 1979–2010". www.cdc.gov. The Centers for Disease Control. Retrieved 1 May 2019.
34. "Circumcision". Columbia Encyclopedia. Columbia University Press. 2011. from the original on 24 September 2015.
35. Clark M (10 March 2011). Islam For Dummies. John Wiley & Sons. p. 170. ISBN 978-1-118-05396-6. from the original on 18 January 2016.
36. Glass JM (January 1999). "Religious circumcision: a Jewish view". BJU International. 83 (Suppl 1): 17–21. doi:10.1046/j.1464-410x.1999.0830s1017.x. PMID 10349410. S2CID 2888024.
37. Ubayd, Anis (2006). The Druze and Their Faith in Tawhid. Syracuse University Press. p. 150. ISBN 9780815630975. Male circumcision is standard practice, by tradition, among the Druze.
38. "Neonatal and child male circumcision: a global review" (PDF). World Health Organization. 2010. (PDF) from the original on 18 January 2016. Retrieved 12 April 2015.
39. Doyle, D. (October 2005). "Ritual male circumcision: a brief history" (PDF). The Journal of the Royal College of Physicians of Edinburgh. 35 (3): 279–285. ISSN 1478-2715. PMID 16402509.
40. Alanis MC, Lucidi RS (May 2004). "Neonatal circumcision: a review of the world's oldest and most controversial operation". Obstetrical & Gynecological Survey. 59 (5): 379–395. doi:10.1097/00006254-200405000-00026. PMID 15097799. S2CID 25226185.
41. Seeth, Avantika (1 June 2018). "'It's hassle-free,' says actor Melusi Yeni about his medical circumcision". News24. Retrieved 5 May 2022. Actor Melusi Yeni was the millionth man to undergo voluntary male medical circumcision at the Sivananda Clinic in KwaZulu-Natal.
42. Chikutsa, Antony; Maharaj, Pranitha (July 2015). "Social representations of male circumcision as prophylaxis against HIV/AIDS in Zimbabwe". BMC Public Health. 15 (1): 603. doi:10.1186/s12889-015-1967-z. ISSN 1471-2458. PMC 4489047. PMID 26133368. It is now generally accepted in public health spheres that medical male circumcision is efficacious in the prevention of HIV infection.
43. Bell, Kirsten (2016). Health and Other Unassailable Values: Reconfigurations of Health, Evidence and Ethics. Taylor & Francis. p. 106. ISBN 9781317482031. ...defending the casual relation between male circumcision and reduced HIV transmission has become essentially hegemonic in the academic literature.
44. Merson, Michael; Inrig, Stephen (2017). The AIDS Pandemic: Searching for a Global Response. Springer International Publishing. p. 379. ISBN 9783319471334.
45. Marrazzo JM, del Rio C, Holtgrave DR, Cohen MS, Kalichman SC, Mayer KH, et al. (23–30 July 2014). "HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel". JAMA. 312 (4): 390–409. doi:10.1001/jama.2014.7999. PMC 6309682. PMID 25038358.
46. Pinto K (August 2012). "Circumcision controversies". Pediatric Clinics of North America. 59 (4): 977–986. doi:10.1016/j.pcl.2012.05.015. PMID 22857844.
47. Wapner, Jessica (24 February 2015). "The Troubled History of Foreskin". Mosaic Science. 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.
48. Morris, Brian J. (November 2007). "Why circumcision is a biomedical imperative for the 21(st) century". BioEssays: News and Reviews in Molecular, Cellular and Developmental Biology. 29 (11): 1147–1158. doi:10.1002/bies.20654. ISSN 0265-9247. PMID 17935209.
49. Morris, Brian J; Krieger, John N; Klausner, Jeffrey D (24 March 2017). "CDC's Male Circumcision Recommendations Represent a Key Public Health Measure". Global Health: Science and Practice. 5 (1): 15–27. doi:10.9745/GHSP-D-16-00390. ISSN 2169-575X. PMC 5478224. PMID 28351877.
50. S. Ellwood, Robert (2008). The Encyclopedia of World Religions. Infobase Publishing. p. 95. ISBN 9781438110387. It is obligatory among Jews, Muslims, and Coptic Christians. Catholic, Orthodox, and Protestant Christians do not require circumcision. Starting in the last half of the 19th century, however, circumcision also became common among Christians in Europe and especially in North America.
51. Ubayd, Anis (2006). The Druze and Their Faith in Tawhid. Syracuse University Press. p. 150. ISBN 9780815630975. Male circumcision is standard practice, by tradition, among the Druze
52. Pitts-Taylor, Victoria (2008). Cultural Encyclopedia of the Body [2 volumes]. ABC-CLIO. p. 394. ISBN 9781567206913. 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.
53. World Health Organization; UNAIDS; Jhpiego (December 2009). (PDF). Archived from the original (PDF) on 15 January 2012. ...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.
54. "Use of devices for adult male circumcision in public health HIV prevention programmes: Conclusions of the Technical Advisory Group on Innovations in Male Circumcision" (PDF). World Health Organization. 2012. (PDF) from the original on 12 March 2013.
55. Perera CL, Bridgewater FH, Thavaneswaran P, Maddern GJ (2010). "Safety and efficacy of nontherapeutic male circumcision: a systematic review". Annals of Family Medicine. 8 (1): 64–72. doi:10.1370/afm.1073. PMC 2807391. PMID 20065281.
56. Professional Standards and Guidelines – Circumcision (Infant Male). College of Physicians and Surgeons of British Columbia (Report). September 2009.
57. Lönnqvist PA (September 2010). "Regional anaesthesia and analgesia in the neonate". Best Practice & Research. Clinical Anaesthesiology. 24 (3): 309–321. doi:10.1016/j.bpa.2010.02.012. PMID 21033009.
58. Shockley RA, Rickett K (April 2011). "Clinical inquiries. What's the best way to control circumcision pain in newborns?". The Journal of Family Practice. 60 (4): 233a–233b. PMID 21472156.
59. Wolter C, Dmochowski R (2008). "Circumcision". Handbook of Office Urological Procedures. Springer. pp. 88–. ISBN 978-1-84628-523-3. from the original on 18 January 2016.
60. Krieger JN (February 2012). "Male circumcision and HIV infection risk". World Journal of Urology. 30 (1): 3–13. doi:10.1007/s00345-011-0696-x. PMID 21590467. S2CID 20737718.
61. Uthman OA, Popoola TA, Uthman MM, Aremu O (March 2010). Van Baal PH (ed.). "Economic evaluations of adult male circumcision for prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa: a systematic review". PLOS ONE. 5 (3): e9628. Bibcode:2010PLoSO...5.9628U. doi:10.1371/journal.pone.0009628. PMC 2835757. PMID 20224784.
62. Weiss HA, Dickson KE, Agot K, Hankins CA (October 2010). "Male circumcision for HIV prevention: current research and programmatic issues". AIDS. 24 (Suppl 4): S61–S69. doi:10.1097/01.aids.0000390708.66136.f4. PMC 4233247. PMID 21042054.
63. "New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications" (PDF). World Health Organization. 28 March 2007. (PDF) from the original on 8 August 2007.
64. Dinh MH, Fahrbach KM, Hope TJ (March 2011). "The role of the foreskin in male circumcision: an evidence-based review". American Journal of Reproductive Immunology. 65 (3): 279–283. doi:10.1111/j.1600-0897.2010.00934.x. PMC 3091617. PMID 21114567.
65. Lei JH, Liu LR, Wei Q, Yan SB, Yang L, Song TR, et al. (5 May 2015). "Circumcision Status and Risk of HIV Acquisition during Heterosexual Intercourse for Both Males and Females: A Meta-Analysis". PLOS ONE. 10 (5): e0125436. Bibcode:2015PLoSO..1025436L. doi:10.1371/journal.pone.0125436. PMC 4420461. PMID 25942703.
66. "STD facts – Human papillomavirus (HPV)". CDC. from the original on 11 September 2012. Retrieved 12 September 2012.
67. 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).
68. Zhu YP, Jia ZW, Dai B, Ye DW, Kong YY, Chang K, Wang Y (8 March 2016). "Relationship between circumcision and human papillomavirus infection: a systematic review and meta-analysis". Asian Journal of Andrology. 19 (1): 125–131. doi:10.4103/1008-682X.175092. PMC 5227661. PMID 26975489.
69. Albero G, Castellsagué X, Giuliano AR, Bosch FX (February 2012). "Male circumcision and genital human papillomavirus: a systematic review and meta-analysis". Sexually Transmitted Diseases. 39 (2): 104–113. doi:10.1097/OLQ.0b013e3182387abd. PMID 22249298. S2CID 26859788.
70. Weiss HA, Thomas SL, Munabi SK, Hayes RJ (April 2006). "Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis". Sexually Transmitted Infections. 82 (2): 101–9, discussion 110. doi:10.1136/sti.2005.017442. PMC 2653870. PMID 16581731.
71. Wetmore CM, Manhart LE, Wasserheit JN (April 2010). "Randomized controlled trials of interventions to prevent sexually transmitted infections: learning from the past to plan for the future". Epidemiologic Reviews. 32 (1): 121–136. doi:10.1093/epirev/mxq010. PMC 2912604. PMID 20519264.
72. Templeton DJ, Millett GA, Grulich AE (February 2010). "Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men". Current Opinion in Infectious Diseases. 23 (1): 45–52. doi:10.1097/QCO.0b013e328334e54d. PMID 19935420. S2CID 43878584.
73. Hayashi Y, Kojima Y, Mizuno K, Kohri K (February 2011). "Prepuce: phimosis, paraphimosis, and circumcision". TheScientificWorldJournal. 11: 289–301. doi:10.1100/tsw.2011.31. PMC 5719994. PMID 21298220.
74. Becker K (January 2011). "Lichen sclerosus in boys". Deutsches Ärzteblatt International. 108 (4): 53–58. doi:10.3238/arztebl.2011.0053. PMC 3036008. PMID 21307992.
75. Moreno G, Corbalán J, Peñaloza B, Pantoja T (September 2014). "Topical corticosteroids for treating phimosis in boys". The Cochrane Database of Systematic Reviews. 9 (9): CD008973. doi:10.1002/14651858.CD008973.pub2. PMID 25180668.
76. Celis S, Reed F, Murphy F, Adams S, Gillick J, Abdelhafeez AH, Lopez PJ (February 2014). "Balanitis xerotica obliterans in children and adolescents: a literature review and clinical series". Journal of Pediatric Urology. 10 (1): 34–39. doi:10.1016/j.jpurol.2013.09.027. PMID 24295833.
77. Krill AJ, Palmer LS, Palmer JS (2011). "Complications of circumcision". TheScientificWorldJournal. 11: 2458–2468. doi:10.1100/2011/373829. PMC 3253617. PMID 22235177.
78. Leber M, Tirumani A (8 June 2006). "Balanitis". EMedicine. from the original on 7 October 2008. Retrieved 14 October 2008.
79. Osipov V, Acker S (November 2006). "Balanoposthitis". Reactive and Inflammatory Dermatoses. EMedicine. from the original on 11 December 2006. Retrieved 20 November 2006.
80. Aridogan IA, Izol V, Ilkit M (August 2011). "Superficial fungal infections of the male genitalia: a review". Critical Reviews in Microbiology. 37 (3): 237–244. doi:10.3109/1040841X.2011.572862. PMID 21668404. S2CID 31957918.
81. Morris BJ, Wiswell TE (June 2013). "Circumcision and lifetime risk of urinary tract infection: a systematic review and meta-analysis". The Journal of Urology. 189 (6): 2118–2124. doi:10.1016/j.juro.2012.11.114. PMID 23201382.
82. Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S (November 2012). Fedorowicz Z (ed.). "Routine neonatal circumcision for the prevention of urinary tract infections in infancy". The Cochrane Database of Systematic Reviews. 11 (5): CD009129. doi:10.1002/14651858.CD009129.pub2. PMID 23152269.
83. "Risk Factors for Penile Cancer". American Cancer Society. 25 June 2018.
84. Hakenberg OW, Compérat EM, Minhas S, Necchi A, Protzel C, Watkin N (January 2015). "EAU guidelines on penile cancer: 2014 update". Eur Urol (Practice guideline). 67 (1): 142–150. doi:10.1016/j.eururo.2014.10.017. PMID 25457021.
85. Larke NL, Thomas SL, dos Santos Silva I, Weiss HA (August 2011). "Male circumcision and penile cancer: a systematic review and meta-analysis". Cancer Causes & Control. 22 (8): 1097–1110. doi:10.1007/s10552-011-9785-9. PMC 3139859. PMID 21695385.
86. Pabalan N, Singian E, Jarjanazi H, Paganini-Hill A (December 2015). "Association of male circumcision with risk of prostate cancer: a meta-analysis". Prostate Cancer and Prostatic Diseases. 18 (4): 352–357. doi:10.1038/pcan.2015.34. PMID 26215783. S2CID 20488528.
87. Li YD, Teng Y, Dai Y, Ding H (2016). "The Association of Circumcision and Prostate Cancer: A Meta-Analysis". Asian Pacific Journal of Cancer Prevention. 17 (8): 3823–3827. PMID 27644623. from the original on 23 February 2017.
88. Grund JM, Bryant TS, Jackson I, Curran K, Bock N, Toledo C, et al. (November 2017). "Association between male circumcision and women's biomedical health outcomes: a systematic review". The Lancet. Global Health. 5 (11): e1113–e1122. doi:10.1016/S2214-109X(17)30369-8. PMC 5728090. PMID 29025633.
89. 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.
    • Dave S, Afshar K, Braga LH, Anderson P (February 2018). "Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version)". Canadian Urological Association Journal. 12 (2): E76–E99. doi:10.5489/cuaj.5033. PMC 5937400. PMID 29381458. There is lack of any convincing evidence that neonatal circumcision will impact sexual function or cause a perceptible change in penile sensation in adulthood.
    • Shabanzadeh DM, Düring S, Frimodt-Møller C (July 2016). "Male circumcision does not result in inferior perceived male sexual function - a systematic review". Danish Medical Journal (Systematic review). 63 (7). PMID 27399981.
    • Friedman B, Khoury J, Petersiel N, Yahalomi T, Paul M, Neuberger A (September 2016). "Pros and cons of circumcision: an evidence-based overview". Clinical Microbiology and Infection. 22 (9): 768–774. doi:10.1016/j.cmi.2016.07.030. PMID 27497811.
    • Staff. "Male Circumcision". Mayo Clinic. Retrieved 21 March 2023. Circumcision doesn't affect fertility, nor is circumcision generally thought to enhance or detract from sexual pleasure for men or their partners.
    • Staff. "Statement on Newborn Male Circumcision". American College of Obstetricians and Gynecologists. Retrieved 21 March 2023. Some parents also may worry that circumcision harms a man's sexual function, sensitivity, or satisfaction. However, current evidence shows that it does not.
    • Shezi, Mirriam Hlelisani; Tlou, Boikhutso; Naidoo, Saloshni (16 February 2023). "Knowledge, attitudes and acceptance of voluntary medical male circumcision among males attending high school in Shiselweni region, Eswatini: a cross sectional study". BMC Public Health. 23 (1): 349. doi:10.1186/s12889-023-15228-3. ISSN 1471-2458. PMC 9933013. PMID 36797696. It was interesting to note that the young males in this study had misconceptions about sexual pleasure post male circumcision...
    • World Health Organization; UNAIDS; Jhpiego (December 2009). (PDF). Archived from the original (PDF) on 15 January 2012. ...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.^{[dead link]}
90. Tian Y, Liu W, Wang JZ, Wazir R, Yue X, Wang KJ (September 2013). "Effects of circumcision on male sexual functions: a systematic review and meta-analysis". Asian Journal of Andrology (Systematic review). 15 (5): 662–666. doi:10.1038/aja.2013.47. PMC 3881635. PMID 23749001.
91. Bossio JA, Pukall CF, Steele S (December 2014). "A review of the current state of the male circumcision literature". The Journal of Sexual Medicine. 11 (12): 2847–2864. doi:10.1111/jsm.12703. PMID 25284631.
92. Friedman B, Khoury J, Petersiel N, Yahalomi T, Paul M, Neuberger A (September 2016). "Pros and cons of circumcision: an evidence-based overview". Clinical Microbiology and Infection. 22 (9): 768–774. doi:10.1016/j.cmi.2016.07.030. PMID 27497811.
93. American Urological Association. . Archived from the original on 25 August 2013. Retrieved 2 November 2008.
94. Krill AJ, Palmer LS, Palmer JS (2011). "Complications of circumcision". TheScientificWorldJournal. 11: 2458–2468. doi:10.1100/2011/373829. PMC 3253617. PMID 22235177.
95. "Neonatal Circumcision". American Academy of Family Physicians. 2013. from the original on 21 July 2015. Retrieved 3 August 2015.
96. Morris BJ, Krieger JN (December 2017). "Does Circumcision Increase Meatal Stenosis Risk?-A Systematic Review and Meta-analysis". Urology. 110: 16–26. doi:10.1016/j.urology.2017.07.027. PMID 28826876. Weak evidence suggests that MS risk might be higher in circumcised boys and young adult males.
97. Sorokan ST, Finlay JC, Jefferies AL (8 September 2015). "Newborn male circumcision". Paediatrics & Child Health. 20 (6): 311–320. doi:10.1093/pch/20.6.311. PMC 4578472. PMID 26435672. from the original on 18 January 2016.
98. Morris BJ, Moreton S, Krieger JN (November 2019). "Critical evaluation of arguments opposing male circumcision: A systematic review". Journal of Evidence-Based Medicine (Systematic review). 12 (4): 263–290. doi:10.1111/jebm.12361. PMC 6899915. PMID 31496128.
99. "Circumcision in men". National Health Service. 22 February 2016.
100. Morris BJ, Wamai RG, Henebeng EB, Tobian AA, Klausner JD, Banerjee J, Hankins CA (1 March 2016). "Estimation of country-specific and global prevalence of male circumcision". Population Health Metrics. 14 (1): 4. doi:10.1186/s12963-016-0073-5. PMC 4772313. PMID 26933388.
101. Taiwo AL, E OO (16 September 2016). "Circumcision and its effects in Africa". Translational Andrology and Urology. 6 (2): 149–157. doi:10.21037/tau.2016.12.02. PMC 5422680. PMID 28540221.
102. Paul KD, Daniel TH, James PH, Jeffrey DK, Robert CB (30 November 2006). "Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries". BMC Infectious Diseases. 6 (172): 4. doi:10.1186/1471-2334-6-172. PMC 1764746. PMID 17137513.
103. Drain PK, Halperin DT, Hughes JP, Klausner JD, Bailey RC (November 2006). "Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries". BMC Infectious Diseases. 6: 172. doi:10.1186/1471-2334-6-172. PMC 1764746. PMID 17137513.
104. Klavs I, Hamers FF (February 2008). "Male circumcision in Slovenia: results from a national probability sample survey". Sexually Transmitted Infections. 84 (1): 49–50. doi:10.1136/sti.2007.027524. PMID 17881413. S2CID 24535897.
105. Ko MC, Liu CK, Lee WK, Jeng HS, Chiang HS, Li CY (April 2007). "Age-specific prevalence rates of phimosis and circumcision in Taiwanese boys". Journal of the Formosan Medical Association = Taiwan Yi Zhi. 106 (4): 302–307. doi:10.1016/S0929-6646(09)60256-4. PMID 17475607.
106. Richters J, Smith AM, de Visser RO, Grulich AE, Rissel CE (August 2006). "Circumcision in Australia: prevalence and effects on sexual health". International Journal of STD & AIDS. 17 (8): 547–554. doi:10.1258/095646206778145730. PMID 16925903. S2CID 24396989.
107. Baskin, Laurence (29 April 2021). Lockwood, Charles; Wilcox, Duncan; Eckler, Kristen (eds.). "Patient education: Circumcision in baby boys (Beyond the Basics)". UpToDate. Retrieved 22 November 2022. The incidence in 2008 was approximately 55 to 57 percent based on hospital coding data, but this is probably an underestimate of the true incidence of circumcised males, which is likely closer to 80 percent, due to miscoding and because some circumcisions are performed later in life for religious, medical, or personal reasons.
108. Scott, Cameron (4 December 2014). "CDC Encourages Circumcision, Even for Adult Men". Healthline. Retrieved 26 November 2022. The CDC's move contributes to a shift in the American scientific community toward stronger support for circumcision... Circumcision rates seem to have ticked upward since the AAP changed its stance.
109. Morris, Brian; Bailis, Stefan; Wiswell, Thomas (May 2014). "Circumcision rates in the United States: rising or falling? What effect might the new affirmative pediatric policy statement have?". Mayo Clinic Proceedings. 89 (5): 677–686. doi:10.1016/j.mayocp.2014.01.001. ISSN 1942-5546. PMID 24702735.
110. Owings M, et al. (22 August 2013). "Trends in Circumcision for Male Newborns in U.S. Hospitals: 1979–2010". Centers for Disease Control and Prevention. from the original on 23 January 2014. Retrieved 22 January 2014.
111. Waskett, Jake H. (August 2007). "Hospital Discharge Data Underestimate Circumcision Rates". Sexually Transmitted Diseases. 34 (8): 624. doi:10.1097/OLQ.0b013e3180de2120. ISSN 0148-5717. PMID 17667534. Researchers should be aware that infant circumcision rates [in the United States] are likely to be significantly higher than hospital discharge data might suggest.
112. Gollaher (2001), ch. 1, The Jewish Tradition, pp. 1–30
113. Campbell, Alec; Coulson, David (2010). "Big Hippo Site, Oued Afar, Algeria" (PDF). Sahara. 21: 85, 90–91. ISSN 1120-5679. S2CID 191103812.
114. Soukopova, Jitka (August 2017). "Central Saharan rock art: Considering the kettles and cupules". Journal of Arid Environments. 143: 12. Bibcode:2017JArEn.143...10S. doi:10.1016/j.jaridenv.2016.12.011. S2CID 132225521.
115. Al-Salem, Ahmed H. (8 November 2016). "Male Circumcision". An Illustrated Guide to Pediatric Urology. Springer Cham. p. 480. doi:10.1007/978-3-319-44182-5_22. ISBN 978-3-319-44182-5. S2CID 79015190.
116. Gollaher, David (2000). "The Jewish Tradition" (PDF). Circumcision: A History Of The World's Most Controversial Surgery. Basic Books. pp. 2–3. ISBN 0-465-02653-2. S2CID 68860890.
117. Dobanovački, Dušanka; et al. (2012). "Surgery Before Common Era (B.C.E.*)" (PDF). Archive of Oncology. 20 (1–2): 29. doi:10.2298/AOO1202028D. S2CID 53008076.
118. McNutt PM (1999). Reconstructing the Society of Ancient Israel. Westminster John Knox Press. p. 41. ISBN 978-0-664-22265-9. Abraham patriarchal known history.
119. "Circumcision". Encyclopaedia Judaica (2 ed.). USA: Macmillan Reference. 2006. ISBN 978-0-02-865928-2.
120. Hirsch EG, Kohler K, Jacobs J, Friedenwald A, Broydé I (1906). "Circumcision". Jewish Encyclopedia. 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 war of Bar Kokba (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).
121. Jacobs, Andrew (2012). Christ Circumcised: A Study in Early Christian History and Difference. United States: University of Pennsylvania Press. ISBN 9780812206517.
122. Bolnick, David; Koyle, Martin; Yosha, Assaf (2012). "Circumcision in the Early Christian Church: The Controversy That Shaped a Continent". Surgical Guide to Circumcision. United Kingdom: Springer. pp. 290–298. ISBN 9781447128588. 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... [has been] examined by many of the greatest scholars and artists of the Western tradition.
123. Gollaher (2001), ch. 2, Christians and Muslims, pp. 31–52
124. Donald Daniel Leslie (1998). (PDF). The Fifty-ninth George Ernest Morrison Lecture in Ethnology. p. 12. Archived from the original (PDF) on 17 December 2010. Retrieved 30 November 2010.
125. Elverskog, Johan (2010). Buddhism and Islam on the Silk Road (illustrated ed.). University of Pennsylvania Press. pp. 228. ISBN 978-0-8122-4237-9. Retrieved 28 June 2010.
126. Gollaher (2001), ch. 3, Symbolic Wounds, pp. 53–72
127. Darby R (2005). A surgical temptation: the demonization of the foreskin and the rise of circumcision in Britain. Chicago: University of Chicago Press. pp. 262–. ISBN 978-0-226-13645-5.
128. Hutchinson, Jonathan (1855). "On the influence of circumcision in preventing syphilis". Medical Times and Gazette. 32: 542–543.
129. Matthew HC (2004). Oxford dictionary of national biography: in association with the British Academy: from the earliest times to the year 2000. Oxford New York: Oxford University Press. ISBN 978-0-19-861411-1.
130. Chubak, Barbara (1 April 2013). "1101 the orthopedic origin of popular male circumcision in america". Journal of Urology. 189 (4S): e451. doi:10.1016/j.juro.2013.02.693. 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, by redefining it as a systemic therapy, rather than a local anatomic alteration. This redefinition was consonant with the contemporary reflex neurosis theory of disease, as well as the historic humoral-mechanical understanding of the human body.
131. Gollaher 2001, p. 106
132. Gollaher (2001), ch. 4, From Ritual to Science, pp. 73–108
133. Darby R (Spring 2003). "The Masturbation Taboo and the Rise of Routine Male Circumcision: A Review of the Historiography". Journal of Social History. 36 (3): 737–757. doi:10.1353/jsh.2003.0047. S2CID 72536074.
134. Laumann, E. O.; Masi, C. M.; Zuckerman, E. W. (2 April 1997). "Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice". JAMA. 277 (13): 1052–1057. doi:10.1001/jama.1997.03540370042034. ISSN 0098-7484. PMID 9091693.
135. Gollaher 2001, p. 106
136. Paige, Jeffery; Paige, Karen (2021). "Summary and Implications for Complex Societies". The Politics of Reproductive Ritual. University of California Press. p. 263. ISBN 9780520306745.
137. Gairdner D (December 1949). "The fate of the foreskin, a study of circumcision". British Medical Journal. 2 (4642): 1433–7, illust. doi:10.1136/bmj.2.4642.1433. PMC 2051968. PMID 15408299.
138. Morris BJ, Wamai RG, Henebeng EB, Tobian AA, Klausner JD, Banerjee J, Hankins CA (1 March 2016). "Estimation of country-specific and global prevalence of male circumcision". Population Health Metrics. 14: 4. doi:10.1186/s12963-016-0073-5. PMC 4772313. PMID 26933388.
139. Hankins, Catherine; Forsythe, Steven; Njeuhmeli, Emmanuel (29 November 2011). "Voluntary Medical Male Circumcision: An Introduction to the Cost, Impact, and Challenges of Accelerated Scaling Up". PLOS Medicine. 8 (11): e1001127. doi:10.1371/journal.pmed.1001127. PMC 3226452. PMID 22140362.
140. McNeil Jr DG (3 March 2009). "AIDS: New Web Site Seeks to Fight Myths About Circumcision and H.I.V." The New York Times. p. D6. from the original on 8 January 2014. Retrieved 1 February 2012.
141. "Clearinghouse on Male Circumcision for HIV Prevention Redesigned". AVAC. May 2015. from the original on 12 March 2017. Retrieved 11 March 2017.
142. al-Sabbagh, Muhammad Lutfi (1996). Islamic ruling on male and female circumcision. World Health Organization. p. 16. ISBN 978-92-9021-216-4.
143. "Circumcision". Encyclopedia of Religion (2 ed.). Gale. 2005.
144. Riggs, Thomas (2006). "Christianity: Coptic Christianity". Worldmark Encyclopedia of Religious Practices: Religions and denominations. Thomson Gale. ISBN 978-0-7876-6612-5. from the original on 18 January 2016.
145. Drower, Ethel Stefana (1937). The Mandaeans of Iraq and Iran. Oxford At The Clarendon Press.
146. Clarence-Smith 2008, pp. 14–22.
147. Cherry, Mark (2013). Religious Perspectives on Bioethics. Taylor & Francis. p. 213. ISBN 978-9026519673.
148. Cohen-Almagor, Raphael (9 November 2020). "Should liberal government regulate male circumcision performed in the name of Jewish tradition?". SN Social Sciences. 1 (1): 8. doi:10.1007/s43545-020-00011-7. ISSN 2662-9283. S2CID 228911544. 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...
149. Bolnick DA, Katz KE (2012). "Jewish Ritual Circumcision". In Bolnick DA, Koyle M, Yosha A (eds.). Surgical Guide to Circumcision. London: Springer. pp. 265–274. doi:10.1007/978-1-4471-2858-8_23. ISBN 978-1-4471-2857-1.
150. Oliver, Isaac W. (14 May 2013). "Forming Jewish Identity by Formulating Legislation for Gentiles". Journal of Ancient Judaism. 4 (1): 105–132. doi:10.30965/21967954-00401005. ISSN 1869-3296.
151. Levine, Amy-Jill; Zvi Brettler, Marc (2017). The Jewish Annotated New Testament. Oxford University Press. p. 673. With rare exceptions (e.g. matters of health), Judaism requires circumcision for all male children on their eighth day of birth.
152. Talmud Avodah Zarah 26b; Menachot 42a; Maimonides' Mishneh Torah, Milah, ii. 1; Shulkhan Arukh, Yoreh De'ah, l.c.
153. . 7 October 2013. Archived from the original on 7 October 2013. Retrieved 20 July 2022.
154. Chernikoff H (3 October 2007). "Jewish "intactivists" in U.S. stop circumcising". Reuters. from the original on 27 December 2008. Retrieved 3 November 2007.
155. Glickman M (12 November 2005). "B'rit Milah: A Jewish Answer to Modernity". Reform Judaism. from the original on 12 March 2017. Retrieved 11 March 2017.
156. Cohen H (20 May 2002). . Jewish Reconstructionist Federation. Archived from the original on 9 October 2007. Retrieved 3 November 2007.
157. Epstein L (2007). . Calgary Jewish Community Council. Archived from the original on 27 December 2008. Retrieved 3 November 2007.
158. Šakūrzāda, Ebrāhīm; Omidsalar, Mahmoud (October 2011). "Circumcision". Encyclopædia Iranica. Vol. V/6. New York: Columbia University. pp. 596–600. doi:10.1163/2330-4804_EIRO_COM_7731. ISSN 2330-4804. from the original on 19 January 2020. Retrieved 7 February 2020.
159. Aldeeb Abu-Sahlieh, Sami A. (1994). "To Mutilate in the Name of Jehovah or Allah: Legitimization of Male and Female Circumcision". Medicine and Law. World Association for Medical Law. 13 (7–8): 575–622. PMID 7731348.; Aldeeb Abu-Sahlieh, Sami A. (1995). "Islamic Law and the Issue of Male and Female Circumcision". Third World Legal Studies. Valparaiso University School of Law. 13: 73–101. from the original on 12 November 2019. Retrieved 13 February 2020.
160. El-Sheemy MS, Ziada AM (2012). "Islam and Circumcision". In Bolnick DA, Koyle M, Yosha A (eds.). Surgical Guide to Circumcision. London: Springer. pp. 275–280. doi:10.1007/978-1-4471-2858-8_24. ISBN 978-1-4471-2857-1.
161. Mark, Elizabeth (2003). The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite. Brandeis University Press. pp. xxiii. ISBN 9781584653073.
162. Pope Eugenius IV (1990) [1442]. "Ecumenical Council of Florence (1438–1445): Session 11—4 February 1442; Bull of union with the Copts". In Tanner, Norman P. (ed.). Decrees of the ecumenical councils. 2 volumes (in Greek and Latin). Washington, D.C.: Georgetown University Press. ISBN 978-0-87840-490-2. LCCN 90003209. Retrieved 25 April 2007. it denounces all who after that time observe circumcision
163. Slosar JP, O'Brien D (2003). "The ethics of neonatal male circumcision: a Catholic perspective". The American Journal of Bioethics. 3 (2): 62–64. doi:10.1162/152651603766436306. PMID 12859824. S2CID 38064474.
164. Pitts-Taylor, Victoria (2008). Cultural Encyclopedia of the Body [2 volumes]. ABC-CLIO. p. 394. ISBN 9781567206913. For most part, Christianity dose 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.
165. J. Sharkey, Heather (2015). American Evangelicals in Egypt: Missionary Encounters in an Age of Empire. Princeton University Press. p. 30. ISBN 9780691168104.
166. Adams G, Adams K (2012). "Circumcision in the Early Christian Church: The Controversy That Shaped a Continent". In Bolnick DA, Koyle M, Yosha A (eds.). Surgical Guide to Circumcision. London: Springer. pp. 291–298. doi:10.1007/978-1-4471-2858-8_26. ISBN 978-1-4471-2857-1.
167. DeMello, Margo (2007). Encyclopedia of Body Adornment. ABC-Clio. p. 66. ISBN 9780313336959. 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.
168. Gruenbaum, Ellen (2015). The Female Circumcision Controversy: An Anthropological Perspective. University of Pennsylvania Press. p. 61. ISBN 9780812292510. 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
169. Hunting, Katherine (2012). Essential Case Studies in Public Health: Putting Public Health Into Practice. Jones & Bartlett Publishers. pp. 23–24. ISBN 9781449648756. Neonatal circumcision is the general practice among Jews, Christians, and many, but not all Muslims.
170. Creighton, Sarah; Liao, Lih-Mei (2019). Female Genital Cosmetic Surgery: Solution to What Problem?. Cambridge University Press. p. 63. ISBN 9781108435529. Christians in Africa, for instance, often practise infant male circumcision.
171. Nga, Armelle (30 December 2019). "The Ritual of Circumcision in Africa: The Case of South Africa". Africanews. This practice is old and widespread among African Christians with very close links to their beliefs. It can be executed traditionally or in hospital.
172. Bakos, Gergely Tibor (2011). On Faith, Rationality, and the Other in the Late Middle Ages:: A Study of Nicholas of Cusa's Manuductive Approach to Islam. Wipf and Stock Publishers. p. 228. ISBN 9781606083420. 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.
173. J. Sharkey, Heather (2017). A History of Muslims, Christians, and Jews in the Middle East. Cambridge University Press. p. 63. ISBN 9780521769372. On the Coptic Christian practice of male circumcision in Egypt, and on its practice by other Christians in western Asia.
174. "Circumcision protest brought to Florence". Associated Press. 30 March 2008. 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.
175. Ian Ross, Jeffrey (2015). Religion and Violence: An Encyclopedia of Faith and Conflict from Antiquity to the Present. Routledge. p. 169. ISBN 9781317461098. For instance, the majority of South Koreans, Americans, and Filipinos, as well as African Christians, practice circumcision.
176. L. Armstrong, Heather (2021). Encyclopedia of Sex and Sexuality: Understanding Biology, Psychology, and Culture [2 volumes]. ABC-CLIO. pp. 115–117. ISBN 9781610698757.
177. Abulafia, Anna Sapir (23 September 2019). "The Abrahamic religions". www.bl.uk. London: British Library. from the original on 12 July 2020. Retrieved 9 March 2021.
178. Obeid, Anis (2006). The Druze & Their Faith in Tawhid. Syracuse University Press. p. 1. ISBN 978-0-8156-5257-1.
179. Jacobs, Daniel (1998). Israel and the Palestinian Territories: The Rough Guide. Rough Guides. p. 147. ISBN 9781858282480. Circumcision is not compulsory and has no religious significance.
180. M. Silver, M. (2022). The History of Galilee, 1538–1949: Mysticism, Modernization, and War. Rowman & Littlefield. p. 97. ISBN 9781793649430. Muslim men are circumcised, whereas this is not a religious obligation among the Druze
181. Dana 2003, p. 56.
182. Brenton Betts, Robert (2013). The Sunni-Shi'a Divide: Islam's Internal Divisions and Their Global Consequences. Potomac Books, Inc. p. 56. ISBN 9781612345239. 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
183. Mark, Elizabeth (2003). The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite. University Press of New England. pp. 94–95. ISBN 9781584653073.
184. Lupieri, Edmundo (2001). The Mandaeans: The Last Gnostics. Wm. B. Eerdmans Publishing. p. 60. ISBN 9780802833501.
185. Schmidinger, Thomas (2019). Beyond ISIS: History and Future of Religious Minorities in Iraq. Transnational Press London. p. 82. ISBN 9781912997152.
186. Deutsch, Nathaniel (1999). Guardians of the Gate: Angelic Vice-regency in the Late Antiquity. BRILL. p. 105. ISBN 9789004109094.
187. Parry, O. H. (Oswald Hutton) (1895). "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". London : H. Cox.
188. Kreyenbroek, Philip G. (2009). Yezidism in Europe: Different Generations Speak about Their Religion. Otto Harrassowitz Verlag. ISBN 978-3-447-06060-8.
189. Cole, William Owen; Sambhi, Piara Singh (1995). The Sikhs: Their Religious Beliefs and Practices. Sussex Academic Press. pp. 155–156. ISBN 978-1-898723-13-4.
190. "Sri Granth: Sri Guru Granth Sahib". www.srigranth.org.
191. Taiwo Lawal; et al. (April 2017). "Circumcision and its effects in Africa". Translational Andrology and Urology. 6 (2): 149–157. doi:10.21037/tau.2016.12.02. PMC 5422680. PMID 28540221.
192. Spencer P (c. 1988). The Maasai of Matapato: A Study of Rituals of Rebellion. London: Manchester University Press. pp. Chapter 5. ISBN 9780719025549.
193. Pathisa N (2008). Zimbabwe's Cultural Heritage. amabooks. pp. 60–61. ISBN 9780797445048.
194. Fogg, Ally (25 August 2014). "The death and deformity caused by male circumcision in Africa can't be ignored". The Guardian. from the original on 20 March 2015.
195. "Tuli a rite of passage for Filipino boys". 6 May 2011. from the original on 8 December 2015. Retrieved 6 December 2015.
196. . Channel News Asia. Agence France-Presse. 19 June 2019. Archived from the original on 20 June 2019. Retrieved 20 June 2019.
197. "Stellungnahme zur Beschneidung von minderjährigen Jungen" (PDF). dakj.de. 25 July 2012. (PDF) from the original on 12 March 2017. Retrieved 11 March 2017.
198. "Non-therapeutic circumcision of male minors – KNMG Viewpoint". Retrieved 7 March 2018.
199. Gressgård, Randi (2012). Multicultural Dialogue: Dilemmas, Paradoxes, Conflicts. Berghahn Books. pp. 7, 94. ISBN 9780857456489. Likewise, non-Christian practices, such as the circumcision of men, are treated by politicians as a health issue, in accordance with the prevailing conventional norms.
200. "Circumcision of Infant Males" (PDF). The Royal Australasian College of Physicians. September 2010. (PDF) from the original on 12 August 2015. Retrieved 11 September 2013.
201. "Circumcision remains legal in Germany". Deutsche Welle. 12 December 2012. from the original on 26 October 2013. Retrieved 11 September 2013.
202. Basaran, Oyman (2023). Circumcision and Medicine in Modern Turkey. University of Texas Press. pp. 156–157. ISBN 9781477327029. 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...
203. Doyle SM, Kahn JG, Hosang N, Carroll PR (January 2010). "The impact of male circumcision on HIV transmission". The Journal of Urology. 183 (1): 21–26. doi:10.1016/j.juro.2009.09.030. PMID 19913816.
204. Grimes CE, Henry JA, Maraka J, Mkandawire NC, Cotton M (January 2014). "Cost-effectiveness of surgery in low- and middle-income countries: a systematic review". World Journal of Surgery. 38 (1): 252–263. doi:10.1007/s00268-013-2243-y. PMID 24101020. S2CID 2166354.
205. Binagwaho A, Pegurri E, Muita J, Bertozzi S (January 2010). Kalichman SC (ed.). "Male circumcision at different ages in Rwanda: a cost-effectiveness study". PLOS Medicine. 7 (1): e1000211. doi:10.1371/journal.pmed.1000211. PMC 2808207. PMID 20098721.
206. Hankins C, Forsythe S, Njeuhmeli E (November 2011). Sansom SL (ed.). "Voluntary medical male circumcision: an introduction to the cost, impact, and challenges of accelerated scaling up". PLOS Medicine. 8 (11): e1001127. doi:10.1371/journal.pmed.1001127. PMC 3226452. PMID 22140362.
207. Xu X, Patel DA, Dalton VK, Pearlman MD, Johnson TR (March 2009). "Can routine neonatal circumcision help prevent human immunodeficiency virus transmission in the United States?". American Journal of Men's Health. 3 (1): 79–84. doi:10.1177/1557988308323616. PMC 2678848. PMID 19430583.
208. Tobian AA, Kacker S, Quinn TC (2014). "Male circumcision: a globally relevant but under-utilized method for the prevention of HIV and other sexually transmitted infections". Annual Review of Medicine. 65: 293–306. doi:10.1146/annurev-med-092412-090539. PMC 4539243. PMID 24111891.

Notes

1. Penile cancer is a rare disease in the developed world, but much more prevalent in the developing world.

General and cited references

• Bolnick DA, Koyle M, Yosha A (September 2012). Surgical Guide to Circumcision. Springer. ISBN 978-1-4471-2857-1.
• Clarence-Smith, William G. (2008). (PDF). Finnish Journal of Ethnicity and Migration. 3 (2: Special Issue: Female Genital Cutting in the Past and Today). Archived from the original (PDF) on 6 March 2009.
• Dana, Nissi (2003). The Druze in the Middle East: Their Faith, Leadership, Identity and Status. University of Michigan Press. p. 56. ISBN 9781903900369.
• Gollaher D (February 2001). Circumcision: A History of the World's Most Controversial Surgery. Basic Books. ISBN 978-0-465-02653-1.^{[permanent dead link]}

External links

 

Wikinews has news related to:

Circumcision

 

Wikimedia Commons has media related to Circumcision.

• 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