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Wikipedia

Circumcision

March 14, 2024

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

Circumcision
Circumcision surgery with hemostats and scissors
ICD-10-PCSZ41.2
ICD-9-CMV50.2
MeSHD002944
OPS-301 code5–640.2
MedlinePlus002998
eMedicine1015820
[edit on Wikidata]

The procedure is associated with reduced rates of sexually transmitted infections[6] and urinary tract infections.[1][7][8] This includes reducing the incidence of cancer-causing forms of human papillomavirus (HPV) and significantly reducing HIV transmission among heterosexual men in high-risk populations;[9] its prophylactic efficacy against HIV transmission in the developed world or among men who have sex with men is debated.[10][11][12] Neonatal circumcision decreases the risk of penile cancer.[13] Complication rates increase significantly with age.[14] Bleeding, infection, and the removal of either too much or too little foreskin are the most common acute complications, while meatal stenosis is the most common long-term.[15] Major medical organizations hold variant views on the strength of circumcision's prophylactic efficacy in developed countries. Some medical organizations take the position that it carries prophylactic health benefits which outweigh the risks, while other medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk.[16][17][18][19]

Circumcision is one of the world's most common and oldest medical procedures.[2] Prophylactic usage originated in England during the 1850s and subsequently widely spread, becoming predominately established as a way to prevent sexually transmitted infections.[20][21] 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.[22][23] It is widespread in Australia, Canada, the United States, South Korea, most of Africa, and parts of Asia.[2] It is relatively rare for non-religious reasons in parts of Southern Africa, Latin America, Europe, and parts of Asia.[2] The origin of circumcision is not known with certainty; the oldest documentation comes from ancient Egypt.[2][24][25]

Uses

Elective

Around half of all circumcisions worldwide are performed for reasons of prophylactic healthcare.[4]

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.[26]

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.[27][11][9]

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.[27] In 2010, this was expanded to routine neonatal circumcision, as long as those undergoing the procedure received assent from their parents.[17] 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.[27][17] 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.[28] There is evidence that circumcision is associated with a reduced risk of HIV infection for such men, particularly in low-income countries.[6]

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.[18]

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.[18] 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.[19][29][30]

The World Health Organization (WHO), UNAIDS, and American medical organizations take the position that it carries prophylactic health benefits which outweigh the risks, while European medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk.[16][17][18][19] Advocates of circumcision consider it to have a net health benefit, and therefore feel that increasing the circumcision rate is "imperative".[31] They recommend performing it during the neonatal period when it is less expensive and has a lower risk of complications.[29] The American Academy of Pediatrics and Centers for Disease Control and Prevention stated that the potential benefits of circumcision outweigh the risks.[1][32]

The World Health Organization in 2010 stated:[17]

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.[17]

Pathologies

Circumcision is also used to treat various pathologies. These include pathological phimosis, refractory balanoposthitis and chronic or recurrent urinary tract infections (UTIs).[3][4]

Contraindications

Circumcision is contraindicated in certain cases.[5][4][33]

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.[5][4][33] 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.[4][33]

Technique

Main article: Circumcision surgical procedure
 
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.[2] 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.[33]

Removal of the foreskin

For infant circumcision, devices such as the Gomco clamp, Plastibell and Mogen clamp are commonly used in the USA.[1] 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.[1] For older babies and adults, circumcision is often performed surgically without specialized instruments,[33] and alternatives such as Unicirc or the Shang ring are available.[34]

Pain management

The circumcision procedure causes pain, and for neonates this pain may interfere with mother-infant interaction or cause other behavioral changes,[35] so the use of analgesia is advocated.[1][36] 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.[1][37][38] 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.[37][38] Topical creams have been found to irritate the skin of low birth weight infants, so penile nerve block techniques are recommended in this group.[1]

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,[38] but the American Academy of Pediatrics (AAP) states that such methods are insufficient alone and should be used to supplement more effective techniques.[1] 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.[38] The available evidence does not indicate that post-procedure pain management is needed.[1] For adults, topical anesthesia, ring block, dorsal penile nerve block (DPNB) and general anesthesia are all options,[39] and the procedure requires four to six weeks of abstinence from masturbation or intercourse to allow the wound to heal.[33]

Effects

Sexually transmitted infections

Human immunodeficiency virus

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

Male circumcision reduces the risk of human immunodeficiency virus (HIV) transmission from HIV positive women to men in high risk populations.[40][41]

In 2020, the World Health Organization (WHO) reiterated that male circumcision is an efficacious intervention for HIV prevention if carried out by medical professionals under safe conditions.[42]

Circumcision reduces the risk that a man will acquire HIV and other sexually transmitted infections (STIs) from an infected female partner through vaginal sex.[43] The evidence regarding whether circumcision helps prevent HIV is not as clear among men who have sex with men (MSM).[42] The effectiveness of using circumcision to prevent HIV in the developed world is not determined.[42][44]

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.[45]

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.[46][47] It also decreases the likelihood of multiple infections.[7] As of 2012 there was no strong evidence that it reduces the rate of new HPV infection,[8][7][48] but the procedure is associated with increased clearance of the virus by the body,[8][7] which can account for the finding of reduced prevalence.[7]

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.[8][47][48]

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.[49] A 2010 review found that circumcision reduced the incidence of HSV-2 (herpes simplex virus, type 2) infections by 28%.[50] The researchers found mixed results for protection against trichomonas vaginalis and chlamydia trachomatis, and no evidence of protection against gonorrhea or syphilis.[50] It may also possibly protect against syphilis in MSM.[51]

Phimosis, balanitis and balanoposthitis

Phimosis is the inability to retract the foreskin over the glans penis.[52] At birth, the foreskin cannot be retracted due to adhesions between the foreskin and glans, and this is considered normal (physiological phimosis).[52] Over time the foreskin naturally separates from the glans, and a majority of boys are able to retract the foreskin by age three.[52] Less than one percent are still having problems at age 18.[52] If the inability to do so becomes problematic (pathological phimosis) circumcision is a treatment option.[3][53] 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.[54] Steroid creams are also a reasonable option and may prevent the need for surgery including in those with mild BXO.[54][55] The procedure may also be used to prevent the development of phimosis.[4] Phimosis is also a complication that can result from circumcision.[56]

An inflammation of the glans penis and foreskin is called balanoposthitis, and the condition affecting the glans alone is called balanitis.[57][58] Most cases of these conditions occur in uncircumcised males,[59] affecting 4–11% of that group.[52] 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.[59] Both conditions are usually treated with topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams.[57][58] 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.[57][58]

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).[1][60][conflicted source][61] Circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects,[1] and may be used to treat recurrent UTIs.[3]

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.[1][61]

Cancers

Not being circumcised is the primary risk factor for penile cancer.[62][63] Pre-adolescent circumcision has a strong protective effect against penile cancer in later life.[13] Penile cancer is a rare disease in the developed world but much more prevalent in the developing world.[13] The penile tissue removed during circumcision is a potential origin for penile cancer.[64] Risk-benefit considerations around the use of circumcision as a cancer-preventive measure are a source of debate.[62]

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.[1] 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.[65] Penile cancer has been observed to be nearly eliminated in populations of males circumcised neonatally.[52]

Important risk factors for penile cancer include phimosis and HPV infection, both of which are mitigated by circumcision.[65] 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.[1][65] Circumcision is also associated with a reduced prevalence of cancer-causing types of HPV in men[7] and a reduced risk of cervical cancer (which is caused by a type of HPV) in female partners of men.[4]

There is some evidence that circumcision is associated with reduced risk of prostate cancer.[66]

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.[67]

Sexual effects

The accumulated data show circumcision does not have an adverse physiological effect on sexual pleasure, function, desire, or fertility.[68][69] There is some evidence that circumcision has no effect on pain with intercourse, premature ejaculation, time until ejaculation, erectile dysfunction or difficulties with orgasm.[70]

According to a 2014 review, the effect of circumcision on sexual partners' experiences is unclear as this has not been well studied.[71] According to a policy statement from the Canadian Paediatric Society that was reaffirmed in 2021,[72] "medical studies do not support circumcision as having an impact on sexual function or satisfaction for partners of circumcised individuals".[69]

There are popular misconceptions that circumcision benefits or adversely impacts the sexual pleasure of the circumcised person.[69]

Adverse effects

Neonatal circumcision is generally a safe, low-risk procedure when done by an experienced practitioner.[73][74][75]

The most common acute complications are bleeding, infection and the removal of either too much or too little foreskin.[1][76] These complications occur in approximately 0.13% of procedures, with bleeding being the most common acute complication in the United States.[76] Minor complications are reported to occur in three percent of procedures.[74] Severe complications are rare.[56] A specific complication rate is difficult to determine due to scant data on complications and inconsistencies in their classification.[1] 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.[14] Significant acute complications happen rarely,[1][14] occurring in about 1 in 500 newborn procedures in the United States.[1] Severe to catastrophic complications, including death, are so rare that they are reported only as individual case reports.[1][75] Where a Plastibell device is used, the most common complication is the retention of the device occurring in around 3.5% of procedures.[15] Other possible complications include buried penis, chordee, phimosis, skin bridges, urethral fistulas, and meatal stenosis.[75] These complications may be partly avoided with proper technique, and are often treatable without requiring surgical revision.[75] 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.[15] It can be treated by meatotomy.[15]

Effective pain management should be used during the procedure.[1] Inadequate pain relief may carry the risks of heightened pain response for newborns.[35] Newborns that experience pain due to being circumcised have different responses to vaccines given afterwards, with higher pain scores observed.[77] For adult men who have been circumcised, there is a risk that the circumcision scar may be tender.[78] There is no good evidence that circumcision affects cognitive abilities.[79]

Prevalence

This section is an excerpt from Prevalence of circumcision.[edit]
 
Map of circumcision prevalence, based on a 2007 WHO report
  Widespread, near-universal: >80% prevalence
  Widespread, common: 20–80% prevalence
  Uncommon: <20% prevalence
  N/A

The prevalence of circumcision is the percentage of males in a given population who have been circumcised, with the procedure most commonly being performed as a part of preventive healthcare, a religious obligation, or cultural practice.

Since 2010, both the World Health Organization and Joint United Nations Programme on HIV/AIDS have been promoting a higher rate of circumcision prevalence as a prevention against HIV transmission and some STIs in areas with high HIV transmission and low circumcision rates.[80][81][82][83] According to Hay & Levin, 2012, around 50% of all circumcisions worldwide are performed for reasons of preventive healthcare, while the other 50% are predominately performed for religious or cultural reasons.[84]

History

Main article: History of circumcision
 
Circumcision knife from the Congo; wood, iron; late 19th/early 20th century

Circumcision is the oldest known surgical procedure.[85] Depictions of circumcised penises are found in Paleolithic art,[86] predating the earliest signs of trepanation.[85][87]

The history of the migration and evolution of circumcision is known mainly from the cultures of two regions. In the lands south and east of the Mediterranean, starting with 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.[88] There is also evidence that circumcision was practiced among the Aztec and Mayan civilizations in the Americas,[2] but little is known about that history.[24][25]

It has been speculated that circumcision originated as a substitute for castration of defeated enemies or as a religious sacrifice.[25] In many traditions, it acts as a rite of passage marking a boy's entrance into adulthood.[25]

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;[89] 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.[90] 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.[89] 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.[91] Some ancient Egyptian mummies, which have been dated as early as 4000 BCE, show evidence of circumcision.[88]: 2–3 [92]

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.[24] The earliest historical record of circumcision comes from Egypt, in the form of an image of the circumcision of an adult carved into the tomb of Ankh-Mahor at Saqqara, dating to about 2400–2300 BCE. Circumcision was possibly done by the Egyptians for hygienic reasons, but also was part of their obsession with purity and was associated with spiritual and intellectual development. No well-accepted theory explains the significance of circumcision to the Egyptians, but it appears to have been endowed with great honor and importance as a rite of passage, performed in a public ceremony emphasizing the continuation of family generations and fertility. It may have been a mark of distinction for the elite: the Egyptian Book of the Dead describes the sun god Ra as having circumcised himself.[25][88]

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

Circumcision is prominent in the Hebrew Bible.[93] In addition to proposing that circumcision was adopted by the Israelites purely as a religious mandate, scholars have suggested that Judaism's patriarchs and their followers adopted circumcision to make penile hygiene easier in hot, sandy climates; as a rite of passage into adulthood; or as a form of blood sacrifice.[24][88][94]

Historical campaigns of ethnic, cultural, and religious persecution frequently included bans on circumcision as a means of forceful assimilation, conversion, and ethnocide.[95] 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.[95] 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.[95] Antiochus IV's restriction on Jewish circumcision was a major factor in the Maccabean Revolt.[95] Hadrian's prohibition has also been considered by some to have been a contributing cause of the Bar Kokhba revolt.[95] 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.[95] His successor, Antoninus Pius, altered the edict to permit Brit Milah.[95] 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,[96] 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.[88][94]

 
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 physical circumcision is not part of the received teachings of Jesus. Circumcision has played an important role in Christian history and theology. Paul the Apostle reinterpreted circumcision as a spiritual concept, arguing literal circumcision to be unnecessary for Gentile converts to Christianity. The teaching that circumcision was unnecessary for membership in a divine covenant was instrumental to the separation of Christianity from Judaism.[97][98] While the circumcision of Jesus is celebrated as a feast day in the liturgical calendar of many Christian denominations.[98]

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.[99]

Genghis Khan and the following Yuan Emperors in China forbade Islamic practices such as halal butchering and circumcision.[100][101]

The practice of circumcision is thought to have been brought to the Bantu-speaking tribes of Africa by either the Jews after one of their many expulsions from European countries, or by Muslim Moors escaping after the 1492 reconquest of Spain. In the second half of the first millennium CE, inhabitants from the Northeast of Africa moved south and encountered groups from Arabia, the Middle East, and West Africa. These people moved south and formed what is known today as the Bantu. Bantu tribes were observed to be upholding what was described as Jewish law, including circumcision, in the 16th century. Circumcision and elements of Jewish dietary restrictions are still found among Bantu tribes.[24]

Indigenous peoples of the Americas and Oceania

Circumcision is practiced by some groups amongst Australian Aboriginal peoples, Polynesians, and Native Americans.[2][24]

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.[24][102]

Christopher Columbus reported circumcision being practiced by Native Americans.[25] It probably started among South American tribes as a blood sacrifice or ritual to test bravery and endurance, and later evolved into a rite of initiation.[24]

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.[20]

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.[103][104] Hutchinson suggested that circumcision lowers the risk of contracting syphilis.[104] Pursuing a successful career as a general practitioner, Hutchinson went on to advocate circumcision for health reasons for the next fifty years,[103] eventually earned a knighthood for his contributions to medicine. His viewpoint that circumcision was prophylactic against disease was adopted by other medical professionals.[105]

In 1870, orthopedic surgeon Lewis Sayre, a founder of the American Medical Association, introduced circumcision in the United States as a purported cure for several cases of young boys presenting with paralysis and other significant gross motor problems. He thought the procedure ameliorated such problems based on the then prominent "reflex neurosis" theory of disease, thinking that a tight foreskin inflamed the nerves and caused systemic problems.[106] The use of circumcision to promote good health also fit the germ theory of disease, which saw validation during the same period: the foreskin was thought to harbor infection-causing smegma.[107]: 106  Sayre published works on the subject and promoted it in speeches.[106] 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.[107][108][109] By the late 19th century, circumcision had become common throughout the Anglophonic world—Australia, Canada, the United States, and the United Kingdom—as well as the Union of South Africa. In the United Kingdom and United States, it was universally recommended.[20][107]

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.[107]: 106 

Interwar Period and World War II (1918–1945)

During the interwar period, medical organizations and doctors in mainland Europe experimented with the idea of routine circumcision for prophylactic reasons as well, alongside developments in the Anglophonic world. In France, the medical profession went so far as to recommend universal routine circumcision. However, prevalence in France and mainland Europe remained low.[18] There is a lack of consensus in the academic literature on why this occurred.[18]

Yosha & Bolnick & Koyle (2012) have suggested that a factor in its Anglophonic adoption and dismissal in mainland Europe relates to attitudes towards Judaism and Jewish practices. While many of these Anglophonic polities would not be considered tolerant by modern standards: the United Kingdom had Benjamin Disraeli—a Jew—as Prime Minister; Jews in the United States were prominent and generally well-respected; while in Australia "the racial issues of the time involved primarily Aborigines and Chinese immigration, and Jews were essentially below the radar". They argue that once "a substantial proportion of the male population [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.[18]

Rates in the Anglophonic world began to sharply diverge after 1945.[25]

 
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.[110]

Mid-20th century (1945–1985)

After the end of World War II, Britain implemented a National Health Service. Douglas Gairdner's 1949 article "The Fate of the Foreskin" argued that the evidence showed that the risks outweighed the benefits, leading to a significant reduction in circumcision incidence within the United Kingdom.[111]

In contrast to Gairdner, American pediatrician Benjamin Spock argued in favor of circumcision in his popular The Common Sense Book of Baby and Child Care which led to rates in the United States significantly rising. In the 1970s, national medical associations in Australia and Canada issued recommendations against routine infant circumcision, leading to drops in the rates of both of those countries. The United States made similar statements in the 1970s but stopped short of recommending against it.[25]

Modernity (since 1985)

An association between circumcision and reduced heterosexual HIV infection rates was first suggested in 1986.[25]

Experimental evidence was needed to establish a causal relationship, so three randomized controlled trials were commissioned to exclude other confounding factors.[11] Trials took place in South Africa, Kenya and Uganda.[11] All three trials were stopped early by their monitoring boards because those in the circumcised group had a substantially lower rate of HIV contraction than the control group, so it was considered unethical to withhold the procedure, in light of strong evidence of prophylactic efficacy.[11][112] WHO assessed these as "gold standard" studies and found "strong and consistent" evidence from later studies that confirmed the results of the studies.[27] A scientific consensus subsequently developed that circumcision reduces heterosexual HIV infection rates in high-risk populations;[12][9][113] the WHO, along with other major medical organizations, have since promoted circumcision of high-risk populations as part of the program to reduce the spread of HIV.[27] The Male Circumcision Clearinghouse website was created in 2009 by WHO, UNAIDS, FHI and AVAC to provide evidence-based guidance, information, and resources to support the delivery of safe male circumcision services in countries that choose to scale up the procedure as one component of comprehensive HIV prevention services.[114][115]

Society and culture

 
A circumcision being performed in Central Asia, c. 1865–1872

The word circumcision is from Latin circumcidere, meaning "to cut around".[2]

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.[18][116][117][118][119][120][121] In contrast, some religions, such as Mandaeism and Hinduism and Sikhism, strongly prohibit the practice of routine circumcision.[122][123][124]

Judaism

Main article: Brit milah

Circumcision is near-universal among Jews.[125] 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.[22][23][95]

 
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.[116][126] 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.[127] There are also certain exceptions for Jews with poor health.[128]

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.[129] 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.[130] An increasing number of Jews in the United States have chosen not to circumcise their sons.[131]

All major rabbinical organizations make the recommendation that male infants should be circumcised. The issue of converts remains controversial in Reform and Reconstructionist Judaism;[132][133] circumcision of converts is not mandatory in either.[134]

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

Islamic scholars have diverse opinions on the obligatory nature of male circumcision, with some considering it mandatory (wājib), while others view it as only being recommended (sunnah).[135] 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.[136] 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).[118][119][137]

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.[118][119][137]

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.[138] 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,[139] and maintains a neutral position on the practice of circumcision for other reasons.[140] 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.[140]

 
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,[141][142] and generally men undergo circumcision shortly after birth as part of a rite of passage.[141] Circumcision is near-universal among Coptic Christians,[143] and they practice circumcision as a rite of passage.[2][117][121][144] The Ethiopian Orthodox Church calls for circumcision, with near-universal prevalence among Orthodox men in Ethiopia.[2] 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".[145] Some Christian churches in South Africa disapprove of the practice, while others require it of their members.[2]

Circumcision is practiced in some predominantly Christian countries and Christian communities.[146][147][148] Christian communities in Africa,[149][150] some Anglosphere countries, the Philippines, the Middle East,[151][152] South Korea and Oceania have high circumcision rates,[153][154] while Christian communities in Europe and South America have low circumcision rates, although none of these are performed out of perceived religious obligation.[141][155] 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.[156]

Druze faith

 
Preparing for a ritual circumcision to a Druze child

Circumcision is widely practiced by the Druze;[157] Druze practice Druzism, an Abrahamic,[158][159] monotheistic, syncretic, and ethnic religion. The procedure is practiced as a cultural tradition, and has no religious significance in the Druze faith.[160][161] There is no special date for this act in the Druze faith: male Druze infants are usually circumcised shortly after birth,[162] however some remain uncircumcised until the age of ten or older.[162]

Some Druses do not circumcise their male children and refuse to observe this "common Muslim practice".[163]

Samaritanism

Like Judaism, the religion of Samaritanism requires ritual circumcision on the eighth day of life.[164]

Mandaeism

Circumcision is forbidden in Mandaeism,[122][165] and the sign of the Jews given to Abraham by God, circumcision, is considered abhorrent by the Mandaeans.[166] According to the Mandaean doctrine a circumcised man cannot serve as a Mandaean priest.[167]

Yazidism

Circumcision is not required in Yazidism, but is practised by some Yazidis due to regional customs.[168] 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.[169]

Sikhism

Sikhism does not require the elective circumcision of its followers and strongly criticizes the practice.[124][170]

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

African cultures

This section is an excerpt from Circumcision in Africa.[edit]
Circumcision in Africa, and the rites of initiation in Africa, as well as "the frequent resemblance between details of ceremonial procedure in areas thousands of kilometres apart, indicate that the circumcision ritual has an old tradition behind it and in its present form is the result of a long process of development."[171]

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.[120]

Filipino culture

Main article: Tuli (rite)

In the Philippines, circumcision is known as "tuli" and is generally viewed as a rite of passage.[172] An overwhelming majority of Filipino men are circumcised.[172][a] Often this occurs, in April and May, when Filipino boys are taken by their parents. The practice dates back to the arrival of Islam in 1450. Pressure to be circumcised is even in the language: one Tagalog profanity for 'uncircumcised' is supot, meaning 'coward' literally. A circumcised eight or ten year-old is no longer considered a boy and is given more adult roles in the family and society.[174]

Ethical and legal issues

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

Ethics

This section is an excerpt from Ethics of circumcision.[edit]
There is substantial disagreement amongst bioethicists and theologians over the practice of circumcision, with many believing that the routine circumcision of neonates for health purposes is a cost-ineffective and ethically-problematic intervention in developed countries, while circumcision on a consenting adult is generally viewed as a morally permissible action. Positions taken on the issue are heavily influenced by prevalence in the given area, religion, and culture.[175] Some medical associations take the position that circumcision is an infringement of the child's autonomy and should be deferred until he is capable of making the decision himself. Others state that parents should be allowed to determine what is in his best interest.[176][177][178]

Legal

Worldwide, the large majority of polities do not have specific laws concerning the circumcision of males,[2] with religious infant circumcision being legal in every country.[125][179] A few countries have passed legislation on the procedure: Germany allows routine circumcision,[180] while non-religious routine circumcision is illegal in South Africa and Sweden.[2][179] No major medical organization recommends circumcising all males, and no major medical organization recommends banning the procedure.[18][181][125]

In the academic literature, there is general agreement among both supporters and opponents of the practice that an outright ban would be predominately ineffective and "harmful".[18][125][182][181] 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.[18][125] 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.[18][179]

During the 2010s, several right-wing nationalist parties prominently called for the banning of circumcision.[183] Gressgård argued that politicians that supported Norway's proposed circumcision ban debated circumcision in a manner which constituted "ethnocentrism".[184]

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.[185] Several analyses have concluded that circumcision programs for adult men in Africa are cost-effective and in some cases are cost-saving.[186][187] In Rwanda, circumcision has been found to be cost-effective across a wide range of age groups from newborn to adult,[48][188] 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.[189][188] 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.[185] 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.[190]

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.[191] 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.[1] 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.[1] 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.[192] 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.[71]

References

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  137. ^ a b 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.
  138. ^ Mark E (2003). The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite. Brandeis University Press. pp. xxiii. ISBN 978-1-58465-307-3.
  139. ^ Pope Eugenius IV (1990) [1442]. "Ecumenical Council of Florence (1438–1445): Session 11—4 February 1442; Bull of union with the Copts". In Tanner NP (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. from the original on 25 April 2009. Retrieved 25 April 2007. it denounces all who after that time observe circumcision
  140. ^ a b 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.
  141. ^ a b c Stearns PN (2008). The Oxford Encyclopedia of the Modern World. Oxford University Press. p. 179. ISBN 978-0-19-517632-2. 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.
  142. ^ Pitts-Taylor V (2008). Cultural Encyclopedia of the Body [2 volumes]. ABC-CLIO. p. 394. ISBN 978-1-56720-691-3. 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.
  143. ^ Sharkey HJ (2015). American Evangelicals in Egypt: Missionary Encounters in an Age of Empire. Princeton University Press. p. 30. ISBN 978-0-691-16810-4.
  144. ^ 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.
  145. ^ DeMello M (2007). Encyclopedia of Body Adornment. ABC-Clio. p. 66. ISBN 978-0-313-33695-9. 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.
  146. ^ Gruenbaum E (2015). The Female Circumcision Controversy: An Anthropological Perspective. University of Pennsylvania Press. p. 61. ISBN 978-0-8122-9251-0. 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
  147. ^ Hunting K (2012). Essential Case Studies in Public Health: Putting Public Health Into Practice. Jones & Bartlett Publishers. pp. 23–24. ISBN 978-1-4496-4875-6. Neonatal circumcision is the general practice among Jews, Christians, and many, but not all Muslims.
  148. ^ Wylie KR (2015). ABC of Sexual Health. John Wiley & Sons. p. 101. ISBN 978-1-118-66569-5. 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.
  149. ^ Creighton S, Liao LM (2019). Female Genital Cosmetic Surgery: Solution to What Problem?. Cambridge University Press. p. 63. ISBN 978-1-108-43552-9. Christians in Africa, for instance, often practise infant male circumcision.
  150. ^ Nga A (30 December 2019). "The Ritual of Circumcision in Africa: The Case of South Africa". Africanews. from the original on 6 December 2022. Retrieved 8 November 2022. This practice is old and widespread among African Christians with very close links to their beliefs. It can be executed traditionally or in hospital.
  151. ^ Bakos GT (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 978-1-60608-342-0. 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.
  152. ^ Sharkey HJ (2017). A History of Muslims, Christians, and Jews in the Middle East. Cambridge University Press. p. 63. ISBN 978-0-521-76937-2. On the Coptic Christian practice of male circumcision in Egypt, and on its practice by other Christians in western Asia.
  153. ^ "Circumcision protest brought to Florence". Associated Press. 30 March 2008. from the original on 26 March 2023. Retrieved 2 August 2022. 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.
  154. ^ Ross JI (2015). Religion and Violence: An Encyclopedia of Faith and Conflict from Antiquity to the Present. Routledge. p. 169. ISBN 978-1-317-46109-8. For instance, the majority of South Koreans, Americans, and Filipinos, as well as African Christians, practice circumcision.
  155. ^ Peteet JR (2017). Spirituality and Religion Within the Culture of Medicine: From Evidence to Practice. Oxford University Press. pp. 97–101. ISBN 978-0-19-027243-2. male circumcision is still observed among Ethiopian and Coptic Christians, and circumcision rates are also high today in the Philippines and the US.
  156. ^ Armstrong HL (2021). Encyclopedia of Sex and Sexuality: Understanding Biology, Psychology, and Culture [2 volumes]. ABC-CLIO. pp. 115–117. ISBN 978-1-61069-875-7.
  157. ^ Ubayd A (2006). The Druze and Their Faith in Tawhid. Syracuse University Press. p. 150. ISBN 978-0-8156-3097-5. Male circumcision is standard practice, by tradition, among the Druze
  158. ^ Abulafia AS (23 September 2019). "The Abrahamic religions". www.bl.uk. London: British Library. from the original on 12 July 2020. Retrieved 9 March 2021.
  159. ^ Obeid A (2006). The Druze & Their Faith in Tawhid. Syracuse University Press. p. 1. ISBN 978-0-8156-5257-1.
  160. ^ Jacobs D (1998). Israel and the Palestinian Territories: The Rough Guide. Rough Guides. p. 147. ISBN 978-1-85828-248-0. Circumcision is not compulsory and has no religious significance.
  161. ^ Silver MM (2022). The History of Galilee, 1538–1949: Mysticism, Modernization, and War. Rowman & Littlefield. p. 97. ISBN 978-1-7936-4943-0. Muslim men are circumcised, whereas this is not a religious obligation among the Druze
  162. ^ a b Dana N (2003). The Druze in the Middle East: Their Faith, Leadership, Identity and Status. University of Michigan Press. p. 56. ISBN 978-1-903900-36-9.
  163. ^ Brenton RB (2013). The Sunni-Shi'a Divide: Islam's Internal Divisions and Their Global Consequences. Potomac Books, Inc. p. 56. ISBN 978-1-61234-523-9. 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
  164. ^ Mark E (2003). The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite. University Press of New England. pp. 94–95. ISBN 978-1-58465-307-3.
  165. ^ Lupieri E (2001). The Mandaeans: The Last Gnostics. Wm. B. Eerdmans Publishing. p. 60. ISBN 978-0-8028-3350-1. from the original on 14 September 2023. Retrieved 6 August 2022.
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Notes

  1. ^ The most commonly-done procedure is in actuality not a circumcision but a dorsal slit, where no foreskin is actually removed. When the foreskin is removed, it is commonly known locally as a "German cut" in reference to the introduction of the modern surgical technique by the founder of plastic and reconstructive surgery, Johann Friedrich Dieffenbach.[173]

External links

 
Wikimedia Commons has media related to Circumcision.
 
Wikinews has news 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

March 14, 2024
circumcision, confused, with, female, circumcision, paintings, procedure, that, removes, foreskin, from, human, penis, most, common, form, operation, foreskin, extended, with, forceps, then, circumcision, device, placed, after, which, foreskin, excised, topica. 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 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 1 Circumcision is generally electively performed most commonly done as a form of preventive healthcare as a religious obligation or as a cultural practice 2 It is also an option for cases of phimosis other pathologies that do not resolve with other treatments and chronic urinary tract infections UTIs 3 4 The procedure is contraindicated in cases of certain genital structure abnormalities or poor general health 4 5 CircumcisionCircumcision surgery with hemostats and scissorsICD 10 PCSZ41 2ICD 9 CMV50 2MeSHD002944OPS 301 code5 640 2MedlinePlus002998eMedicine1015820 edit on Wikidata The procedure is associated with reduced rates of sexually transmitted infections 6 and urinary tract infections 1 7 8 This includes reducing the incidence of cancer causing forms of human papillomavirus HPV and significantly reducing HIV transmission among heterosexual men in high risk populations 9 its prophylactic efficacy against HIV transmission in the developed world or among men who have sex with men is debated 10 11 12 Neonatal circumcision decreases the risk of penile cancer 13 Complication rates increase significantly with age 14 Bleeding infection and the removal of either too much or too little foreskin are the most common acute complications while meatal stenosis is the most common long term 15 Major medical organizations hold variant views on the strength of circumcision s prophylactic efficacy in developed countries Some medical organizations take the position that it carries prophylactic health benefits which outweigh the risks while other medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk 16 17 18 19 Circumcision is one of the world s most common and oldest medical procedures 2 Prophylactic usage originated in England during the 1850s and subsequently widely spread becoming predominately established as a way to prevent sexually transmitted infections 20 21 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 22 23 It is widespread in Australia Canada the United States South Korea most of Africa and parts of Asia 2 It is relatively rare for non religious reasons in parts of Southern Africa Latin America Europe and parts of Asia 2 The origin of circumcision is not known with certainty the oldest documentation comes from ancient Egypt 2 24 25 Contents 1 Uses 1 1 Elective 1 1 1 Prophylactic usage in high risk populations 1 1 2 Prophylactic usage in developed countries 1 2 Pathologies 2 Contraindications 3 Technique 3 1 Removal of the foreskin 3 2 Pain management 4 Effects 4 1 Sexually transmitted infections 4 1 1 Human immunodeficiency virus 4 1 2 Human papillomavirus 4 1 3 Other infections 4 2 Phimosis balanitis and balanoposthitis 4 3 Urinary tract infections 4 4 Cancers 4 5 Women s health 4 6 Sexual effects 5 Adverse effects 6 Prevalence 7 History 7 1 Middle East Africa and Europe 7 2 Indigenous peoples of the Americas and Oceania 7 3 Prophylactic circumcision 7 3 1 Anglophonic adoption 1855 1918 7 3 2 Interwar Period and World War II 1918 1945 7 3 3 Mid 20th century 1945 1985 7 3 4 Modernity since 1985 8 Society and culture 8 1 Cultures and religions 8 1 1 Judaism 8 1 2 Islam 8 1 3 Christianity 8 1 4 Druze faith 8 1 5 Samaritanism 8 1 6 Mandaeism 8 1 7 Yazidism 8 1 8 Sikhism 8 1 9 African cultures 8 1 10 Australian cultures 8 1 11 Filipino culture 8 2 Ethical and legal issues 8 2 1 Ethics 8 2 2 Legal 8 3 Economic considerations 9 References 10 Notes 11 External linksUsesElective Around half of all circumcisions worldwide are performed for reasons of prophylactic healthcare 4 Prophylactic usage in high risk populations nbsp Actor Melusi Yeni became the 1 millionth VMMC against HIV AIDS transmission in the province of KwaZulu Natal South Africa 26 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 27 11 9 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 27 In 2010 this was expanded to routine neonatal circumcision as long as those undergoing the procedure received assent from their parents 17 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 27 17 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 28 There is evidence that circumcision is associated with a reduced risk of HIV infection for such men particularly in low income countries 6 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 18 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 18 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 19 29 30 The World Health Organization WHO UNAIDS and American medical organizations take the position that it carries prophylactic health benefits which outweigh the risks while European medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk 16 17 18 19 Advocates of circumcision consider it to have a net health benefit and therefore feel that increasing the circumcision rate is imperative 31 They recommend performing it during the neonatal period when it is less expensive and has a lower risk of complications 29 The American Academy of Pediatrics and Centers for Disease Control and Prevention stated that the potential benefits of circumcision outweigh the risks 1 32 The World Health Organization in 2010 stated 17 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 17 Pathologies Circumcision is also used to treat various pathologies These include pathological phimosis refractory balanoposthitis and chronic or recurrent urinary tract infections UTIs 3 4 ContraindicationsCircumcision is contraindicated in certain cases 5 4 33 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 5 4 33 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 4 33 TechniqueMain article Circumcision surgical procedure nbsp 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 2 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 33 Removal of the foreskin For infant circumcision devices such as the Gomco clamp Plastibell and Mogen clamp are commonly used in the USA 1 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 1 For older babies and adults circumcision is often performed surgically without specialized instruments 33 and alternatives such as Unicirc or the Shang ring are available 34 Pain management The circumcision procedure causes pain and for neonates this pain may interfere with mother infant interaction or cause other behavioral changes 35 so the use of analgesia is advocated 1 36 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 1 37 38 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 37 38 Topical creams have been found to irritate the skin of low birth weight infants so penile nerve block techniques are recommended in this group 1 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 38 but the American Academy of Pediatrics AAP states that such methods are insufficient alone and should be used to supplement more effective techniques 1 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 38 The available evidence does not indicate that post procedure pain management is needed 1 For adults topical anesthesia ring block dorsal penile nerve block DPNB and general anesthesia are all options 39 and the procedure requires four to six weeks of abstinence from masturbation or intercourse to allow the wound to heal 33 EffectsSexually transmitted infections Human immunodeficiency virus See also Circumcision in Africa Circumcision to prevent the spread of human immunodeficiency virus in Africa This section is an excerpt from Circumcision and HIV edit Male circumcision reduces the risk of human immunodeficiency virus HIV transmission from HIV positive women to men in high risk populations 40 41 In 2020 the World Health Organization WHO reiterated that male circumcision is an efficacious intervention for HIV prevention if carried out by medical professionals under safe conditions 42 Circumcision reduces the risk that a man will acquire HIV and other sexually transmitted infections STIs from an infected female partner through vaginal sex 43 The evidence regarding whether circumcision helps prevent HIV is not as clear among men who have sex with men MSM 42 The effectiveness of using circumcision to prevent HIV in the developed world is not determined 42 44 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 45 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 46 47 It also decreases the likelihood of multiple infections 7 As of 2012 update there was no strong evidence that it reduces the rate of new HPV infection 8 7 48 but the procedure is associated with increased clearance of the virus by the body 8 7 which can account for the finding of reduced prevalence 7 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 8 47 48 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 49 A 2010 review found that circumcision reduced the incidence of HSV 2 herpes simplex virus type 2 infections by 28 50 The researchers found mixed results for protection against trichomonas vaginalis and chlamydia trachomatis and no evidence of protection against gonorrhea or syphilis 50 It may also possibly protect against syphilis in MSM 51 Phimosis balanitis and balanoposthitis Phimosis is the inability to retract the foreskin over the glans penis 52 At birth the foreskin cannot be retracted due to adhesions between the foreskin and glans and this is considered normal physiological phimosis 52 Over time the foreskin naturally separates from the glans and a majority of boys are able to retract the foreskin by age three 52 Less than one percent are still having problems at age 18 52 If the inability to do so becomes problematic pathological phimosis circumcision is a treatment option 3 53 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 54 Steroid creams are also a reasonable option and may prevent the need for surgery including in those with mild BXO 54 55 The procedure may also be used to prevent the development of phimosis 4 Phimosis is also a complication that can result from circumcision 56 An inflammation of the glans penis and foreskin is called balanoposthitis and the condition affecting the glans alone is called balanitis 57 58 Most cases of these conditions occur in uncircumcised males 59 affecting 4 11 of that group 52 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 59 Both conditions are usually treated with topical antibiotics metronidazole cream and antifungals clotrimazole cream or low potency steroid creams 57 58 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 57 58 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 1 60 conflicted source 61 Circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects 1 and may be used to treat recurrent UTIs 3 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 1 61 Cancers Not being circumcised is the primary risk factor for penile cancer 62 63 Pre adolescent circumcision has a strong protective effect against penile cancer in later life 13 Penile cancer is a rare disease in the developed world but much more prevalent in the developing world 13 The penile tissue removed during circumcision is a potential origin for penile cancer 64 Risk benefit considerations around the use of circumcision as a cancer preventive measure are a source of debate 62 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 1 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 65 Penile cancer has been observed to be nearly eliminated in populations of males circumcised neonatally 52 Important risk factors for penile cancer include phimosis and HPV infection both of which are mitigated by circumcision 65 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 1 65 Circumcision is also associated with a reduced prevalence of cancer causing types of HPV in men 7 and a reduced risk of cervical cancer which is caused by a type of HPV in female partners of men 4 There is some evidence that circumcision is associated with reduced risk of prostate cancer 66 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 67 Sexual effects The accumulated data show circumcision does not have an adverse physiological effect on sexual pleasure function desire or fertility 68 69 There is some evidence that circumcision has no effect on pain with intercourse premature ejaculation time until ejaculation erectile dysfunction or difficulties with orgasm 70 According to a 2014 review the effect of circumcision on sexual partners experiences is unclear as this has not been well studied 71 According to a policy statement from the Canadian Paediatric Society that was reaffirmed in 2021 72 medical studies do not support circumcision as having an impact on sexual function or satisfaction for partners of circumcised individuals 69 There are popular misconceptions that circumcision benefits or adversely impacts the sexual pleasure of the circumcised person 69 Adverse effectsNeonatal circumcision is generally a safe low risk procedure when done by an experienced practitioner 73 74 75 The most common acute complications are bleeding infection and the removal of either too much or too little foreskin 1 76 These complications occur in approximately 0 13 of procedures with bleeding being the most common acute complication in the United States 76 Minor complications are reported to occur in three percent of procedures 74 Severe complications are rare 56 A specific complication rate is difficult to determine due to scant data on complications and inconsistencies in their classification 1 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 14 Significant acute complications happen rarely 1 14 occurring in about 1 in 500 newborn procedures in the United States 1 Severe to catastrophic complications including death are so rare that they are reported only as individual case reports 1 75 Where a Plastibell device is used the most common complication is the retention of the device occurring in around 3 5 of procedures 15 Other possible complications include buried penis chordee phimosis skin bridges urethral fistulas and meatal stenosis 75 These complications may be partly avoided with proper technique and are often treatable without requiring surgical revision 75 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 15 It can be treated by meatotomy 15 Effective pain management should be used during the procedure 1 Inadequate pain relief may carry the risks of heightened pain response for newborns 35 Newborns that experience pain due to being circumcised have different responses to vaccines given afterwards with higher pain scores observed 77 For adult men who have been circumcised there is a risk that the circumcision scar may be tender 78 There is no good evidence that circumcision affects cognitive abilities 79 PrevalenceThis section is an excerpt from Prevalence of circumcision edit nbsp Map of circumcision prevalence based on a 2007 WHO report Widespread near universal gt 80 prevalence Widespread common 20 80 prevalence Uncommon lt 20 prevalence N AThe prevalence of circumcision is the percentage of males in a given population who have been circumcised with the procedure most commonly being performed as a part of preventive healthcare a religious obligation or cultural practice Since 2010 both the World Health Organization and Joint United Nations Programme on HIV AIDS have been promoting a higher rate of circumcision prevalence as a prevention against HIV transmission and some STIs in areas with high HIV transmission and low circumcision rates 80 81 82 83 According to Hay amp Levin 2012 around 50 of all circumcisions worldwide are performed for reasons of preventive healthcare while the other 50 are predominately performed for religious or cultural reasons 84 HistoryMain article History of circumcision This section may lend undue weight to certain ideas incidents or controversies Please help to create a more balanced presentation Discuss and resolve this issue before removing this message November 2023 nbsp Circumcision knife from the Congo wood iron late 19th early 20th centuryCircumcision is the oldest known surgical procedure 85 Depictions of circumcised penises are found in Paleolithic art 86 predating the earliest signs of trepanation 85 87 The history of the migration and evolution of circumcision is known mainly from the cultures of two regions In the lands south and east of the Mediterranean starting with 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 88 There is also evidence that circumcision was practiced among the Aztec and Mayan civilizations in the Americas 2 but little is known about that history 24 25 It has been speculated that circumcision originated as a substitute for castration of defeated enemies or as a religious sacrifice 25 In many traditions it acts as a rite of passage marking a boy s entrance into adulthood 25 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 89 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 90 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 89 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 91 Some ancient Egyptian mummies which have been dated as early as 4000 BCE show evidence of circumcision 88 2 3 92 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 24 The earliest historical record of circumcision comes from Egypt in the form of an image of the circumcision of an adult carved into the tomb of Ankh Mahor at Saqqara dating to about 2400 2300 BCE Circumcision was possibly done by the Egyptians for hygienic reasons but also was part of their obsession with purity and was associated with spiritual and intellectual development No well accepted theory explains the significance of circumcision to the Egyptians but it appears to have been endowed with great honor and importance as a rite of passage performed in a public ceremony emphasizing the continuation of family generations and fertility It may have been a mark of distinction for the elite the Egyptian Book of the Dead describes the sun god Ra as having circumcised himself 25 88 nbsp Detail of the Artemision Bronze the Greeks abhorred circumcision making life difficult for circumcised Jews living among the Greeks Circumcision is prominent in the Hebrew Bible 93 In addition to proposing that circumcision was adopted by the Israelites purely as a religious mandate scholars have suggested that Judaism s patriarchs and their followers adopted circumcision to make penile hygiene easier in hot sandy climates as a rite of passage into adulthood or as a form of blood sacrifice 24 88 94 Historical campaigns of ethnic cultural and religious persecution frequently included bans on circumcision as a means of forceful assimilation conversion and ethnocide 95 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 95 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 95 Antiochus IV s restriction on Jewish circumcision was a major factor in the Maccabean Revolt 95 Hadrian s prohibition has also been considered by some to have been a contributing cause of the Bar Kokhba revolt 95 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 95 His successor Antoninus Pius altered the edict to permit Brit Milah 95 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 96 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 88 94 nbsp The Circumcision of Jesus Christ by Ludovico MazzolinoA narrative in the Christian Gospel of Luke makes a brief mention of the circumcision of Jesus but physical circumcision is not part of the received teachings of Jesus Circumcision has played an important role in Christian history and theology Paul the Apostle reinterpreted circumcision as a spiritual concept arguing literal circumcision to be unnecessary for Gentile converts to Christianity The teaching that circumcision was unnecessary for membership in a divine covenant was instrumental to the separation of Christianity from Judaism 97 98 While the circumcision of Jesus is celebrated as a feast day in the liturgical calendar of many Christian denominations 98 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 99 Genghis Khan and the following Yuan Emperors in China forbade Islamic practices such as halal butchering and circumcision 100 101 The practice of circumcision is thought to have been brought to the Bantu speaking tribes of Africa by either the Jews after one of their many expulsions from European countries or by Muslim Moors escaping after the 1492 reconquest of Spain In the second half of the first millennium CE inhabitants from the Northeast of Africa moved south and encountered groups from Arabia the Middle East and West Africa These people moved south and formed what is known today as the Bantu Bantu tribes were observed to be upholding what was described as Jewish law including circumcision in the 16th century Circumcision and elements of Jewish dietary restrictions are still found among Bantu tribes 24 Indigenous peoples of the Americas and Oceania Circumcision is practiced by some groups amongst Australian Aboriginal peoples Polynesians and Native Americans 2 24 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 24 102 Christopher Columbus reported circumcision being practiced by Native Americans 25 It probably started among South American tribes as a blood sacrifice or ritual to test bravery and endurance and later evolved into a rite of initiation 24 Prophylactic circumcision Anglophonic adoption 1855 1918 nbsp 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 20 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 103 104 Hutchinson suggested that circumcision lowers the risk of contracting syphilis 104 Pursuing a successful career as a general practitioner Hutchinson went on to advocate circumcision for health reasons for the next fifty years 103 eventually earned a knighthood for his contributions to medicine His viewpoint that circumcision was prophylactic against disease was adopted by other medical professionals 105 In 1870 orthopedic surgeon Lewis Sayre a founder of the American Medical Association introduced circumcision in the United States as a purported cure for several cases of young boys presenting with paralysis and other significant gross motor problems He thought the procedure ameliorated such problems based on the then prominent reflex neurosis theory of disease thinking that a tight foreskin inflamed the nerves and caused systemic problems 106 The use of circumcision to promote good health also fit the germ theory of disease which saw validation during the same period the foreskin was thought to harbor infection causing smegma 107 106 Sayre published works on the subject and promoted it in speeches 106 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 107 108 109 By the late 19th century circumcision had become common throughout the Anglophonic world Australia Canada the United States and the United Kingdom as well as the Union of South Africa In the United Kingdom and United States it was universally recommended 20 107 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 107 106 Interwar Period and World War II 1918 1945 During the interwar period medical organizations and doctors in mainland Europe experimented with the idea of routine circumcision for prophylactic reasons as well alongside developments in the Anglophonic world In France the medical profession went so far as to recommend universal routine circumcision However prevalence in France and mainland Europe remained low 18 There is a lack of consensus in the academic literature on why this occurred 18 Yosha amp Bolnick amp Koyle 2012 have suggested that a factor in its Anglophonic adoption and dismissal in mainland Europe relates to attitudes towards Judaism and Jewish practices While many of these Anglophonic polities would not be considered tolerant by modern standards the United Kingdom had Benjamin Disraeli a Jew as Prime Minister Jews in the United States were prominent and generally well respected while in Australia the racial issues of the time involved primarily Aborigines and Chinese immigration and Jews were essentially below the radar They argue that once a substantial proportion of the male population 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 18 Rates in the Anglophonic world began to sharply diverge after 1945 25 nbsp 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 110 Mid 20th century 1945 1985 After the end of World War II Britain implemented a National Health Service Douglas Gairdner s 1949 article The Fate of the Foreskin argued that the evidence showed that the risks outweighed the benefits leading to a significant reduction in circumcision incidence within the United Kingdom 111 In contrast to Gairdner American pediatrician Benjamin Spock argued in favor of circumcision in his popular The Common Sense Book of Baby and Child Care which led to rates in the United States significantly rising In the 1970s national medical associations in Australia and Canada issued recommendations against routine infant circumcision leading to drops in the rates of both of those countries The United States made similar statements in the 1970s but stopped short of recommending against it 25 Modernity since 1985 An association between circumcision and reduced heterosexual HIV infection rates was first suggested in 1986 25 Experimental evidence was needed to establish a causal relationship so three randomized controlled trials were commissioned to exclude other confounding factors 11 Trials took place in South Africa Kenya and Uganda 11 All three trials were stopped early by their monitoring boards because those in the circumcised group had a substantially lower rate of HIV contraction than the control group so it was considered unethical to withhold the procedure in light of strong evidence of prophylactic efficacy 11 112 WHO assessed these as gold standard studies and found strong and consistent evidence from later studies that confirmed the results of the studies 27 A scientific consensus subsequently developed that circumcision reduces heterosexual HIV infection rates in high risk populations 12 9 113 the WHO along with other major medical organizations have since promoted circumcision of high risk populations as part of the program to reduce the spread of HIV 27 The Male Circumcision Clearinghouse website was created in 2009 by WHO UNAIDS FHI and AVAC to provide evidence based guidance information and resources to support the delivery of safe male circumcision services in countries that choose to scale up the procedure as one component of comprehensive HIV prevention services 114 115 Society and culture nbsp A circumcision being performed in Central Asia c 1865 1872The word circumcision is from Latin circumcidere meaning to cut around 2 Cultures and religions See also Cultural views on circumcision and Religious male circumcision This section may lend undue weight to certain ideas incidents or controversies Please help to create a more balanced presentation Discuss and resolve this issue before removing this message November 2023 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 18 116 117 118 119 120 121 In contrast some religions such as Mandaeism and Hinduism and Sikhism strongly prohibit the practice of routine circumcision 122 123 124 Judaism Main article Brit milahCircumcision is near universal among Jews 125 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 22 23 95 nbsp Preparing for a Jewish ritual circumcisionThe 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 116 126 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 127 There are also certain exceptions for Jews with poor health 128 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 129 However most streams of non Orthodox Judaism allow female mohels called mohalot Hebrew מו ה לו ת the plural of מו ה ל ת 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 130 An increasing number of Jews in the United States have chosen not to circumcise their sons 131 All major rabbinical organizations make the recommendation that male infants should be circumcised The issue of converts remains controversial in Reform and Reconstructionist Judaism 132 133 circumcision of converts is not mandatory in either 134 Islam Main article Khitan circumcision nbsp Children in Turkey wearing traditional circumcision costumes nbsp Boys in white clothing with bonnets at Tireli market just after circumcision Mali 1990Islamic scholars have diverse opinions on the obligatory nature of male circumcision with some considering it mandatory wajib while others view it as only being recommended sunnah 135 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 136 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 118 119 137 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 118 119 137 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 138 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 139 and maintains a neutral position on the practice of circumcision for other reasons 140 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 140 nbsp Coptic Children wearing traditional circumcision costumesThus 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 141 142 and generally men undergo circumcision shortly after birth as part of a rite of passage 141 Circumcision is near universal among Coptic Christians 143 and they practice circumcision as a rite of passage 2 117 121 144 The Ethiopian Orthodox Church calls for circumcision with near universal prevalence among Orthodox men in Ethiopia 2 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 145 Some Christian churches in South Africa disapprove of the practice while others require it of their members 2 Circumcision is practiced in some predominantly Christian countries and Christian communities 146 147 148 Christian communities in Africa 149 150 some Anglosphere countries the Philippines the Middle East 151 152 South Korea and Oceania have high circumcision rates 153 154 while Christian communities in Europe and South America have low circumcision rates although none of these are performed out of perceived religious obligation 141 155 Scholar Heather L Armstrong writes that as of 2021 update about half of Christian males worldwide are circumcised with most of them being located in Africa Anglosphere countries and the Philippines 156 Druze faith nbsp Preparing for a ritual circumcision to a Druze childCircumcision is widely practiced by the Druze 157 Druze practice Druzism an Abrahamic 158 159 monotheistic syncretic and ethnic religion The procedure is practiced as a cultural tradition and has no religious significance in the Druze faith 160 161 There is no special date for this act in the Druze faith male Druze infants are usually circumcised shortly after birth 162 however some remain uncircumcised until the age of ten or older 162 Some Druses do not circumcise their male children and refuse to observe this common Muslim practice 163 Samaritanism Like Judaism the religion of Samaritanism requires ritual circumcision on the eighth day of life 164 Mandaeism Circumcision is forbidden in Mandaeism 122 165 and the sign of the Jews given to Abraham by God circumcision is considered abhorrent by the Mandaeans 166 According to the Mandaean doctrine a circumcised man cannot serve as a Mandaean priest 167 Yazidism Circumcision is not required in Yazidism but is practised by some Yazidis due to regional customs 168 The ritual is usually performed soon after birth it takes place on the knees of the kerif approximately godfather with whom the child will have a life long formal relationship 169 Sikhism Sikhism does not require the elective circumcision of its followers and strongly criticizes the practice 124 170 For example Bhagat Kabir criticizes the practise of circumcision in the hymn of Guru Granth Sahib African cultures This section is an excerpt from Circumcision in Africa edit Circumcision in Africa and the rites of initiation in Africa as well as the frequent resemblance between details of ceremonial procedure in areas thousands of kilometres apart indicate that the circumcision ritual has an old tradition behind it and in its present form is the result of a long process of development 171 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 120 Filipino culture Main article Tuli rite In the Philippines circumcision is known as tuli and is generally viewed as a rite of passage 172 An overwhelming majority of Filipino men are circumcised 172 a Often this occurs in April and May when Filipino boys are taken by their parents The practice dates back to the arrival of Islam in 1450 Pressure to be circumcised is even in the language one Tagalog profanity for uncircumcised is supot meaning coward literally A circumcised eight or ten year old is no longer considered a boy and is given more adult roles in the family and society 174 Ethical and legal issues Main article Ethics of circumcision See also Circumcision controversies and Circumcision and law Ethics This section is an excerpt from Ethics of circumcision edit There is substantial disagreement amongst bioethicists and theologians over the practice of circumcision with many believing that the routine circumcision of neonates for health purposes is a cost ineffective and ethically problematic intervention in developed countries while circumcision on a consenting adult is generally viewed as a morally permissible action Positions taken on the issue are heavily influenced by prevalence in the given area religion and culture 175 Some medical associations take the position that circumcision is an infringement of the child s autonomy and should be deferred until he is capable of making the decision himself Others state that parents should be allowed to determine what is in his best interest 176 177 178 Legal Worldwide the large majority of polities do not have specific laws concerning the circumcision of males 2 with religious infant circumcision being legal in every country 125 179 A few countries have passed legislation on the procedure Germany allows routine circumcision 180 while non religious routine circumcision is illegal in South Africa and Sweden 2 179 No major medical organization recommends circumcising all males and no major medical organization recommends banning the procedure 18 181 125 In the academic literature there is general agreement among both supporters and opponents of the practice that an outright ban would be predominately ineffective and harmful 18 125 182 181 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 18 125 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 18 179 During the 2010s several right wing nationalist parties prominently called for the banning of circumcision 183 Gressgard argued that politicians that supported Norway s proposed circumcision ban debated circumcision in a manner which constituted ethnocentrism 184 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 185 Several analyses have concluded that circumcision programs for adult men in Africa are cost effective and in some cases are cost saving 186 187 In Rwanda circumcision has been found to be cost effective across a wide range of age groups from newborn to adult 48 188 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 189 188 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 185 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 190 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 191 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 1 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 1 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 192 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 71 References a b c d e f g h i j k l m n o p q r s t u v w 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 Archived from the original on 20 September 2012 a b c d e f g h i j k l m n 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 Archived PDF from the original on 22 December 2015 a b c d Lissauer T Clayden G October 2011 Illustrated Textbook of Paediatrics Fourth edition Elsevier pp 352 353 ISBN 978 0 7234 3565 5 a b c d e f g h i 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 Archived from the original on 18 January 2016 a b c Rudolph C Rudolph A Lister G First L Gershon A 18 March 2011 Rudolph s Pediatrics 22nd ed McGraw Hill Companies Incorporated p 188 ISBN 978 0 07 149723 7 Archived from the original on 18 January 2016 a b Yuan T Fitzpatrick T Ko NY Cai Y Chen Y Zhao J et al 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 The Lancet Global Health Mata analysis 7 4 e436 e447 doi 10 1016 S2214 109X 18 30567 9 PMC 7779827 PMID 30879508 a b c d e f 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 a b c d 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 a b c For sources on this see Chikutsa A Maharaj P 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 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 Bell K 2016 Health and Other Unassailable Values Reconfigurations of Health Evidence and Ethics Taylor amp Francis p 106 ISBN 978 1 317 48203 1 defending the casual relation between male circumcision and reduced HIV transmission has become essentially hegemonic in the academic literature Merson M Inrig S 2017 The AIDS Pandemic Searching for a Global Response Springer International Publishing p 379 ISBN 978 3 319 47133 4 Manual for early infant male circumcision under local anaesthesia Geneva World Health Organization 2010 Archived from the original on 14 April 2022 Retrieved 14 April 2022 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 a b c d e 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 a b Merson M Inrig S 2017 The AIDS Pandemic Searching for a Global Response Springer Publishing p 379 ISBN 978 3 319 47133 4 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 a b c Thomas A Necchi A Muneer A Tobias Machado M Tran AT Van Rompuy AS et al February 2021 Penile cancer Nature Reviews Disease Primers Review 7 1 11 doi 10 1038 s41572 021 00246 5 PMID 33574340 S2CID 231877615 a b c 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 a b c d 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 978 0 323 67227 6 a b Gable L Gamharter K Gostin L Hodge Jr J Puymbroeck R 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 0 8213 7105 3 a b c d e f Manual for early infant male circumcision under local anaesthesia Geneva World Health Organization 2010 Archived from the original on 14 April 2022 Retrieved 14 April 2022 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 a b c d e f g h i j k l 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 a b c 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 Archived from the original on 18 January 2016 a b c Al Salem A 2016 An Illustrated Guide to Pediatric Urology Springer Publishing p 481 ISBN 978 3 319 44182 5 Afshar K Kazemi B MacNeily A 2018 The Role of Circumcision in Preventing Sexually Transmitted Infections In Singh S ed Diagnostics to Pathogenomics of Sexually Transmitted Infections Wiley pp 28 34 ISBN 978 1 119 38084 9 a b Mark E 2003 Frojmovic Travelers to the Circumcision The Covenant of Circumcision New Perspectives on an Ancient Jewish Rite Brandeis University Press p 141 ISBN 978 1 58465 307 3 Circumcision became the single most important commandment the one without which no Jew could attain the world to come a b Hamilton V 1990 The Book of Genesis Chapters 1 17 Eerdmans Publishing Company p 473 ISBN 978 0 8028 2521 6 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 a b c d e f g h 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 PMID 16402509 Archived PDF from the original on 14 March 2023 Retrieved 16 January 2023 a b c d e f g h i Alanis MC Lucidi RS May 2004 Neonatal circumcision a review of the world s oldest and most controversial operation Obstetrical amp Gynecological Survey 59 5 379 395 doi 10 1097 00006254 200405000 00026 PMID 15097799 S2CID 25226185 Seeth A 1 June 2018 It s hassle free says actor Melusi Yeni about his medical circumcision News24 Archived from the original on 5 May 2022 Retrieved 5 May 2022 Actor Melusi Yeni was the millionth man to undergo voluntary male medical circumcision at the Sivananda Clinic in KwaZulu Natal a b c d e Preventing HIV Through Safe Voluntary Medical Male Circumcision For Adolescent Boys And Men In Generalized HIV Epidemics World Health Organization 2020 Archived from the original on 22 November 2021 Retrieved 24 May 2021 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 a b 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 Wapner J 24 February 2015 The Troubled History of Foreskin Mosaic Science Archived from the original on 26 December 2021 Retrieved 3 February 2022 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 Morris BJ November 2007 Why circumcision is a biomedical imperative for the 21 st century BioEssays 29 11 1147 1158 doi 10 1002 bies 20654 PMID 17935209 Archived from the original on 26 December 2021 Retrieved 26 December 2021 Background Methods and Synthesis of Scientific Information Used to Inform Information for Providers to Share with Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV Infection Sexually Transmitted Infections and other Health Outcomes stacks cdc gov Archived from the original on 22 October 2023 Retrieved 12 October 2023 a b c d e f World Health Organization UNAIDS Jhpiego Johns Hopkins Program for International Education in Gynecology and Obstetrics December 2009 Manual for Male Circumcision Under Local Anaesthesia 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 Alt URL Archived 30 March 2023 at the Wayback Machine 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 Archived PDF from the original on 12 March 2013 a b 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 Professional Standards and Guidelines Circumcision Infant Male College of Physicians and Surgeons of British Columbia Report September 2009 a b Lonnqvist PA September 2010 Regional anaesthesia and analgesia in the neonate Best Practice amp Research Clinical Anaesthesiology 24 3 309 321 doi 10 1016 j bpa 2010 02 012 PMID 21033009 a b c d 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 Wolter C Dmochowski R 2008 Circumcision Handbook of Office Urological Procedures Springer pp 88 ISBN 978 1 84628 523 3 Archived from the original on 18 January 2016 Sharma AL Hokello J Tyagi M 25 June 2021 Circumcision as an Intervening Strategy against HIV Acquisition in the Male Genital Tract Pathogens 10 7 806 doi 10 3390 pathogens10070806 ISSN 2076 0817 PMC 8308621 PMID 34201976 There is disputed immunological evidence in support of MC in preventing the heterosexual acquisition of HIV 1 Merson M Inrig S 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 a b c 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 Information for providers counseling male patients and parents regarding male circumcision and the prevention of HIV infection STIs and other health outcomes Report Centers for Disease Control and Prevention 22 August 2018 Archived from the original on 6 May 2021 Retrieved 26 May 2021 Kim HH Li PS Goldstein M November 2010 Male circumcision Africa and beyond Curr Opin Urol 20 6 515 9 doi 10 1097 MOU 0b013e32833f1b21 PMID 20844437 S2CID 2158164 STD facts Human papillomavirus HPV CDC Archived from the original on 11 September 2012 Retrieved 12 September 2012 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 a b Zhu YP Jia ZW Dai B Ye DW Kong YY Chang K et al 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 a b c Albero G Castellsague 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 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 a b 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 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 a b c d e f 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 Becker K January 2011 Lichen sclerosus in boys Deutsches Arzteblatt International 108 4 53 58 doi 10 3238 arztebl 2011 0053 PMC 3036008 PMID 21307992 a b Moreno G Ramirez C Corbalan J Penaloza B Morel Marambio M Pantoja T January 2024 Topical corticosteroids for treating phimosis in boys The Cochrane Database of Systematic Reviews 1 1 CD008973 doi 10 1002 14651858 CD008973 pub3 PMC 10809033 PMID 38269441 Celis S Reed F Murphy F Adams S Gillick J Abdelhafeez AH et al 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 a b Krill AJ Palmer LS Palmer JS 2011 Complications of circumcision TheScientificWorldJournal 11 2458 2468 doi 10 1100 2011 373829 PMC 3253617 PMID 22235177 a b c Leber M Tirumani A 8 June 2006 Balanitis EMedicine Archived from the original on 7 October 2008 Retrieved 14 October 2008 a b c Osipov V Acker S November 2006 Balanoposthitis Reactive and Inflammatory Dermatoses EMedicine Archived from the original on 11 December 2006 Retrieved 20 November 2006 a b 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 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 a b 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 a b Ottenhof SR Bleeker MC Heideman DA Snijders PJ Meijer CJ et al 2016 Etiology of Penile Cancer In Muneer A Horenblas S eds Textbook of Penile Cancer 2nd ed Springer pp 11 15 doi 10 1007 978 3 319 33220 8 2 ISBN 978 3 319 33220 8 Risk Factors for Penile Cancer American Cancer Society 25 June 2018 Archived from the original on 25 July 2022 Retrieved 25 January 2023 Hakenberg OW Comperat EM Minhas S Necchi A Protzel C Watkin N January 2015 EAU guidelines on penile cancer 2014 update European Urology Practice guideline 67 1 142 150 doi 10 1016 j eururo 2014 10 017 PMID 25457021 a b c 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 amp Control 22 8 1097 1110 doi 10 1007 s10552 011 9785 9 PMC 3139859 PMID 21695385 Morris BJ Matthews JG Pabalan N Moreton S Krieger JN August 2021 Male circumcision and prostate cancer a meta analysis revisited The Canadian Journal of Urology Meta analysis 28 4 10768 10776 PMID 34378513 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 Banuelos Marco B Garcia Heil JL March 2021 Circumcision in childhood and male sexual function a blessing or a curse International Journal of Impotence Research 33 2 139 148 doi 10 1038 s41443 020 00354 y PMC 7985026 PMID 32994555 a b c 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 Journal de l Association des Urologues du Canada 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 During S Frimodt Moller 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 Statement on Newborn Male Circumcision American College of Obstetricians and Gynecologists Archived from the original on 21 March 2023 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 MH Tlou B Naidoo S 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 PMC 9933013 PMID 36797696 It was interesting to note that the young males in this study had misconceptions about sexual pleasure post male circumcision Sorokan ST Finlay JC Jefferies AL 8 September 2015 Newborn male circumcision Paediatrics amp Child Health 20 6 311 320 doi 10 1093 pch 20 6 311 PMC 4578472 PMID 26435672 medical studies do not support circumcision as having a negative impact on sexual function or satisfaction in males or their partners World Health Organization UNAIDS Jhpiego December 2009 Manual for Male Circumcision Under Local Anaesthesia 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 Alt URL Archived 30 March 2023 at the Wayback Machine 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 a b 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 Newborn male circumcision Canadian Paediatric Society Archived from the original on 11 April 2023 Retrieved 10 April 2023 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 a b American Urological Association Circumcision Archived from the original on 25 August 2013 Retrieved 2 November 2008 a b c d Krill AJ Palmer LS Palmer JS 2011 Complications of circumcision TheScientificWorldJournal 11 2458 2468 doi 10 1100 2011 373829 PMC 3253617 PMID 22235177 a b Neonatal Circumcision American Academy of Family Physicians 2013 Archived from the original on 21 July 2015 Retrieved 3 August 2015 Sorokan ST Finlay JC Jefferies AL 8 September 2015 Newborn male circumcision Paediatrics amp Child Health 20 6 311 320 doi 10 1093 pch 20 6 311 PMC 4578472 PMID 26435672 Archived from the original on 18 January 2016 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 Circumcision in men National Health Service 22 February 2016 Archived from the original on 29 June 2020 Retrieved 30 October 2018 Staff Sexually transmitted infections STIs World Health Organization Archived from the original on 11 June 2023 Retrieved 24 December 2022 Leach P 2010 The Essential First Year Dorling Kindersley Limited p 30 ISBN 978 0 7566 6331 5 Perry S Hockenberry M Cashion M Rhodes Alden K Olshansky E Leonard Lowdermilk D 2022 Nursing Care of the Newborn and Family Maternal Child Nursing Care Elsevier Health Sciences ISBN 978 0 323 82587 0 The World Health Organization recognizes male circumcision as an important intervention in reducing the risk of heterosexually acquired HIV in men Manual for early infant male circumcision under local anaesthesia PDF Geneva World Health Organization 2010 Archived PDF from the original on 23 April 2022 Retrieved 31 May 2022 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 Archived from the original on 18 January 2016 a b Cox G Morris BJ 2012 Why Circumcision From Prehistory to the Twenty First Century In Bolnick D Koyle M Yosha A eds Surgical Guide to Circumcision Springer Science amp Business Media pp 243 244 ISBN 978 1 4471 2858 8 Angulo JC Garcia Diez M July 2009 Male genital representation in paleolithic art erection and circumcision before history Urology 74 1 10 14 doi 10 1016 j urology 2009 01 010 hdl 10400 26 23819 PMID 19395004 Archived from the original on 10 November 2011 Retrieved 7 February 2024 Faria MA 7 May 2015 Neolithic trepanation decoded A unifying hypothesis Has the mystery as to why primitive surgeons performed cranial surgery been solved Surgical Neurology International 6 72 doi 10 4103 2152 7806 156634 PMC 4427816 PMID 25984386 a b c d e Gollaher D February 2001 Chapter 1 The Jewish Tradition Circumcision A History of the World s Most Controversial Surgery Basic Books pp 1 30 ISBN 978 0 465 02653 1 Archived from the original on 18 January 2016 a b Campbell A Coulson D 2010 Big Hippo Site Oued Afar Algeria PDF Sahara 21 85 90 91 ISSN 1120 5679 S2CID 191103812 Archived from the original PDF on 26 October 2022 Retrieved 27 August 2022 Soukopova J 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 Archived from the original on 7 November 2021 Retrieved 27 August 2022 Al Salem AH 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 Archived from the original on 23 August 2022 Retrieved 27 August 2022 Dobanovacki D Milovanovic L Slavkovic A Tatic M Miskovic Skeledzija S Skoric Jokic S et al 2012 Surgery Before Common Era B C E PDF Archive of Oncology 20 1 2 29 doi 10 2298 AOO1202028D S2CID 53008076 Archived PDF from the original on 12 February 2023 Retrieved 27 August 2022 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 a b Skolnik F Berenbaum M eds 2006 Circumcision Encyclopaedia Judaica 2nd ed USA Macmillan Reference ISBN 978 0 02 865928 2 a b c d e f g h For sources see Livingston M 2021 Dreamworld or Dystopia The Nordic Model and Its Influence in the 21st Century Cambridge University Press p 87 ISBN 978 1 108 75726 3 In Jewish history the banning of circumcision brit mila has historically been a first step toward more extreme and violent forms of persecution Wilson R 2018 The Contested Place of Religion in Family Law Cambridge University Press p 174 ISBN 978 1 108 41760 0 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 GP Spring 2002 Circumcision Cultural Legal Analysis Virginia Journal of Social Policy amp 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 E 2006 Circumcision Anti Semitism and Christ s Foreskin From Abraham to America A History of Jewish Circumcision Rowman amp Littlefield pp 161 162 ISBN 978 0 7425 1669 4 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 F 2003 Encyclopedia of Jewish Medical Ethics Feldheim Publishers p 196 ISBN 978 1 58330 592 8 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 Hirsch EG Kohler K Jacobs J Friedenwald A Broyde I 1906 Circumcision Jewish Encyclopedia Archived from the original on 4 August 2011 Retrieved 8 March 2018 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 Jacobs A 2012 Christ Circumcised A Study in Early Christian History and Difference United States University of Pennsylvania Press ISBN 978 0 8122 0651 7 a b Bolnick D Koyle M Yosha A 2012 Circumcision in the Early Christian Church The Controversy That Shaped a Continent Surgical Guide to Circumcision United Kingdom Springer pp 290 298 ISBN 978 1 4471 2858 8 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 Gollaher D February 2001 Chapter 2 Christians and Muslims Circumcision A History of the World s Most Controversial Surgery Basic Books pp 31 52 ISBN 978 0 465 02653 1 Archived from the original on 18 January 2016 Leslie DD 1998 The Integration of Religious Minorities in China The Case of Chinese Muslims 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 Johan E 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 Gollaher D February 2001 Chapter 3 Symbolic Wounds Circumcision A History of the World s Most Controversial Surgery Basic Books pp 53 72 ISBN 978 0 465 02653 1 Archived from the original on 18 January 2016 a b 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 a b Hutchinson J 1855 On the influence of circumcision in preventing syphilis Medical Times and Gazette 32 542 543 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 a b Chubak B 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 as systemic therapy rather than a local anatomic alteration This redefinition was consistent with the contemporary reflex neurosis theory of disease as well as the historic humoral mechanical understanding of the human body a b c d Gollaher D February 2001 Chapter 4 From Ritual to Science Circumcision A History of the World s Most Controversial Surgery Basic Books pp 73 108 ISBN 978 0 465 02653 1 Archived from the original on 18 January 2016 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 Laumann EO Masi CM Zuckerman EW April 1997 Circumcision in the United States Prevalence prophylactic effects and sexual practice JAMA 277 13 1052 1057 doi 10 1001 jama 1997 03540370042034 PMID 9091693 Archived from the original on 19 December 2021 Retrieved 19 December 2021 Paige J Paige K 2021 Summary and Implications for Complex Societies The Politics of Reproductive Ritual University of California Press p 263 ISBN 978 0 520 30674 5 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 Hankins C Forsythe S Njeuhmeli E 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 Bell K 2016 Health and Other Unassailable Values Reconfigurations of Health Evidence and Ethics Taylor amp Francis p 106 ISBN 978 1 317 48203 1 defending the casual relation between male circumcision and reduced HIV transmission has become essentially hegemonic in the academic literature 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 Archived from the original on 8 January 2014 Retrieved 1 February 2012 Clearinghouse on Male Circumcision for HIV Prevention Redesigned AVAC May 2015 Archived from the original on 12 March 2017 Retrieved 11 March 2017 a b 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 a b Circumcision Columbia Encyclopedia Columbia University Press 2011 Archived from the original on 24 September 2015 a b c Clark M 10 March 2011 Islam For Dummies John Wiley amp Sons p 170 ISBN 978 1 118 05396 6 Archived from the original on 18 January 2016 a b c al Sabbagh Muhammad Lutfi 1996 Islamic ruling on male and female circumcision World Health Organization p 16 ISBN 978 92 9021 216 4 a b Circumcision Encyclopedia of Religion 2 ed Gale 2005 a b Riggs T 2006 Christianity Coptic Christianity Worldmark Encyclopedia of Religious Practices Religions and denominations Thomson Gale ISBN 978 0 7876 6612 5 Archived from the original on 18 January 2016 a b Drower ES 1937 The Mandaeans of Iraq and Iran Oxford At The Clarendon Press Clarence Smith WG 2008 Islam and Female Genital Cutting in Southeast Asia The Weight of the Past PDF Finnish Journal of Ethnicity and Migration 3 2 Special Issue Female Genital Cutting in the Past and Today 14 22 Archived from the original PDF on 6 March 2009 a b Cherry M 2013 Religious Perspectives on Bioethics Taylor amp Francis p 213 ISBN 978 90 265 1967 3 a b c d e Cohen Almagor R 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 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 Oliver IW 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 Archived from the original on 14 September 2023 Retrieved 22 December 2022 Levine A Zvi Brettler M 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 Talmud Avodah Zarah 26b Menachot 42a Maimonides Mishneh Torah Milah ii 1 Shulkhan Arukh Yoreh De ah l c Berit Mila Program of Reform Judaism 7 October 2013 Archived from the original on 7 October 2013 Retrieved 20 July 2022 Chernikoff H 3 October 2007 Jewish intactivists in U S stop circumcising Reuters Archived from the original on 27 December 2008 Retrieved 3 November 2007 Glickman M 12 November 2005 B rit Milah A Jewish Answer to Modernity Reform Judaism Archived from the original on 12 March 2017 Retrieved 11 March 2017 Cohen H 20 May 2002 Bo Defining Boundaries Jewish Reconstructionist Federation Archived from the original on 9 October 2007 Retrieved 3 November 2007 Epstein L 2007 The Conversion Process Calgary Jewish Community Council Archived from the original on 27 December 2008 Retrieved 3 November 2007 Dabbagh H December 2022 Is Circumcision Necessary in Islam A Philosophical Argument Based on Peer Disagreement Journal of Religion and Health 61 6 4871 4886 doi 10 1007 s10943 022 01635 0 PMC 9569283 PMID 36006531 Abu Sahlieh SA 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 SA 1995 Islamic Law and the Issue of Male and Female Circumcision Third World Legal Studies Valparaiso University School of Law 13 73 101 Archived from the original on 12 November 2019 Retrieved 13 February 2020 a b 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 Mark E 2003 The Covenant of Circumcision New Perspectives on an Ancient Jewish Rite Brandeis University Press pp xxiii ISBN 978 1 58465 307 3 Pope Eugenius IV 1990 1442 Ecumenical Council of Florence 1438 1445 Session 11 4 February 1442 Bull of union with the Copts In Tanner NP 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 Archived from the original on 25 April 2009 Retrieved 25 April 2007 it denounces all who after that time observe circumcision a b 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 a b c Stearns PN 2008 The Oxford Encyclopedia of the Modern World Oxford University Press p 179 ISBN 978 0 19 517632 2 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 Pitts Taylor V 2008 Cultural Encyclopedia of the Body 2 volumes ABC CLIO p 394 ISBN 978 1 56720 691 3 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 Sharkey HJ 2015 American Evangelicals in Egypt Missionary Encounters in an Age of Empire Princeton University Press p 30 ISBN 978 0 691 16810 4 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 DeMello M 2007 Encyclopedia of Body Adornment ABC Clio p 66 ISBN 978 0 313 33695 9 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 Gruenbaum E 2015 The Female Circumcision Controversy An Anthropological Perspective University of Pennsylvania Press p 61 ISBN 978 0 8122 9251 0 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 Hunting K 2012 Essential Case Studies in Public Health Putting Public Health Into Practice Jones amp Bartlett Publishers pp 23 24 ISBN 978 1 4496 4875 6 Neonatal circumcision is the general practice among Jews Christians and many but not all Muslims Wylie KR 2015 ABC of Sexual Health John Wiley amp Sons p 101 ISBN 978 1 118 66569 5 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 Creighton S Liao LM 2019 Female Genital Cosmetic Surgery Solution to What Problem Cambridge University Press p 63 ISBN 978 1 108 43552 9 Christians in Africa for instance often practise infant male circumcision Nga A 30 December 2019 The Ritual of Circumcision in Africa The Case of South Africa Africanews Archived from the original on 6 December 2022 Retrieved 8 November 2022 This practice is old and widespread among African Christians with very close links to their beliefs It can be executed traditionally or in hospital Bakos GT 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 978 1 60608 342 0 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 Sharkey HJ 2017 A History of Muslims Christians and Jews in the Middle East Cambridge University Press p 63 ISBN 978 0 521 76937 2 On the Coptic Christian practice of male circumcision in Egypt and on its practice by other Christians in western Asia Circumcision protest brought to Florence Associated Press 30 March 2008 Archived from the original on 26 March 2023 Retrieved 2 August 2022 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 Ross JI 2015 Religion and Violence An Encyclopedia of Faith and Conflict from Antiquity to the Present Routledge p 169 ISBN 978 1 317 46109 8 For instance the majority of South Koreans Americans and Filipinos as well as African Christians practice circumcision Peteet JR 2017 Spirituality and Religion Within the Culture of Medicine From Evidence to Practice Oxford University Press pp 97 101 ISBN 978 0 19 027243 2 male circumcision is still observed among Ethiopian and Coptic Christians and circumcision rates are also high today in the Philippines and the US Armstrong HL 2021 Encyclopedia of Sex and Sexuality Understanding Biology Psychology and Culture 2 volumes ABC CLIO pp 115 117 ISBN 978 1 61069 875 7 Ubayd A 2006 The Druze and Their Faith in Tawhid Syracuse University Press p 150 ISBN 978 0 8156 3097 5 Male circumcision is standard practice by tradition among the Druze Abulafia AS 23 September 2019 The Abrahamic religions www bl uk London British Library Archived from the original on 12 July 2020 Retrieved 9 March 2021 Obeid A 2006 The Druze amp Their Faith in Tawhid Syracuse University Press p 1 ISBN 978 0 8156 5257 1 Jacobs D 1998 Israel and the Palestinian Territories The Rough Guide Rough Guides p 147 ISBN 978 1 85828 248 0 Circumcision is not compulsory and has no religious significance Silver MM 2022 The History of Galilee 1538 1949 Mysticism Modernization and War Rowman amp Littlefield p 97 ISBN 978 1 7936 4943 0 Muslim men are circumcised whereas this is not a religious obligation among the Druze a b Dana N 2003 The Druze in the Middle East Their Faith Leadership Identity and Status University of Michigan Press p 56 ISBN 978 1 903900 36 9 Brenton RB 2013 The Sunni Shi a Divide Islam s Internal Divisions and Their Global Consequences Potomac Books Inc p 56 ISBN 978 1 61234 523 9 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 Mark E 2003 The Covenant of Circumcision New Perspectives on an Ancient Jewish Rite University Press of New England pp 94 95 ISBN 978 1 58465 307 3 Lupieri E 2001 The Mandaeans The Last Gnostics Wm B Eerdmans Publishing p 60 ISBN 978 0 8028 3350 1 Archived from the original on 14 September 2023 Retrieved 6 August 2022 Schmidinger T 2019 Beyond ISIS History and Future of Religious Minorities in Iraq Transnational Press London p 82 ISBN 978 1 912997 15 2 Deutsch N 1999 Guardians of the Gate Angelic Vice regency in the Late Antiquity BRILL p 105 ISBN 978 90 04 10909 4 Parry OH 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 Kreyenbroek PG 2009 Yezidism in Europe Different Generations Speak about Their Religion Otto Harrassowitz Verlag ISBN 978 3 447 06060 8 Cole WO Sambhi PS 1995 The Sikhs Their Religious Beliefs and Practices Sussex Academic Press pp 155 156 ISBN 978 1 898723 13 4 Wagner G 1949 Circumcision And Initiation Rites PDF The Bantu of North Kavirondo Volume 1 Oxford University Press p 335 doi 10 4324 9780429485817 ISBN 9780429485817 a b Tuli a rite of passage for Filipino boys 6 May 2011 Archived from the original on 8 December 2015 Retrieved 6 December 2015 Zirkumzision nach Dieffenbach Archived 2022 09 02 at the Wayback Machine vgl Schumpelick u a S 434 ff Circumcision season Philippine rite puts boys under pressure Channel News Asia Agence France Presse 19 June 2019 Archived from the original on 20 June 2019 Retrieved 20 June 2019 Bedzow I July September 2020 Male circumcision as an example of bioethics as immaterial social ethics Ethics Medicine and Public Health 14 100519 doi 10 1016 j jemep 2020 100519 ISSN 2352 5525 S2CID 225629172 Diekema DS Mercurio MR Adam MB eds 8 September 2011 Clinical Ethics in Pediatrics A Case Based Textbook Cambridge University Press pp 43 48 ISBN 978 1 139 50183 5 Archived from the original on 23 April 2021 Retrieved 3 February 2021 Task force on circumcision March 1999 Circumcision policy statement American Academy of Pediatrics Task Force on Circumcision Pediatrics 103 3 686 93 doi 10 1542 peds 103 3 686 PMID 10049981 Archived from the original on 29 December 2015 Non Therapeutic Circumcision of Male Minors Archived 2012 05 13 at the Wayback Machine Utrecht Royal Dutch Medical Association 2010 a b c Circumcision of Infant Males PDF The Royal Australasian College of Physicians September 2010 Archived PDF from the original on 12 August 2015 Retrieved 11 September 2013 Circumcision remains legal in Germany Deutsche Welle 12 December 2012 Archived from the original on 26 October 2013 Retrieved 11 September 2013 a b Basaran O 2023 Circumcision and Medicine in Modern Turkey University of Texas Press pp 156 157 ISBN 978 1 4773 2702 9 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 Non therapeutic circumcision of male minors KNMG Viewpoint Utrecht The Netherlands Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst KNMG Royal Dutch Society for the Promotion of Medicine May 2010 Archived from the original on 8 March 2018 Retrieved 7 March 2018 Bruns A Bu Y Merkt H 2021 Legal Theory and Interpretation in a Dynamic Society Nomos Verlagsgesellschaft p 352 ISBN 978 3 7489 2584 2 Gressgard R 2012 Multicultural Dialogue Dilemmas Paradoxes Conflicts Berghahn Books pp 7 94 ISBN 978 0 85745 648 9 a b 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 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 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 a b 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 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 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 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 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 The most commonly done procedure is in actuality not a circumcision but a dorsal slit where no foreskin is actually removed When the foreskin is removed it is commonly known locally as a German cut in reference to the introduction of the modern surgical technique by the founder of plastic and reconstructive surgery Johann Friedrich Dieffenbach 173 External links nbsp Wikimedia Commons has media related to Circumcision nbsp Wikinews has news 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 Retrieved from https en wikipedia org w index php title Circumcision amp oldid 1213519532, wikipedia, wiki, book, books, library,

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