CIRCUMCISION
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(Redirected from Male circumcision)
'Circumcision' is a surgical procedure that removes some or all of the foreskin (prepuce) from the penis.[1] The word "circumcision" comes from Latin ''circum'' (meaning "around") and ''caedere'' (meaning "to cut").
Circumcision predates recorded human history, with depictions in stone-age cave drawings and Ancient Egyptian tombs, though some depictions may be open to interpretation.[2][3] Theories include that circumcision is a form of ritual sacrifice or offering, a health precaution, a sign of submission to a deity, a rite of passage to adulthood, a mark of defeat or slavery, or an attempt to alter esthetics or sexuality.
Male circumcision is a religious commandment in Judaism as well as in Islam,[4][5] and customary in some Oriental Orthodox and other Christian churches in Africa.Customary in some Coptic and other churches:
★ "The Coptic Christians in Egypt and the Ethiopian Orthodox Christians— two of the oldest surviving forms of Christianity— retain many of the features of early Christianity, including male circumcision. Circumcision is not prescribed in other forms of Christianity... Some Christian churches in South Africa oppose the practice, viewing it as a pagan ritual, while others, including the Nomiya church in Kenya, require circumcision for membership and participants in focus group discussions in Zambia and Malawi mentioned similar beliefs that Christians should practice circumcision since Jesus was circumcised and the Bible teaches the practice." Male Circumcision: context, criteria and culture (Part 1), Joint United Nations Programme on HIV/AIDS, February 26, 2007.
★ "The decision that Christians need not practice circumcision is recorded in Acts 15; there was never, however, a prohibition of circumcision, and it is practiced by Coptic Christians." "circumcision", The Columbia Encyclopedia, Sixth Edition, 2001-05.
Circumcision is common in the Middle East, the USA and parts of Africa and Asia.
According to WHO, 30% of men worldwide have had the procedure, mostly in countries where it is common for religious or cultural reasons.[6]
Genital integrity supporters condemn infant circumcision as a human rights abuse and a genital mutilation like female genital cutting Circumcision: A medical or a human rights issue?, , Marilyn Fayre, Milos, Journal of Nurse-Midwifery, 1992
, while advocates of circumcision regard it as a worthwhile public health measure,[7] particularly in the control of HIV. Male circumcision to cut HIV risk in the general population, , Marie-Lousie, Newell, The Lancet,
[8][9]
Since March 2007 the World Health Organization and UNAIDS recognize male circumcision as an efficacious intervention for HIV prevention, while cautioning that male circumcision only provides partial protection and should not replace other interventions to prevent heterosexual transmission of HIV.[10]
Circumcision may also be used to treat inflammation of the glans and penile cancer.[11][12] Using circumcision to treat phimosis (see section below) is debated in medical literature.[13][14]
Circumcision removes the foreskin from the penis. For infant circumcision, clamps, such as the Gomco clamp, Plastibell, and Mogen are often used.[15] Clamps are designed to cut the blood supply to the foreskin, stop any bleeding and protect the glans. Before using a clamp, the foreskin and the glans are separated with a blunt probe and/or curved hemostat.
★ With the Plastibell, the foreskin and the clamp come away in three to seven days.
★ With a Gomco clamp, a section of skin is first crushed with a hemostat then slit with scissors. The foreskin is drawn over the bell shaped portion of the clamp and inserted through a hole in the base of the clamp and the clamp is tightened, "crushing the foreskin between the bell and the base plate." The crushing limits bleeding (provides hemostasis). While the flared bottom of the bell fits tightly against the hole of the base plate, the foreskin is then cut away with a scalpel from above the base plate. The bell prevents the glans being reached by the scalpel.[16]
★ With a Mogen clamp, the foreskin is grabbed dorsally with a straight hemostat, and lifted up. The Mogen clamp is then slid between the glans and hemostat, following the angle of the corona to "avoid removing excess skin ventrally and to obtain a superior cosmetic result," than with Gomco or Plastibell circumcisions. The clamp is locked shut, and a scalpel is used to cut the foreskin from the flat (upper) side of the clamp.[17][18]
The frenulum is cut if frenular chordee is evident.[19]
Main articles: Circumcision in the Bible
Circumcising cultures may circumcise their males either shortly after birth, during childhood or around puberty as part of a rite of passage. Circumcision is most prevalent in Muslim countries, Israel, the United States, the Philippines and South Korea and is most prevalent in the Jewish and Muslim faiths. It is less common in Europe, Latin America, China and India.
Circumcision is a positive commandment obligatory under Jewish law for Jewish males, and is only postponed or abrogated in the case of threat to the life or health of the child.[20] It is usually performed by a ''mohel'' on the eighth day after birth in a ceremony called a ''Brit milah'' (or ''Bris milah'', colloquially simply ''bris'') (Hebrew for "Covenant of circumcision").
While in most countries, Christians do not circumcise, The Arabian Nights, tales from a thousand and one nights, , Richard, Burton, , ,
it is customary among the Coptic, Ethiopian, and Eritrean Orthodox Churches, and also some other African churches. Some Christian churches in South Africa oppose circumcision, viewing it as a pagan ritual, while others, including the Nomiya church in Kenya[21], require circumcision for membership. Some Christian churches celebrate the Circumcision of Christ. [22][23]
In Islam, circumcision is mentioned in some ''hadith'', but not in the Qur'an. Some Fiqh scholars state that circumcision is ''recommended'' (Sunnah); others that it is ''obligatory''.[24] Some have quoted the ''hadith'' to argue that the requirement of circumcision is based on the covenant with Abraham.[25]
Circumcision in South Korea is largely the result of American cultural and military influence following the Korean War. In West Africa infant circumcision may have had tribal significance as a rite of passage or otherwise in the past; today in some non-Muslim Nigerian societies it is medicalised and is simply a cultural norm.[26]
Circumcision is part of initiation rites in some African, Pacific Islander, and Australian aboriginal traditions in areas such as Arnhem Land,[27] where the practice was introduced by Makassan traders from Sulawesi in the Indonesian Archipelago.[28] Circumcision ceremonies among certain Australian aboriginal societies are noted for their painful nature, including subincision for some aboriginal peoples in the Western Desert.[29]
In the Pacific, ritual circumcision is nearly universal in the Melanesian islands of Fiji and Vanuatu;[30] participation in the traditional land diving on Pentecost Island is reserved for those who have been circumcised.[31]
Circumcision is also commonly practised in the Polynesian islands of Samoa, Tonga, Niue, and Tikopia. In Samoa, it is accompanied by a celebration. Among some West African animist groups, such as the Dogon and Dowayo, it is taken to represent a removal of "feminine" aspects of the male, turning boys into fully masculine males.[32] Among the Urhobo of southern Nigeria it is symbolic of a boy entering into manhood. The ritual expression, ''Omo te Oshare'' ("the boy is now man"), constitutes a rite of passage from one age set to another.[33] For Nilotic peoples, such as the Kalenjin and Maasai, circumcision is a rite of passage observed collectively by a number of boys every few years, and boys circumcised at the same time are taken to be members of a single age set.[34]
Main articles: Bioethics of neonatal circumcision
The American Medical Association defines “non-therapeutic†circumcision as the non-religious, non-ritualistic, not medically necessary, elective circumcision of male newborns. It states that medical associations in the US, Australia, and Canada do not recommend the routine non-therapeutic circumcision of newborns. Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision
Those advocating circumcision assert that circumcision is a significant public health measure, preventing infections, and slowing down the spread of AIDS. Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial, , Bertran, Auvert, PLoS Medicine, 2005
Those opposing circumcision, however, question the legality of infant circumcision by asserting that infant circumcision is a human rights violation or a sexual assault.
Involuntary circumcision: the legal issues, , R.S., Van Howe, BJU International, 1999
Views differ on whether limits should be placed on caregivers having a child circumcised.
Somerville argues that the nature of the medical benefits cited as a justification for infant circumcision are such that the potential medical problems can be avoided or, if they occur, treated in far less invasive ways than circumcision. She states that the removal of healthy genital tissue from a minor should not be subject to parental discretion, or that physicians who perform the procedure are not acting in accordance with their ethical duties to the patient, regardless of parental consent. Another argument questions why the genital cutting of males is allowed while the genital cutting of females is prohibited.[35]
Others argue that there is no convincing evidence of sexual or emotional harm, and that there are greater monetary and psychological costs in circumcising later rather than in infancy.[36]
Some medical associations accept that the parents should determine what is in the best interest of the infant or child,
but the Royal Australasian College of Physicians (RACP) and the British Medical Association (BMA) observe that controversy exists on this issue. Policy Statement On Circumcision
The law and ethics of male circumcision - guidance for doctors Medical Ethics Committee
The BMA insists that a circumcision must not go ahead without the consent of both parents and the competent child.
Moses ''et al.'' (1998) state that "scientific evidence is lacking" for psychological and emotional harm, and cite a longitudinal study finding no difference in developmental and behavioural indices.[37] Goldman (1999) discussed the possible trauma of circumcision on children and parents, anxieties over the circumcised state, a tendency to repeat the trauma, and suggested a need on the part of circumcised doctors to find medical justifications for the procedure.[38] Some organizations have been formed as support groups for men who are resentful about being circumcised.
Main articles: Circumcision and law
Traditionally, circumcision has been presumed to be legal when performed by a trained operator.
In 2001, Sweden allowed only persons certified by the National Board of Health to circumcise infants, requiring a medical doctor or an anesthesia nurse to accompany the circumciser and for anaesthetic to be applied beforehand. Jews and Muslims in Sweden objected to the law,[39] and in 2001, the World Jewish Congress stated that it was “the first legal restriction on Jewish religious practice in Europe since the Nazi era.â€[40] However, in 2006, the United States State Department stated, in a report on Sweden, that most Jewish mohels had been certified under the law and 3000 Muslim and 40-50 Jewish boys were circumcised each
year. The National Board of Health and Welfare reviewed the law in 2005 and recommended that it be maintained.[41]
According to the American Academy of Pediatrics' 1999 Circumcision Policy Statement, “There is considerable evidence that newborns who are circumcised without analgesia experience pain and psychologic stress.†In the statement, the Academy recommends the use of pain relief for circumcision. One of the supporting studies, Taddio 1997, found a correlation between circumcision and intensity of pain response during vaccination months later. They acknowledge that there may be "other factors" besides circumcision that account for different levels of pain response, but stated that they did not find evidence of such. They concluded "[p]retreatment and postoperative management of neonatal circumcision pain is recommended based on these results." Effect of neonatal circumcision on pain response during subsequent routine vaccination, , Anna, Taddio, The Lancet, 1997
Other medical associations also cite evidence that circumcision without anesthetic is painful. Circumcision: Position Paper on Neonatal Circumcision
Stang, 1998, found 45% of physicians used anaesthesia - most commonly a dorsal penile nerve block - for infant circumcisions. Obstetricians used anaesthesia significantly less often (25%) than family practitioners (56%) or pediatricians (71%).
J.M. Glass, 1999, stated that Jewish ritual circumcision is so quick that "most ''mohelim'' do not routinely use any anaesthesia as they feel there is probably no need in the neonate. However, there is no Talmudic objection and should the parents wish for local anaesthetic cream to be applied there is no reason why this cannot be done." Tannenbaum and Shechet, 2000, stated that an “authentic, traditional bris performed by a mohel does not use clamps, so there is no pain associated with crushing tissue.†Circumcision---The Debates Goes On, , Jacob, Shechet, Pediatrics, 2000
They also asserted that due to the speed of the procedure and rarity of complication, it is “more humane not to subject the infant to a local anesthetic.â€
Lander ''et al.'', found that babies circumcised without pain relief "exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the circumcision and following. Two newborns ... became ill following circumcision (choking and apnea)."[1] A 2004 Cochrane review, which compared the dorsal penile nerve block and EMLA (topical anaesthesia) found both anaesthetics appear safe, but neither of them completely eliminated pain.[42] Razmus et al reported that newborns circumcised with the dorsal block and the ring block in combination with the concentrated oral sucrose had the lowest pain scores.[43] Ng ''et al'' found that EMLA cream, in addition to local anaesthetic, effectively reduces the sharp pain induced by needle puncture.[44]
Main articles: Sexual effects of circumcision
The American Academy of Pediatrics (1999) stated "a survey of adult males using self-report suggests more varied sexual practice and less sexual dysfunction in circumcised adult men. There are anecdotal reports that penile sensation and sexual satisfaction are decreased for circumcised males. Masters and Johnson noted no difference in exteroceptive and light tactile discrimination on the ventral or dorsal surfaces of the glans penis between circumcised and uncircumcised men." In January 2007, The American Academy of Family Physicians (AAFP) stated "The effect of circumcision on penile sensation or sexual satisfaction is unknown. Because the epithelium of a circumcised glans becomes cornified, and because some feel nerve over-stimulation leads to desensitization, many believe that the glans of a circumcised penis is less sensitive. ... No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."
Boyle ''et al.'' (2002) stated that "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings—many of which are lost to circumcision."[45] They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."
Main articles: Medical analysis of circumcision
The British Medical Association, states “there is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research.†Cost-benefit analyses have varied. Some found a small net benefit of circumcision,[46][47] some found a small net decrement,[48][49] and one found that the benefits and risks balanced each other out and suggested that the decision could "most reasonably be made on nonmedical factors."[50]
Main articles: Medical analysis of circumcision
While the risk in a competently performed medical circumcision is very low,[51] complications from bleeding, infection and poorly carried out circumcisions can be catastrophic.[52] According to the AMA, blood loss and infection are the most common complications, and most bleeding is minor and can be stopped by applying pressure. Kaplan identified other complications, including urinary fistulas, chordee, cysts, lymphedema, ulceration of the glans, necrosis of all or part of the penis, hypospadias, epispadias, impotence and removal of too much tissue, sometimes causing secondary phimosis. He stated “Virtually all of these complications are preventable with only a modicum of care" and "most such complications occur at the hands of inexperienced operators who are neither urologists nor surgeons.â€[53]
Complication rates ranging from 0.06% to 55% have been cited. Neonatal circumcision revisited, , , Fetus and Newborn Committee, Canadian Medical Association Journal, 1996 Infant circumcision may result in skin bridges, [54] and meatal stenosis may be a common longer-term complication from circumcision. [55] [56] The RACP states that the penis is lost in 1 in 1,000,000 circumcisions. Complications Of Circumcision
Deaths have been reported.[57]
The American Academy of Family Physicians states that death is rare, and cites an estimated death rate of 1 infant in 500,000 from circumcision. Gairdner's 1949 study reported that an average of 16 children per year out of about 90,000 died following circumcision in the UK. He found that most deaths had occurred suddenly under anaesthesia and could not be explained further, but hemorrhage and infection had also proven fatal. Deaths attributed to phimosis and circumcision were grouped together, but Gairdner argued that such deaths were probably due to the circumcision operation. The Fate of the Foreskin, , Douglas, Gairdner, British Medical Journal, 1949
Adult circumcisions are often performed without clamps, and require 4 to 6 weeks of abstinence from masturbation or intercourse after the operation to allow the wound to heal.11
Three randomised control trials published since 2005 confirm that adult male circumcision results in a 50-60% reduction in risk of HIV transmission from female to male.[58]
In 2007, the World Health Organisation and UNAIDS recommended that male circumcision should now be recognized as an efficacious intervention for HIV prevention,10 but emphasised that it does not provide complete protection against HIV infection.[59]
McCoombe ''et al.'' stated that a layer of keratin could provide protection from viral entry, and found that the keratin is thinner on the foreskin than the glans penis, and thinnest on the inner surface of the foreskin.[27]
A meta-analysis found that circumcision is associated with lower rates of syphilis, chancroid and possibly genital herpes. [61]
Studies have found that boys with foreskins tend to have higher rates of various infections and inflammations of the penis than those who are circumcised. Neonatal circumcision and penile problems: an 8-year longitudinal study, , DM, Fergusson, Pediatrics, 1988 [62][63] Several hypotheses have been suggested:
★ The foreskin may harbor bacteria and become infected if it is not cleaned properly.[64]
★ The foreskin may become inflamed if it is cleaned too often with soap.[65]
★ The forcible retraction of the foreskin in boys can lead to infections.
The usual treatment for balanoposthitis is to use topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams.[66]
There are less invasive treatments than circumcision that have been shown to be effective in treating most mild cases of balanitis. HANDBOOK OF DERMATOLOGY & VENEREOLOGY, , T.S., Au, Department of Dermatology—Hospital Pulido Valente, 2003, ISBN 978-962-334-030-4
The less invasive procedures are not as successful in treating balanitis xerotica obliterans, or 'BXO',[67][68][69] which is much less common but harder to treat.[70] Circumcision is believed to reliably reduce the threat of BXO.[71]
Several studies have shown that uncircumcised men are at greater risk of human papilloma virus (HPV) infection.[72][73] One study found no statistically significant difference in HPV infection between circumcised and uncircumcised men, but did note a significantly higher incidence of urethritis in the uncircumcised.[74]
Twelve studies have indicated that neonatal circumcision reduces the rate of Urinary tract infections (UTI's) in male infants by a factor of about 10.[75] Some UTI studies have been criticized for not taking into account a high rate of UTI's among premature infants, [2] who are usually not circumcised because of their fragile health status. The AMA states that “depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI."
Penile cancer affects approximately 1 in 100,000 to 1 in 10,000 men per year, varying by region. Studies have reported a rate of penile cancer from 3 to 22 times higher in uncircumcised than circumcised men. [76][77]
The American Academy of Pediatrics (1999) stated that studies suggest that neonatal circumcision confers some protection from penile cancer, but circumcision at a later age does not seem to confer the same level of protection. Further, because penile cancer is a rare disease, the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, remains low.
The American Academy of Family Physicians (2007) recommends that physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering circumcision for newborn boys. Circumcision: Position Paper on Neonatal Circumcision
The American Academy of Pediatrics (1999) found both potential benefits and risks in infant circumcision. It felt that there was insufficient data to recommend routine neonatal circumcision, and recommended that parental decisions on circumcision should be made with as much accurate and unbiased information as possible, taking medical, cultural, ethnic, traditional, and religious factors into account. The AAP also recommended using analgesia as a safe and effective method for reducing pain associated with circumcision, and that circumcision on newborns only be performed on infants who are stable and healthy.
“Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided. If circumcision is performed in the newborn period, it should only be done on infants who are stable and healthy.â€
The American Medical Association supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics.
The American Urological Association (2007) recommends "that circumcision should be presented as an option for health benefits."[78]
The Fetus and Newborn Committee of the Canadian Paediatric Society posted "Circumcision: Information for Parents" in November 2004, Circumcision: Information for parents
and "Neonatal circumcision revisited" in 1996. The 1996 position statement says that "circumcision of newborns should not be routinely performed," (a statement with which the Royal Australasian College of Physicians concurs,) and the 2004 advice to parents says it "does not recommend circumcision for newborn boys. Many
paediatricians no longer perform circumcisions."
Neonatal circumcision revisited, , , Fetus and Newborn Committee, Canadian Medical Association Journal, 1996
“We undertook this literature review to consider whether the CPS should change its position on routine neonatal circumcision from that stated in 1982. The review led us to conclude the following. There is evidence that circumcision results in an approximately 12-fold reduction in the incidence of UTI during infancy. The overall incidence of UTI in male infants appears to be 1% to 2%. The incidence rate of the complications of circumcision reported in published articles varies, but it is generally in the order of 0.2% to 2%. Most complications are minor, but occasionally serious complications occur. There is a need for good epidemiological data on the incidence of the surgical complications of circumcision, of the later complications of circumcision and of problems associated with lack of circumcision. Evaluation of alternative methods of preventing UTI in infancy is required. More information on the effect of simple hygienic interventions is needed. Information is required on the incidence of circumcision that is truly needed in later childhood. There is evidence that circumcision results in a reduction in the incidence of penile cancer and of HIV transmission. However, there is inadequate information to recommend circumcision as a public health measure to prevent these diseases. When circumcision is performed, appropriate attention needs to be paid to pain relief. The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns. There is therefore no indication that the position taken by the CPS in 1982 should be changed. When parents are making a decision about circumcision, they should be advised of the present state of medical knowledge about its benefits and harms. Their decision may ultimately be based on personal, religious or cultural factors.
The British Medical Association's position (June 2006) was that male circumcision for medical purposes should only be used where less invasive procedures are either unavailable or not as effective. The BMA specifically refrained from issuing a policy regarding “non-therapeutic circumcision,†stating that as a general rule, it “believes that parents should be entitled to make choices about how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices.â€
The law and ethics of male circumcision - guidance for doctors Medical Ethics Committee
The Royal Australasian College of Physicians states 'there is no medical indication for routine neonatal circumcision' (emphasis as in the original). It states, "If the operation is to be performed, the medical attendant should ensure this is done by a competent operator, using appropriate anaesthesia and in a safe child-friendly environment"
Main articles: History of male circumcision
It has been variously proposed that circumcision began as a religious sacrifice, as a rite of passage marking a boy's entrance into adulthood, as a form of sympathetic magic to ensure virility, as a means of suppressing (or enhancing) sexual pleasure or to increase a man's attractiveness to women, or as an aid to hygiene where regular bathing was impractical, among other possibilities. It has been suggested that the custom of circumcision gave advantages to tribes that practiced it and thus led to its spread regardless of whether the people understood this.[79]
It is possible that circumcision arose independently in different cultures for different reasons.
The oldest documentary evidence for circumcision comes from ancient Egypt.[80] Circumcision was common, although not universal, among ancient Semitic peoples. [81] In the aftermath of the conquests of Alexander the Great, however, Greek dislike of circumcision led to a decline in its incidence among many peoples that had previously practised it. [82]
There are several hypotheses to explain why infant circumcision was accepted in the United States about the year 1900. The success of the germ theory of disease made surgery safer, and made the public suspicious of dirt and bodily secretions, so circumcision was seen as good penile hygiene.[4] Some of the other possible reasons include because it was thought to be a way to discourage masturbation, [83] and to protect against syphilis.[84]
Infant circumcision was taken up in the United States, Australia and the English-speaking parts of Canada, South Africa and to a lesser extent in the United Kingdom and New Zealand. Although it is difficult to determine historical circumcision rates, one estimate[6] of infant circumcision rates in the United States holds that 30% of newborn American boys were being circumcised in 1900, 55% in 1925, and 72% in 1950.
In 1949, the United Kingdom's newly-formed National Health Service removed infant circumcision from its list of covered services. Since then, circumcision has been an out-of-pocket cost to parents, and the proportion of newborns circumcised in England and Wales has fallen to less than one percent. In Canada, individual provincial health services began delisting circumcision in the 1980s.
In South Korea, circumcision grew in popularity following the establishment of the United States trusteeship in 1945 and the spread of American influence. More than 90% of South Korean high school boys are now circumcised, but the average age of circumcision is 12 years.[85]
In some South African ethnic groups, circumcision has roots in several belief systems, and is performed most of the time on teenage boys.
A study in 1987 found that the prominent reasons for parents choosing circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns.[7] A 2005 study speculated that increased recognition of the potential benefits may be responsible for an observed increase in the rate of neonatal circumcision in the USA between 1988 and 2000.[8]
Main articles: Prevalence of circumcision
Estimates of the proportion of males that are circumcised worldwide vary from one sixth (12.5%)[86] to one third (33.3%).[87] According to one author, the practice is "a falling trend internationally",[88] although another notes indications of increasing demand in Southern Africa.[89]
It has been estimated on the basis of an academic medical survey that some 78% of South Korean men may be circumcised, possibly the largest absolute number of teenage or adult circumcisions anywhere in the world. [90] For the United States, statistics from different sources give widely varying estimates of circumcision rates, from 55.9% National Hospital Discharge Survey: 2003 annual summary with detailed diagnosis and procedure data., , LJ, Kozak, Vital Health Statistics, 2006 to 91%[27]
Rickwood ''et al'' reported that the proportion of English boys circumcised for medical reasons had fallen from 35% in the early 1930s to 6.5% by the mid-1980s. An estimated 3.8% of male children in the UK in 2000 were being circumcised by the age of 15 [9].
According to the Sydney Morning Herald, the infant circumcision rate in Australia was 12.9% in 2003.[92] In 1986, only 511 out of approximately 478,000 Danish boys aged 0-14 years were circumcised. This corresponds to a cumulative national circumcision rate of around 1.6% by the age of 15 years.
[10].
★ Brit milah
★ Circumcision scar
★ Foreskin restoration
★ Genital integrity
★ Holy Prepuce
★ Preputioplasty, alternative to circumcision in the treatment for phimosis
★ Zeved habat
1. Surgery:
★ "Male circumcision is the surgical removal of all or part of the foreskin of the penis." Information Package on Male Ci rcumcision and HIV Prevention:Insert 1, World Health Organization
★ "Circumcision, surgical removal of all or part of the foreskin of the human male...", "Circumcision", Microsoft Encarta, 2007.
★ "Male circumcision is an elective surgery to remove the foreskin..." Circumcision, British Columbia Health Guide, June 2, 2006. Retrieved July 18, 2007.
★ "Circumcision is surgery..." Pain and Your Infant: Medical Procedures, Circumcision and Teething, University of Michigan Health System, February 2007. Retrieved July 18, 2007.
★ " Circumcision is cutting away part of the foreskin... When this surgery is performed..." Newborn Care, Danbury Hospital website. Retrieved July 18, 2007.
2. http://www.cirp.org/library/history/hodges2 See 'Egyptians'
3. Historical review: Circumcision, , P., Wrana, Archives of Pediatrics, 1939 as quoted in: Male Circumcision: A Gender Perspective, , Joseph, Zoske, Journal of Men’s Studies, 1998
4. Circumcision
5.
6. Insert 2
7. Benefits of newborn circumcision: is Europe ignoring medical evidence?, , Edgar J, Schoen, Archives of Disease in Childhood, 1997
8. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial, , Robert C, Bailey, The Lancet,
9. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial, , Ronald H, Gray, The Lancet,
10.
11.
12. Carcinoma of the penis: experience from 360 cases, Rempelakos A, , , J BUON, 2004
13. Phimosis: Is circumcision necessary?, , P.A., Dewan, Journal of Paediatrics and Child Health, 1996
14. The causes of adolescent phimosis, , Michel, Beaugé, British Journal of Sexual Medicine, 1997
15.
16.
17.
18. Use of the Mogen clamp for neonatal circumcision, , RD, Reynolds, American Family Physician, 1996
19. Frenular chordee: implications and treatment, Griffin A, Kroovand R, , , Urology, 1990
20. Religious circumcision: a Jewish view, , J.M., Glass, BJU International, 1999
21. Mattson CL, Bailey RC, Muga R, Poulussen R, Onyango T (2005) Acceptability of male circumcision and predictors of circumcision preference among men and women in Nyanza province Kenya. AIDS Care 17:182–194.
22. Greek Orthodox Archdiocese calendar of Holy Days
23. Russian Orthodox Church, Patriarchate of Moscow
24. Question #9412: Circumcision: how it is done and the rulings on it
25. Question #7073: The health and religious benefits of circumcision
26. Ajuwon et al., "Indigenous surgical practices in rural southwestern Nigeria: Implications for disease," Health Educ. Res..1995; 10: 379-384 Health Educ. Res..1995; 10: 379-384 Retrieved 3 October 2006
27.
28. Migration and Trade
29.
30. RECENT GUEST SPEAKER
31. Weird & Wonderful
32. Circumcision amongst the Dogon
33. Aesthetics and Rituals of the Opha Ceremony among the Urhobo People, , John Tokpabere, Agberia, Journal of Asian and African Studies, 2006
34. Masai of Kenya
35. Similarities in Attitudes and Misconceptions toward Infant Male Circumcision in North America and Ritual Female Genital Mutilation in Africa.
36. How not to argue about circumcision, , David, Benatar, American Journal of
Bioethics, 2003
37. Male circumcision: assessment of health benefits and risks, Moses, S, , , Sex Transm Infect, 1998
38. The psychological impact of circumcision, , R., Goldman, BJU International, 1999
39. Sweden restricts circumcisions
40. Jews protest Swedish circumcision restriction Reuters
41. Sweden Bureau of Democracy, Human Rights, and Labor
42. Pain relief for neonatal circumcision, , B, Brady-Fryer, The Cochrane Database of Systematic Reviews, 2004
43. Pain management for newborn circumcision, Razmus I, Dalton M, Wilson D, , , Pediatr Nurs,
44. The use of topical lidocaine/prilocaine cream prior to childhood circumcision under local anesthesia, , WT, Ng, Ambul Surg, 2001
45. Male circumcision: pain, trauma, and psychosexual sequelae
46. Cost Analysis of Neonatal Circumcision in a Large Health Maintenance Organization, , Edgar J., Schoen, The Journal of Urology, 2006
47. Neonatal Circumcision: A Review of the World’s Oldest and Most Controversial Operation, , Mark C., Alanis, Obstetrical & Gynecological Survey, 2004
48. A Cost-Utility Analysis of Neonatal Circumcision, , Robert S., Van Howe, Medical Decision Making, 2004
49. Routine neonatal circumcision: a cost-utility analysis, , TG, Ganiats, Medical Decision Making, 1991
50. Circumcision: a decision analysis of its medical value., , FH, Lawler, Family Medicine, 1991
51. A Trade-off Analysis of Routine Newborn Circumcision, , Dmitry A., Christakis, Pediatrics, 2000
52.
53. Complications of Circumcision, , George W., M.D., Kaplan, UROLOGIC CLINICS OF NORTH AMERICA, 1983
54. Office Management of Penile Skin Bridges with Electrocautery, , Sody A., Naimer, Journal of the American Board of Family Practice, 2002
55. Late complications of circumcision in Iran, , Rooh-Allah, Yegane, Pediatric Surgery International, 2006
56. http://www.emedicine.com/PED/topic2356.htm
57. Coroner's Corner Circumcision: A minor procedure? Paediatric Death Review Committee: Office of the Chief Coroner of Ontario
58. WHO and UNAIDS Secretariat welcome corroborating findings of trials assessing impact of male circumcision on HIV risk
59. WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention
60.
61. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis, , HA, Weiss, Sex Transm Infect, 2006
62. An argument for circumcision. Prevention of balanitis in the adult, , N, Fakjian, Arch Dermatol, 1990
63. The frequency of foreskin problems in uncircumcised children, , LW, Herzog, Am J Dis Child, 1986
64. Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study, , Nigel, O’Farrel, International Journal of STD & AIDS, 2005
'Editor’s note: I cannot confirm that the article substantiates the claim as I cannot access the full article.
65. Clinical Features and management of recurrent balanitis; association with atopy and genital washing, , , Birley, Genitourinary Medicine, 1993
66. Balanoposthitis
67. The response of clinical balanitis xerotica obliterans to the application of topical steroid-based creams, , Michelle Valerie, Vincent, Journal of Pediatric Surgery, 2005
68. The treatment of childhood phimosis with topical steroid, , J.E., Wright, The Australian and New Zealand journal of surgery, 1994
69. Topical steroid therapy for phimosis, , T.M., Webster, The Canadian journal of urology, 2002
70. http://www.emedicine.com/derm/topic46.htm
71. Lichen sclerosus et atrophicus in children with phimosis and hypospadias, , G., Mattioli, Pediatric Surgery International, 2002
72. Male circumcision, penile human papillomavirus infection, and cervical cancer, , Xavier, Castellsagué, The New England Journal of Medicine, 2002
73. Determinants of Prevalence, Acquisition, and Persistence of Human Papillomavirus in Healthy Mexican Military Men, , MartÃn, Lajous, Cancer Epidemiology Biomarkers and Prevention, July
74. Developmental factors of urethral human papillomavirus lesions: correlation with circumcision, , O., Aynaud, BJU International, July
75. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies, , D., Singh-Grewal, Archives of Disease in Childhood,
76. History of circumcision, medical conditions, and sexual activity and risk of penile cancer, , C, Maden, J Natl Cancer Inst, 1993
77. The highly protective effect of newborn circumcision against invasive penile cancer, , EJ, Schoen, Pediatrics, 2000
78. Circumcision American Urological Association
79. A Biocultural Analysis of Circumcision, Ronald Immerman and Wade Mackey, , , Social Biology, 1997
80. Tomb artwork from the Sixth Dynasty (2345-2181 BCE) shows men with circumcised penises, and one relief from this period shows the rite being performed on a standing adult male. The Egyptian hieroglyph for "penis" depicts either a circumcised or an erect organ. The examination of Egyptian mummies has found some with foreskins and others who were circumcised.
81. The Book of Jeremiah, written in the sixth century BCE, lists the Egyptians, Jews, Edomites, Ammonites, and Moabites as circumcising cultures. Herodotus, writing in the fifth century BCE, would add the Colchians, Ethiopians, Phoenicians, and Syrians to that list.
82. The writer of the 1 Maccabees wrote that under the Seleucids, many Jewish men attempted to hide or reverse their circumcision so they could exercise in Greek gymnasia, where nudity was the norm. First Maccabees also relates that the Seleucids forbade the practice of brit milah (Jewish circumcision), and punished those who performed it–as well as the infants who underwent it–with death.
83. [5] ''All About the Baby'', a popular parenting book of the 1890s, recommended infant circumcision for this purpose. (However, a survey of 1410 men in the United States in 1992, Laumann found that circumcised men were ''more'' likely to report masturbating at least once a month.)
84. On the influence of circumcision in preventing syphilis, , , , Medical Times and Gazette, 1855
85. Extraordinarily high rates of male circumcision in South Korea: history and underlying causes, , MG, Pang, BJU Int, 2002
86. Complications of circumcision (full text), , N, Williams, British Journal of Surgery, 1993
87. Crawford DA. Circumcision: a consideration of some of the controversy. ''J Child Health Care.'' 2002 December;6(4):259-70. PMID 12503896
88. Circumcision in Western Australia, , Z., StanWisniewski, ANZ Journal of Surgery, 2004
89. Demand for male circumcision rises in a bid to prevent HIV, , , , Bulletin of the World Health Organization, 2006
90. J.H. Ku, M.E. Kim, N.K. Lee and Y.H. Park, "Circumcision practice patterns in South Korea: community based survey" (Sex Transm Inf 2003;79:65-67 http://sti.bmjjournals.com/cgi/content/full/79/1/65 retrieved 1 October 2006
91.
92. Circumcision rates rise for some
★ The Circumcision Information and Resource Pages by Geoffrey T. Falk
★ Doctors Opposing Circumcision presided by George C. Denniston, MD, MPH
★ National Organization of Circumcision Information Resource Centers by Marilyn Milos, RN
★ Intactivism: pictures of skin bridges
★ Benefits of circumcision: medical, health and sexual by Professor Brian Morris
★ Circumcision: a lifetime of medical benefits by Edgar Schoen, BSc., M.D.
★ Circumcision Information by Gerald N. Weiss, M.D.
★ Description of an adult circumcision from the American Academy of Family Physicians.
★ Description of a Plastibell circumcision from the Medical College of Georgia.
★ Billy Ray Boyd. ''Circumcision Exposed: Rethinking a Medical and Cultural Tradition.'' Freedom, CA: The Crossing Press, 1998. (ISBN 978-0-89594-939-4)
★ Anne Briggs. ''Circumcision: What Every Parent Should Know.'' Charlottesville, VA: Birth & Parenting Publications, 1985. (ISBN 978-0-9615484-0-7)
★ Robert Darby. ''A surgical temptation: The demonization of the foreskin and the rise of circumcision in Britain.'' Chicago: University of Chicago Press, 2005. (ISBN 978-0-226-13645-5)
★ Aaron J. Fink, M.D. ''Circumcision: A Parent's Decision for Life''. Kavanah Publishing Company, Inc., 1988. (ISBN 978-0-9621347-0-8)
★ Paul M. Fleiss, M.D. and Frederick Hodges, D. Phil. ''What Your Doctor May'' Not ''Tell You About Circumcision.'' New York: Warner Books, 2002. (ISBN 978-0-446-67880-3)
★ Leonard B. Glick. ''Marked in Your Flesh: Circumcision from Ancient Judea to Modern America.'' New York: Oxford University Press, 2005. (ISBN 978-0-19-517674-2)
★ David L. Gollaher. ''Circumcision: A History of the World's Most Controversial Surgery.'' New York: Basic Books, 2000. (ISBN 0465026532)
★ Ronald Goldman, Ph.D. ''Circumcision: The Hidden Trauma.'' Boston: Vanguard, 1996. (ISBN 978-0-9644895-3-0)
★ Paysach J. Krohn, Rabbi. ''Bris Milah. Circumcision-The Covenant Of Abraham/A Compendium of Laws, Rituals, And Customs From Birth To Bris, Anthologized From Talmudic, And Traditional Sources.'' New York: Mesorah Publications, 1985, 2005.
★ Brian J. Morris, Ph.D., D.Sc. ''In Favour of Circumcision.'' Sydney: UNSW Press, 1999. (ISBN 978-0-86840-537-7)
★ Rosemary Romberg. ''Circumcision: The Painful Dilemma.'' South Hadley, MA Bergan & Garvey, 1985. (ISBN 978-0-89789-073-1)
★ Edgar J Schoen, M.D. ''Ed Schoen, MD on Circumcision.'' Berkeley, CA: RDR Books, 2005. (ISBN 978-1-57143-123-3)
★ Edward Wallerstein. ''Circumcision: An American Health Fallacy.'' New York: Springer, 1980 (ISBN 978-0-8261-3240-6)
★ Gerald N. Weiss M.D. and Andrea W Harter. ''Circumcision: Frankly Speaking.'' Wiser Publications, 1998. (ISBN 978-0-9667219-0-4)
★ Yosef David Weisberg, Rabbi. ''Otzar Habris. Encyclopedia of the laws and customs of Bris Milah and Pidyon Haben.'' Jerusalem: Hamoer, 2002.
Family circumcision set and trunk, ca. eighteenth century
Wooden box covered in cow hide with silver implements: silver trays, clip, pointer, silver flask, spice vessel.
Wooden box covered in cow hide with silver implements: silver trays, clip, pointer, silver flask, spice vessel.
'Circumcision' is a surgical procedure that removes some or all of the foreskin (prepuce) from the penis.[1] The word "circumcision" comes from Latin ''circum'' (meaning "around") and ''caedere'' (meaning "to cut").
Circumcision predates recorded human history, with depictions in stone-age cave drawings and Ancient Egyptian tombs, though some depictions may be open to interpretation.[2][3] Theories include that circumcision is a form of ritual sacrifice or offering, a health precaution, a sign of submission to a deity, a rite of passage to adulthood, a mark of defeat or slavery, or an attempt to alter esthetics or sexuality.
Male circumcision is a religious commandment in Judaism as well as in Islam,[4][5] and customary in some Oriental Orthodox and other Christian churches in Africa.Customary in some Coptic and other churches:
★ "The Coptic Christians in Egypt and the Ethiopian Orthodox Christians— two of the oldest surviving forms of Christianity— retain many of the features of early Christianity, including male circumcision. Circumcision is not prescribed in other forms of Christianity... Some Christian churches in South Africa oppose the practice, viewing it as a pagan ritual, while others, including the Nomiya church in Kenya, require circumcision for membership and participants in focus group discussions in Zambia and Malawi mentioned similar beliefs that Christians should practice circumcision since Jesus was circumcised and the Bible teaches the practice." Male Circumcision: context, criteria and culture (Part 1), Joint United Nations Programme on HIV/AIDS, February 26, 2007.
★ "The decision that Christians need not practice circumcision is recorded in Acts 15; there was never, however, a prohibition of circumcision, and it is practiced by Coptic Christians." "circumcision", The Columbia Encyclopedia, Sixth Edition, 2001-05.
Circumcision is common in the Middle East, the USA and parts of Africa and Asia.
According to WHO, 30% of men worldwide have had the procedure, mostly in countries where it is common for religious or cultural reasons.[6]
Genital integrity supporters condemn infant circumcision as a human rights abuse and a genital mutilation like female genital cutting Circumcision: A medical or a human rights issue?, , Marilyn Fayre, Milos, Journal of Nurse-Midwifery, 1992
, while advocates of circumcision regard it as a worthwhile public health measure,[7] particularly in the control of HIV. Male circumcision to cut HIV risk in the general population, , Marie-Lousie, Newell, The Lancet,
[8][9]
Since March 2007 the World Health Organization and UNAIDS recognize male circumcision as an efficacious intervention for HIV prevention, while cautioning that male circumcision only provides partial protection and should not replace other interventions to prevent heterosexual transmission of HIV.[10]
Circumcision may also be used to treat inflammation of the glans and penile cancer.[11][12] Using circumcision to treat phimosis (see section below) is debated in medical literature.[13][14]
Circumcision procedures
Circumcision removes the foreskin from the penis. For infant circumcision, clamps, such as the Gomco clamp, Plastibell, and Mogen are often used.[15] Clamps are designed to cut the blood supply to the foreskin, stop any bleeding and protect the glans. Before using a clamp, the foreskin and the glans are separated with a blunt probe and/or curved hemostat.
★ With the Plastibell, the foreskin and the clamp come away in three to seven days.
★ With a Gomco clamp, a section of skin is first crushed with a hemostat then slit with scissors. The foreskin is drawn over the bell shaped portion of the clamp and inserted through a hole in the base of the clamp and the clamp is tightened, "crushing the foreskin between the bell and the base plate." The crushing limits bleeding (provides hemostasis). While the flared bottom of the bell fits tightly against the hole of the base plate, the foreskin is then cut away with a scalpel from above the base plate. The bell prevents the glans being reached by the scalpel.[16]
★ With a Mogen clamp, the foreskin is grabbed dorsally with a straight hemostat, and lifted up. The Mogen clamp is then slid between the glans and hemostat, following the angle of the corona to "avoid removing excess skin ventrally and to obtain a superior cosmetic result," than with Gomco or Plastibell circumcisions. The clamp is locked shut, and a scalpel is used to cut the foreskin from the flat (upper) side of the clamp.[17][18]
The frenulum is cut if frenular chordee is evident.[19]
Cultures and religions
Main articles: Circumcision in the Bible
Circumcising cultures may circumcise their males either shortly after birth, during childhood or around puberty as part of a rite of passage. Circumcision is most prevalent in Muslim countries, Israel, the United States, the Philippines and South Korea and is most prevalent in the Jewish and Muslim faiths. It is less common in Europe, Latin America, China and India.
Circumcision is a positive commandment obligatory under Jewish law for Jewish males, and is only postponed or abrogated in the case of threat to the life or health of the child.[20] It is usually performed by a ''mohel'' on the eighth day after birth in a ceremony called a ''Brit milah'' (or ''Bris milah'', colloquially simply ''bris'') (Hebrew for "Covenant of circumcision").
While in most countries, Christians do not circumcise, The Arabian Nights, tales from a thousand and one nights, , Richard, Burton, , ,
it is customary among the Coptic, Ethiopian, and Eritrean Orthodox Churches, and also some other African churches. Some Christian churches in South Africa oppose circumcision, viewing it as a pagan ritual, while others, including the Nomiya church in Kenya[21], require circumcision for membership. Some Christian churches celebrate the Circumcision of Christ. [22][23]
In Islam, circumcision is mentioned in some ''hadith'', but not in the Qur'an. Some Fiqh scholars state that circumcision is ''recommended'' (Sunnah); others that it is ''obligatory''.[24] Some have quoted the ''hadith'' to argue that the requirement of circumcision is based on the covenant with Abraham.[25]
Circumcision in South Korea is largely the result of American cultural and military influence following the Korean War. In West Africa infant circumcision may have had tribal significance as a rite of passage or otherwise in the past; today in some non-Muslim Nigerian societies it is medicalised and is simply a cultural norm.[26]
Circumcision is part of initiation rites in some African, Pacific Islander, and Australian aboriginal traditions in areas such as Arnhem Land,[27] where the practice was introduced by Makassan traders from Sulawesi in the Indonesian Archipelago.[28] Circumcision ceremonies among certain Australian aboriginal societies are noted for their painful nature, including subincision for some aboriginal peoples in the Western Desert.[29]
In the Pacific, ritual circumcision is nearly universal in the Melanesian islands of Fiji and Vanuatu;[30] participation in the traditional land diving on Pentecost Island is reserved for those who have been circumcised.[31]
Circumcision is also commonly practised in the Polynesian islands of Samoa, Tonga, Niue, and Tikopia. In Samoa, it is accompanied by a celebration. Among some West African animist groups, such as the Dogon and Dowayo, it is taken to represent a removal of "feminine" aspects of the male, turning boys into fully masculine males.[32] Among the Urhobo of southern Nigeria it is symbolic of a boy entering into manhood. The ritual expression, ''Omo te Oshare'' ("the boy is now man"), constitutes a rite of passage from one age set to another.[33] For Nilotic peoples, such as the Kalenjin and Maasai, circumcision is a rite of passage observed collectively by a number of boys every few years, and boys circumcised at the same time are taken to be members of a single age set.[34]
Ethical, emotional and legal considerations
Ethical issues
Main articles: Bioethics of neonatal circumcision
The American Medical Association defines “non-therapeutic†circumcision as the non-religious, non-ritualistic, not medically necessary, elective circumcision of male newborns. It states that medical associations in the US, Australia, and Canada do not recommend the routine non-therapeutic circumcision of newborns. Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision
Those advocating circumcision assert that circumcision is a significant public health measure, preventing infections, and slowing down the spread of AIDS. Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial, , Bertran, Auvert, PLoS Medicine, 2005
Those opposing circumcision, however, question the legality of infant circumcision by asserting that infant circumcision is a human rights violation or a sexual assault.
Involuntary circumcision: the legal issues, , R.S., Van Howe, BJU International, 1999
Consent
Views differ on whether limits should be placed on caregivers having a child circumcised.
Somerville argues that the nature of the medical benefits cited as a justification for infant circumcision are such that the potential medical problems can be avoided or, if they occur, treated in far less invasive ways than circumcision. She states that the removal of healthy genital tissue from a minor should not be subject to parental discretion, or that physicians who perform the procedure are not acting in accordance with their ethical duties to the patient, regardless of parental consent. Another argument questions why the genital cutting of males is allowed while the genital cutting of females is prohibited.[35]
Others argue that there is no convincing evidence of sexual or emotional harm, and that there are greater monetary and psychological costs in circumcising later rather than in infancy.[36]
Some medical associations accept that the parents should determine what is in the best interest of the infant or child,
but the Royal Australasian College of Physicians (RACP) and the British Medical Association (BMA) observe that controversy exists on this issue. Policy Statement On Circumcision
The law and ethics of male circumcision - guidance for doctors Medical Ethics Committee
The BMA insists that a circumcision must not go ahead without the consent of both parents and the competent child.
Emotional consequences
Moses ''et al.'' (1998) state that "scientific evidence is lacking" for psychological and emotional harm, and cite a longitudinal study finding no difference in developmental and behavioural indices.[37] Goldman (1999) discussed the possible trauma of circumcision on children and parents, anxieties over the circumcised state, a tendency to repeat the trauma, and suggested a need on the part of circumcised doctors to find medical justifications for the procedure.[38] Some organizations have been formed as support groups for men who are resentful about being circumcised.
Legality
Main articles: Circumcision and law
Traditionally, circumcision has been presumed to be legal when performed by a trained operator.
In 2001, Sweden allowed only persons certified by the National Board of Health to circumcise infants, requiring a medical doctor or an anesthesia nurse to accompany the circumciser and for anaesthetic to be applied beforehand. Jews and Muslims in Sweden objected to the law,[39] and in 2001, the World Jewish Congress stated that it was “the first legal restriction on Jewish religious practice in Europe since the Nazi era.â€[40] However, in 2006, the United States State Department stated, in a report on Sweden, that most Jewish mohels had been certified under the law and 3000 Muslim and 40-50 Jewish boys were circumcised each
year. The National Board of Health and Welfare reviewed the law in 2005 and recommended that it be maintained.[41]
Pain and pain relief during circumcision
According to the American Academy of Pediatrics' 1999 Circumcision Policy Statement, “There is considerable evidence that newborns who are circumcised without analgesia experience pain and psychologic stress.†In the statement, the Academy recommends the use of pain relief for circumcision. One of the supporting studies, Taddio 1997, found a correlation between circumcision and intensity of pain response during vaccination months later. They acknowledge that there may be "other factors" besides circumcision that account for different levels of pain response, but stated that they did not find evidence of such. They concluded "[p]retreatment and postoperative management of neonatal circumcision pain is recommended based on these results." Effect of neonatal circumcision on pain response during subsequent routine vaccination, , Anna, Taddio, The Lancet, 1997
Other medical associations also cite evidence that circumcision without anesthetic is painful. Circumcision: Position Paper on Neonatal Circumcision
Stang, 1998, found 45% of physicians used anaesthesia - most commonly a dorsal penile nerve block - for infant circumcisions. Obstetricians used anaesthesia significantly less often (25%) than family practitioners (56%) or pediatricians (71%).
J.M. Glass, 1999, stated that Jewish ritual circumcision is so quick that "most ''mohelim'' do not routinely use any anaesthesia as they feel there is probably no need in the neonate. However, there is no Talmudic objection and should the parents wish for local anaesthetic cream to be applied there is no reason why this cannot be done." Tannenbaum and Shechet, 2000, stated that an “authentic, traditional bris performed by a mohel does not use clamps, so there is no pain associated with crushing tissue.†Circumcision---The Debates Goes On, , Jacob, Shechet, Pediatrics, 2000
They also asserted that due to the speed of the procedure and rarity of complication, it is “more humane not to subject the infant to a local anesthetic.â€
Lander ''et al.'', found that babies circumcised without pain relief "exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the circumcision and following. Two newborns ... became ill following circumcision (choking and apnea)."[1] A 2004 Cochrane review, which compared the dorsal penile nerve block and EMLA (topical anaesthesia) found both anaesthetics appear safe, but neither of them completely eliminated pain.[42] Razmus et al reported that newborns circumcised with the dorsal block and the ring block in combination with the concentrated oral sucrose had the lowest pain scores.[43] Ng ''et al'' found that EMLA cream, in addition to local anaesthetic, effectively reduces the sharp pain induced by needle puncture.[44]
Sexual effects
Main articles: Sexual effects of circumcision
The American Academy of Pediatrics (1999) stated "a survey of adult males using self-report suggests more varied sexual practice and less sexual dysfunction in circumcised adult men. There are anecdotal reports that penile sensation and sexual satisfaction are decreased for circumcised males. Masters and Johnson noted no difference in exteroceptive and light tactile discrimination on the ventral or dorsal surfaces of the glans penis between circumcised and uncircumcised men." In January 2007, The American Academy of Family Physicians (AAFP) stated "The effect of circumcision on penile sensation or sexual satisfaction is unknown. Because the epithelium of a circumcised glans becomes cornified, and because some feel nerve over-stimulation leads to desensitization, many believe that the glans of a circumcised penis is less sensitive. ... No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."
Boyle ''et al.'' (2002) stated that "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings—many of which are lost to circumcision."[45] They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."
Medical aspects
Main articles: Medical analysis of circumcision
The British Medical Association, states “there is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research.†Cost-benefit analyses have varied. Some found a small net benefit of circumcision,[46][47] some found a small net decrement,[48][49] and one found that the benefits and risks balanced each other out and suggested that the decision could "most reasonably be made on nonmedical factors."[50]
Risks of circumcision
Main articles: Medical analysis of circumcision
While the risk in a competently performed medical circumcision is very low,[51] complications from bleeding, infection and poorly carried out circumcisions can be catastrophic.[52] According to the AMA, blood loss and infection are the most common complications, and most bleeding is minor and can be stopped by applying pressure. Kaplan identified other complications, including urinary fistulas, chordee, cysts, lymphedema, ulceration of the glans, necrosis of all or part of the penis, hypospadias, epispadias, impotence and removal of too much tissue, sometimes causing secondary phimosis. He stated “Virtually all of these complications are preventable with only a modicum of care" and "most such complications occur at the hands of inexperienced operators who are neither urologists nor surgeons.â€[53]
A circumcised penis with a skin bridge.
Complication rates ranging from 0.06% to 55% have been cited. Neonatal circumcision revisited, , , Fetus and Newborn Committee, Canadian Medical Association Journal, 1996 Infant circumcision may result in skin bridges, [54] and meatal stenosis may be a common longer-term complication from circumcision. [55] [56] The RACP states that the penis is lost in 1 in 1,000,000 circumcisions. Complications Of Circumcision
Deaths have been reported.[57]
The American Academy of Family Physicians states that death is rare, and cites an estimated death rate of 1 infant in 500,000 from circumcision. Gairdner's 1949 study reported that an average of 16 children per year out of about 90,000 died following circumcision in the UK. He found that most deaths had occurred suddenly under anaesthesia and could not be explained further, but hemorrhage and infection had also proven fatal. Deaths attributed to phimosis and circumcision were grouped together, but Gairdner argued that such deaths were probably due to the circumcision operation. The Fate of the Foreskin, , Douglas, Gairdner, British Medical Journal, 1949
Adult circumcisions are often performed without clamps, and require 4 to 6 weeks of abstinence from masturbation or intercourse after the operation to allow the wound to heal.11
HIV and other sexually transmitted diseases
Three randomised control trials published since 2005 confirm that adult male circumcision results in a 50-60% reduction in risk of HIV transmission from female to male.[58]
In 2007, the World Health Organisation and UNAIDS recommended that male circumcision should now be recognized as an efficacious intervention for HIV prevention,10 but emphasised that it does not provide complete protection against HIV infection.[59]
McCoombe ''et al.'' stated that a layer of keratin could provide protection from viral entry, and found that the keratin is thinner on the foreskin than the glans penis, and thinnest on the inner surface of the foreskin.[27]
A meta-analysis found that circumcision is associated with lower rates of syphilis, chancroid and possibly genital herpes. [61]
Hygiene, and infectious and chronic conditions
Studies have found that boys with foreskins tend to have higher rates of various infections and inflammations of the penis than those who are circumcised. Neonatal circumcision and penile problems: an 8-year longitudinal study, , DM, Fergusson, Pediatrics, 1988 [62][63] Several hypotheses have been suggested:
★ The foreskin may harbor bacteria and become infected if it is not cleaned properly.[64]
★ The foreskin may become inflamed if it is cleaned too often with soap.[65]
★ The forcible retraction of the foreskin in boys can lead to infections.
The usual treatment for balanoposthitis is to use topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams.[66]
There are less invasive treatments than circumcision that have been shown to be effective in treating most mild cases of balanitis. HANDBOOK OF DERMATOLOGY & VENEREOLOGY, , T.S., Au, Department of Dermatology—Hospital Pulido Valente, 2003, ISBN 978-962-334-030-4
The less invasive procedures are not as successful in treating balanitis xerotica obliterans, or 'BXO',[67][68][69] which is much less common but harder to treat.[70] Circumcision is believed to reliably reduce the threat of BXO.[71]
Several studies have shown that uncircumcised men are at greater risk of human papilloma virus (HPV) infection.[72][73] One study found no statistically significant difference in HPV infection between circumcised and uncircumcised men, but did note a significantly higher incidence of urethritis in the uncircumcised.[74]
Twelve studies have indicated that neonatal circumcision reduces the rate of Urinary tract infections (UTI's) in male infants by a factor of about 10.[75] Some UTI studies have been criticized for not taking into account a high rate of UTI's among premature infants, [2] who are usually not circumcised because of their fragile health status. The AMA states that “depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI."
Penile cancer
Penile cancer affects approximately 1 in 100,000 to 1 in 10,000 men per year, varying by region. Studies have reported a rate of penile cancer from 3 to 22 times higher in uncircumcised than circumcised men. [76][77]
The American Academy of Pediatrics (1999) stated that studies suggest that neonatal circumcision confers some protection from penile cancer, but circumcision at a later age does not seem to confer the same level of protection. Further, because penile cancer is a rare disease, the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, remains low.
Policies of various national medical associations
United States
The American Academy of Family Physicians (2007) recommends that physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering circumcision for newborn boys. Circumcision: Position Paper on Neonatal Circumcision
The American Academy of Pediatrics (1999) found both potential benefits and risks in infant circumcision. It felt that there was insufficient data to recommend routine neonatal circumcision, and recommended that parental decisions on circumcision should be made with as much accurate and unbiased information as possible, taking medical, cultural, ethnic, traditional, and religious factors into account. The AAP also recommended using analgesia as a safe and effective method for reducing pain associated with circumcision, and that circumcision on newborns only be performed on infants who are stable and healthy.
“Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided. If circumcision is performed in the newborn period, it should only be done on infants who are stable and healthy.â€
The American Medical Association supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics.
The American Urological Association (2007) recommends "that circumcision should be presented as an option for health benefits."[78]
Canada
The Fetus and Newborn Committee of the Canadian Paediatric Society posted "Circumcision: Information for Parents" in November 2004, Circumcision: Information for parents
and "Neonatal circumcision revisited" in 1996. The 1996 position statement says that "circumcision of newborns should not be routinely performed," (a statement with which the Royal Australasian College of Physicians concurs,) and the 2004 advice to parents says it "does not recommend circumcision for newborn boys. Many
paediatricians no longer perform circumcisions."
Neonatal circumcision revisited, , , Fetus and Newborn Committee, Canadian Medical Association Journal, 1996
“We undertook this literature review to consider whether the CPS should change its position on routine neonatal circumcision from that stated in 1982. The review led us to conclude the following. There is evidence that circumcision results in an approximately 12-fold reduction in the incidence of UTI during infancy. The overall incidence of UTI in male infants appears to be 1% to 2%. The incidence rate of the complications of circumcision reported in published articles varies, but it is generally in the order of 0.2% to 2%. Most complications are minor, but occasionally serious complications occur. There is a need for good epidemiological data on the incidence of the surgical complications of circumcision, of the later complications of circumcision and of problems associated with lack of circumcision. Evaluation of alternative methods of preventing UTI in infancy is required. More information on the effect of simple hygienic interventions is needed. Information is required on the incidence of circumcision that is truly needed in later childhood. There is evidence that circumcision results in a reduction in the incidence of penile cancer and of HIV transmission. However, there is inadequate information to recommend circumcision as a public health measure to prevent these diseases. When circumcision is performed, appropriate attention needs to be paid to pain relief. The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns. There is therefore no indication that the position taken by the CPS in 1982 should be changed. When parents are making a decision about circumcision, they should be advised of the present state of medical knowledge about its benefits and harms. Their decision may ultimately be based on personal, religious or cultural factors.
United Kingdom
The British Medical Association's position (June 2006) was that male circumcision for medical purposes should only be used where less invasive procedures are either unavailable or not as effective. The BMA specifically refrained from issuing a policy regarding “non-therapeutic circumcision,†stating that as a general rule, it “believes that parents should be entitled to make choices about how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices.â€
The law and ethics of male circumcision - guidance for doctors Medical Ethics Committee
Australasia
The Royal Australasian College of Physicians states 'there is no medical indication for routine neonatal circumcision' (emphasis as in the original). It states, "If the operation is to be performed, the medical attendant should ensure this is done by a competent operator, using appropriate anaesthesia and in a safe child-friendly environment"
History of circumcision
Main articles: History of male circumcision
It has been variously proposed that circumcision began as a religious sacrifice, as a rite of passage marking a boy's entrance into adulthood, as a form of sympathetic magic to ensure virility, as a means of suppressing (or enhancing) sexual pleasure or to increase a man's attractiveness to women, or as an aid to hygiene where regular bathing was impractical, among other possibilities. It has been suggested that the custom of circumcision gave advantages to tribes that practiced it and thus led to its spread regardless of whether the people understood this.[79]
It is possible that circumcision arose independently in different cultures for different reasons.
Ancient Egyptian carved scene of circumcision, from the inner northern wall of the Temple of Khonspekhrod at the Precinct of Mut, Luxor, Egypt. Eighteenth dynasty, Amenhotep III, c. 1360 BC.
'Köçeks at a fair'
Köçek troupe dancing at Sultan Ahmed III's 14-day celebration of his sons' circumcision in 1720. Miniature from the ''Surname-i Vehbi'', Topkapı Palace, Istanbul.
Köçek troupe dancing at Sultan Ahmed III's 14-day celebration of his sons' circumcision in 1720. Miniature from the ''Surname-i Vehbi'', Topkapı Palace, Istanbul.
The oldest documentary evidence for circumcision comes from ancient Egypt.[80] Circumcision was common, although not universal, among ancient Semitic peoples. [81] In the aftermath of the conquests of Alexander the Great, however, Greek dislike of circumcision led to a decline in its incidence among many peoples that had previously practised it. [82]
Medical circumcision in the 19th century and early 20th century
There are several hypotheses to explain why infant circumcision was accepted in the United States about the year 1900. The success of the germ theory of disease made surgery safer, and made the public suspicious of dirt and bodily secretions, so circumcision was seen as good penile hygiene.[4] Some of the other possible reasons include because it was thought to be a way to discourage masturbation, [83] and to protect against syphilis.[84]
Infant circumcision was taken up in the United States, Australia and the English-speaking parts of Canada, South Africa and to a lesser extent in the United Kingdom and New Zealand. Although it is difficult to determine historical circumcision rates, one estimate[6] of infant circumcision rates in the United States holds that 30% of newborn American boys were being circumcised in 1900, 55% in 1925, and 72% in 1950.
Circumcision since 1950
In 1949, the United Kingdom's newly-formed National Health Service removed infant circumcision from its list of covered services. Since then, circumcision has been an out-of-pocket cost to parents, and the proportion of newborns circumcised in England and Wales has fallen to less than one percent. In Canada, individual provincial health services began delisting circumcision in the 1980s.
In South Korea, circumcision grew in popularity following the establishment of the United States trusteeship in 1945 and the spread of American influence. More than 90% of South Korean high school boys are now circumcised, but the average age of circumcision is 12 years.[85]
In some South African ethnic groups, circumcision has roots in several belief systems, and is performed most of the time on teenage boys.
A study in 1987 found that the prominent reasons for parents choosing circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns.[7] A 2005 study speculated that increased recognition of the potential benefits may be responsible for an observed increase in the rate of neonatal circumcision in the USA between 1988 and 2000.[8]
Prevalence of circumcision
Main articles: Prevalence of circumcision
Estimates of the proportion of males that are circumcised worldwide vary from one sixth (12.5%)[86] to one third (33.3%).[87] According to one author, the practice is "a falling trend internationally",[88] although another notes indications of increasing demand in Southern Africa.[89]
It has been estimated on the basis of an academic medical survey that some 78% of South Korean men may be circumcised, possibly the largest absolute number of teenage or adult circumcisions anywhere in the world. [90] For the United States, statistics from different sources give widely varying estimates of circumcision rates, from 55.9% National Hospital Discharge Survey: 2003 annual summary with detailed diagnosis and procedure data., , LJ, Kozak, Vital Health Statistics, 2006 to 91%[27]
Rickwood ''et al'' reported that the proportion of English boys circumcised for medical reasons had fallen from 35% in the early 1930s to 6.5% by the mid-1980s. An estimated 3.8% of male children in the UK in 2000 were being circumcised by the age of 15 [9].
According to the Sydney Morning Herald, the infant circumcision rate in Australia was 12.9% in 2003.[92] In 1986, only 511 out of approximately 478,000 Danish boys aged 0-14 years were circumcised. This corresponds to a cumulative national circumcision rate of around 1.6% by the age of 15 years.
[10].
See also
★ Brit milah
★ Circumcision scar
★ Foreskin restoration
★ Genital integrity
★ Holy Prepuce
★ Preputioplasty, alternative to circumcision in the treatment for phimosis
★ Zeved habat
References
| Some referenced articles are available on-line only in the Circumcision Information and Resource Page’s (CIRP) library or in The Circumcision Reference Library (CIRCS). CIRP articles are chosen from an anti-circumcision point of view, and text in support of this position is often highlighted on-screen using HTML. CIRCS articles are chosen from a pro-circumcision point of view. If documents are not freely available on-line elsewhere, links to articles in one or other of these two websites may be provided. |
1. Surgery:
★ "Male circumcision is the surgical removal of all or part of the foreskin of the penis." Information Package on Male Ci rcumcision and HIV Prevention:Insert 1, World Health Organization
★ "Circumcision, surgical removal of all or part of the foreskin of the human male...", "Circumcision", Microsoft Encarta, 2007.
★ "Male circumcision is an elective surgery to remove the foreskin..." Circumcision, British Columbia Health Guide, June 2, 2006. Retrieved July 18, 2007.
★ "Circumcision is surgery..." Pain and Your Infant: Medical Procedures, Circumcision and Teething, University of Michigan Health System, February 2007. Retrieved July 18, 2007.
★ " Circumcision is cutting away part of the foreskin... When this surgery is performed..." Newborn Care, Danbury Hospital website. Retrieved July 18, 2007.
2. http://www.cirp.org/library/history/hodges2 See 'Egyptians'
3. Historical review: Circumcision, , P., Wrana, Archives of Pediatrics, 1939 as quoted in: Male Circumcision: A Gender Perspective, , Joseph, Zoske, Journal of Men’s Studies, 1998
4. Circumcision
5.
6. Insert 2
7. Benefits of newborn circumcision: is Europe ignoring medical evidence?, , Edgar J, Schoen, Archives of Disease in Childhood, 1997
8. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial, , Robert C, Bailey, The Lancet,
9. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial, , Ronald H, Gray, The Lancet,
10.
11.
12. Carcinoma of the penis: experience from 360 cases, Rempelakos A, , , J BUON, 2004
13. Phimosis: Is circumcision necessary?, , P.A., Dewan, Journal of Paediatrics and Child Health, 1996
14. The causes of adolescent phimosis, , Michel, Beaugé, British Journal of Sexual Medicine, 1997
15.
16.
17.
18. Use of the Mogen clamp for neonatal circumcision, , RD, Reynolds, American Family Physician, 1996
19. Frenular chordee: implications and treatment, Griffin A, Kroovand R, , , Urology, 1990
20. Religious circumcision: a Jewish view, , J.M., Glass, BJU International, 1999
21. Mattson CL, Bailey RC, Muga R, Poulussen R, Onyango T (2005) Acceptability of male circumcision and predictors of circumcision preference among men and women in Nyanza province Kenya. AIDS Care 17:182–194.
22. Greek Orthodox Archdiocese calendar of Holy Days
23. Russian Orthodox Church, Patriarchate of Moscow
24. Question #9412: Circumcision: how it is done and the rulings on it
25. Question #7073: The health and religious benefits of circumcision
26. Ajuwon et al., "Indigenous surgical practices in rural southwestern Nigeria: Implications for disease," Health Educ. Res..1995; 10: 379-384 Health Educ. Res..1995; 10: 379-384 Retrieved 3 October 2006
27.
28. Migration and Trade
29.
30. RECENT GUEST SPEAKER
31. Weird & Wonderful
32. Circumcision amongst the Dogon
33. Aesthetics and Rituals of the Opha Ceremony among the Urhobo People, , John Tokpabere, Agberia, Journal of Asian and African Studies, 2006
34. Masai of Kenya
35. Similarities in Attitudes and Misconceptions toward Infant Male Circumcision in North America and Ritual Female Genital Mutilation in Africa.
36. How not to argue about circumcision, , David, Benatar, American Journal of
Bioethics, 2003
37. Male circumcision: assessment of health benefits and risks, Moses, S, , , Sex Transm Infect, 1998
38. The psychological impact of circumcision, , R., Goldman, BJU International, 1999
39. Sweden restricts circumcisions
40. Jews protest Swedish circumcision restriction Reuters
41. Sweden Bureau of Democracy, Human Rights, and Labor
42. Pain relief for neonatal circumcision, , B, Brady-Fryer, The Cochrane Database of Systematic Reviews, 2004
43. Pain management for newborn circumcision, Razmus I, Dalton M, Wilson D, , , Pediatr Nurs,
44. The use of topical lidocaine/prilocaine cream prior to childhood circumcision under local anesthesia, , WT, Ng, Ambul Surg, 2001
45. Male circumcision: pain, trauma, and psychosexual sequelae
46. Cost Analysis of Neonatal Circumcision in a Large Health Maintenance Organization, , Edgar J., Schoen, The Journal of Urology, 2006
47. Neonatal Circumcision: A Review of the World’s Oldest and Most Controversial Operation, , Mark C., Alanis, Obstetrical & Gynecological Survey, 2004
48. A Cost-Utility Analysis of Neonatal Circumcision, , Robert S., Van Howe, Medical Decision Making, 2004
49. Routine neonatal circumcision: a cost-utility analysis, , TG, Ganiats, Medical Decision Making, 1991
50. Circumcision: a decision analysis of its medical value., , FH, Lawler, Family Medicine, 1991
51. A Trade-off Analysis of Routine Newborn Circumcision, , Dmitry A., Christakis, Pediatrics, 2000
52.
53. Complications of Circumcision, , George W., M.D., Kaplan, UROLOGIC CLINICS OF NORTH AMERICA, 1983
54. Office Management of Penile Skin Bridges with Electrocautery, , Sody A., Naimer, Journal of the American Board of Family Practice, 2002
55. Late complications of circumcision in Iran, , Rooh-Allah, Yegane, Pediatric Surgery International, 2006
56. http://www.emedicine.com/PED/topic2356.htm
57. Coroner's Corner Circumcision: A minor procedure? Paediatric Death Review Committee: Office of the Chief Coroner of Ontario
58. WHO and UNAIDS Secretariat welcome corroborating findings of trials assessing impact of male circumcision on HIV risk
59. WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention
60.
61. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis, , HA, Weiss, Sex Transm Infect, 2006
62. An argument for circumcision. Prevention of balanitis in the adult, , N, Fakjian, Arch Dermatol, 1990
63. The frequency of foreskin problems in uncircumcised children, , LW, Herzog, Am J Dis Child, 1986
64. Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study, , Nigel, O’Farrel, International Journal of STD & AIDS, 2005
'Editor’s note: I cannot confirm that the article substantiates the claim as I cannot access the full article.
65. Clinical Features and management of recurrent balanitis; association with atopy and genital washing, , , Birley, Genitourinary Medicine, 1993
66. Balanoposthitis
67. The response of clinical balanitis xerotica obliterans to the application of topical steroid-based creams, , Michelle Valerie, Vincent, Journal of Pediatric Surgery, 2005
68. The treatment of childhood phimosis with topical steroid, , J.E., Wright, The Australian and New Zealand journal of surgery, 1994
69. Topical steroid therapy for phimosis, , T.M., Webster, The Canadian journal of urology, 2002
70. http://www.emedicine.com/derm/topic46.htm
71. Lichen sclerosus et atrophicus in children with phimosis and hypospadias, , G., Mattioli, Pediatric Surgery International, 2002
72. Male circumcision, penile human papillomavirus infection, and cervical cancer, , Xavier, Castellsagué, The New England Journal of Medicine, 2002
73. Determinants of Prevalence, Acquisition, and Persistence of Human Papillomavirus in Healthy Mexican Military Men, , MartÃn, Lajous, Cancer Epidemiology Biomarkers and Prevention, July
74. Developmental factors of urethral human papillomavirus lesions: correlation with circumcision, , O., Aynaud, BJU International, July
75. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies, , D., Singh-Grewal, Archives of Disease in Childhood,
76. History of circumcision, medical conditions, and sexual activity and risk of penile cancer, , C, Maden, J Natl Cancer Inst, 1993
77. The highly protective effect of newborn circumcision against invasive penile cancer, , EJ, Schoen, Pediatrics, 2000
78. Circumcision American Urological Association
79. A Biocultural Analysis of Circumcision, Ronald Immerman and Wade Mackey, , , Social Biology, 1997
80. Tomb artwork from the Sixth Dynasty (2345-2181 BCE) shows men with circumcised penises, and one relief from this period shows the rite being performed on a standing adult male. The Egyptian hieroglyph for "penis" depicts either a circumcised or an erect organ. The examination of Egyptian mummies has found some with foreskins and others who were circumcised.
81. The Book of Jeremiah, written in the sixth century BCE, lists the Egyptians, Jews, Edomites, Ammonites, and Moabites as circumcising cultures. Herodotus, writing in the fifth century BCE, would add the Colchians, Ethiopians, Phoenicians, and Syrians to that list.
82. The writer of the 1 Maccabees wrote that under the Seleucids, many Jewish men attempted to hide or reverse their circumcision so they could exercise in Greek gymnasia, where nudity was the norm. First Maccabees also relates that the Seleucids forbade the practice of brit milah (Jewish circumcision), and punished those who performed it–as well as the infants who underwent it–with death.
83. [5] ''All About the Baby'', a popular parenting book of the 1890s, recommended infant circumcision for this purpose. (However, a survey of 1410 men in the United States in 1992, Laumann found that circumcised men were ''more'' likely to report masturbating at least once a month.)
84. On the influence of circumcision in preventing syphilis, , , , Medical Times and Gazette, 1855
85. Extraordinarily high rates of male circumcision in South Korea: history and underlying causes, , MG, Pang, BJU Int, 2002
86. Complications of circumcision (full text), , N, Williams, British Journal of Surgery, 1993
87. Crawford DA. Circumcision: a consideration of some of the controversy. ''J Child Health Care.'' 2002 December;6(4):259-70. PMID 12503896
88. Circumcision in Western Australia, , Z., StanWisniewski, ANZ Journal of Surgery, 2004
89. Demand for male circumcision rises in a bid to prevent HIV, , , , Bulletin of the World Health Organization, 2006
90. J.H. Ku, M.E. Kim, N.K. Lee and Y.H. Park, "Circumcision practice patterns in South Korea: community based survey" (Sex Transm Inf 2003;79:65-67 http://sti.bmjjournals.com/cgi/content/full/79/1/65 retrieved 1 October 2006
91.
92. Circumcision rates rise for some
External links
Circumcision opposition
★ The Circumcision Information and Resource Pages by Geoffrey T. Falk
★ Doctors Opposing Circumcision presided by George C. Denniston, MD, MPH
★ National Organization of Circumcision Information Resource Centers by Marilyn Milos, RN
★ Intactivism: pictures of skin bridges
Circumcision promotion
★ Benefits of circumcision: medical, health and sexual by Professor Brian Morris
★ Circumcision: a lifetime of medical benefits by Edgar Schoen, BSc., M.D.
★ Circumcision Information by Gerald N. Weiss, M.D.
Circumcision techniques
★ Description of an adult circumcision from the American Academy of Family Physicians.
★ Description of a Plastibell circumcision from the Medical College of Georgia.
Further reading
★ Billy Ray Boyd. ''Circumcision Exposed: Rethinking a Medical and Cultural Tradition.'' Freedom, CA: The Crossing Press, 1998. (ISBN 978-0-89594-939-4)
★ Anne Briggs. ''Circumcision: What Every Parent Should Know.'' Charlottesville, VA: Birth & Parenting Publications, 1985. (ISBN 978-0-9615484-0-7)
★ Robert Darby. ''A surgical temptation: The demonization of the foreskin and the rise of circumcision in Britain.'' Chicago: University of Chicago Press, 2005. (ISBN 978-0-226-13645-5)
★ Aaron J. Fink, M.D. ''Circumcision: A Parent's Decision for Life''. Kavanah Publishing Company, Inc., 1988. (ISBN 978-0-9621347-0-8)
★ Paul M. Fleiss, M.D. and Frederick Hodges, D. Phil. ''What Your Doctor May'' Not ''Tell You About Circumcision.'' New York: Warner Books, 2002. (ISBN 978-0-446-67880-3)
★ Leonard B. Glick. ''Marked in Your Flesh: Circumcision from Ancient Judea to Modern America.'' New York: Oxford University Press, 2005. (ISBN 978-0-19-517674-2)
★ David L. Gollaher. ''Circumcision: A History of the World's Most Controversial Surgery.'' New York: Basic Books, 2000. (ISBN 0465026532)
★ Ronald Goldman, Ph.D. ''Circumcision: The Hidden Trauma.'' Boston: Vanguard, 1996. (ISBN 978-0-9644895-3-0)
★ Paysach J. Krohn, Rabbi. ''Bris Milah. Circumcision-The Covenant Of Abraham/A Compendium of Laws, Rituals, And Customs From Birth To Bris, Anthologized From Talmudic, And Traditional Sources.'' New York: Mesorah Publications, 1985, 2005.
★ Brian J. Morris, Ph.D., D.Sc. ''In Favour of Circumcision.'' Sydney: UNSW Press, 1999. (ISBN 978-0-86840-537-7)
★ Rosemary Romberg. ''Circumcision: The Painful Dilemma.'' South Hadley, MA Bergan & Garvey, 1985. (ISBN 978-0-89789-073-1)
★ Edgar J Schoen, M.D. ''Ed Schoen, MD on Circumcision.'' Berkeley, CA: RDR Books, 2005. (ISBN 978-1-57143-123-3)
★ Edward Wallerstein. ''Circumcision: An American Health Fallacy.'' New York: Springer, 1980 (ISBN 978-0-8261-3240-6)
★ Gerald N. Weiss M.D. and Andrea W Harter. ''Circumcision: Frankly Speaking.'' Wiser Publications, 1998. (ISBN 978-0-9667219-0-4)
★ Yosef David Weisberg, Rabbi. ''Otzar Habris. Encyclopedia of the laws and customs of Bris Milah and Pidyon Haben.'' Jerusalem: Hamoer, 2002.
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