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Circumcision resources
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circumcision resources
CIRP: Circumcision Information
and Resource Pages - Contains medical, legal, historical,
ethical, religious and human rights references. Resources for
parents and educators including anatomy, circumcision methods,
and foreskin restortion.
BabyCenter
- Find out what circumcision involves, what the health benefits
and risks are, and other things to consider when you're deciding
whether to have it done.
Circumcision
- Extensive alphabetical listing of circumcision related web pages.
List contains title and source.
Circumcision Information
for Parents - Links to basic information for parents about
circumcision, care of both the intact and circumcised penis, protection
from wrongful circumcision and legal recourses.
Circumcision article
Circumcision is the removal of some
or all of the prepuce (foreskin). The frenulum is often excised
at the same time, in a procedure called frenectomy. The word circumcision
comes from Latin circum (="around") and caedere (="to
cut"). Female circumcision is a term applied to a variety
of procedures performed on the female genitalia, of which only
one, the removal of the clitoral hood, is comparable to male circumcision.
Except where specified, "circumcision" in this article
should be taken as "male circumcision."
Reasons for circumcision
Circumcision is performed for religious, cultural, and medical
reasons. Elective adult circumcision may also be chosen as a form
of body modification, or for aesthetic or other reasons.
Religious and cultural circumcision
Circumcision is a religious practice traditionally required by
Judaism, usually performed in a ceremony called a Brit milah or
Bris Milah (Hebrew for "Covenant of circumcision").
The ceremony is to be performed on the eighth day of life of the
newborn boy unless health reasons force a delay. See also: Circumcision
in the Bible.
According to nearly all Muslim religious leaders, circumcision
is an important element of Islam. Although circumcision is not
mentioned in the Qur'an (and the mutilation of the body is expressly
forbidden therein), it is mentioned in some parts of the Hadith,
a set of texts explaining Islamic law that most Muslims view as
authoritative. Most Muslims believe that Muhammad was born circumcised.
Moreover, Hadiths describe that the ritual of circumcision was
started by Abraham, who is seen as the founder of Islam. Muslim
custom on circumcision varies. Some Muslim communities perform
circumcision on the eighth day of life, as the Jews do, while
others perform the rite at a different time. Turkish, Balkan,
and Central Asian Muslims typically circumcise boys at between
six and eleven years of age, and the event is viewed communally
as a joyous occasion and celebrated with sweets and feasting.
In contrast, Iranian Muslims are typically circumcised in the
hospital at birth without much ado. In Egypt, farmers in rural
areas celebrate circumcision as a joyous occasion, while in urban
populations, as in many industrialized countries such as the USA,
the procedure is routinely performed at a hospital.
Circumcision is also customary in the Coptic Christian religious
tradition. It is usually performed on the eighth day of life.
This practice was condemned by the Council of Florence (http://www.newadvent.org/cathen/06111a.htm)]
in 1442, held by leading theologians of the Roman Catholic Church,
which said in part:
Therefore it strictly orders all who glory in the name of Christian,
not to practise circumcision either before or after baptism, since
whether or not they place their hope in it, it cannot possibly
be observed without loss of eternal salvation. (http://www.cirp.org/library/cultural/councilflorence/)
The United States and South Korea are countries that practice
circumcision routinely on a majority of males for non-religious
reasons. Routine circumcision practices in South Korea are largely
the result of American cultural and military influence following
the Korean War.
Medical circumcision
Circumcision may be recommended in cases such as phimosis (a
very tight foreskin), or posthitis (an inflamed foreskin), for
which it is an effective treatment. It may also be advised in
cases of recurrent balanitis and urinary tract infections, balanitis
xerotica obliterans, Zoon's balanitis, and penile cancer.
Whether or not circumcision has medical benefits is controversial;
some argue that circumcision is an essential public health measure,
while others believe that there are no benefits to the procedure.
For a detailed discussion, see medical analysis of circumcision.
Most major medical societies and other countries do not recommend
routine infant circumcision, though some organisations argue that
parents should make an informed decision based upon medical and
other benefits and risks, while others discourage the procedure
altogether.
Circumcision and body modification
Circumcision may be undertaken voluntarily as a body modification
(see also: foreskin restoration). This may be for aesthetic reasons,
as part of a Dom/sub relationship, or as part of a Circumcision
fetish.
History of circumcision
It has been variously proposed that circumcision began as a religious
sacrifice, as a rite of passage marking a boy's entrance into
adulthood, as a form of sympathetic magic to ensure virility,
as a means of suppressing (or enhancing) sexual pleasure, as an
aid to hygiene where regular bathing was impractical, as a means
of marking those of lower (or higher) social status, as a means
of differentiating a circumcising group from their non-circumcising
neighbors, as a means of discouraging masturbation or other socially
proscribed sexual behaviors, to increase a man's attractiveness
to women, as a symbolic castration, as a demonstration of one's
ability to endure pain, or as a male counterpart to menstruation
or the breaking of the hymen. It is possible that circumcision
arose independently in different cultures for different reasons.
Circumcision in the Ancient World
The oldest documentary evidence for circumcision comes from Egypt.
Tomb artwork from the Sixth Dynasty (2345 - 2181 BC) 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
both circumcised and uncircumcised men.
Circumcision was common, although not universal, among ancient
Semitic peoples. The Book of Jeremiah, written in the sixth century
BC, lists the Egyptians, Jews, Edomites, Ammonites, and Moabites
as circumcising people. Herodotus, writing in the fifth century
BC, would add the Colchians, Ethiopians, Phoenicians, and Syrians
to that list.
Circumcision was also practiced by the Jews in a military context.
The Biblical account of David's campaigns indicates that he circumcised
two hundred fallen enemy warriors, offering the foreskins to King
Saul as bride price for one of his daughters.
Except in the portrayal of satyrs, lechers, and barbarians, ancient
Greek artwork portrayed penises covered by foreskins. In the aftermath
of Alexander the Great's conquests, the Greek dislike of the appearance
of the circumcised penis led to a decline in the incidence of
circumcision among many peoples that had previously practiced
it. The writer of 1 Maccabees wrote that under the Seleucids,
many Jewish men attempted to hide or reverse their circumcision
so they could exercise in Greek gymnasia. Because of these attempts,
and for other reasons, the Pharisees, ca. 100, added two more
steps to the Biblical rite of circumcision:
* Brit Peri'ah, which went beyond the relatively simple and
Biblical trimming of excess foreskin, and stripped the mucosal
lining of the foreskin back to the coronal sulcus.
* Brit Mezizah, by which the trained rabbi ("mohel")
fills his mouth with wine and sucks the wound made by the circumcision,
repeating the process a few times
Cultural pressures to circumcise operated throughout the Hellenistic
world: when the Judean king John Hyrcanus conquered the Idumeans,
he forced them to become circumcised and convert to Judaism, but
their ancestors the Edomites had practiced circumcision in pre-Hellenistic
times. In Egypt, only the priestly caste retained circumcision,
and by the second century, the only circumcising groups in the
Roman Empire were Jews, Egyptian priests, and the Nabatean Arabs.
Circumcision was sufficiently rare among non-Jews that being circumcised
was considered conclusive evidence of Judaism in Roman courts.
Medical circumcision in the 19th century
Until 1870, medical circumcisions were performed to treat conditions
local to the penis: phimosis, balanitis, and penile cancer. In
that year, Lewis Sayre, a prominent New York orthopedic surgeon
and vice president of the newly-formed American Medical Association,
examined a five-year-old boy who was unable to straighten his
legs, and whose condition had so far defied treatment. Upon noting
that the boy's genitals were inflamed, Sayre hypothesized that
chronic irritation of the boy's foreskin had paralyzed his knees
via reflex neurosis. Sayre circumcised the boy, and within a few
weeks, he recovered from his paralysis. After several additional
incidents in which circumcision also appeared effective in treating
paralyzed joints, Sayre began to promote circumcision as a powerful
orthopedic remedy.
Sayre's prominence within the medical profession allowed him
to reach a wide audience. He lectured widely in the United States
and the United Kingdom, and his ideas influenced physicians throughout
the English-speaking world. As more practitioners tried circumcision
as a treatment for otherwise intractable medical conditions, sometimes
achieving positive results, the list of ailments reputed to be
treatable through circumcision grew. By the 1890s, hernia, bladder
infections, kidney stones, insomnia, chronic indigestion, rheumatism,
epilepsy, asthma, bedwetting, Bright's disease, erectile dysfunction,
syphilis, insanity, and skin cancer had all been linked to the
foreskin, and many physicians advocated universal circumcision
as a preventive health measure.
Specific medical arguments aside, several hypotheses have been
raised in explaining the public's acceptance of infant circumcision
as preventive medicine. The success of the germ theory of disease
had not only enabled physicians to combat many of the postoperative
complications of surgery, but had made the wider public deeply
suspicious of dirt and bodily secretions. Accordingly, the smegma
that collects under the foreskin was viewed as unhealthy, and
circumcision readily accepted as good penile hygiene. (http://www.cirp.org/library/history/gollaher/)
Secondly, moral sentiment of the day regarded masturbation as
not only sinful, but also physically and mentally unhealthy, stimulating
the foreskin to produce the host of maladies of which it was suspected.
In this climate, circumcision could be employed as a means of
discouraging masturbation. (http://www.noharmm.org/paige.htm)
All About the Baby, a popular parenting book of the 1890s, recommended
infant circumcision for precisely this purpose. Thirdly, with
the proliferation of hospitals in urban areas, childbirth, at
least among the upper and middle classes, was increasingly undertaken
in the care of a physician in a hospital rather than that of a
midwife in the home. It has been suggested that once a critical
mass of infants were being circumcised in the hospital, circumcision
became a class marker of those wealthy enough to afford a hospital
birth. (http://www.cirp.org/library/legal/USA/waldeck1/)
During the same time period, circumcision was becoming easier
to perform. William Halstead's 1885 discovery of hypodermic cocaine
as a local anaesthetic made it easier for doctors without expertise
in the use of chloroform and other general anaesthetics to perform
minor surgeries. Also, several mechanically-aided circumcision
techniques, forerunners of modern clamp-based circumcision methods,
were first published in the medical literature of the 1890s, allowing
surgeons to perform circumcisions more safely and successfully.
By the 1920s, advances in the understanding of disease had undermined
much of the original medical basis for preventive circumcision.
Doctors continued to promote it, however, as good penile hygeine
and as a preventive for a handful of conditions local to the penis:
balanitis, phimosis, and penile cancer.
Routine infant circumcision was successfully promoted in the
English-speaking parts of Canada, Australia, New Zealand, the
United States and the United Kingdom. Although it is difficult
to determine historical circumcision rates, one estimate (http://www.boystoo.com/history/statistics.htm)
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, a lack of consensus in the medical community as to whether
circumcision carried with it any notable health benefit motivated
the United Kingdom's newly-formed National Health Service to remove
routine infant circumcision from its list of covered services.
Since then, circumcision has been an out-of-pocket cost to parents,
and the fraction of newborns circumcised in the hospital has fallen
to less than one percent.
The practice was quickly dropped in the United Kingdom shortly
after World War II, partially owing to the nation's massive post-war
depression and devastation of much of its cities. Families during
this time barely had the resources to get food and water, let
alone money to spend on an operation whose necessity was already
being called into question.
Trends similar to Britain's National Health Service have operated
in Canada. Individual provincial heath services began delisting
circumcision in the 1980s; at present, only Manitoba pays for
the procedure. The infant circumcision rate in Canada has fallen
from roughly half in the 1970s to its present value of 13%, albeit
with strong regional variations (http://www.courtchallenge.com/refs/yr99p-e.html)
In South Korea, circumcision was largely unknown before the establishment
of the United States trusteeship in 1945 and the spread of Christianity.
More than 90% of South Korean high school boys are now circumcised,
but the average age of circumcision is 12 years (http://www.cirp.org/library/cultural/pang1/).
In South Africa circumcision has roots in several belief systems
and is performed much of the time to teen aged males : "...The
young men in the eastern Cape belong to the Xhosa ethnic group
for whom circumcision is considered part of the passage into manhood...
A law was recently introduced requiring initiation schools to
be licensed and only allowing circumcisions to be performed on
youths aged 18 and older. But Eastern Cape provincial Health Department
spokesman Sizwe Kupelo told Reuters news agency that boys as young
as 11 had died. Each year thousands of young men go into the bush
alone, without water, to attend initiation schools. Many do not
survive the ordeal..." (http://news.bbc.co.uk/2/hi/africa/3069491.stm).
In the United States, statistics collected by the National Center
for Health Statistics show that the overall rate of neonatal circumcision
has remained near 65% since data collection began in 1979 (http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions_race.htm).
However, strong regional differences in the circumcision rates
have developed during this time. While more than 80% of newborn
boys are circumcised in the Midwest and South, circumcision rates
have declined to about 37% in the West (http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions_region.htm).
This has been attributed in part to increasing births among Latin
Americans, who usually do not circumcise (http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions.htm).
Thirteen states no longer pay for the procedure under Medicaid;
the other 37 still do.
The major medical societies in Britain, Canada, Australia and
New Zealand do not support routine non-therapeutic infant circumcision.
Major medical organizations in the United States state that parents
should decide what is in their child's best interests, declining
to make a recommendation one way or another. Neonatal circumcision
nonetheless still remains the most common pediatric operation
carried out in the U.S. today.
International circumcision rates
Country Year Neonatal circumcisions (%)
United States 1999 65.4%
Canada 2003 11.5%
Australia 2004 12.7%
New Zealand 1995 0.35%
United Kingdom 1972 0.41%
Emotional impact of circumcision and non-circumcision
Much attention has been given to the emotional impact of the
female form of circumcision, but some argue that male circumcision
has just as much impact in this area. Emotional impact will vary
from person to person and depend on cultural context and other
factors. Issues about the rights of the child are often overlooked,
as is the possibility that circumcision causes emotional harm
to some males.
Two large-scale internet surveys have found that the percentages
of circumcised and uncircumcised males dissatisfied with their
status are approximately equal, with about 10-15% dissatisfied
in each group. (http://sizesurvey.com/result.html) (http://www.jackinworld.com/library/surveys/survey5.html)
The only formal study in the literature, by Schlossberger et al.,
found that circumcised boys scored higher on satisfaction items.
(http://www.circs.org/library/schlossberger/index.html)
Support groups
There are an increasing number of support groups for circumcised
males that feel violated by their circumcision which, they often
feel, was forced on them and had little or no medical value. These
groups often advocate foreskin restoration. There are also support
groups for men dissatisfied with being uncircumcised, and considering
adult circumcision.
Consent
The issue of consent is of particular relevance to circumcision
since its often done to infants, the segment of the population
most unable to understand or communicate wishes about the procedure.
The decision therefore must ride entirely on the child's caregiver.
In particular, debate focuses on what limits if any should be
placed on the caregiver's ability to make a decision for their
child about a procedure with disputed immediate medical value
which causes pain and, some argue, mutilation, that may be unwanted
later in life. Some suggest that circumcision may cause emotional
scarring later on.
Medical circumcision of a minor
There is some question whether or not most parents without medical
training have the understanding to grant informed consent on behalf
of their child for medical circumcision since circumcision is
a taboo subject in many cultures. Little or no information about
it appears in the media, and given circumcision's religious and
cultural importance, the impartiality of information about circumcision
may be drawn into question. Individuals and organizations from
cultures where circumcision is common may lean too much towards
ideals of circumcision being painless, beneficial or harmless,
while the opposite might be true for cultures where circumcision
is uncommon. Scientific and medical data may be set aside and
ignored in favour of a more culturally palatable view of the procedure.
Religious circumcision of a minor
It is not uncommon in some parts of the world to circumcise minors
for medicinal, religious or cultural reasons. Many people believe
that this practice is protected fundamentally under the principal
of freedom of religion and conscience. Other people disagree,
arguing that no right has precedence over the rights of the child.
Still others contend that freedom of religion only applies to
belief and not action involving others.
Circumcision of an adult
Although the right to consent on behalf of a minor is widely
debated, the right for an adult to consent to relgious or cultural
circumcision is less controversial. In most cases doing so is
legal at one's own volition. This view is often true for female
circumcision too, although female circumcision is often viewed
as more distasteful in Western cultures.
Prevalence of circumcision
Estimates of the proportion of males that are circumcised worldwide
vary from one
sixth to one
third.
The majority of males are circumcised in the following
countries:
Afghanistan, Albania, Algeria, Azerbaijan, Bahrain, Bangladesh,
Benin, Cameroon, Chad, Comoros, Djibouti, Egypt, Eritrea, Ethiopia,
Gabon, Gambia, Ghana, Guinea, Indonesia, Iran, Iraq, Israel, Kazakhstan,
Kenya, Kuwait, Lebanon, Libya, Madagascar, Malaysia, Maldives,
Mali, Mauritania, Morocco, Nigeria, Niger, Pakistan, Philippines,
Qatar, Republic of the Congo, Samoa. Tonga, Saudi Arabia, Sierra
Leone, Somalia, "Somaliland", South Africa, South Korea,
Sudan, Syria, Tajikistan, Togo, Tunisia, Turkey, "Turkish
Republic of Northern Cyprus", Turkmenistan, United Arab Emirates,
the United States of America, Uzbekistan, Vanuatu and Yemen.
In most of these countries the predominant religion (usually
Islam or Judaism) endorses circumcision.
In the United States, statistics collected by the National Center
for Health Statistics show that the overall rate of neonatal circumcision
has remained near 65%
since data collection began in 1979. However, strong regional
differences in the circumcision rates have developed during this
time. While more than 80% of newborn boys are circumcised in the
Midwest and South, circumcision rates have declined to about 37%
in the West.
This has been attributed in part to increasing births among Latin
Americans, who usually do not circumcise. A recent study used
data from the Nationwide Inpatient Sample (a 20% sample of the
nation's total inpatients), and found a significant rise
in circumcisions between 1988 and 2000. Thirteen states no
longer pay for the procedure under Medicaid, causing some parents
to request the procedure at a later time.
This informational article is licensed under the
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article Circumcision
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