Difference between revisions of "Circumcision" - New World Encyclopedia

Revision as of 21:43, 3 October 2007

This article is about male circumcision. For the practice sometimes referred to as "female circumcision", see Female genital cutting.

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.

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").

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.^[2] According to WHO, 30% of men worldwide have had the procedure, mostly in countries where it is common for religious or cultural reasons.^[3]

Circumcision predates recorded human history, with depictions in stone-age cave drawings and Ancient Egyptian tombs.^[4] 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.^[5] Male circumcision is a religious commandment in Judaism, expected in Islam,^[6]^[7] and customary in some Oriental Orthodox and other Christian churches in Africa.^[8]

Circumcision is common in the Middle East,in north América (USA and Canada ),in Australia and parts of Africa and Asia. ^[3]

Genital integrity supporters condemn infant circumcision as a human rights abuse and a genital mutilation like female genital cutting^[9], while advocates of circumcision like internationales organisations WHO,UNAIDS,UNICEF,UNFPA ,World Bank ,NIAID [1] regard it as a worthwhile public health measure^[10], particularly in the control of HIV [2] ^[11]^[12]^[13]. Circumcision may also be used to treat inflammation of the glans and penile cancer.^[14]^[15] Using circumcision to treat phimosis (see section below) is debated in medical literature.^[16]^[17]

Circumcision procedures

File:Uncircumcised Penis.jpg

Uncircumcised penis, flaccid (left) and erect (right)

File:Circumsised penis - Flacid and Erect - High Res.jpg

Circumcised penis, flaccid (left) and erect (right)

Circumcision removes the foreskin from the penis. For infant circumcision, clamps, such as the Gomco clamp, Plastibell, and Mogen are often used.^[18] 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.^[19]

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.^[20]^[21]

The frenulum is cut if frenular chordee is evident.^[22]^[23]

Cultures and religions

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. Hodges argues that in Ancient Greece the foreskin was valued and that Greek and Roman attempts to abolish ritual circumcision were prompted by humanitarian concerns.^[24]

Judaism

Circumcision is a fundamental rite of Judaism. It 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.^[25] It is usually performed in a ceremony called a Brit milah (or Bris milah, colloquially simply bris) (Hebrew for "Covenant of circumcision"). A mohel performs the ceremony on the eighth day after birth unless health reasons force a delay. According to the Torah (Genesis, chapter 17 verses 9-14), God commanded Abraham to circumcise himself, his offspring and his slaves as a sign of an everlasting covenant. According to Jewish law, failure to follow the commandment carries the penalty of karet, or being cut off from the community by God. Brit milah is considered to be so important that should the eighth day fall on the Sabbath, actions that would normally be forbidden because of the sanctity of the day are permitted in order to fulfill the requirement to circumcise. The expressly ritual element of circumcision in Judaism, as distinguished from its non-ritual requirement in Islam, is shown by the requirement that a child who either is born aposthetic (without a foreskin) or who has been circumcised without the ritual must nevertheless undergo a Brit milah in which a drop of blood (hatafat-dam, הטפת דם) is drawn from the penis at the point where the foreskin would have been or was attached.^[26]

Less commonly practised, and more controversial, is metzitzah b'peh, or oral suction,^[27]^[28] where the mohel sucks blood from the circumcision wound. The traditional reason for this procedure is to promote healing,^[29]^[30] though the practice has been implicated in the spreading of herpes to the infant.^[31] Today, if it is performed, the mohel generally uses a sterilized glass tube.^[32]^[33]

Christianity

Christianity does not call for circumcision. The first Church Council in Jerusalem declared that circumcision was not necessary (Acts 15). St. Paul had Timothy circumcised (Acts 16:1-3) but in his letters he warned gentile Christians against adopting the practice (Galatians 6:12-16, Philippians 3:2-3). While in most countries, Christians do not circumcise,^[34] it is customary among the Coptic, Ethiopian, and Eritrean Orthodox Churches, and also some other African churches^[8]. Some Christian churches in South Africa oppose circumcision, viewing it as a pagan ritual, while others, including the Nomiya church in Kenya^[35]^[8], require circumcision for membership. Some participants in focus group discussions in Zambia and Malawi said that Christians should practice circumcision because 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 Greek Orthodox Church celebrates the Circumcision of Christ on 1 January,^[36] while Orthodox churches following the Julian calendar celebrate it on 14 January. The Russian Orthodox Church considers it a "Great Feast".^[37] In the Catholic, Anglican and Lutheran churches it has been replaced by other commemorations.^[38] At the Council of Basel-Florence in 1442, the Catholic Church condemned circumcision among the Copts and ordered against its practice.^[34]

Islam

The origin of circumcision in Islam is a matter of religious and scholarly debate. It 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.^[39] Some have quoted the hadith to argue that the requirement of circumcision is based on the covenant with Abraham.^[40]

The timing of Muslim circumcision varies. Turkish, Balkan, rural Egyptians and Central and South Asian Muslims typically circumcise boys between the ages of six and eleven ^{[citation needed]}. Traditionally, Turkish circumcisions are celebrated with sweets and the "Sünnet Düğünü," or "Circumcision Feast/Celebration." It is considered a very important celebration in man's life as a passage to a manhood. However, in the middle class circumcision is more usually done in infancy.^[41] In Pakistan, Muslims may be circumcised at all ages from the newborn period to adulthood, though the medical profession has encouraged medical circumcisions in the first week after birth to reduce complications: "Circumcision is performed by barbers, medical technicians, quacks and doctors including paediatric surgeon[s] [and as] yet there is no consensus for the best age and method."^[42] In Iran, Dr. Paula Drew states that “circumcision, which formerly celebrated the onset of manhood, has for many years now been more customarily performed at the age of 5 or 6 for children born at home, and at two days old for those born in a medical setting.…By puberty, all Muslim Iranian boys must be circumcised if they are to participate fully in religious activities.”^[43] Kamyar et al describe circumcision as an "obligatory custom" and note that it is not necessary for the circumciser to be a Muslim.^[44]

Other faiths and traditions

Bahá'ís do not have any particular tradition or rituals regarding male circumcision, but view female circumcision as mutilation.^[45]

The Druze have no male circumcision in their religion,^[46] although, according to one source, it is practiced among those living in urban areas or outside the Middle East, mainly for hygienic reasons.[3]

There is no specific reference to male circumcision in the Hindu holy books [4], and Hindus in India generally do not practice circumcision. [5]

Sikh male infants are not circumcised.^[47]

Circumcision in South Korea is largely the result of American cultural and military influence following the Korean War. The origin of circumcision in the Philippines is uncertain. One newspaper article speculates that it is due to the influence of western colonizers.^[48] However, Antonio de Morga's seventeenth century History of the Philippine Islands, speculates that it is due to Islamic influence.^[49] 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.^[50] In early 2007 it was announced that rural aidpost orderlies in the East Sepik Province of Papua New Guinea are to undergo training in the circumcision of men and boys of all ages with a view to introducing the procedure as a means of prophylaxis against HIV/AIDS, which is becoming a significant problem in the country.^[51]

Circumcision is part of initiation rites in some African, Pacific Islander, and Australian aboriginal traditions in areas such as Arnhem Land,^[52] where the practice was introduced by Makassan traders from Sulawesi in the Indonesian Archipelago.^[53] Circumcision ceremonies among certain Australian aboriginal societies are noted for their painful nature, including subincision for some aboriginal peoples in the Western Desert.^[54] In the Pacific, ritual circumcision is nearly universal in the Melanesian islands of Fiji and Vanuatu;^[55] participation in the traditional land diving on Pentecost Island is reserved for those who have been circumcised.^[56] 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.^[57] In many West African traditional societies circumcision has become medicalised and is simply performed in infancy without ado or any particular conscious cultural significance ^{[citation needed]}. 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.^[58] 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.^[59]

Ethical issues

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.^[60]

Therefore, circumcising infants is controversial. Those advocating circumcision assert that circumcision is a significant public health measure, preventing infections, and slowing down the spread of AIDS.^[61] Those opposing circumcision, however, question the legality of infant circumcision by asserting that infant circumcision is a human rights violation or a sexual assault.^[62]^[63]

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.^[62] Another argument questions why the genital cutting of males is allowed while the genital cutting of females is prohibited.^[64]

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.^[65]

Some medical associations accept that the parents should determine what is in the best interest of the infant or child,^[66]^[60]^[67]^[68] but the Royal Australasian College of Physicians (RACP) and the British Medical Association (BMA) observe that controversy exists on this issue.^[69]^[70] The BMA insists that a circumcision must not go ahead without the consent of both parents and the competent child.^[70]

Emotional consequences

Goldman discussed the extent to which circumcision may cause emotional harm to males.^[71] Some organizations have been formed as support groups for men who are resentful about being circumcised.^[72]

Legality

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,^[73] 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.”^[74] However, in 2006, the United States State Department reported 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.^[75]

Sexual effects

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."^[66] In January 2007, The American Academy of Family Physicians (AAFP) stated "The effect of circumcision on penile sensation or sexual satisfaction is unknown. Because the epithelium of a circumcised glans becomes cornified, and because some feel nerve over-stimulation leads to desensitization, many believe that the glans of a circumcised penis is less sensitive. Opinions differ about how this decreased sensitivity, which may result in prolonged time to orgasm, affects sexual satisfaction. An investigation of the exteroceptive and light tactile discrimination of the glans of circumcised and uncircumcised men found no difference on comparison. No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."^[76]

Boyle et al. (2002) argued that circumcision and frenectomy remove tissues with "heightened erogenous sensitivity," stating "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings—many of which are lost to circumcision."^[77] 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

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.”^[70] Cost-benefit analyses have varied. Some found a small net benefit of circumcision,^[78]^[79] some found a small net decrement,^[80]^[81] 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."^[82]

Risks of circumcision

While the risk in a competently performed medical circumcision is very low,^[83] complications from bleeding, infection and poorly carried out circumcisions can be catastrophic.^[84] According to the AMA, blood loss and infection are the most common complications. Bleeding is mostly minor; applying pressure will stop it.^[60] 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.”^[85]

File:Flaccid-erect.jpg

A circumcised penis with a skin bridge.

HIV

Observational studies in the 1980's identified a strong association of circumcision status and reduced risk of HIV infection, as well as of sexually transmitted genital ulcer disease, although behavioural factors may have been a part of that association.^[86] Population based studies suggested that circumcision may protect against HIV but likewise social or religious factors may have skewed results. In March 2005, the Cochrane review found the medical evidence at that point "insufficient" to consider implementing circumcision "as a public-health intervention" but the positive results of observational studies suggested that circumcision was "worth evaluating in randomised controlled trials.”^[87]

Hygiene

The American Academy of Pediatrics observes “Circumcision has been suggested as an effective method of maintaining penile hygiene since the time of the Egyptian dynasties, but there is little evidence to affirm the association between circumcision status and optimal penile hygiene.”^[66]^[88] It states that the "relationship among hygiene, phimosis, and penile cancer is uncertain" and further remarks that "genital hygiene needs to be emphasized as a preventive health topic throughout a patient's lifetime."

The Royal Australasian College of Physicians emphasizes that the penis of an uncircumcised infant requires no special care and should be left alone. It states that attempts to forcibly retract the foreskin, e.g. to clean it, are painful, often injure the foreskin, and can lead to scarring, infections and pathologic phimosis.^[89] Birley (1993) stated that the use of soap to wash the foreskin and the glans can lead to balanitis.^[90]

Smegma is a combination of exfoliated epithelial cells, transudated skin oils, and moisture that can accumulate under the foreskin of males and within the female vulva area. It is common to all mammals—male and female. In rare cases, accumulating smegma may help cause balanitis.^[91]

Hutson speculated that circumcision arose in peoples living in arid and sandy regions as a public health measure intended to prevent recurring irritation and infection caused by sand accumulating under the foreskin.^[92] Darby, after checking the official war histories of Britain, Australia and New Zealand and other records, and finding no mention of ‘balanitis’ or ‘foreskin’ or ‘circumcision’, dismissed this idea as a “medical urban myth,” concluding that “‘sand under the foreskin,’ balanitis, and circumcision were not significant problems during either of the World Wars.”^[93]

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.^[94]^[95]^[96] The reasons are unclear, but several hypotheses have been suggested:

The foreskin may harbor bacteria and become infected if it is not cleaned properly.^[97]
The foreskin may become inflamed if it is cleaned too often with soap.^[90]
The forcible retraction of the foreskin in boys can lead to infections.^[98]

The usual treatment for balanoposthitis is to use topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams.^[99]

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 remove "excess" pleasure, 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 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.^[100] It is possible that circumcision arose independently in different cultures for different reasons.

File:Circumcision Precinct of Mut.png

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 B.C.E.

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.

Circumcision in the ancient world

The oldest documentary evidence for circumcision comes from ancient Egypt. Tomb artwork from the Sixth Dynasty (2345-2181 B.C.E.) 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.

Circumcision was common, although not universal, among ancient Semitic peoples. The Book of Jeremiah, written in the sixth century B.C.E., lists the Egyptians, Jews, Edomites, Ammonites, and Moabites as circumcising cultures. Herodotus, writing in the fifth century B.C.E., would add the Colchians, Ethiopians, Phoenicians, and Syrians to that list.

In the aftermath of the conquests of Alexander the Great, Greek dislike of circumcision led to a decline in its incidence among many peoples that had previously practised it. 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.

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 deeply suspicious of dirt and bodily secretions. So smegma was viewed as unhealthy, and circumcision was seen as good penile hygiene.[6] At that time when people regarded masturbation as both sinful, and physically and mentally unhealthy, circumcision was promoted as a way of discouraging it. [7] 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.)

In 1855, the Quaker surgeon, Jonathan Hutchinson, observed that circumcision appeared to protect against syphilis.^[101] Although this observation was challenged (the protection that Jews appear to have are more likely due to cultural factors^[102]), a 2006 systematic review concluded that the evidence "strongly indicates that circumcised men are at lower risk ... syphilis."^[103]

As hospitals proliferated in urban areas, childbirth, at least among the upper and middle classes, was increasingly under the care of physicians in hospitals rather than with midwives 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.^[104]

By the 1920s, advances in the understanding of disease had undermined much of the original medical basis for preventive circumcision but doctors continued to promote it as good penile hygiene and as a preventive for balanitis, phimosis, and penile cancer. ^{[citation needed]}

Infant circumcision was taken up in the United States, Australia and the English-speaking parts of Canada and to a lesser extent in the United Kingdom and New Zealand. The British Royal Family had a long tradition requiring that all male children be circumcised” (Alfred J. Kolatach’s The Jewish Book of Why, Middle Village, New York; Jonathan David, 1981). Although it is difficult to determine historical circumcision rates, one estimate[8] 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. One reason may have been Douglas Gairdner’s famous study, The fate of the foreskin, which revealed that for the years 1942–1947, about 16 children per year in England and Wales had died because of circumcision, a rate of about 1 per 6000 circumcisions.^[105] 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 (where public medical insurance is universal, and where private insurance does not replicate services already paid from the public purse), individual provincial health services began delisting circumcision in the 1980s.

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.^[106]

In some South African ethnic groups, circumcision has roots in several belief systems, and is performed most of the time on teenage boys:

"...The young men in the eastern Cape belong to the Xhosa ethnic group for whom circumcision is considered part of the passage into manhood... A law was recently introduced requiring initiation schools to be licensed and only allowing circumcisions to be performed on youths aged 18 and older. But Eastern Cape provincial Health Department spokesman Sizwe Kupelo told Reuters news agency that boys as young as 11 had died. Each year thousands of young men go into the bush alone, without water, to attend initiation schools. Many do not survive the ordeal..." [9].

Prior to 1989, the American Academy of Pediatrics had a long-standing opinion that medical indications for routine circumcision were lacking. This stance, according to the AMA, was reversed in 1989, following new evidence of reduction in risk of urinary tract infection.^[60] 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.[10] A 1999 study reported that reasons for circumcision included "ease of hygiene (67 percent), ease of infant circumcision compared with adult circumcision (63 percent), medical benefit (41 percent), and father circumcised (37 percent)." The authors commented that "Medical benefits were cited more frequently in this study than in past studies, although medical issues remain secondary to hygience and convenience."[11] A 2001 study reported that "The most important reason to circumcise or not circumcise the child was health reasons."^[107] 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.[12] In a 2001 survey, 86.6% of parents felt respected by their medical provider, and parents who did not circumcise "felt less respected by their medical provider".^[107]

The major medical societies in Britain, Canada, Australia and New Zealand do not support routine non-therapeutic infant circumcision. Major medical organizations in the United States do not recommend routine circumcision, but instead state that parents should decide what is in their child's best interests.

The AMA remarked that, in one study, physicians in "nearly half" of neonatal circumcisions "did not discuss the potential medical risks and benefits of elective circumcision prior to delivery of the infant son. Deferral of discussion until after birth, combined with the fact that many parents' decisions about circumcision are preconceived, contribute to the high rate of elective circumcision."^[60]

**Table 1: International circumcision rates**
Country	Year	Neonatal circumcisions (%)
United States	2003	55.9%* [13]
Canada	2003	< 14% [14]
Australia	2004	10%-20% [15]
New Zealand	1995	0-5%[16]
*The percentage refers to infants born in non-Federal hospitals; see p 52, Table 44 of the reference.
**Samoans, Tongans and Niueans in New Zealand continue to practice circumcision, but not in public hospitals, to which these data refer.

Notes

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.

↑
Surgery:
- " Circumcision is cutting away part of the foreskin... When this surgery is performed..." Newborn Care, Danbury Hospital website. Retrieved July 18, 2007.
↑ (March 28, 2007). "New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications". World Health Organization. Retrieved 2007-08-13.
↑ ^3.0 ^3.1 Insert 2. Information Package on Male Ci rcumcision and HIV Prevention. World Health Organization (2007). Retrieved 2007-08-15.
↑ Wrana, P. (1939). Historical review: Circumcision. Archives of Pediatrics 56: 385–392. as quoted in: Zoske, Joseph (Winter 1998). Male Circumcision: A Gender Perspective. Journal of Men’s Studies 6 (2): 189–208.
↑ Gollaher, David L. (February 2000). Circumcision: a history of the world’s most controversial surgery. New York, NY: Basic Books, 53–72. ISBN 978-0-465-04397-2 LCCN 99-40015.
↑ Circumcision. American-Israeli Cooperative Enterprise. Retrieved 2006-10-03.
↑ Beidelman, T.. (1987). "CIRCUMCISION". The Encyclopedia of religion Volume 3: 511–514. Ed. Mircea Eliade. New York, NY: Macmillan Publishers. LCCN 86-5432 ISBN 978-0-02-909480-8. Retrieved on 2006-10-03.
↑ ^8.0 ^8.1 ^8.2
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.
↑ Milos, Marilyn Fayre and Donna Macris (March-April 1992). Circumcision: A medical or a human rights issue?. Journal of Nurse-Midwifery 37 (2 S1): S87–S96.
↑ Schoen, Edgar J (1997). Benefits of newborn circumcision: is Europe ignoring medical evidence?. Archives of Disease in Childhood 77 (3): 258-260.
↑ Newell, Marie-Lousie and Till Bärnighausen (February 24, 2007). Male circumcision to cut HIV risk in the general population. The Lancet 369 (9562): 617–619.
↑ Bailey, Robert C and Stephen Moses, Corette B Parker, Kawango Agot, Ian Maclean, John N Krieger, Carolyn F M Williams, Richard T Campbell, Jeckoniah O Ndinya-Achola (February 24, 2007). Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. The Lancet 369 (9562): 643–656.
↑ Gray, Ronald H and Godfrey Kigozi, David Serwadda, Frederick Makumbi, Stephen Watya, Fred Nalugoda, Noah Kiwanuka, Lawrence H Moulton, Mohammad A Chaudhary, Michael Z Chen, Nelson K Sewankambo, Fred Wabwire-Mangen, Melanie C Bacon, Carolyn F M Williams, Pius Opendi, Steven J Reynolds, Oliver Laeyendecker, Thomas C Quinn, Maria J Wawer (February 24, 2007). Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. The Lancet 369 (9562): 657–666.
↑ Holman, John R. and Keith A. Stuessi (March 15, 1999). Adult Circumcision. American Family Physician 59 (6): 1514–1518. ISSN 0002-838X PMID 10193593.
↑ Rempelakos A and et al (Jan-Mar 2004). Carcinoma of the penis: experience from 360 cases. J BUON 9 (1): 51-5.
↑ Dewan, P.A. and Tieu H.C., and Chieng B.S. (August 1996). Phimosis: Is circumcision necessary?. Journal of Paediatrics and Child Health 32 (4): 285–289. PMID 8844530.
↑ Beaugé, Michel (September/October 1997). The causes of adolescent phimosis. British Journal of Sexual Medicine 26.
↑ Holman, John R. and Evelyn L. Lewis, Robert L. Ringler (August 1995). Neonatal circumcision techniques - includes patient information sheet. American Family Physician 52 (2): 511–520. ISSN 0002-838X PMID 7625325.
↑ Peleg, David and Ann Steiner (September 15, 1998). The Gomco Circumcision: Common Problems and Solutions. American Family Physician 58 (4): 891–898. ISSN 0002-838X PMID 9767725.
↑ Pfenninger, John L. and Grant C. Fowler [1994] (July 21, 2003). Procedures for primary care, 2nd, Mosby. ISBN 978-0-323-00506-7 LCCN 2003-56227.
↑ Reynolds, RD (July 1996). Use of the Mogen clamp for neonatal circumcision. American Family Physician 54 (1): 177–182. PMID 8677833.
↑ Griffin A, Kroovand R (1990). Frenular chordee: implications and treatment. Urology 35 (2): 133-4. PMID 2305537.
↑ Cite error: Invalid <ref> tag; no text was provided for refs named Shechet
↑ Hodges, Frederick, M. (2001). Religious circumcision: a Jewish view. The Bulletin of the History of Medicine 75 (Fall 2001): 375–405.
↑ Glass, J.M. (January 1999). Religious circumcision: a Jewish view. BJU International 83 (Supplement 1): 17–21. PMID 10766529.
↑ Shulchan Aruch, Yoreh De'ah, 263:4
↑ Nussbaum Cohen, Debra (October 14, 2005). City Risking Babies' Lives With Brit Policy: Health Experts. The Jewish Week. Retrieved 2007-04-19.
↑ Nussbaum Cohen, Debra; Larry Cohler-Esses (December 23, 2005). City Challenged On Ritual Practice. The Jewish Week. Retrieved 2007-04-19.
↑ Talmud Bavli Tractate Shabbos 133b: Rav Pappa said, “A mohel who does not perform metzitzah endangers the baby and is dismissed.”
↑ Halperin, Mordechai; (translated by Yocheved Lavon), "Metzitzah B’peh Controversy: The View from Israel", Jewish Action 67(2), Orthodox Union, Winter 2006, pp. 25, 33–39. Retrieved 2007-02-15.
↑ Gesundheit, B. and et al. (August 2004). Neonatal Genital Herpes Simplex Virus Type 1 Infection After Jewish Ritual Circumcision: Modern Medicine and Religious Tradition. Pediatrics 114 (2): e259–e263. ISSN 1098-4275.
↑ Metzitza Be'Peh - Halachic Clarification. Rabbinical Council of America (June 7, 2005). Retrieved 2007-04-06.
↑ Hartog, Kelly, "Death Spotlights Old Circumcision Rite", The Jewish Journal of Greater Los Angeles, February 18 2005. Retrieved 2006-11-22.
↑ ^34.0 ^34.1 Burton, Richard (1882-1884). "Nur Al-Din Ali and the Damsel Anis Al-Jalis, footnote FN#26", The Arabian Nights, tales from a thousand and one nights (HTML) (in English). Retrieved 2007-07-07. “ [FN#26] In one matter Moslems contrast strongly with Christians, by most scrupulously following the example of their law-giver: hence they are the model Conservatives. But (European) Christendom is here, as in other things, curiously contradictory: for instance, it still keeps a "Feast of the Circumcision," and practically holds circumcision in horror. Eastern Christians, however, have not wholly abolished it, and the Abyssinians, who find it a useful hygenic precaution, still practise it. For ulcers, syphilis and other venereals which are readily cured in Egypt become dangerous in the Highlands of Ethiopia.” Cite error: Invalid <ref> tag; name "CoF" defined multiple times with different content
↑ 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.
↑ Greek Orthodox Archdiocese calendar of Holy Days
↑ Russian Orthodox Church, Patriarchate of Moscow
↑ For example, "The Calendar of the Church Year" in The (Online) Book of Common Prayer (Episcopal Church in the United States of America), http://www.bcponline.org/ retrieved 11 October 2006.
↑ Al-Munajjid, Muhammed Salih. Question #9412: Circumcision: how it is done and the rulings on it. Islam Q&A. Retrieved 2006-07-01.
↑ Al-Munajjid, Muhammed Salih. Question #7073: The health and religious benefits of circumcision. Islam Q&A. Retrieved 2006-07-01.
↑ Hamdullah Aydın, M.D. and Zeynep Gülçat, Ph.D., "Turkey," in The International Encyclopedia of Sexuality, http://www2.hu-berlin.de/sexology/IES/turkey.html#5 retrieved 8 July 2007.
↑ Iftikhar Ahmad Jan, "Circumcision in babies and children with Plastibell technique: An easy procedure with minimal complications - Experience of 316 cases," Pak J Med Sci 2004, 20(3) 175-180.
↑ Drew, Paula E..; F. A. Sadeghpour and anonymous "Iran". The International Encyclopedia of Sexuality. Ed. Robert T. Francoeur. New York, NY: Continuum Publishing Company. Retrieved on 2006-10-18.
↑ Kamyar M. Hedayat, MD and Roya Pirzadeh, MD, "Issues in Islamic Biomedical Ethics: A Primer for the Pediatrician," Pediatrics Vol. 108 No. 4 October 2001, pp. 965-971, http://imamreza.net/eng/imamreza.php?print=3107 retrieved 11 October 2006.
↑ WHEN YOUR PATIENT IS A BAHA'I. National Spiritual Assembly of the Bahá'ís of New Zealand. Retrieved 2007-01-30.
↑ Who Are the Druze?. SEMP Biot #176. Suburban Emergency Management Project (February 17, 2005). Retrieved 2007-01-30.
↑ Guidelines for health Care Providers Interacting with Patients of the Sikh Religion and their Families. Metropolitan Chicago Healthcare Council (November 2000). Retrieved 2007-05-01.
↑ Rebollido, Rommel G., "Passage to manhood", General Santos, Sun Star Publishing, Inc., March 21, 2005. Retrieved 2006-07-01.
↑ de Morga, Antonio [1609] (1907). "11", History of the Philippine Islands, Translated by Alfonso de Salvio, Norman F. Hall, and James Alexander Robertson. LCCN unk82-42869. Retrieved 2006-07-01. “These Borneans are Mahometans, and were already introducing their religion among the natives of Luzon, and were giving them instructions, ceremonies, and the form of observing their religion.…and those the chiefest men, were commencing, although by piecemeal, to become Moros, and were being circumcised and taking the names of Moros.”
↑ 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
↑ "PNG circumcision campaign hopes to halt HIV," (htm). ABC Radio Australia citing the Papua New Guinea Post-Courier (2007-02-08, 14:21:13,).
↑ Aaron David Samuel Corn (2001). "Ngukurr Crying: Male Youth in a Remote Indigenous Community". Working Paper Series No. 2. University of Wollongong. Retrieved 2006-10-18.
↑ Migration and Trade. Green Turtle Dreaming. Retrieved 2006-10-18.
↑ Jones, IH (June 1969). Subincision among Australian western desert Aborigines. British Journal of Medical Psychology 42 (2): 183–190. ISSN 0007-1129 PMID 5783777.
↑ RECENT GUEST SPEAKER. Australian AIDS Fund Incorporated (2006). Retrieved 2006-07-01.
↑ Weird & Wonderful. United Travel. Retrieved 2006-07-01.
↑ Circumcision amongst the Dogon. The Non-European Components of European Patrimony (NECEP) Database (2006). Retrieved 2006-09-03.
↑ Agberia, John Tokpabere (2006). Aesthetics and Rituals of the Opha Ceremony among the Urhobo People. Journal of Asian and African Studies 41 (3): 249-260.
↑ Masai of Kenya. Retrieved 2007-04-06.
↑ ^60.0 ^60.1 ^60.2 ^60.3 ^60.4 Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision. 1999 AMA Interim Meeting: Summaries and Recommendations of Council on Scientific Affairs Reports pp. 17. American Medical Association (December 1999). Retrieved 2006-06-13.
↑ Auvert, Bertran and Dirk Taljaard, Emmanuel Lagarde, Joëlle Sobngwi-Tambekou, Rémi Sitta, Adrian Puren (November 2005). Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial. PLoS Medicine 2 (11): 1112–1122. PMID 16231970.
↑ ^62.0 ^62.1 Sommerville, Margaret (November 2000). "Altering Baby Boys’ Bodies: The Ethics of Infant Male Circumcision", The ethical canary: science, society, and the human spirit. New York, NY: Viking Penguin Canada, 202–219. LCCN 2001-369341. ISBN 0670893021. Retrieved 2007-02-12.
↑ Van Howe, R.S. and J.S. Svoboda, J.G. Dwyer, and C.P. Price (January 1999). Involuntary circumcision: the legal issues. BJU International 83 (Supp1): 63–73.
↑ Lightfoot-Klein, Hanny (2003). Similarities in Attitudes and Misconceptions toward Infant Male Circumcision in North America and Ritual Female Genital Mutilation in Africa.. The FGC Education and Networking Project. Retrieved 2006-07-01.
↑ Benatar, David and Benatar, Michael (2003). How not to argue about circumcision. American Journal of Bioethics 3 (2): W1-W9.
↑ ^66.0 ^66.1 ^66.2 American Academy of Pediatrics Task Force on Circumcision (March 1, 1999). Circumcision Policy Statement. Pediatrics 103 (3): 686–693. ISSN 0031-4005 PMID 10049981.
↑ Cite error: Invalid <ref> tag; no text was provided for refs named CMAJ2
↑ Cite error: Invalid <ref> tag; no text was provided for refs named BMAGuide2
↑ Policy Statement On Circumcision (PDF). Royal Australasian College of Physicians (September 2004). Retrieved 2007-02-28.
↑ ^70.0 ^70.1 ^70.2 Medical Ethics Committee (June 2006). The law and ethics of male circumcision - guidance for doctors. British Medical Association. Retrieved 2006-07-01.
↑ Goldman, R. (January 1999). The psychological impact of circumcision. BJU International 83 (S1): 93–102.
↑ National Organization of Restoring Men (2006). Retrieved 2006-07-01.
↑ Sweden restricts circumcisions. BBC Europe (October 1, 2001). Retrieved 2006-10-18.
↑ Reuters (June 7, 2001). Jews protest Swedish circumcision restriction. Canadian Children's Rights Council. Retrieved 2006-10-18.
↑ Bureau of Democracy, Human Rights, and Labor (September 15, 2006). Sweden. International Religious Freedom Report 2006. US Department of State. Retrieved 2007-07-04.
↑ Cite error: Invalid <ref> tag; no text was provided for refs named AAFP
↑ Boyle, Gregory J; Svoboda, J Steven; Goldman, Ronald; Fernandez, Ephrem (2002). Male circumcision: pain, trauma, and psychosexual sequelae. Bond University Faculty of Humanities and Social Sciences.
↑ Schoen, Edgar J. and Christopher J. Colby, Trinh T. To (March 2006). Cost Analysis of Neonatal Circumcision in a Large Health Maintenance Organization. The Journal of Urology 175 (3): 1111–1115. PMID 16469634.
↑ Alanis, Mark C. and Richard S. Lucidi (May 2004). Neonatal Circumcision: A Review of the World’s Oldest and Most Controversial Operation. Obstetrical & Gynecological Survey 59 (5): 379-395. PMID 15097799.
↑ Van Howe, Robert S. (November 2004). A Cost-Utility Analysis of Neonatal Circumcision. Medical Decision Making 24 (6): 584–601. PMID 15534340.
↑ Ganiats, TG and Humphrey JB, Taras HL, Kaplan RM. (Oct–Dec 1991). Routine neonatal circumcision: a cost-utility analysis. Medical Decision Making 11 (4): 282–293. PMID 1766331.
↑ Lawler, FH and Bisonni RS, Holtgrave DR. (Nov–Dec 1991). Circumcision: a decision analysis of its medical value.. Family Medicine 23 (8): 587–593. PMID 1794670.
↑ Christakis, Dmitry A. and Eric Harvey, Danielle M. Zerr, Chris Feudtner, Jeffrey A. Wright, and Frederick A. Connell (January 2000). A Trade-off Analysis of Routine Newborn Circumcision. Pediatrics 105 (1): 246–249. PMID 10617731.
↑ Ahmed A,, A and Mbibi NH, Dawam D, Kalayi GD (March 1999). Complications of traditional male circumcision. Annals of Tropical Paediatrics 19 (1): 113–117. PMID 10605531 ISSN 0272-4936.
↑ Kaplan, George W., M.D. (August 1983). Complications of Circumcision. UROLOGIC CLINICS OF NORTH AMERICA 10 (3): 543–549.
↑ www.ncbi.nlm.nih.gov/
↑ Siegfried, N and M Muller, J Deeks, J Volmink, M Egger, N Low, S Walker, and P Williamson (March 2005). HIV and male circumcision—a systematic review with assessment of the quality of studies. The Lancet Infectious Diseases 5 (3): 165–173. PMID 15766651.
↑ Although the Academy's 1975 statement asserted that "A program of education leading to continuing good personal hygiene would offer all the advantages of circumcision without the attendant surgical risk," the 1999 statement cites a study which found that "appropriate hygiene decreased significantly the incidence of phimosis, adhesions, and inflammation, but did not eliminate all problems."
↑ Care Of The Foreskin. Paediatric Policy - Circumcision. The Royal Australasian College of Physicians (October 2004). Retrieved 2006-07-13.
↑ ^90.0 ^90.1 Birley (October 1993). Clinical Features and management of recurrent balanitis; association with atopy and genital washing. Genitourinary Medicine 69 (5): 400–403. PMID 8244363.
↑ Sonnex, C and Croucher, PE; Dockerty WG (Dec 1997). Balanoposthitis associated with the presence of subpreputial "smegma stones". Genitourin Med 73 (6): 567.
↑ Hutson, J.M. (June 2004). Circumcision: a surgeon’s perspective. Journal of Medical Ethics 30 (3): 238–240. PMID 15173354.
↑ Darby, Robert (July 2005). The riddle of the sands: circumcision, history, and myth. The New Zealand Medical Journal 118 (1218): 76–82. ISSN 11758716 PMID 16027753.
↑ Fergusson, DM and JM Lawton and FT Shannon (April 1988). Neonatal circumcision and penile problems: an 8-year longitudinal study. Pediatrics 81 (4): 537–541. PMID 3353186.
↑ Fakjian, N and S Hunter, GW Cole and J Miller (August 1990). An argument for circumcision. Prevention of balanitis in the adult. Arch Dermatol 126 (8): 1046–7. PMID 2383029.
↑ Herzog, LW and SR Alvarez (March 1986). The frequency of foreskin problems in uncircumcised children. Am J Dis Child 140 (3): 254–6. PMID 3946358.
↑ O’Farrel, Nigel and Maria Quigley and Paul Fox (August 2005). Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study. International Journal of STD & AIDS 16 (8): 556–588(4). PMID 16105191. Editor’s note: I cannot confirm that the article substantiates the claim as I cannot access the full article.
↑ Cite error: Invalid <ref> tag; no text was provided for refs named CMAJ
↑ Osipov, Vladimir O.; Scott M. Acker (November 14, 2006). Balanoposthitis. Reactive and Inflammatory Dermatoses. EMedicine. Retrieved 2006-11-20.
↑ Ronald Immerman and Wade Mackey (1997). A Biocultural Analysis of Circumcision. Social Biology 44: 265-275.
↑ (1855). On the influence of circumcision in preventing syphilis. Medical Times and Gazette NS Vol II: 542–3.
↑ Epstein E (1874). Have the Jews any Immunity from Certain Diseases?. Medical and Surgical Reporter (Philadelphia) XXX: 40–41.
↑ Weiss, HA and Thomas, SL; Munabi SK; Hayes RJ (Apr 2006). Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect 82 (2): 101-9. PMID 16581731.
↑ Waldeck, S.E. (2003). Using Male Circumcision to Understand Social Norms as Multipliers. UNIVERSITY OF CINCINNATI LAW REVIEW 72 (2): 455-526.
↑ Cite error: Invalid <ref> tag; no text was provided for refs named Gairdner
↑ Pang, MG and Kim DS (2002). Extraordinarily high rates of male circumcision in South Korea: history and underlying causes. BJU Int 89 (1): 48-54.
↑ ^107.0 ^107.1 Adler, R and et al (2001). Circumcision: we have heard from the experts; now let's hear from the parents. Pediatrics 107 (2): E20.

References
ISBN links support NWE through referral fees

External links

The Circumcision Information and Resource Pages by Geoffrey T. Falk
Doctors Opposing Circumcision presided by George C. Denniston, MD, MPH

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Circumcision ^history

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History of "Circumcision"

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[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] "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

[3] "Circumcision, surgical removal of all or part of the foreskin of the human male...," "Circumcision," Microsoft Encarta, 2007.

[4] "Male circumcision is an elective surgery to remove the foreskin..." Circumcision, British Columbia Health Guide, June 2, 2006. Retrieved July 18, 2007.

[5] "Circumcision is surgery..." Pain and Your Infant: Medical Procedures, Circumcision and Teething, University of Michigan Health System, February 2007. Retrieved July 18, 2007.

[6] " Circumcision is cutting away part of the foreskin... When this surgery is performed..." Newborn Care, Danbury Hospital website. Retrieved July 18, 2007.

[WHO-C.26R-2] (March 28, 2007). "New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications". World Health Organization. Retrieved 2007-08-13.

[WHO-Info-2-3] 3.0 ^3.1 Insert 2. Information Package on Male Ci rcumcision and HIV Prevention. World Health Organization (2007). Retrieved 2007-08-15.

[4] Wrana, P. (1939). Historical review: Circumcision. Archives of Pediatrics 56: 385–392. as quoted in: Zoske, Joseph (Winter 1998). Male Circumcision: A Gender Perspective. Journal of Men’s Studies 6 (2): 189–208.

[Gollaher-5] Gollaher, David L. (February 2000). Circumcision: a history of the world’s most controversial surgery. New York, NY: Basic Books, 53–72. ISBN 978-0-465-04397-2 LCCN 99-40015.

[6] Circumcision. American-Israeli Cooperative Enterprise. Retrieved 2006-10-03.

[7] Beidelman, T.. (1987). "CIRCUMCISION". The Encyclopedia of religion Volume 3: 511–514. Ed. Mircea Eliade. New York, NY: Macmillan Publishers. LCCN 86-5432 ISBN 978-0-02-909480-8. Retrieved on 2006-10-03.

[Christian-8] 8.0 ^8.1 ^8.2 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.

[14] "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.

[15] "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.

[Milos-9] Milos, Marilyn Fayre and Donna Macris (March-April 1992). Circumcision: A medical or a human rights issue?. Journal of Nurse-Midwifery 37 (2 S1): S87–S96.

[Schoen-10] Schoen, Edgar J (1997). Benefits of newborn circumcision: is Europe ignoring medical evidence?. Archives of Disease in Childhood 77 (3): 258-260.

[Newell-11] Newell, Marie-Lousie and Till Bärnighausen (February 24, 2007). Male circumcision to cut HIV risk in the general population. The Lancet 369 (9562): 617–619.

[baileyrct-12] Bailey, Robert C and Stephen Moses, Corette B Parker, Kawango Agot, Ian Maclean, John N Krieger, Carolyn F M Williams, Richard T Campbell, Jeckoniah O Ndinya-Achola (February 24, 2007). Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. The Lancet 369 (9562): 643–656.

[grayrct-13] Gray, Ronald H and Godfrey Kigozi, David Serwadda, Frederick Makumbi, Stephen Watya, Fred Nalugoda, Noah Kiwanuka, Lawrence H Moulton, Mohammad A Chaudhary, Michael Z Chen, Nelson K Sewankambo, Fred Wabwire-Mangen, Melanie C Bacon, Carolyn F M Williams, Pius Opendi, Steven J Reynolds, Oliver Laeyendecker, Thomas C Quinn, Maria J Wawer (February 24, 2007). Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. The Lancet 369 (9562): 657–666.

[aafpadult-14] Holman, John R. and Keith A. Stuessi (March 15, 1999). Adult Circumcision. American Family Physician 59 (6): 1514–1518. ISSN 0002-838X PMID 10193593.

[15] Rempelakos A and et al (Jan-Mar 2004). Carcinoma of the penis: experience from 360 cases. J BUON 9 (1): 51-5.

[dewan-16] Dewan, P.A. and Tieu H.C., and Chieng B.S. (August 1996). Phimosis: Is circumcision necessary?. Journal of Paediatrics and Child Health 32 (4): 285–289. PMID 8844530.

[beauge-17] Beaugé, Michel (September/October 1997). The causes of adolescent phimosis. British Journal of Sexual Medicine 26.

[18] Holman, John R. and Evelyn L. Lewis, Robert L. Ringler (August 1995). Neonatal circumcision techniques - includes patient information sheet. American Family Physician 52 (2): 511–520. ISSN 0002-838X PMID 7625325.

[19] Peleg, David and Ann Steiner (September 15, 1998). The Gomco Circumcision: Common Problems and Solutions. American Family Physician 58 (4): 891–898. ISSN 0002-838X PMID 9767725.

[Pfenninger-20] Pfenninger, John L. and Grant C. Fowler [1994] (July 21, 2003). Procedures for primary care, 2nd, Mosby. ISBN 978-0-323-00506-7 LCCN 2003-56227.

[Reynolds-21] Reynolds, RD (July 1996). Use of the Mogen clamp for neonatal circumcision. American Family Physician 54 (1): 177–182. PMID 8677833.

[22] Griffin A, Kroovand R (1990). Frenular chordee: implications and treatment. Urology 35 (2): 133-4. PMID 2305537.

[Shechet-23] Cite error: Invalid <ref> tag; no text was provided for refs named Shechet

[24] Hodges, Frederick, M. (2001). Religious circumcision: a Jewish view. The Bulletin of the History of Medicine 75 (Fall 2001): 375–405.

[GlassJM-25] Glass, J.M. (January 1999). Religious circumcision: a Jewish view. BJU International 83 (Supplement 1): 17–21. PMID 10766529.

[26] Shulchan Aruch, Yoreh De'ah, 263:4

[27] Nussbaum Cohen, Debra (October 14, 2005). City Risking Babies' Lives With Brit Policy: Health Experts. The Jewish Week. Retrieved 2007-04-19.

[28] Nussbaum Cohen, Debra; Larry Cohler-Esses (December 23, 2005). City Challenged On Ritual Practice. The Jewish Week. Retrieved 2007-04-19.

[29] Talmud Bavli Tractate Shabbos 133b: Rav Pappa said, “A mohel who does not perform metzitzah endangers the baby and is dismissed.”

[30] Halperin, Mordechai; (translated by Yocheved Lavon), "Metzitzah B’peh Controversy: The View from Israel", Jewish Action 67(2), Orthodox Union, Winter 2006, pp. 25, 33–39. Retrieved 2007-02-15.

[Gesundheit-31] Gesundheit, B. and et al. (August 2004). Neonatal Genital Herpes Simplex Virus Type 1 Infection After Jewish Ritual Circumcision: Modern Medicine and Religious Tradition. Pediatrics 114 (2): e259–e263. ISSN 1098-4275.

[RCAMetzitzah-32] Metzitza Be'Peh - Halachic Clarification. Rabbinical Council of America (June 7, 2005). Retrieved 2007-04-06.

[33] Hartog, Kelly, "Death Spotlights Old Circumcision Rite", The Jewish Journal of Greater Los Angeles, February 18 2005. Retrieved 2006-11-22.

[CoF-34] 34.0 ^34.1 Burton, Richard (1882-1884). "Nur Al-Din Ali and the Damsel Anis Al-Jalis, footnote FN#26", The Arabian Nights, tales from a thousand and one nights (HTML) (in English). Retrieved 2007-07-07. “ [FN#26] In one matter Moslems contrast strongly with Christians, by most scrupulously following the example of their law-giver: hence they are the model Conservatives. But (European) Christendom is here, as in other things, curiously contradictory: for instance, it still keeps a "Feast of the Circumcision," and practically holds circumcision in horror. Eastern Christians, however, have not wholly abolished it, and the Abyssinians, who find it a useful hygenic precaution, still practise it. For ulcers, syphilis and other venereals which are readily cured in Egypt become dangerous in the Highlands of Ethiopia.” Cite error: Invalid <ref> tag; name "CoF" defined multiple times with different content

[35] 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.

[36] Greek Orthodox Archdiocese calendar of Holy Days

[37] Russian Orthodox Church, Patriarchate of Moscow

[38] For example, "The Calendar of the Church Year" in The (Online) Book of Common Prayer (Episcopal Church in the United States of America), http://www.bcponline.org/ retrieved 11 October 2006.

[39] Al-Munajjid, Muhammed Salih. Question #9412: Circumcision: how it is done and the rulings on it. Islam Q&A. Retrieved 2006-07-01.

[40] Al-Munajjid, Muhammed Salih. Question #7073: The health and religious benefits of circumcision. Islam Q&A. Retrieved 2006-07-01.

[41] Hamdullah Aydın, M.D. and Zeynep Gülçat, Ph.D., "Turkey," in The International Encyclopedia of Sexuality, http://www2.hu-berlin.de/sexology/IES/turkey.html#5 retrieved 8 July 2007.

[42] Iftikhar Ahmad Jan, "Circumcision in babies and children with Plastibell technique: An easy procedure with minimal complications - Experience of 316 cases," Pak J Med Sci 2004, 20(3) 175-180.

[43] Drew, Paula E..; F. A. Sadeghpour and anonymous "Iran". The International Encyclopedia of Sexuality. Ed. Robert T. Francoeur. New York, NY: Continuum Publishing Company. Retrieved on 2006-10-18.

[44] Kamyar M. Hedayat, MD and Roya Pirzadeh, MD, "Issues in Islamic Biomedical Ethics: A Primer for the Pediatrician," Pediatrics Vol. 108 No. 4 October 2001, pp. 965-971, http://imamreza.net/eng/imamreza.php?print=3107 retrieved 11 October 2006.

[45] WHEN YOUR PATIENT IS A BAHA'I. National Spiritual Assembly of the Bahá'ís of New Zealand. Retrieved 2007-01-30.

[46] Who Are the Druze?. SEMP Biot #176. Suburban Emergency Management Project (February 17, 2005). Retrieved 2007-01-30.

[47] Guidelines for health Care Providers Interacting with Patients of the Sikh Religion and their Families. Metropolitan Chicago Healthcare Council (November 2000). Retrieved 2007-05-01.

[48] Rebollido, Rommel G., "Passage to manhood", General Santos, Sun Star Publishing, Inc., March 21, 2005. Retrieved 2006-07-01.

[49] Morga, Antonio [1609] (1907). "11", History of the Philippine Islands, Translated by Alfonso de Salvio, Norman F. Hall, and James Alexander Robertson. LCCN unk82-42869. Retrieved 2006-07-01. “These Borneans are Mahometans, and were already introducing their religion among the natives of Luzon, and were giving them instructions, ceremonies, and the form of observing their religion.…and those the chiefest men, were commencing, although by piecemeal, to become Moros, and were being circumcised and taking the names of Moros.”

[50] 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

[51] "PNG circumcision campaign hopes to halt HIV," (htm). ABC Radio Australia citing the Papua New Guinea Post-Courier (2007-02-08, 14:21:13,).

[52] Aaron David Samuel Corn (2001). "Ngukurr Crying: Male Youth in a Remote Indigenous Community". Working Paper Series No. 2. University of Wollongong. Retrieved 2006-10-18.

[53] Migration and Trade. Green Turtle Dreaming. Retrieved 2006-10-18.

[54] Jones, IH (June 1969). Subincision among Australian western desert Aborigines. British Journal of Medical Psychology 42 (2): 183–190. ISSN 0007-1129 PMID 5783777.

[55] RECENT GUEST SPEAKER. Australian AIDS Fund Incorporated (2006). Retrieved 2006-07-01.

[56] Weird & Wonderful. United Travel. Retrieved 2006-07-01.

[57] Circumcision amongst the Dogon. The Non-European Components of European Patrimony (NECEP) Database (2006). Retrieved 2006-09-03.

[58] Agberia, John Tokpabere (2006). Aesthetics and Rituals of the Opha Ceremony among the Urhobo People. Journal of Asian and African Studies 41 (3): 249-260.

[59] Masai of Kenya. Retrieved 2007-04-06.

[CSA:I-99-60] 60.0 ^60.1 ^60.2 ^60.3 ^60.4 Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision. 1999 AMA Interim Meeting: Summaries and Recommendations of Council on Scientific Affairs Reports pp. 17. American Medical Association (December 1999). Retrieved 2006-06-13.

[ANRS-61] Auvert, Bertran and Dirk Taljaard, Emmanuel Lagarde, Joëlle Sobngwi-Tambekou, Rémi Sitta, Adrian Puren (November 2005). Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial. PLoS Medicine 2 (11): 1112–1122. PMID 16231970.

[Sommerville-62] 62.0 ^62.1 Sommerville, Margaret (November 2000). "Altering Baby Boys’ Bodies: The Ethics of Infant Male Circumcision", The ethical canary: science, society, and the human spirit. New York, NY: Viking Penguin Canada, 202–219. LCCN 2001-369341. ISBN 0670893021. Retrieved 2007-02-12.

[VanHoweLegal-63] Van Howe, R.S. and J.S. Svoboda, J.G. Dwyer, and C.P. Price (January 1999). Involuntary circumcision: the legal issues. BJU International 83 (Supp1): 63–73.

[64] Lightfoot-Klein, Hanny (2003). Similarities in Attitudes and Misconceptions toward Infant Male Circumcision in North America and Ritual Female Genital Mutilation in Africa.. The FGC Education and Networking Project. Retrieved 2006-07-01.

[65] Benatar, David and Benatar, Michael (2003). How not to argue about circumcision. American Journal of Bioethics 3 (2): W1-W9.

[AAP1999-66] 66.0 ^66.1 ^66.2 American Academy of Pediatrics Task Force on Circumcision (March 1, 1999). Circumcision Policy Statement. Pediatrics 103 (3): 686–693. ISSN 0031-4005 PMID 10049981.

[CMAJ2-67] Cite error: Invalid <ref> tag; no text was provided for refs named CMAJ2

[BMAGuide2-68] Cite error: Invalid <ref> tag; no text was provided for refs named BMAGuide2

[RACPSumm-69] Policy Statement On Circumcision (PDF). Royal Australasian College of Physicians (September 2004). Retrieved 2007-02-28.

[BMAGuide-70] 70.0 ^70.1 ^70.2 Medical Ethics Committee (June 2006). The law and ethics of male circumcision - guidance for doctors. British Medical Association. Retrieved 2006-07-01.

[71] Goldman, R. (January 1999). The psychological impact of circumcision. BJU International 83 (S1): 93–102.

[72] National Organization of Restoring Men (2006). Retrieved 2006-07-01.

[73] Sweden restricts circumcisions. BBC Europe (October 1, 2001). Retrieved 2006-10-18.

[74] Reuters (June 7, 2001). Jews protest Swedish circumcision restriction. Canadian Children's Rights Council. Retrieved 2006-10-18.

[75] Bureau of Democracy, Human Rights, and Labor (September 15, 2006). Sweden. International Religious Freedom Report 2006. US Department of State. Retrieved 2007-07-04.

[AAFP-76] Cite error: Invalid <ref> tag; no text was provided for refs named AAFP

[77] Boyle, Gregory J; Svoboda, J Steven; Goldman, Ronald; Fernandez, Ephrem (2002). Male circumcision: pain, trauma, and psychosexual sequelae. Bond University Faculty of Humanities and Social Sciences.

[78] Schoen, Edgar J. and Christopher J. Colby, Trinh T. To (March 2006). Cost Analysis of Neonatal Circumcision in a Large Health Maintenance Organization. The Journal of Urology 175 (3): 1111–1115. PMID 16469634.

[79] Alanis, Mark C. and Richard S. Lucidi (May 2004). Neonatal Circumcision: A Review of the World’s Oldest and Most Controversial Operation. Obstetrical & Gynecological Survey 59 (5): 379-395. PMID 15097799.

[80] Van Howe, Robert S. (November 2004). A Cost-Utility Analysis of Neonatal Circumcision. Medical Decision Making 24 (6): 584–601. PMID 15534340.

[81] Ganiats, TG and Humphrey JB, Taras HL, Kaplan RM. (Oct–Dec 1991). Routine neonatal circumcision: a cost-utility analysis. Medical Decision Making 11 (4): 282–293. PMID 1766331.

[82] Lawler, FH and Bisonni RS, Holtgrave DR. (Nov–Dec 1991). Circumcision: a decision analysis of its medical value.. Family Medicine 23 (8): 587–593. PMID 1794670.

[UWstudy-83] Christakis, Dmitry A. and Eric Harvey, Danielle M. Zerr, Chris Feudtner, Jeffrey A. Wright, and Frederick A. Connell (January 2000). A Trade-off Analysis of Routine Newborn Circumcision. Pediatrics 105 (1): 246–249. PMID 10617731.

[84] Ahmed A,, A and Mbibi NH, Dawam D, Kalayi GD (March 1999). Complications of traditional male circumcision. Annals of Tropical Paediatrics 19 (1): 113–117. PMID 10605531 ISSN 0272-4936.

[kaplan-85] Kaplan, George W., M.D. (August 1983). Complications of Circumcision. UROLOGIC CLINICS OF NORTH AMERICA 10 (3): 543–549.

[86] www.ncbi.nlm.nih.gov/

[Sig-87] Siegfried, N and M Muller, J Deeks, J Volmink, M Egger, N Low, S Walker, and P Williamson (March 2005). HIV and male circumcision—a systematic review with assessment of the quality of studies. The Lancet Infectious Diseases 5 (3): 165–173. PMID 15766651.

[88] Although the Academy's 1975 statement asserted that "A program of education leading to continuing good personal hygiene would offer all the advantages of circumcision without the attendant surgical risk," the 1999 statement cites a study which found that "appropriate hygiene decreased significantly the incidence of phimosis, adhesions, and inflammation, but did not eliminate all problems."

[RACPAnat-89] Care Of The Foreskin. Paediatric Policy - Circumcision. The Royal Australasian College of Physicians (October 2004). Retrieved 2006-07-13.

[birley-90] 90.0 ^90.1 Birley (October 1993). Clinical Features and management of recurrent balanitis; association with atopy and genital washing. Genitourinary Medicine 69 (5): 400–403. PMID 8244363.

[91] Sonnex, C and Croucher, PE; Dockerty WG (Dec 1997). Balanoposthitis associated with the presence of subpreputial "smegma stones". Genitourin Med 73 (6): 567.

[92] Hutson, J.M. (June 2004). Circumcision: a surgeon’s perspective. Journal of Medical Ethics 30 (3): 238–240. PMID 15173354.

[93] Darby, Robert (July 2005). The riddle of the sands: circumcision, history, and myth. The New Zealand Medical Journal 118 (1218): 76–82. ISSN 11758716 PMID 16027753.

[Ferg-94] Fergusson, DM and JM Lawton and FT Shannon (April 1988). Neonatal circumcision and penile problems: an 8-year longitudinal study. Pediatrics 81 (4): 537–541. PMID 3353186.

[95] Fakjian, N and S Hunter, GW Cole and J Miller (August 1990). An argument for circumcision. Prevention of balanitis in the adult. Arch Dermatol 126 (8): 1046–7. PMID 2383029.

[96] Herzog, LW and SR Alvarez (March 1986). The frequency of foreskin problems in uncircumcised children. Am J Dis Child 140 (3): 254–6. PMID 3946358.

[97] O’Farrel, Nigel and Maria Quigley and Paul Fox (August 2005). Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study. International Journal of STD & AIDS 16 (8): 556–588(4). PMID 16105191. Editor’s note: I cannot confirm that the article substantiates the claim as I cannot access the full article.

[CMAJ-98] Cite error: Invalid <ref> tag; no text was provided for refs named CMAJ

[99] Osipov, Vladimir O.; Scott M. Acker (November 14, 2006). Balanoposthitis. Reactive and Inflammatory Dermatoses. EMedicine. Retrieved 2006-11-20.

[100] Ronald Immerman and Wade Mackey (1997). A Biocultural Analysis of Circumcision. Social Biology 44: 265-275.

[101] (1855). On the influence of circumcision in preventing syphilis. Medical Times and Gazette NS Vol II: 542–3.

[102] Epstein E (1874). Have the Jews any Immunity from Certain Diseases?. Medical and Surgical Reporter (Philadelphia) XXX: 40–41.

[103] Weiss, HA and Thomas, SL; Munabi SK; Hayes RJ (Apr 2006). Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect 82 (2): 101-9. PMID 16581731.

[104] Waldeck, S.E. (2003). Using Male Circumcision to Understand Social Norms as Multipliers. UNIVERSITY OF CINCINNATI LAW REVIEW 72 (2): 455-526.

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[106] Pang, MG and Kim DS (2002). Extraordinarily high rates of male circumcision in South Korea: history and underlying causes. BJU Int 89 (1): 48-54.

[adler-107] 107.0 ^107.1 Adler, R and et al (2001). Circumcision: we have heard from the experts; now let's hear from the parents. Pediatrics 107 (2): E20.

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Difference between revisions of "Circumcision" - New World Encyclopedia

Revision as of 21:43, 3 October 2007

Contents

Circumcision procedures

Cultures and religions

Judaism

Christianity

Islam

Other faiths and traditions

Ethical issues

Consent

Emotional consequences

Legality

Sexual effects

Medical aspects

Risks of circumcision

HIV

Hygiene

Infectious and chronic conditions

History of circumcision

Circumcision in the ancient world

Medical circumcision in the 19th century and early 20th century

Circumcision since 1950

Notes

References
ISBN links support NWE through referral fees

External links

Further reading

Credits

@@ Line 759: / Line 759: @@
 </ref>
-==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.”<ref name="AAP1999"/> In the statement, the Academy recommends the use of pain relief for circumcision.<ref name="AAP1999"/> 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." <ref name = "Taddio">{{cite journal
- | last = Taddio
- | first = Anna
- | coauthors = Joel Katz, A Lane Ilersich, [[Gideon Koren]]
- | year = 1997
- | month = March
- | title = Effect of neonatal circumcision on pain response during subsequent routine vaccination
- | journal = [[The Lancet]]
- | volume = 349
- | issue = 9052
- | pages = 599&ndash;603
- | doi = 10.1016/S0140-6736(96)10316-0
- | id =
- | url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673696103160.pdf
- | format = PDF &mdash; free registration required
- | accessdate = 2007-08-08
- }}
-</ref>
-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%).<ref name = "Stang">{{cite journal
- | last = Stang
- | first = Howard J.
- | coauthors = Leonard W. Snellman
- | year = 1998
- | month = June
- | title = Circumcision Practice Patterns in the United States
- | journal = [[Pediatrics (journal)|Pediatrics]]
- | volume = 101
- | issue = 6
- | pages = e5&ndash;
- | doi = 10.1542/peds.101.6.e5
- | id = {{ISSN|1098-4275}}
- | url = http://pediatrics.aappublications.org/cgi/reprint/101/6/e5.pdf
- | format = PDF
- | accessdate = 2006-06-29
- }}
-</ref>
-J.M. Glass, 1999, stated that Jewish ritual circumcision is so quick that "most ''mohelim'' do not routinely use any anaesthesia as they feel there is probably no need in the neonate. However, there is no Talmudic objection and should the parents wish for local anaesthetic cream to be applied there is no reason why this cannot be done."<ref name="GlassJM"/> Tannenbaum and Shechet, 2000, stated that an “authentic, traditional [[Brit milah|bris]] performed by a [[mohel]] does not use clamps, so there is no pain associated with crushing tissue.”<ref name = "Shechet">{{cite journal
- | last = Shechet
- | first = Jacob
- | coauthors = Barton Tanenbaum
- | year = 2000
- | title = Circumcision---The Debates Goes On
- | journal = [[Pediatrics (journal)|Pediatrics]]
- | volume = 105
- | issue = 3
- | pages = 682–683
- | pmid = 10733391
- | doi = doi:10.1542/peds.105.3.681
- | url = http://pediatrics.aappublications.org/cgi/reprint/105/3/681.pdf
- | format = PDF
- | accessdate = 2007-04-06
-}}
-</ref> They also asserted that due to the speed of the procedure and rarity of complication, it is “more humane not to subject the infant to a local anesthetic.”<ref name = "Shechet" />
-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)."[http://www.cirp.org/library/pain/lander/] A 2004 Cochrane review, which compared the dorsal penile nerve block and EMLA (topical anaesthesia) found both anaesthetics appear safe, but neither of them completely eliminated pain.<ref>{{cite journal | last = Brady-Fryer | first = B | coauthors = Wiebe N, Lander JA | year = 2004 | month = July | title = Pain relief for neonatal circumcision | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = Art. No.: CD004217 | doi = 10.1002/14651858.CD004217.pub2 | id = PMID 15495086 | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15495086&query_hl=2&itool=pubmed_docsum | format =  | accessdate = 2006-06-29 }} </ref> Razmus et al reported that newborns circumcised with the dorsal block and the ring block in combination with the concentrated oral sucrose had the lowest pain scores.<ref>{{cite journal |author=Razmus I, Dalton M, Wilson D |title=Pain management for newborn circumcision |journal=Pediatr Nurs |volume=30 |issue=5 |pages=414-7, 427 |year= |id=PMID 15587537}}</ref> Ng ''et al'' found that EMLA cream, in addition to local anaesthetic, effectively reduces the sharp pain induced by needle puncture.<ref>{{cite journal |first=WT |last=Ng |coauthors=''et al''|title=The use of topical lidocaine/prilocaine cream prior to childhood circumcision under local anesthesia |journal=Ambul Surg |volume=9 |issue=1 |pages=9-12 |year=2001 |id=PMID 11179706}}</ref>
 ==Sexual effects==
@@ Line 966: / Line 908: @@
   | accessdate = 2006-09-29
   }}
-</ref> [[Image:Flaccid-erect.jpg|right|thumb|A circumcised penis with a skin bridge.]]<!-- Image is at http://en.wikipedia.org/wiki/Image:Flaccid-erect.jpg in case the tag needs an administrator's touch. —> Infant circumcision may result in skin bridges, when the cut skin does not heal neatly but attaches to the [[glans penis]] instead. This does not commonly require surgical correction; rather, a brief, simple office procedure may be performed.<ref>{{cite journal
+</ref> [[Image:Flaccid-erect.jpg|right|thumb|A circumcised penis with a skin bridge.]]
- | last =  Naimer
- | first = Sody A.
- | coauthors = Roni Peleg, Yevgeni Meidvidovski, Alex Zvulunov, Arnon Dov Cohen, and Daniel Vardy
- | year = 2002
- | month = November
- | title = Office Management of Penile Skin Bridges with Electrocautery
- | journal = Journal of the American Board of Family Practice
- | volume = 15
- | issue = 6
- | pages = 485&ndash;488
- | id = PMID 10605531
- | url = http://www.jabfm.org/cgi/reprint/15/6/485
- | format = PDF
- | accessdate = 2006-07-01
- }}
-</ref>
-The [[American Medical Association]] quotes a complication rate of 0.2%–0.6%,<ref name = "CSA:I-99" /> based on the studies of Gee<ref>{{cite journal
- | last = Gee
- | first = W.F.
- | coauthors = J.S. Ansell
- | year = 1976
- | month = December
- | title = Neonatal circumcision: a ten-year overview: with comparison of the Gomco clamp and the Plastibell device
- | journal = Pediatrics
- | volume = 58
- | issue = 6
- | pages = 824&ndash;827
- | doi =
- | id = PMID 995507
- | url = http://pediatrics.aappublications.org/cgi/content/abstract/58/6/824
- | format = Abstract
- | accessdate = 2006-07-11
- }}
-</ref> and Harkavy.<ref>{{cite journal
- | last = Harkavy
- | first = K.L.
- | year = 1987
- | month = April
- | title = The circumcision debate
- | journal = Pediatrics
- | volume = 79
- | issue = 4
- | pages = 649&ndash;650
- | doi =
- | id = PMID 3822689
- | url =
- | format = Pubmed Entry
- | accessdate = 2006-07-11
- }}
-</ref> These same studies are quoted by the [[American Academy of Pediatrics]].<ref name = "AAP1999" /> The [[American Academy of Family Physicians]] quotes a range of anywhere between 0.1% and 35%.<ref name = "AAFP">{{cite web
-| url = http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html
-| title = Circumcision: Position Paper on Neonatal Circumcision
-| accessdate = 2007-01-30
-| year = 2007
-| publisher = [[American Academy of Family Physicians]]
-}}
-</ref> The [[Canadian Paediatric Society]] cite these results in addition to other figures ranging anywhere between 0.06% to 55%, and remark that Williams & Kapila<ref name="WillKap">{{cite journal
- | last = Williams
- | first = N
- | coauthors = L. Kapila
- | year = 1993
- | month = October
- | title = Complications of circumcision [http://www.cirp.org/library/complications/williams-kapila/ (full text)]
- | journal = British Journal of Surgery
- | volume = 80
- | issue = 10
- | pages = 1231&ndash;1236
- | doi = 10.1002/bjs.1800801005
- | id = PMID 8242285
- | url = http://www.bjs.co.uk/bjsCda/cda/microJournalArticleDetail.do;jsessionid=96BD3288E9BFA69C74CC1737D0AA6B90?DOI=10.1002%2Fbjs.1800801005&issueDOI=10.1002%2Fbjs.v80%3A10&vid=2
- | format = Abstract
- | accessdate = 2006-07-11
- }}
-</ref>  suggested that 2-10% is a realistic estimate.<ref name = "CMAJ" /> [[Meatal stenosis]] may be a common longer-term complication from circumcision. Recent publications give a frequency of occurrence between 0.9%<ref>{{cite journal
- | last = Yegane
- | first = Rooh-Allah
- | coauthors = Abdol-Reza Kheirollahi, Nour-Allah Salehi, Mohammad Bashashati, Jamal-Aldin Khoshdel, and Mina Ahmadi
- | year = 2006
- | month = May
- | title = Late complications of circumcision in Iran
- | journal = Pediatric Surgery International
- | volume = 22
- | issue = 5
- | pages = 442&ndash;445
- | doi = 10.1007/s00383-006-1672-1
- | id = PMID 16649052
- | url = http://www.springerlink.com/(qzpwjv55lf23wj454qsmor45)/app/home/contribution.asp?referrer=parent&backto=issue,9,19;journal,4,147;linkingpublicationresults,1:101176,1
- | format = Abstract
- | accessdate = 2006-07-02
- }}
-</ref> and 9% to 10%.<ref>{{cite web
-| url = http://www.emedicine.com/PED/topic2356.htm
-| title = http://www.emedicine.com/PED/topic2356.htm
-| accessdate = 2006-07-02
-| last = Angel
-| first = Carlos A.
-| date = June 12, 2006
-| work = eMedicine
-| publisher = WebMD
-}}
-</ref>  The RACP states that the penis is lost in 1 in 1,000,000 circumcisions.<ref name = "RACPComp">{{cite web
-| url = http://www.racp.edu.au/hpu/paed/circumcision/complications.htm
-| title = Complications Of Circumcision
-| accessdate = 2006-07-11
-| year = 2004
-| month = October
-| work = Paediatric Policy - Circumcision
-| publisher = The Royal Australasian College of Physicians
-}}
-</ref>
-Deaths have been reported.<ref name="kaplan"/><ref>{{cite web
-| url = http://www.pulsus.com/Paeds/12_04/Pdf/zwol_ed.pdf
-| title = Coroner's Corner Circumcision: A minor procedure?
-| author = Paediatric Death Review Committee: Office of the Chief Coroner of Ontario
-| accessdate = 2007-06-17
-| year = 2007
-| month = April
-| work = Paediatric Child Health Vol 12 No 4, April 2007 pages 311-312
-| publisher = Pulsus Group Inc.
-}}
-</ref>
-The American Academy of Family Physicians states that death is rare, and cites an estimated death rate of 1 infant in 500,000 from circumcision.<ref name = "AAFP" /> Gairdner's 1949 study reported that an average of 16 children per year out of about 90,000 died following circumcision in the [[United Kingdom|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.<ref name = "Gairdner">{{cite journal
- | last = Gairdner
- | first = Douglas
- | year = 1949
- | month = December
- | title = The Fate of the Foreskin
- | journal = British Medical Journal
- | volume = 2
- | issue = 4642
- | pages = 1433&ndash;1437
- | doi =
- | id =
- | url = http://www.cirp.org/library/general/gairdner/
- | format =
- | accessdate = 2006-07-01
- }}
-</ref>
-Adult circumcisions are often performed without clamps, and require 4 to 6 weeks of abstinence from masturbation or intercourse after the operation to allow the wound to heal.<ref name="aafpadult" />
 ===HIV===
@@ Line 1,128: / Line 928: @@
   | accessdate = 2007-07-09
   }}
-</ref>
-Three [[randomized controlled trial|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) during heterosexual intercourse.<ref name="WHOsec">{{cite web | url = http://www.who.int/mediacentre/news/statements/2007/s04/en/index.html | title = WHO and UNAIDS Secretariat welcome corroborating findings of trials assessing impact of male circumcision on HIV risk | accessdate = 2007-02-23 | date = February 23, 2007 | publisher = World Health Organization}}</ref> The results of the first trial were published in November 2005. It found a 60% reduction in the rate of new HIV infection (from 2.1 per 100 to 0.85 per 100 in the intervention group. The authors said, “Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa.”<ref name = "ANRS" /> Two further trials conducted in Uganda and Kenya were stopped early on December 13, 2006 on grounds that circumcision was so effective that it would be unethical to continue the experiment and not offer circumcision in the uncircumcised men who were acting as controls. The results showed that circumcised males in Uganda were, depending upon the analysis, 51%-60% less likely to be infected.<ref name="grayrct" /> In Kenya, circumcised males were 53%-60% less likely to be infected.<ref name="baileyrct" /> A paper published in the journal [[PLoS Medicine]] in July, 2006, calculated that if all men in sub-Saharan Africa were circumcised over the next 10 years, two million new infections could potentially be avoided.<ref name = "PLoS-7-06">{{cite journal
- | last = Williams
- | first = Brian G.
- | authorlink =
- | coauthors = James O. Lloyd-Smith, Eleanor Gouws, Catherine Hankins, Wayne M. Getz, John Hargrove, Isabelle de Zoysa, Christopher Dye, Bertran Auvert
- | year = 2006
- | month = July
- | title = The Potential Impact of Male Circumcision on HIV in Sub-Saharan Africa
- | journal = [[PLoS Medicine]]
- | volume = 3
- | issue = 7
- | pages = e262
- | doi = 10.1371/journal.pmed.0030262
- | id = PMID 16822094
- | url = http://medicine.plosjournals.org/archive/1549-1676/3/7/pdf/10.1371_journal.pmed.0030262-p-L.pdf
- | format = PDF
- | accessdate = 2006-07-13
- }}
-</ref>
-The World Health Organization (WHO) said: “Although these results demonstrate that male circumcision reduces the risk of men becoming infected with HIV, the UN agencies emphasize that it does not provide complete protection against HIV infection. Circumcised men can still become infected with the virus and, if HIV-positive, can infect their sexual partners. Male circumcision should never replace other known effective prevention methods and should always be considered as part of a comprehensive prevention package, which includes correct and consistent use of male or female condoms, reduction in the number of sexual partners, delaying the onset of sexual relations, and HIV testing and counselling.”.<ref name="WHOsec"/> Others have also expressed concern that some may mistakenly believe they will be fully protected against HIV through circumcision and see circumcision as a safe alternative to other forms of protection, such as condoms.<ref>{{cite web
-| url = http://www.who.int/mediacentre/news/statements/2006/s18/en/index.html
-| title = Male circumcision reduces the risk of becoming infected with HIV, but does not provide complete protection
-| accessdate = 2006-07-20
-| date = December 13, 2006
-| publisher = World Health Organization
-}}
-</ref><ref>{{cite web
-| url = http://news.bbc.co.uk/2/hi/health/4371384.stm
-| title = Circumcision 'reduces HIV risk'
-| date = October 25, 2005
-| publisher = BBC News
-}}
-</ref> An interim analysis from the Rakai Health Sciences Program in Uganda suggested that newly circumcised HIV positive men may be more likely to spread HIV to their female partners if they have sexual intercourse before the wound is fully healed. “Because the total number of men who resumed sex before certified wound healing is so small, the finding of increased transmission after surgery may have occurred by chance alone. However, we need to err on the side of caution to protect women in the context of any future male circumcision programme,” said Dr Maria Wawer, the study's principal investigator.<ref>{{cite web
-| url =http://www.aidsmap.com/en/news/3CBF12A3-A1AC-4A0E-A79C-54FC6EF93E28.asp
-| author = Virginia Differding
-| title = Women may be at heightened risk of HIV infection immediately after male partner is circumcised
-| accessdate = 2007-03-14
-| date = March 12, 2007
-| publisher = Aidsmap News}}
-</ref>
-There is also a danger of HIV being spread from unhygienic circumcision procedures. Brewer ''et al.'' studied HIV infection rates in Kenya, Lethotho and Tanzania and found that "[circumcised] male and female virgins were substantially more likely to be HIV infected than uncircumcised virgins. Among adolescents, regardless of sexual experience, circumcision was just as strongly associated with prevalent HIV infection. However, uncircumcised adults were more likely to be HIV positive than circumcised adults." The authors concluded, "HIV transmission may occur through circumcision-related blood exposures in eastern and southern Africa."<ref>{{cite journal | last = Brewer | first= Devon | year = 2007| month= February | title = Male and Female Circumcision Associated with Prevalent HIV Infection in Virgins and Adolescents in Kenya, Lesotho, and Tanzania | journal = Annals of Epidemiology | volume = 17 | issue = 3| pages = pp.217-226 | url = http://www.annalsofepidemiology.org/article/PIIS1047279706002651/abstract| accessdate = 2007-03-04| quote = <small> (Kenyan females: 3.2% vs. 1.4%, odds ratio [OR] = 2.38; Kenyan males: 1.8% vs. 0%, OR undefined; Lesothoan males: 6.1% vs. 1.9%, OR 3.36; Tanzanian males: 2.9% vs. 1.0%, OR 2.99; weighted mean phi correlation = 0.07, 95% confidence interval, 0.03 to 0.11).</small>}}</ref>
-On March 28, 2007, the [[World Health Organisation]] and [[UNAIDS]] issued joint recommendations about male circumcision and HIV/AIDS.<ref name="WHOpr0307">{{cite web |title=WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention |publisher=World Health Organisation |month=March |year=2007 |url=http://www.who.int/hiv/mediacentre/news68/en/index.html}}</ref> These are:
-* Male circumcision should now be recognized as an efficacious intervention for HIV prevention.
-* Promoting male circumcision should be recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men.<ref name="WHO-C&R" />
-Newell and Bärnighausen (2007) also stated there was "firm evidence that the risk of acquiring HIV is halved by male circumcision."<ref name = "Newell">{{cite journal
- | last = Newell
- | first = Marie-Lousie
- | coauthors = Till Bärnighausen
- | date = February 24, 2007
- | title = Male circumcision to cut HIV risk in the general population
- | journal = [[The Lancet]]
- | volume = 369
- | issue = 9562
- | pages = 617–619
- | pmid = 17321292
- | doi = DOI:10.1016/S0140-6736(07)60288-8
- | url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673607602888.pdf
- |format = PDF
- | accessdate = 2007-04-01
-}}
-</ref><ref name="baileyrct">{{cite journal
- | last = Bailey
- | first = Robert C
- | coauthors = Stephen Moses, Corette B Parker, Kawango Agot, Ian Maclean, John N Krieger, Carolyn F M Williams, Richard T Campbell, Jeckoniah O Ndinya-Achola
- | date = February 24, 2007
- | title = Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial
- | journal = [[The Lancet]]
- | volume = 369
- | issue = 9562
- | pages = 643–656
- | pmid = 17321310
- | doi = DOI:10.1016/S0140-6736(07)60312-2
- | url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673607603122.pdf
- | format = PDF
- | accessdate = 2007-04-01
-}}
-</ref><ref name="grayrct">{{cite journal
- | last = Gray
- | first = Ronald H
- | coauthors = Godfrey Kigozi, David Serwadda, Frederick Makumbi, Stephen Watya, Fred Nalugoda, Noah Kiwanuka, Lawrence H Moulton, Mohammad A Chaudhary, Michael Z Chen, Nelson K Sewankambo, Fred Wabwire-Mangen, Melanie C Bacon, Carolyn F M Williams, Pius Opendi, Steven J Reynolds, Oliver Laeyendecker, Thomas C Quinn, Maria J Wawer
- | date = February 24, 2007
- | title = Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial
- | journal = [[The Lancet]]
- | volume = 369
- | issue = 9562
- | pages = 657–666
- | pmid = 17321311
- | doi = DOI:10.1016/S0140-6736(07)60313-4
- | url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673607603134.pdf
- | format = PDF
- | accessdate = 2007-04-01
-}}
-</ref> However, Garenne (2006) doubted its value in reducing HIV.<ref name = "Garenne">{{cite journal
- | last = Garenne
- | first = Michel
- | year = 2006
- | month = January
- | title = Male Circumcision and HIV Control in Africa
- | journal = [[PLoS Medicine]]
- | volume = 3
- | issue = 1
- | pages = e78
- | pmid = 16435906
- | doi = doi:10.1371/journal.pmed.0030078
- | url = http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030078
- | accessdate = 2007-04-01
- }}
-</ref> and Talbott (2007), in a controversial paper [http://www.plosone.org/annotation/listThread.action?inReplyTo=info%3Adoi%2F10.1371%2Fannotation%2F723&root=info%3Adoi%2F10.1371%2Fannotation%2F723] stated that cross country regression data pointed to prostitution as the key factor in the AIDS epidemic rather than circumcision.<ref name = "PROSTITUTION">{{cite journal
- | last = Talbott
- | first = John R.
- | year = 2007
- | month = June
- | title = Size Matters: The Number of Prostitutes and the Global HIV/AIDS Pandemic
- | journal = [[PLoS ONE]]
- | volume = 2
- | issue = 6
- | pages = e543
- | doi = doi:10.1371/journal.pone.0000543
- | url = http://www.plosone.org/article/fetchArticle.action?articleURI=info:doi/10.1371/journal.pone.000054
- | accessdate = 2007-07-099
-}}
-</ref> A World Health Organization AIDS Prevention Team official Tim Farley disagreed with the findings of the paper, while Chris Surridge, PLoS One's managing editor, defended its publication.<ref>{{cite journal |title=Circumcision for HIV needs follow-up |author=Butler, D; Odling-Smee, L |journal=Nature |year=2007 |month=June |Volume=447 |pages=1040-1041 |url=http://www.nature.com/nature/journal/v447/n7148/box/4471040a_BX1.html}}</ref> In 1999 the American Medical Association had stated, "behavioral factors are far more important in preventing these infections than the presence or absence of a foreskin."<ref name = "CSA:I-99" />
-====Langerhans cells and HIV transmission====
-[[Langerhans cells]] are part of the human immune system. Three studies identified high concentrations of Langerhans and other "HIV target" cells in the foreskin<ref>{{cite journal
- | last = Hussain LA
- | first = LA
- | authorlink =
- | coauthors = T. Lehner
- | year = 1995
- | month = July
- | title = Comparative investigation of Langerhans' cells and potential receptors for HIV in oral, genitourinary and rectal epithelia
- | journal = Immunology
- | volume = 85
- | issue = 3
- | pages = 475&ndash;484
- | doi =
- | id = PMID 7558138
- | url =
- | format = Abstract
- | accessdate = 2006-07-09
- }}
-</ref><ref>{{cite journal
- | last = Patterson
- | first = Bruce K.
- | authorlink =
- | coauthors = Alan Landay, Joan N. Siegel, Zareefa Flener, Dennis Pessis, Antonio Chaviano, and Robert C. Bailey
- | year = 2002
- | month =
- | title = Susceptibility to Human Immunodeficiency Virus-1 Infection of Human Foreskin and Cervical Tissue Grown in Explant Culture
- | journal = American Journal of Pathology
- | volume = 161
- | issue = 3
- | pages = 867&ndash;873
- | doi =
- | id = PMID 12213715
- | url = http://ajp.amjpathol.org/cgi/reprint/161/3/867.pdf
- | format = PDF
- | accessdate = 2006-07-09
- }}
-</ref><ref>{{cite journal
- | last = Donoval
- | first = BA
- | authorlink =
- | coauthors =  AL Landay, S Moses, K Agot, JO Ndinya-Achola, EA Nyagaya, I MacLean, and RC Bailey
- | year = 2006
- | month = March
- | title = HIV-1 target cells in foreskins of African men with varying histories of sexually transmitted infections
- | journal = American Journal of Clinical Pathology
- | volume = 125
- | issue = 3
- | pages = 386&ndash;391
- | doi = 10.1309/JVHQ-VDJD-YKM5-8EPH
- | id = PMID 16613341
- | url = http://ajcp.metapress.com/link.asp?id=jvhqvdjdykm58eph
- | format = Abstract
- | accessdate = 2006-07-09
- }}
-</ref> and Szabo and Short suggested that the Langerhans cells in the foreskin may provide an entry point for viral infection.<ref name = "Szabo">{{cite journal
- | last = Szabo
- | first = Robert
- | coauthors = Roger V. Short
- | year = 2000
- | month = June
- | title = How does male circumcision protect against HIV infection?
- | journal = BMJ
- | volume = 320
- | issue = 7249
- | pages = 1592&ndash;1594
- | doi = 10.1136/bmj.320.7249.1592
- | id = PMID 10845974
- | url = http://bmj.bmjjournals.com/cgi/reprint/320/7249/1592
- | format = PDF
- | accessdate = 2006-07-09
- }}
-</ref> McCoombe, Cameron, and Short also found that the keratin is thinnest on the foreskin and frenulum.<ref>{{cite paper
-  |author= McCoombe SG, Cameron PU, Short RV
-  |date= July 7, 2002
-  |url= http://www.aegis.com/conferences/iac/2002/WePeA5739.html
-  |format= Abstract
-  |title= The distribution of HIV-1 target cells and keratin in the human penis.
-  |publisher= International AIDS Society
-  |version=
-  |accessdate= 2006-07-09
- }}
-</ref> Fleiss, Hodges and Van Howe had previously stated a belief that the prepuce has an immunological function.<ref name=Fleiss>{{cite journal
- | last = Fleiss
- | first = PM
- | authorlink =
- | coauthors = FM Hodges, RS Van Howe
- | year = 1998
- | month = October
- | title = Immunological functions of the human prepuce
- | journal = Sexually Transmitted Infections
- | volume = 74
- | issue = 5
- | pages = 364&ndash;367
- | doi =
- | id = PMID 10195034
- | url = http://sti.bmjjournals.com/cgi/reprint/74/5/364.pdf
- | format = PDF
- | accessdate = 2006-07-09
- }}
-</ref> While their specific hypothesis was criticised on technical grounds.<ref>{{cite web
-| url = http://sti.bmj.com/cgi/eletters/74/5/364#112
-| title = Apocrine glands in inner prepuce doubtful
-| accessdate = 2006-07-09
-| last = Waskett
-| first = Jake H.
-| date = June 20, 2005
-| work = Electronic letters
-| publisher = BMJ Publishing Group Ltd
-}}
-</ref> a  study published in 2007 by de Witte and others said that Langerlin, excreted by Langerhans cells, is a natural barrier to HIV-1 transmission by Langerhans cells.<ref>{{cite web
-| url =http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17334373&query_hl=4&itool=pubmed_docsum
-| title = Langerin is a natural barrier to HIV-1 transmission by Langerhans cells
-| accessdate = 2007-03-19
-| last = de Witte
-| first = L.
-| date = March 4, 2007
-| work = Abstract
-| publisher = www.Pubmed.gov
-}}
 </ref>
@@ Line 1,498: / Line 1,048: @@
 | publisher = [[EMedicine]]
 }}
-</ref>
-====Balanitis====
-{{main|Balanitis}}
-[[Balanitis]], an inflammation of the [[glans penis]], has a variety of causes.<ref name = "HKhandbook">{{cite book
- | last = Au
- | first = T.S.
- | coauthors = K.H. Yeung
- | editor = Pedro Sá Cabral, Luís Leite, and José Pinto (eds.)
- | title = HANDBOOK OF DERMATOLOGY & VENEREOLOGY
- | origdate =
- | origyear =
- | origmonth =
- | url = http://www.hkmj.org.hk/skin/cover.htm
- | accessdate = 2006-09-04
- | edition = 2nd ed.
- | year = 2003
- | publisher = Department of Dermatology—Hospital Pulido Valente
- | location = [[Lisbon, Portugal]]
- | id = ISBN 978-962-334-030-4
- | chapter = Balanitis, Bacterial Vaginosis and Other Genital Conditions
- | chapterurl = http://www.hkmj.org.hk/skin/balaniti.htm
- }}
-</ref> Some of these, such as anaerobic infection, occur more frequently in uncircumcised men.<ref name = "EdwardsGU">{{cite journal
- | last = Edwards
- | first = Sarah
- | year = 1996
- | month = June
- | title = Balanitis and balanoposthitis: a review
- | journal = Genitourinary Medicine
- | volume = 72
- | issue = 3
- | pages = 155–159
- | doi =
- | id = PMID 8707315
- | url = http://www.cirp.org/library/disease/balanitis/edwards1/
- | accessdate = 2006-09-04
- }}
-</ref> There are less invasive treatments than circumcision that have been shown to be effective in treating most mild cases of balanitis.<ref name = "HKhandbook" /> Birley, et al, found that in 90% of their cases of chronic or recurring balanitis "use of emollient creams and restriction of soap washing alone controlled symptoms satisfactorily." They also state that circumcision “might be of benefit in a patient whose balanitis relapses despite these measures, and remains the principal treatment for specific conditions such as [[Lichen sclerosus et atrophicus|lichen sclerosus]] and plasma cell balanitis.”<ref name = "birley" /> The, less invasive procedures are not as successful in treating [[balanitis xerotica obliterans]], or '''BXO''',<ref>{{cite journal
- | last = Vincent
- | first = Michelle Valerie
- | coauthors =  Ewan MacKinnon
- | year = 2005
- | month = April
- | title = The response of clinical balanitis xerotica obliterans to the application of topical steroid-based creams
- | journal = Journal of Pediatric Surgery
- | volume = 40
- | issue = 4
- | pages = 709–712
- | doi = 10.1016/j.jpedsurg.2004.12.001
- | id = PMID 15852285
- | url = http://www.jpedsurg.org/article/PIIS002234680400867X/abstract
- | format = Abstract
- | accessdate = 2006-09-21
- }}
-</ref><ref>{{cite journal
- | last = Wright
- | first = J.E.
- | year = 1994
- | month = May
- | title = The treatment of childhood phimosis with topical steroid
- | journal = The Australian and New Zealand journal of surgery
- | volume = 64
- | issue = 5
- | pages = 327–328
- | id = PMID 8179528
- | url = http://www.cirp.org/library/treatment/phimosis/wright/
- | accessdate = 2006-09-21
- }}
-</ref><ref>{{cite journal
- | last = Webster
- | first = T.M.
- | coauthors = M.P. Leonard
- | year = 2002
- | month = April
- | title = Topical steroid therapy for phimosis
- | journal = The Canadian journal of urology
- | volume = 9
- | issue = 2
- | pages = 1492–1495
- | id = PMID 12010594
- | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12010594&query_hl=5
- | format = Abstract
- | accessdate = 2006-09-21
- }}
-</ref> which is much less common but harder to treat.<ref>{{cite web
-| url = http://www.emedicine.com/derm/topic46.htm
-| title = http://www.emedicine.com/derm/topic46.htm
-| accessdate = 2006-09-21
-| last = Scheinfeld
-| first = Noah S.
-| authorlink =
-| coauthors = George C. Keough, Daniel Lehman
-| date = January 11, 2006
-| work = Diseases Of The Dermis
-| publisher = [[EMedicine]]
-}}
-</ref>
-[[Lichen sclerosus et atrophicus]] ('''LSA''') produces a whitish-yellowish patch on the skin, and is not believed to be always harmful or painful, and may sometimes disappear without intervention. Some consider [[balanitis xerotica obliterans]] to be a form of LSA that happens to be on the foreskin, where it may cause pathological [[phimosis]]. Circumcision is believed to reliably reduce the threat of BXO.<ref>{{cite journal
- | last = Mattioli
- | first = G.
- | coauthors = P. Repetto, C. Carlini, C. Granata, C. Gambini, and V. Jasonni
- | year = 2002
- | month = May
- | title = Lichen sclerosus et atrophicus in children with phimosis and hypospadias
- | journal = Pediatric Surgery International
- | volume = 18
- | issue = 4
- | pages = 273–275
- | doi = 10.1007/s003830100699
- | id = PMID 12021978
- | url = http://www.springerlink.com/content/dy5cgm3h11prdy76/
- | format = Abstract
- | accessdate = 2006-09-21
- }}
-</ref>
-===Penile cancer===
-{{main|Penile cancer}}
-Most cases of penile cancer occur in men over the age of 70.<ref>{{cite web
-| url = http://www.cancerhelp.org.uk/help/default.asp?page=6833
-| title = Cancer of the penis (penile cancer)
-| accessdate = 2006-09-26
-| date = January 14, 2004
-| work = Questions and Answers: Penis cancer questions
-| publisher = [[Cancer Research UK]]
-| quote = Penile cancer is more common in older men. Most cases are in men over 70. It is rare in men under 40.
-}}
-</ref> Boczko and Freed (1979) stated that since Wolbarst's 1932 review, "there have been only eight documented cases of penile carcinoma in an individual circumcised in infancy." They described the ninth reported case, concluding that "performing it in infancy continues to be the most effective prophylactic measure against penile carcinoma."<ref>{{cite journal |last=Boczko |first=S |coauthors=Freed, S |title=Penile carcinoma in circumcised males |journal=N Y State J Med |year=1979 |volume=79 |issue=12 |pages=1903-4}} [http://www.cirp.org/library/disease/cancer/boczko/]</ref> The AMA remarked that in six case series published from 1932 and 1986, "all penile cancers occurred in uncircumcised individuals."<ref name = "CSA:I-99" /> Maden ''et al'' (1993) reported that the risk of penile cancer was 3.2 times greater in men who were never circumcised and 3 times greater among those who were circumcised after the neonatal period.<ref>{{cite journal |title=History of circumcision, medical conditions, and sexual activity and risk of penile cancer |first=C |last=Maden |coauthors=''et al'' |journal=J Natl Cancer Inst |year=1993 |month=Jan |volume=85 |issue=1 |pages=19-24 |id=PMID 8380060}}</ref> An editorial by Holly and Palefsky complimented the study for noting other risk factors for penile cancer, and also for providing corroborating evidence as to the association between a lack of neonatal circumcision and the development of penile cancer. However, they criticised include the study for combining data from invasive and ''in situ'' cancers. They concluded that as Maden reported that 20% of the men with penile cancer were circumcised at birth, the recommendation of circumcision for medical indications remained somewhat controversial and the risks and benefits must be weighed.<ref>{{cite journal |url=http://jnci.oxfordjournals.org/cgi/reprint/85/1/2 |last=Holly |first=EA |coauthors=Palefsky, JM |title=Factors related to risk of penile cancer: new evidence from a study in the Pacific Northwest |journal=J Natl Cancer Inst |year=1993 |month=Jan |volume=85 |issue=1 |pages=2-4}}</ref> The American Academy of Pediatrics made similar criticism, also noting the possibly inaccurate use of self-report to determine circumcision status.<ref name = "AAP1999" /> Schoen ''et al'' studied the association between neonatal circumcision and invasive penile cancer in 2000, and found that the relative risk for uncircumcised men was 22 times that of circumcised men.<ref>{{cite journal |url=http://pediatrics.aappublications.org/cgi/content/full/105/3/e36 |title=The highly protective effect of newborn circumcision against invasive penile cancer |first=EJ |last=Schoen |coauthors=Oehrli, M; Colby, C; Machin, G | journal=Pediatrics |year=2000 |month=Mar |volume=105 |issue=3 |pages=e36}}</ref>
-The [[American Cancer Society]] states that “In the United States, men who are circumcised in childhood have a lower rate of penile cancer. It’s not known whether this is due to the absence of the foreskin or other lifestyle factors. Recent studies have found that circumcised men are less likely to be infected with HPV, even after this risk is adjusted for differences in sexual behavior. Other studies suggest that circumcision may reduce the risk of more invasive forms of penile cancer.,” “In weighing the risks and benefits of circumcision, doctors consider the fact that penile cancer is one of the least common forms of cancer in the United States” and “Ultimately, decisions about circumcision are highly personal and depend more on social and religious factors than on medical evidence.”  They state that it is important to concentrate on the main risk factors: poor hygiene, having unprotected sex with multiple partners, and cigarette smoking.<ref name="CancerRisk">{{cite web
-| url = http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_penile_cancer_35.asp?sitearea=
-| title = What Are the Risk Factors for Penile Cancer?
-| accessdate = 2006-10-01
-| date = May 31, 2006
-| work = Cancer Reference Information
-| publisher = [[American Cancer Society]]
-}}
-</ref> They also state that the current consensus of most experts is that circumcision should not be recommended as a prevention strategy for penile cancer.<ref>{{cite web
-| url = http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_penile_cancer_be_prevented_35.asp
-| title = Can Penile Cancer Be Prevented?
-| accessdate = 2006-10-01
-| date = May 31, 2006
-| work = Cancer Reference Information
-| publisher = [[American Cancer Society]]
-}}
-</ref>
-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, penile cancer is a rare disease and the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, remains low.<ref name = "AAP1999" /> Similarly, the [[American Medical Association]] states that although neonatal circumcision seems to lower the risk of contracting penile cancer, because it is rare and occurs later in life, the use of circumcision as a preventive practice is not justified.<ref name = "CSA:I-99" />
-Kochen and McCurdy performed a [[life table]] analysis on penile cancer rates. They assumed that penile cancer occurred only in uncircumcised males and that the rates from older groups applied to the 1971 birth cohort.<ref name="Kochen">{{cite journal
- | last = Kochen
- | first = Mosze
- | coauthors = Stephen McCurdy
- | year = 1980
- | month = May
- | title = Circumcision and the risk of cancer of the penis. A life-table analysis
- | journal = American Journal of Diseases of Children
- | volume = 134
- | issue = 5
- | pages = 484–486
- | doi = 10.1001/archpedi.134.5.484
- | id = PMID 7377156
- | url = http://www.circs.org/library/kochen/index.html
- | accessdate = 2006-09-26
- }}
-</ref> They estimated a rate of 1 in 600, or 0.167% in uncircumcised males, with a median age of occurrence of 67 years. They stated, “Since the uncircumcised male is uniquely susceptible, virtually all of these cancers are preventable by neo-natal circumcision. The number of lifetime incident cancers that could be prevented annually by circumcision can be estimated with birth statistics available for 1971. In that year, there were 1,822,910 recorded live male births. If none had been neonatally circumcised, our analysis predicts that one in 600, or more than 3,000 would have penile cancer in their lifetimes.”<ref name = "Kochen" />
-The Medical College of Georgia is now studying the impact of the new vaccine against "HPV types 16 and 18, the two most common causes of cervical and penile cancer" [http://www.sciencedaily.com/releases/2004/11/041123162300.htm]
-===HPV===
-Several studies have shown that uncircumcised men are at greater risk of [[human papilloma virus]] (HPV) infection.<ref>{{cite journal
- | last = Castellsagué
- | first = Xavier
- | coauthors = et al.
- | year = 2002
- | month = April 11,
- | title = Male circumcision, penile human papillomavirus infection, and cervical cancer
- | journal = The New England Journal of Medicine
- | volume = 346
- | issue = 15
- | pages = 1105&ndash;1112
- | doi = 10.1056/NEJMoa011688
- | id = PMID 11948269
- | url = http://content.nejm.org/cgi/reprint/346/15/1105.pdf
- | format = PDF &mdash; free registration required
- | accessdate = 2006-07-09
- }}
-</ref><ref>{{cite journal
- | last = Lajous
- | first = Martín
- | coauthors = Nancy Mueller, Aurelio Cruz-Valdéz, Luis Victor Aguilar, Silvia Franceschi, Mauricio Hernández-Ávila, and Eduardo Lazcano-Ponce
- | year = July
- | month = 2005
- | title = Determinants of Prevalence, Acquisition, and Persistence of Human Papillomavirus in Healthy Mexican Military Men
- | journal = Cancer Epidemiology Biomarkers and Prevention
- | volume = 14
- | issue = 7
- | pages = 1710&ndash;1716
- | doi = 10.1158/1055-9965.EPI-04-0926
- | id = PMID 16030106
- | url = http://cebp.aacrjournals.org/cgi/reprint/14/7/1710.pdf
- | format = PDF
- | accessdate = 2006-07-09
- }}
-</ref> Some genital [[HPV]] strains some can cause genital warts, cervical or penile [[cancer]] [http://www.sciencedaily.com/releases/2004/11/041123162300.htm]. 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.<ref>{{cite journal
- | last = Aynaud
- | first = O.
- | coauthors = D. Piron, G. Bijaoui, and JM Casanova
- | year = July
- | month = 1999
- | title = Developmental factors of urethral human papillomavirus lesions: correlation with circumcision
- | journal = BJU International
- | volume = 84
- | issue = 1
- | pages = 57&ndash;60
- | doi = 10.1046/j.1464-410x.1999.00104.x
- | id = PMID 10444125
- | url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.00104.x
- | format = PDF
- | accessdate = 2006-07-09
- }}
-</ref>
-===Phimosis and paraphimosis===
-It is normal for an infant's foreskin to be attached to the glans. Phimosis is defined by some sources as an inability to retract the foreskin, others by that occurring after age 5, and still others by a form of the first source's definition caused by a specific disease ([[balanitis xerotica obliterans]]). Dawson and Whitfield, say "True phimosis is rare but may cause appreciable problems in either childhood or adolescence."[http://www.bmj.com/cgi/content/full/312/7041/1291]
-The AAP state that the true frequency of problems such as phimosis is unknown.<ref name = "AAP1999" /> Fergusson et al found phimosis in 16% of non-circumcised boys,<ref name = "Ferg" /> while Herzog and Alvarez found it in 2.6%.[http://www.circs.org/library/herzog/index.html] Rickwood and Walker raised concern that phimosis is frequently misdiagnosed by physicians confusing it with the developmentally non-retractable foreskin.<ref name = "Rickwood2">{{cite journal
- | last = Rickwood
- | first = AM.
- | coauthors = Jenny Walker
- | year = 1989
- | month = September
- | title = Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence?
- | journal = Annals of the Royal College of Surgeons of England
- | volume = 71
- | issue = 5
- | pages = 275–277
- | id = PMID 2802472
- | url = http://www.cirp.org/library/treatment/phimosis/rickwood2/
- | accessdate = 2006-10-10
- }}
-</ref>
-Several researchers have described less invasive treatments for phimosis than circumcision, and recommend that they be tried first.<ref name="dewan" /><ref name="beauge" />
-Several studies have identified phimosis as a risk factor for penile cancer. A letter to the British Medical Journal stated it would be irresponsible to expose a patient to risk for longer than necessary.<ref>Robin J Willcourt, "Re: Circumcision is a last resort - to be avoided, whenever possible" - letters to the editor, ''British Medical Journal'' [http://bmj.bmjjournals.com/cgi/eletters/321/7264/792#110919 http://bmj.bmjjournals.com/cgi/eletters/321/7264/792#110919]</ref>
-[[Paraphimosis]] is an acute condition when a tight foreskin is stuck behind the glans and cannot be returned to its original position, curbing the blood flow to the glans. In children, it is sometimes caused by a caregiver trying to [[forcible retraction of the foreskin|forcibly retract the infant foreskin]].<ref name = "Gairdner" />
-===Urinary tract infections===
-Twelve studies have indicated that neonatal circumcision reduces the rate of [[Urinary tract infections]] in male infants by a factor of about 10.<ref name="singhgrewal2005">{{cite journal
- | last = Singh-Grewal
- | first = D.
- | coauthors = J. Macdessi, and J. Craig
- | date = August 1, 2005
- | title = Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies
- | journal = Archives of Disease in Childhood
- | volume = 90
- | issue = 8
- | pages = 853-858
- | doi = 10.1136/adc.2004.049353
- | id = PMID 15890696
- | url = http://adc.bmjjournals.com/cgi/reprint/90/8/853.pdf
- | format = PDF
- | accessdate = 2006-09-21
- }}
-</ref> The March 1999 AAP statement notes that premature boys are usually not circumcised because of their fragile health status.<ref name = "AAP1999" /> Studies have found that 1 in 10 premature infants will have a urinary tract infection during the first month of life. [http://www.drspock.com/article/0,1510,5362,00.html] Some UTI studies have been criticised for not taking this and other factors into account. A Swedish study found that the cumulative incidence of UTIs in boys under 2 years of age was 2.2%.<ref name="jakobsson1999">Jakobsson 1999, ''et al''. Minimum incidence and diagnostic rate of first urinary tract infection. ''Pediatrics.'' 1999 August;104 (2 Pt 1):222–6. ([http://pediatrics.aappublications.org/cgi/content/full/104/2/222 full text])</ref> The AMA cites evidence that the incidence of UTI’s is “small (0.4%–1%)” in uncircumcised infants, and “depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI…One model of decision analysis concluded that the incidence of UTI would have to be substantially higher in uncircumcised males to justify circumcision as a preventive measure against this condition.”<ref name = "CSA:I-99" />
-The [[Canadian Paediatric Society]] questions whether increased [[Urinary tract infection|UTI]] and [[balanitis]] rates in uncircumcised male infants may be caused by [[forcible retraction of the foreskin|forced premature retraction]].<ref name = "CMAJ" />  Lerman and Liao, state that apart from its effects on UTI infection rates, "Most of the other medical benefits of circumcision probably can be realized without circumcision as long as access to clean water and proper penile hygiene are achieved."<ref name="lerman2001">Lerman SE, Liao JC. Neonatal circumcision. ''Pediatr Clin North Am.'' 2001 December;48(6):1539-57. PMID 11732129</ref>
-===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.<ref name = "AAFP2">{{cite web
-| url = http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html
-| title = Circumcision: Position Paper on Neonatal Circumcision
-| accessdate = 2007-01-30
-| year = 2007
-| publisher = [[American Academy of Family Physicians]]
-| quote = <small>Considerable controversy surrounds neonatal circumcision. Putative indications for neonatal circumcision have included preventing UTIs and their sequelae, preventing the contraction of STDs including HIV, and preventing penile cancer as well as other reasons for adult circumcision. Circumcision is not without risks. Bleeding, infection, and failure to remove enough foreskin occur in less than 1% of circumcisions. Evidence-based complications from circumcision include pain, bruising, and meatitis. More serious complications have also occurred. Although numerous studies have been conducted to evaluate these postulates, only a few used the quality of methodology necessary to consider the results as high level evidence.<br />
-<br />
-The evidence indicates that neonatal circumcision prevents UTIs in the first year of life with an absolute risk reduction of about 1% and prevents the development of penile cancer with an absolute risk reduction of less than 0.2%. The evidence suggests that circumcision reduces the rate of acquiring an STD, but careful sexual practices and hygiene may be as effective. Circumcision appears to decrease the transmission of HIV in underdeveloped areas where the virus is highly prevalent. No study has systematically evaluated the utility of routine neonatal circumcision for preventing all medically-indicated circumcisions in later life. Evidence regarding the association between cervical cancer and a woman’s partner being circumcised or uncircumcised, and evidence regarding the effect of circumcision on sexual functioning is inconclusive. If the decision is made to circumcise, anesthesia should be used.<br />
-<br />
-The American Academy of Family Physicians recommends physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering this procedure for their newborn son.</small>
-}}
-</ref>
-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.<ref name = "AAP19992">{{cite journal
- | last = Task Force on Circumcision
- | coauthors =
- | year = 1999
- | month = March 1,
- | title = Circumcision Policy Statement
- | journal = Pediatrics
- | volume = 103
- | issue = 3
- | pages = 686&ndash;693
- | doi = 10.1542/peds.103.3.686
- | id = {{ISSN|0031-4005}} PMID 10049981
- | url = http://pediatrics.aappublications.org/cgi/reprint/pediatrics;103/3/686.pdf
- | format = PDF
- | accessdate = 2006-07-01
- }}
-<small>“Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided. If circumcision is performed in the newborn period, it should only be done on infants who are stable and healthy.”</small>
-</ref>
-The American Medical Association supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics.<ref name = "CSA:I-99" />
-The American Urological Association (2007) recommends "that circumcision should be presented as an option for health benefits."[http://www.auanet.org/about/policy/services.cfm#circumcision]
-====Canada====
-The Fetus and Newborn Committee of the [[Canadian Paediatric Society]] posted "Circumcision: Information for Parents" in November 2004,<ref name = "CPSIFP2">{{cite web
-| url = http://www.caringforkids.cps.ca/babies/Circumcision.htm
-| title = Circumcision: Information for parents
-| accessdate = 2006-10-24
-| year = 2004
-| month = November
-| work = Caring for kids
-| publisher = [[Canadian Paediatric Society]]
-| quote = <small>Circumcision is a “non-therapeutic” procedure, which means it is not medically necessary. Parents who decide to circumcise their newborns often do so for religious, social or cultural reasons. To help make the decision about circumcision, parents should have information about risks and benefits. It is helpful to speak with your baby’s doctor. After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.</small>
-}}
-</ref> 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."<ref name = "CMAJ2">
-{{cite journal
- | last = Fetus and Newborn Committee
- | year = 1996
- | month = March
- | title = Neonatal circumcision revisited
- | journal = Canadian Medical Association Journal
- | volume = 154
- | issue = 6
- | pages = 769&ndash;780
- | doi =
- | id =
- | url = http://www.cps.ca/english/statements/FN/fn96-01.htm
- | format =
- | accessdate = 2006-07-02
- }}
-<small>“We undertook this literature review to consider whether the CPS should change its position on routine neonatal circumcision from that stated in 1982. The review led us to conclude the following. There is evidence that circumcision results in an approximately 12-fold reduction in the incidence of UTI during infancy. The overall incidence of UTI in male infants appears to be 1% to 2%. The incidence rate of the complications of circumcision reported in published articles varies, but it is generally in the order of 0.2% to 2%. Most complications are minor, but occasionally serious complications occur. There is a need for good epidemiological data on the incidence of the surgical complications of circumcision, of the later complications of circumcision and of problems associated with lack of circumcision. Evaluation of alternative methods of preventing UTI in infancy is required. More information on the effect of simple hygienic interventions is needed. Information is required on the incidence of circumcision that is truly needed in later childhood. There is evidence that circumcision results in a reduction in the incidence of penile cancer and of HIV transmission. However, there is inadequate information to recommend circumcision as a public health measure to prevent these diseases. When circumcision is performed, appropriate attention needs to be paid to pain relief. The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns. There is therefore no indication that the position taken by the CPS in 1982 should be changed. When parents are making a decision about circumcision, they should be advised of the present state of medical knowledge about its benefits and harms. Their decision may ultimately be based on personal, religious or cultural factors.</small>
 </ref>
-====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.”<ref name = "BMAGuide2">
-{{cite web
-| url = http://www.bma.org.uk/ap.nsf/Content/malecircumcision2006?OpenDocument&Highlight=2,circumcision
-| title = The law and ethics of male circumcision - guidance for doctors
-| accessdate = 2006-07-01
-| author = Medical Ethics Committee
-| year = 2006
-| month = June
-| publisher = [[British Medical Association]]
-| quote = <small>'''Circumcision for medical purposes'''<br />
-Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.
-Male circumcision in cases where there is a clear clinical need is not normally controversial. Nevertheless, normal anatomical and physiological characteristics of the infant foreskin have in the past been misinterpreted as being abnormal. The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision. Doctors should be aware of this and reassure parents accordingly.<br />
-<br />
-'''Non-therapeutic circumcision'''<br />
-Male circumcision that is performed for any reason other than physical clinical need is termed non-therapeutic (or sometimes “ritual”) circumcision. Some people ask for non-therapeutic circumcision for religious reasons, some to incorporate a child into a community, and some want their sons to be like their fathers. Circumcision is a defining feature of some faiths.<br />
-<br />
-There is a spectrum of views within the BMA’s membership about whether non-therapeutic male circumcision is a beneficial, neutral or harmful procedure or whether it is superfluous, and whether it should ever be done on a child who is not capable of deciding for himself. The medical harms or benefits have not been unequivocally proven except to the extent that there are clear risks of harm if the procedure is done inexpertly. The Association has no policy on these issues. Indeed, it would be difficult to formulate a policy in the absence of unambiguously clear and consistent medical data on the implications of the intervention. As a general rule, however, the BMA believes that parents should be entitled to make choices about how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices.</small>
-}}
-</ref>
-====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"<ref name = "RACPSumm" />
 ==History of circumcision==
@@ Line 1,945: / Line 1,135: @@
 |}
-==Prevalence of circumcision==
-{{main|Prevalence of circumcision}}
-Estimates of the proportion of males that are circumcised worldwide vary from one sixth (12.5%)<ref name="WillKap"/> to one third (33.3%).<ref name="crawford2002">Crawford DA. Circumcision: a consideration of some of the controversy. ''J Child Health Care.'' 2002 December;6(4):259-70.  PMID 12503896</ref> According to one author, the practice is "a falling trend internationally",<ref>{{cite journal
- | last = StanWisniewski
- | first = Z.
- | year = 2004
- | title = Circumcision in Western Australia
- | journal = ANZ Journal of Surgery
- | volume = 74
- | issue = 5
- | pages = 387-388
- | doi = 10.1111
- | url = http://pt.wkhealth.com/pt/re/aunz/fulltext.00130494-200405000-00028.htm
- | accessdate = 2007-03-31
-}}</ref>{{Verify source|date=April 2007}} although another notes indications of increasing demand in Southern Africa.<ref>{{cite journal |title=Demand for male circumcision rises in a bid to prevent HIV |journal=Bulletin of the World Health Organization |volume=84 |issue=7 |year=2006 |pages=505-588 |url=http://www.scielosp.org/pdf/bwho/v84n7/v84n7a05.pdf |quote=As a result, there are already indications of increasing demand for male circumcision in traditionally non-circumcising societies in southern Africa.}}</ref>
-===Australia===
-According to the Sydney Morning Herald, the infant circumcision rate in Australia was 12.9% in 2003. The rates varied with Queensland (19.3%), New South Wales (16.3%) and South Australia (14.3%). The lowest rate was in Tasmania (1.6%).<ref>{{cite web |first=Judy |last=Skatssoon |month=July |year=2004 |title=Circumcision rates rise for some |publisher=Sydney Morning Herald (reprint: CIRP.org) |location=Sydney, New South Wales, Australia |url=http://www.cirp.org/news/smh07-01-04/}}</ref> Non-therapeutic infant circumcision is no longer provided in public hospitals in New South Wales, Tasmania, and Western Australia, with a similar ban taking effect in Victoria in September 2007.<ref>{{cite news |title=Victoria to scrap public hospital circumcision |url=http://www.theage.com.au/news/national/victoria-to-scrap-public-hospital-circumcision/2007/08/12/1186857323447.html |work= |publisher=The Age |date=2007-08-12 |accessdate=2007-08-12 }}</ref>
-===Denmark===
-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.
-[http://bmj.bmjjournals.com/cgi/content/full/311/7018/1471]
-===South Korea===
-It has been estimated on the basis of an academic medical survey that some 78% of South Korean men may be circumcised and it has been stated that "South Korea has possibly the largest absolute number of teenage or adult circumcisions anywhere in the world. Because circumcision started through contact with the American military during the Korean War, South Korea has an unusual history of circumcision."<ref>J.H. 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</ref>
-===United Kingdom===
-A national survey on sexual attitudes in 2000 found that 11.7% of 16-19 year olds, and 19.6% of 40-44 year olds said they had been circumcised. It also found that, apart from black Caribbeans, overseas born men were more likely to be circumcised.<ref>{{cite journal |title=Male circumcision in Britain:
-findings from a national probability sample survey |url=http://sti.bmj.com/cgi/content/full/79/6/499 |first=SS |last=Dave |coauthors=''et al'' |journal=Sex Transm Infect |year=2003 |volume=79 |issue=6 |pages=499-500}}</ref>  Rickwood ''et al'' reported that the proportion of English boys circumcised for medical reasons had fallen from 35% in the early 1930s to 6.5% by the mid-1980s. An estimated 3.8% of male children in the UK  in 2000 were being circumcised by the age of 15 [http://bmj.bmjjournals.com/cgi/content/full/321/7264/792]. The researchers stated that too many boys, especially under the age of 5, were still being circumcised because of a misdiagnosis of phimosis. They called for a target to reduce the percentage to 2%.
-===United States===
-Statistics from different sources give widely varying estimates of infant circumcision rates in the United States.
-Nelson, 2005 used data from the Nationwide Inpatient Sample (a sample of 5-7 million of the nation's total inpatient stays, and representing a 20% sample taken from 8 states in 1988 and 28 in 2000), stated that circumcisions rose from 48.3% in 1988 to 61.1% in 1997.<ref>{{cite journal
- | last = Nelson
- | first = CP.
- | coauthors =  R. Dunn, J. Wan, JT. Wei
- | year = 2005
- | month = March
- | title = The increasing incidence of newborn circumcision: data from the nationwide inpatient sample
- | journal = Journal of Urology
- | volume = 173
- | issue = 3
- | pages = 978–981
- | id = {{ISSN|0022-5347}} PMID 15711354
- | url = http://www.jurology.com/article/PIIS0022534705604193/abstract
- | format = Abstract
- | doi = 10.1097/01.ju.0000145758.80937.7d
- | accessdate = 2006-09-21
- }}
-</ref>
-The 2003 Nationwide Hospital Discharge Survey stated that circumcision rates declined from 64.7% in 1980 to 59.0% in 1990, rose to 64.1% in 1995, and fell again to 55.9% in 2003.<ref name = "NHDS">{{cite journal
+==Notes==
- | last = Kozak
- | first = LJ
- | coauthors = KA Lees, and CJ DeFrances
- | year = 2006
- | title = National Hospital Discharge Survey: 2003 annual summary with detailed diagnosis and procedure data.
- | journal = Vital Health Statistics
- | volume = 13
- | issue = 160
- | pages =
- | doi =
- | id =
- | url = http://www.cdc.gov/nchs/data/series/sr_13/sr13_160.pdf
- | format = PDF
- | accessdate = 2007-01-30
- }}</ref> On page 52, it is shown that the western region of the United States has seen the most significant change, declining from 61.8% in 1980 to 31.4% in 2003.<ref name = "NHDS" /> The decline in the western region has been partly attributed to increasing births among [[Latin American]]s, who usually do not circumcise.<ref>{{cite web
-| url = http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions.htm
-| title = Trends in circumcisions among newborns
-| accessdate = 2007-01-30
-| date = January 11, 2007
-| work = Health E-Stats
-| publisher = [[National Center for Health Statistics]]
-| quote = <small>However, the most notable change occurred in the West where newborn circumcisions dropped from 62 percent in 1980 to 37 percent in 1999. This latest available figure for the West represents over a two-fold difference when compared with circumcision estimates for the Midwest. This dramatic decline, in part, reflects the increased birth rate among Hispanics who have been shown in several other studies to be less likely to receive circumcisions than other white and black infants.</small>
-}}
-</ref>
-A national survey of adult men found that 91% of men born in the 1970s, and 83% of men born in the 1980s were circumcised.<ref>{{cite paper
-  | author = Xu, F, L Markowitz, M Sternberg, and S Aral
-  | title = Prevalence of circumcision in men in the United States: data from the National Health and Nutrition Examination Survey (NHANES), 1999-2002
-  | publisher = XVI International AIDS Conference
-  | date = 2006
-  | url = http://www.iasociety.org/abstract/show.asp?abstract_id=2183186
-  | accessdate =  2006-09-21
-}}
-</ref>
-Schoen, 2006, claimed that "the published results of national statistical surveys represent only coded diagnoses obtained from birth centers; the reported figures do not include males who are circumcised at a later date for religious, medical, or personal reasons or who received newborn circumcision that was not coded."<ref>{{cite journal
- | last = Schoen
- | first = Edgar J.
- | year = 2006
- | month = July
- | title = Ignoring evidence of circumcision benefits
- | journal = Pediatrics
- | volume = 118
- | issue = 1
- | pages = 385&ndash;387
- | id = {{ISSN|0031-4005}} PMID 16818586
- | url = http://pediatrics.aappublications.org/cgi/content/extract/118/1/385
- | accessdate = 2006-09-21
- }}
-</ref>
-There are various explanations why the infant circumcision rate in the United States are different from comparable countries. Some obstetricians have been accused of using circumcision as a quick and easy way of making money.<ref>{{cite news
- | first = Lehman
- | last = Betsy A.
- | title = The Age-old Question of Circumcision
- | url = http://www.cirp.org/news/bostonglobe06-22-87
- | format = CIRP (CIRP has modified text display)
- | publisher = [[The Boston Globe]]
- | pages = 41 & 43
- | date = June 22, 1987
- | accessdate = 2007-04-06
-}}
-</ref> Many parents’ decisions about circumcision are preconceived, and this may contribute to the high rate of elective circumcision.<ref name = "CSA:I-99" />
-[[Medicaid]] funding for infant circumcision used to be universal in the United States; however, sixteen states no longer pay for the procedure under Medicaid [http://www.circumstitions.com/Images/map-usa-notfund.gif]. One study in the Midwest of the U.S. found that this had no effect on the newborn circumcision rate but it did affect the demand for circumcision at a later time.<ref>{{cite journal
- | last = Quayle
- | first = SS.
- | coauthors =  DE. Coplen, PF. Austin
- | year = 2003
- | month = October
- | title = The effect of health care coverage on circumcision rates among newborns
- | journal = Journal of Urology
- | volume = 170
- | issue = 4 Pt 2
- | pages = 1533&ndash;1536
- | id = {{ISSN|0022-5347}} PMID 14501653
- | accessdate = 2006-09-21
- }}
-</ref>
-==See also==
-*[[Brit milah]]
-*[[Circumcision scar]]
-*[[Foreskin restoration]]
-*[[Genital integrity]]
-*[[Holy Prepuce]]
-*[[Preputioplasty]], alternative to circumcision in the treatment for phimosis
-*[[Zeved habat]]
-==References==
 {| class="messagebox" style="background: {{{#666666}}};"
  |-
@@ Line 2,095: / Line 1,147: @@
 <references />
 </div>
+==References==
 ==External links==
-===Circumcision opposition===
 * [http://www.cirp.org The Circumcision Information and Resource Pages] by Geoffrey T. Falk
 * [http://www.doctorsopposingcircumcision.org Doctors Opposing Circumcision] presided by George C. Denniston, MD, MPH
-* [http://www.nocirc.org National Organization of Circumcision Information Resource Centers] by Marilyn Milos, RN
-===Circumcision promotion===
-* [http://www.circinfo.net/ Benefits of circumcision: medical, health and sexual] by Professor Brian Morris
-* [http://medicirc.org/ Circumcision: a lifetime of medical benefits] by Edgar Schoen, BSc., M.D.
-* [http://www.drweiss.org/ Circumcision Information] by Gerald N. Weiss, M.D.
-===Circumcision techniques===
-* [http://www.aafp.org/afp/990315ap/1514.html Description of an adult circumcision] from the [[AAFP|American Academy of Family Physicians]].
-* [http://www.mcg.edu/pediatrics/CCNotebook/chapter2/circumsion.htm Description of a Plastibell circumcision] from the Medical College of Georgia.
 ==Further reading==

Difference between revisions of "Circumcision" - New World Encyclopedia

Revision as of 21:43, 3 October 2007

Circumcision procedures

Cultures and religions

Judaism

Christianity

Islam

Other faiths and traditions

Ethical issues

Consent

Emotional consequences

Legality

Sexual effects

Medical aspects

Risks of circumcision

HIV

Hygiene

Infectious and chronic conditions

History of circumcision

Circumcision in the ancient world

Medical circumcision in the 19th century and early 20th century

Circumcision since 1950

Notes

ReferencesISBN links support NWE through referral fees

External links

Further reading

Credits

References
ISBN links support NWE through referral fees