Circumcision

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. 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. According to WHO, 30 percent of men worldwide have had the procedure, mostly in countries where it is common for religious or cultural reasons.

Circumcision predates recorded human history, with depictions in stone-age cave drawings and Ancient Egyptian tombs. Theories include that circumcision is a form of ritual sacrifice or offering, a health precaution, a sign of submission to a deity, a rite of passage to adulthood, a mark of defeat or slavery, or an attempt to alter esthetics or sexuality.

Male circumcision is a religious commandment in Judaism, expected in Islam, and customary in some Oriental Orthodox and other Christian churches in Africa. Circumcision is common in the Middle East,in north América (USA and Canada ),in Australia and parts of Africa and Asia.

Genital integrity supporters condemn infant circumcision as a human rights abuse and a genital mutilation like female genital cutting, while advocates of circumcision like international organizations, like WHO, UNAIDS, UNICEF, UNFPA, World Bank, and NIAID regard it as a worthwhile public health measure, particularly in the control of HIV.

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. 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.

• 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. The frenulum is cut if frenular chordee is evident.

Cultures and religions

Some 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.

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. 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.

Christianity

Christianity does not call for circumcision. The first Church Council in Jerusalem declared that circumcision was not necessary. St. Paul had Timothy circumcised, but in his letters he warned gentile Christians against adopting the practice. While in most countries, Christians do not circumcise.

But (European) Christendom, as in other things, is 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. It is customary among the Coptic, Ethiopian, and Eritrean Orthodox Churches, and also some other African churches.

Some Christian churches in South Africa oppose circumcision, viewing it as a pagan ritual, while others, including the men and women in Nyanza province Kenya, find male circumcision acceptable. AIDS care requires 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.

The Greek Orthodox Church celebrates the Circumcision of Christ on January 1, while Orthodox churches following the Julian calendar celebrate it on January 14. The Russian Orthodox Church considers it a "Great Feast". In the Catholic, Anglican and Lutheran churches it has been replaced by other commemorations. At the Council of Basel-Florence in 1442, the Catholic Church condemned circumcision among the Copts and ordered against its practice.

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. Some have quoted the hadith to argue that the requirement of circumcision is based on the covenant with Abraham.

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 11. 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.

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."

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 five or six 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.” Kamyar et al describe circumcision as an "obligatory custom" and note that it is not necessary for the circumciser to be a Muslim.

Other faiths and traditions

Bahá'ís do not have any particular tradition or rituals regarding male circumcision, but view female circumcision as mutilation. The Druze have no male circumcision in their religion, although, according to one source, it is practiced among those living in urban areas or outside the Middle East, mainly for hygienic reasons.

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

Sikh male infants are not circumcised.

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. However, Antonio de Morga's seventeenth century History of the Philippine Islands, speculates that it is due to Islamic influence. 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. 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.

Circumcision is part of initiation rites in some African, Pacific Islander, and Australian aboriginal traditions in areas such as Arnhem Land, where the practice was introduced by Makassan traders from Sulawesi in the Indonesian Archipelago.

Circumcision ceremonies among certain Australian aboriginal societies are noted for their painful nature, including subincision for some aboriginal peoples in the Western Desert.

In the Pacific, ritual circumcision is nearly universal in the Melanesian islands of Fiji and Vanuatu; participation in the traditional land diving on Pentecost Island is reserved for those who have been circumcised. 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. In additional African societies, circumcision has become medicalized and is simply performed in infancy without ado or any particular conscious cultural significance. 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.

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. Authority derives from the age-group and the age-set. Prior to circumcision a natural leader, or olaiguenani, is selected; he leads his age-group through a series of rituals until old age, sharing responsibility with a select few, of whom the ritual expert (oloiboni) is the ultimate authority. Masai youths are not circumcised until they are mature, and a new age-set is initiated together at regular intervals of 12 to 15 years. The young warriors (ilmurran) remain initiates for some time, using blunt arrows to hunt small birds which are stuffed and tied to a frame to form a head-dress.

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 United States, Australia, and Canada do not recommend the routine non-therapeutic circumcision of newborns. 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.

Those opposing circumcision, however, question the legality of infant circumcision by asserting that infant circumcision is a human rights violation or a sexual assault.

Consent

Views differ on whether limits should be placed on caregivers having a child circumcised.

Somerville argues that the nature of the medical benefits cited as a justification for infant circumcision are such that the potential medical problems can be avoided or, if they occur, treated in far less invasive ways than circumcision. She states that the removal of healthy genital tissue from a minor should not be subject to parental discretion, or that physicians who perform the procedure are not acting in accordance with their ethical duties to the patient, regardless of parental consent. Another argument questions why the genital cutting of males is allowed while the genital cutting of females is prohibited.

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. The BMA insists that a circumcision must not go ahead without the consent of both parents and the competent child.

Emotional consequences

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

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 new law, saying it violates their religious rights. In 2001, the World Jewish Congress stated that it was “the first legal restriction on Jewish religious practice in Europe since the Nazi era.” However, in 2006, the United States State Department reported that most Jewish mohels had been certified under the law and 3000 Muslim and 40 to 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.

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."

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."

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." 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.” Cost-benefit analyses have varied. Some found a small net benefit of circumcision, some found a small net decrement, 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."

Risks of circumcision

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

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. 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.”

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.” 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.

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.

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.

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 nineteenth century and early twentieth 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. At that time when people regarded masturbation as both sinful, and physically and mentally unhealthy, circumcision was promoted as a way of discouraging it. 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. Although this observation was challenged (the protection that Jews appear to have are more likely due to cultural factors, a 2006 systematic review concluded that the evidence "strongly indicates that circumcised men are at lower risk ... syphilis."

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.

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.

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[1] of infant circumcision rates in the United States holds that 30% of newborn American boys were being circumcised in 1900, 55 percent in 1925, and 72 percent.

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. 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. The infant circumcision rate in Canada has fallen from roughly 50 percent in the 1970s to 13.9 percent in 2003. However, the figures varied from 29.5 percent on Prince Edward Island to zero in Newfoundland and Labrador.

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 percent of South Korean high-school boys are now circumcised, but the average age of circumcision is 12 years.

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..." [2].

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. 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.[3] 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."[4]

A 2001 study reported that "The most important reason to circumcise or not circumcise the child was health reasons." 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 United States between 1988 and 2000.[5] In a 2001 survey, 86.6 percent of parents felt respected by their medical provider, and parents who did not circumcise "felt less respected by their medical provider".

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."

Table 1: International circumcision rates

Country	Year	Neonatal circumcisions (%)
United States	2003	55.9%* [6]
Canada	2003	< 14% [7]
Australia	2004	10%-20% [8]
New Zealand	1995	0-5%[9]
*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.

References

ISBN links support NWE through referral fees

• Gollaher, David L. Circumcision: A History of the World's Most Controversial Surgery, Basic Books, 2001. ISBN 978-0465026531
• Glick, Leonard B. Marked in Your Flesh: Circumcision from Ancient Judea to Modern America, Oxford University Press, 2006. ISBN 978-0195315943
• Goldman, Ronald. Questioning Circumcision: A Jewish Perspective, Vanguard Publications, 1997. ISBN 978-0964489561
• Ritter, Thomas J. Doctors Re-examine Circumcision, Third Millennium Publishers, 2001. ISBN 978-0971187801

External links

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

Further reading

• Billy Ray Boyd. Circumcision Exposed: Rethinking a Medical and Cultural Tradition. Freedom, CA: The Crossing Press, 1998. (ISBN 978-0-89594-939-4)
• Anne Briggs. Circumcision: What Every Parent Should Know. Charlottesville, VA: Birth & Parenting Publications, 1985. (ISBN 978-0-9615484-0-7)
• Robert Darby. A surgical temptation: The demonization of the foreskin and the rise of circumcision in Britain. Chicago: University of Chicago Press, 2005. (ISBN 978-0-226-13645-5)
• Aaron J. Fink, M.D. Circumcision: A Parent's Decision for Life. Kavanah Publishing Company, Inc., 1988. (ISBN 978-0-9621347-0-8)
• Paul M. Fleiss, M.D. and Frederick Hodges, D. Phil. What Your Doctor May Not Tell You About Circumcision. New York: Warner Books, 2002. (ISBN 978-0-446-67880-3)
• Leonard B. Glick. Marked in Your Flesh: Circumcision from Ancient Judea to Modern America. New York: Oxford University Press, 2005. (ISBN 978-0-19-517674-2)
• David L. Gollaher. Circumcision: A History of the World's Most Controversial Surgery. New York: Basic Books, 2000. (ISBN 0465026532)
• Ronald Goldman, Ph.D. Circumcision: The Hidden Trauma. Boston: Vanguard, 1996. (ISBN 978-0-9644895-3-0)
• Paysach J. Krohn, Rabbi. Bris Milah. Circumcision-The Covenant Of Abraham/A Compendium of Laws, Rituals, And Customs From Birth To Bris, Anthologized From Talmudic, And Traditional Sources. New York: Mesorah Publications, 1985, 2005.
• Brian J. Morris, Ph.D., D.Sc. In Favour of Circumcision. Sydney: UNSW Press, 1999. (ISBN 978-0-86840-537-7)
• Rosemary Romberg. Circumcision: The Painful Dilemma. South Hadley, MA Bergan & Garvey, 1985. (ISBN 978-0-89789-073-1)
• Edgar J Schoen, M.D. Ed Schoen, MD on Circumcision. Berkeley, CA: RDR Books, 2005. (ISBN 978-1-57143-123-3)
• Edward Wallerstein. Circumcision: An American Health Fallacy. New York: Springer, 1980 (ISBN 978-0-8261-3240-6)
• Gerald N. Weiss M.D. and Andrea W Harter. Circumcision: Frankly Speaking. Wiser Publications, 1998. (ISBN 978-0-9667219-0-4)
• Yosef David Weisberg, Rabbi. Otzar Habris. Encyclopedia of the laws and customs of Bris Milah and Pidyon Haben. Jerusalem: Hamoer, 2002.

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