2 Alternative treatments

For many disorders, such as phimosis, alternative conservative treatments exist. A dorsal slit or the use of steroid creams often resolve phimosis. Urinary tract infections, while much less common in circumcised boys than in either girls or uncircumcised boys, can often be effectively treated with antibiotics.[5]

3 Prevalence

Approximately one sixth of males worldwide are circumcised [6]; the vast majority for religious or cultural reasons. The United States is the only country that still practices circumcision routinely on a majority of male infants for non-religious reasons.

The majority of males are circumcised in the following countries:

AfghanistanAfghanistan ( Dari/ Pashtu: Afgnistn is a country in Central Asia. It is bordered by Iran in the west, Pakistan in the south and east, Turkmenistan, Uzbekistan and Tajikistan in the north, and China in the easternmost part of the country. It is among the, AlbaniaAlbania is a country in southeastern Europe. It is bordered by Montenegro in the north, Serbia ( Kosovo) in the north-east, the Republic of Macedonia in the east, and Greece in the south, has a coast on the Adriatic Sea in the west, and a coast on the Ion, AlgeriaAlgeria is a country in northern Africa with a coast on the Mediterranean Sea along the north and bordered by Tunisia in the northeast, Libya in the east, Niger in the southeast, Mali and Mauritania in the southwest, and Morocco in the west (the Moroccan, AzerbaijanThe Republic of Azerbaijan ( Azerbaijani: Azərbaycan or #x4D9;јҹ is a country in the Caucasus adjacent to the Caspian Sea that shares borders with Russia in the north, Georgia, Armenia, in the west and Iran in the south. The Nakhchivan Au, BahrainThe Kingdom of Bahrain or Bahrain is a borderless country in the Persian Gulf ( Southwest Asia/ Middle East, Asia). Saudi Arabia is to the west and is connected to Bahrain by a causeway, and Qatar is to the south across the Gulf of Bahrain. History Main a, BangladeshThe People's Republic of Bangladesh is a country in South Asia that forms the eastern part of the ancient region of Bengal. Bangladesh literally means "The Country of Bengal". Lying north of the Bay of Bengal, on land it borders India almost exclusively,, BeninThe Republic of Benin is a nation of western Africa, formerly known as Dahomey . It has a small coast line with the Bight of Benin in the south, borders Togo in the west, Nigeria in the east, and Burkina Faso and Niger in the north. History Main article:, Cameroon, Chad, Comoros, Djibouti, Egypt, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Indonesia, Iran, Iraq, Israel, Kazakhstan, Kenya, Kuwait, Lebanon, Libya, Madagascar, Malaysia, Maldives, Mali, Mauritania, Morocco, Nigeria, Niger, Pakistan, Philippines, Qatar, Republic of the Congo, Samoa. Tonga, Saudi Arabia, Sierra Leone, Somalia, South Africa, South Korea, Sudan, Syria, Tajikistan, Togo, Tunisia, Turkey, Turkmenistan, United Arab Emirates, the United States of America, Uzbekistan, Vanuatu, and Yemen.

In most of these countries the predominant religion endorses circumcision, such as Islam or Judaism.

Historically, routine infant circumcision was promoted during late Victorian times in the English-speaking parts of Canada, Australia, New Zealand, the United States and the United Kingdom and was widely practiced during the first part of the 20th century in these countries. However, the practice declined sharply in the United Kingdom after the Second World War, and somewhat later in Canada, Australia and New Zealand. It has been argued (e.g., Goldman 1997) that the practice did not spread to other European countries because others considered the arguments for it fallacious. In South Korea, circumcision was largely unknown before the establishment of the United States trusteeship in 1945. More than 90% of South Korean high school boys are now circumcised, but the average age of circumcision is 12 years, which makes South Korea a unique case [7].

From the late Victorian era, circumcision became more common in the higher classes in the United Kingdom. Queen Victoria had the notion that her family was descended from King David of Israel, and mandated that her sons, including the future King Edward VII be circumcised. King Edward continued the practice, and among the English royal family, the practice is still widespread: Prince Charles, Prince Andrew, and Prince Edward, were all circumcised. Reportedly, the late Diana, Princess of Wales rebelled against the royal tradition and refused to allow her sons, Prince William and Prince Harry, to be circumcised.

Routine infant circumcision has been abandoned in New Zealand and Britain, and is now much less common in Australia and in Canada (see table 1). The decline in circumcision in the United Kingdom followed the decision by the National Health Service (NHS) in 1948 not to cover the procedure following an influential article by Douglas Gardiner which claimed that circumcision resulted in the deaths of about 16 children under the age of five every year in the United Kingdom. [8]. In most of the rest of the world, circumcision is done either as a religious or cultural practice.

Before the 1870s, circumcision in the United States was performed to treat phimosis and cancerous lesions. During the last few decades of the nineteenth century, in accord with the accepted reflex neurosis theory of the time, circumcision came to be used to treat diseases that were not localized to the penis, especially those that affected the nervous system. In addition, circumcision was performed to prevent chronic masturbation, which was then believed to cause various diseases. Social considerations helped make the procedure widespread. During the Victorian era a great emphasis was placed on cleanliness and secretions such as smegma were treated with suspicion. In the end, however, routine neonatal circumcision eventually came to be practiced on a majority of males around the turn of the century because of the hygenic and preventative benefits of the procedure, the same justification that is still used today.

In the United States, statistics collected by the National Center for Health Statistics show that the overall rate of neonatal circumcision has remained near 65% since data collection began in 1979[9]. However, strong regional differences in the circumcision rates have developed during this time. While more than 80% of newborn boys are circumcised in the Midwest and South, circumcision rates have declined to about 37% in the West[10]. This has been attributed, in part to increasing births among Latin Americans, who usually do not circumcise[11]. Thirteen states no longer pay for the procedure under Medicaid; the other 37 still do.

The medical benefits of circumcision are a controversial topic. Some argue that circumcision is an essential public health measure, while others believe that there are no benefits to the procedure. (See medical analysis of circumcision.)

The major medical societies in Britain, Canada, Australia and New Zealand do not support routine infant circumcision. All major medical organizations in the United States now judge the benefits of the procedure to be too small to justify the risks associated with performing it routinely. Neonatal circumcision nonetheless still remains the most common pediatric operation carried out in the U.S. today.

Table 1 International circumcision rates
Country	Year	Routine neonatal circumcisions (%)
United States	1999	65.4% [12]
Canada	FY 1996/97	17% [13]
Australia	1995-96	10.6% [14]
New Zealand	1995	0.35%* [15]
United Kingdom	1972	0.41% [16]
*Samoans, Tongans and Niueans in New Zealand continue to practice circumcision, but not in public hospitals, which these data refer to

4 Circumcision for religious purposes

Circumcision of males is a religious practice traditionally required by Judaism. The Jewish ceremony of circumcision is called a Brit milah or Bris Milah ( Hebrew for "Covenant of circumcision"). The ceremony is to be performed on the eighth day of life of the newborn boy unless health reasons force a delay. See also Circumcision in the Bible.

According to nearly all Muslim religious leaders, circumcision is an important element of Islam. Although circumcision is not mentioned in the Quran (and the mutilation of the body is expressly forbidden therein), it is mentioned in some parts of the Hadith, a set of texts explaining Islamic law that most Muslims view as authoritative. Most Muslims believe that Mohammed was born circumcised. Moreover, Hadiths describe that the ritual of circumcision was started by Abraham, who is seen as the founder of Islam. Muslim custom on circumcision varies. Some Muslim communities perform circumcision on the eighth day of life, as the Jews do, while others perform the rite at a different time. Turkish, Balkan, and Central Asian Muslims typically circumcise boys at between six and eleven years of age, and the event is viewed communally as a joyous occasion and celebrated with sweets and feasting. In contrast, Iranian Muslims are typically circumcised in the hospital at birth without much ado. In Egypt, rural areas celebrate circumcision as a joyous occasion, while urban populations have it done in the hostpital.

Circumcision is also customary in the Coptic Christian religious tradition. It is usually performed on the eighth day of life, as the Jews do. This practice was condemned by the Council of Florence[17] in 1442, held by leading theologians of the Roman Catholic Church, which said in part:

Therefore it strictly orders all who glory in the name of Christian, not to practise circumcision either before or after baptism, since whether or not they place their hope in it, it cannot possibly be observed without loss of eternal salvation. [18]

A number non-Western cultures practice circumcision, such as the Machapunga tribe of Native North Americans, some Australian Aborigines, some tribes in New Guinea, Tongans, Niueans, Samoans and widley across Africa. Circumcision practices among these societies vary, including at what age the procedure is done, whether women may be present, what celebrations are attendant on the procedure, and whether the procedure is viewed as an initiation.

5 Contemporary attitudes toward circumcision

Just as circumcision rates vary widely between circumcising countries, and even between different regions in countries, so attitudes toward circumcision vary widely.

Besides cultural or religious motivations for circumcision, some people believe that circumcised penises are more attractive, while others do not. Most men, whether circumcised or not, are content with their circumcision status. Many circumcised men believe that being circumcised as an infant is better than later, so they cannot remember the pain of the procedure. Other men resent having been circumcised without their consent, especially after hearing of the heightened pleasure uncircumcised men claim to have. Some campaign against circumcision. A few seek to regain their foreskin through surgical or non-surgical foreskin restoration procedures.

Over the past twenty years there has been a growing movement against circumcision. Most in this movement are not opposed to adults choosing circumcision but regard circumcision of minors as a sexual mutilation, and consider it barbaric, primitive, unnecessary, and dangerous. Most oppose infant circumcision in all cases, especially when it is done without pain relief, something that still often happens. Many try to avoid vocabulary like "anti-circumcision" in order to avoid confusion with the adult circumcision issue and prefer to use words such as 'intact' and 'genital integrity'.

The goal of this movement is to end, and possibly even criminalize, the forced circumcision of males and females. Anti-circumcision/genital integrity groups take a varying approach toward Judaism and Islam. Some make no distinction between differently motivated types of circumcision, while others ask for reform instead of criminalization [19]. Jews mostly circumcise their boys on the eighth day while Muslims may circumcise at any time during childhood. In countries with a high Muslim or Jewish population, circumcision is prevalent. Most Jewish and Muslim groups oppose any moves against circumcision, because it could stigmatize or criminalize this practice of their religions.

Genital integrity groups include: NOCIRC (National Organization of Circumcision Information Resource Centers), ARC (Attorneys for the Rights of the Child), NOHARMM (the National Organization to Halt the Abuse and Routine Mutilation of Males), D.O.C. (Doctors Opposing Circumcision), and NRC (Nurses for the Rights of the Child). One of the positions held by opponents of circumcision is that a significant part of the infant's body is unnecessarily and permanently removed without the subject's consent, the same argument used by opponents of female genital mutilation. Some have tried to challenge the legal status of circumcision. An umbrella organization, the International Coalition for Genital Integrity [20], is unilaterally opposed to any forced genital cutting, whether on males, females or the intersexed. Many of the above organizations are members of ICGI.

Some liberal Jews oppose circumcision. Doctor Ronald Goldman (no relation to the murder victim of the same name) has argued against circumcision in his book Questioning Circumcision: A Jewish Perspective. He states that circumcision is unnecessary and dangerous, and claims that foregoing the practice would be consistent with traditional and reform Jewish ethics, while continuing it would not. The book has been strongly condemned in the Jewish community. Several Reconstructionist and Reform rabbis, who no longer follow Jewish law, have given it favorable reviews. A small number of Jews have joined a group called Jews Against Circumcision [21]. People in this group and some other Jews opposed to the Brit Milah practice an alternative ritual called Brit Shalom that does not involve circumcision [22]. Such alternative rituals are rejected by the mainstream Jewish community.

Those who try to restore their foreskin nonsurgically use methods such as stretching the skin covering the distal penile shaft down over the glans penis through techniques such as wearing weights on it, or taping the skin over a small cap worn over the glans. This process is known as epispasm or foreskin restoration and is mentioned as far back as the Maccabees, over 2000 years ago (1 Macc 1:15). Those attempting to restore their foreskins have reported some success, although a great deal of patience and consistency is required to have any permanent effect. Cosmetic surgical procedures to repair the foreskin also exist.

6 History of circumcision

The origin of circumcision is hidden in the mists of pre-history. Many, possibly hundreds, of hypotheses have been advanced as to the origin of the practice. Some of propose 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) male sexual pleasure, as an aid to hygiene where regular bathing was impractical, as a means of marking those of lower (or higher) social status, as a means of differentiating a circumcising group from their non-circumcising neighbors, as a means of discouraging masturbation or other socially proscribed sexual behaviors, to increase a man's attractiveness to women, as a symbolic castration, as a demonstration of one's ability to endure pain, or as a male counterpart to menstruation or the breaking of the hymen. It is probable that circumcision arose independently in different cultures for different reasons.

The oldest documentary evidence for circumcision comes from Egypt. Tomb artwork from the Sixth Dynasty (2345 - 2181 BC) shows men with circumcised penises, and one relief from this period shows the rite being performed on a standing adult male. The Egyptian hieroglyph for "penis" depicts either a circumcised or an erect organ. The examination of Egyptian mummies has found both circumcised and uncircumcised men.

6.1 Circumcision in the Ancient World

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

The ancient Greeks, however, considered an unmodified penis far more aesthetic than a circumcised one. Ancient Greek artwork portrayed penises as covered by the foreskin (sometimes in exquisite detail), except in the portrayal of satyrs, lechers, and barbarians.[23] The Greek preference for the uncircumcised penis is reflected in Herodotus' comment on the Egyptians: "They practice circumcision for the sake of cleanliness, considering it better to be clean than comely." (Herodotus, Book 2, 37:2).

In the aftermath of Alexander the Great's conquests, the Greek prejudice against the appearance of the circumcised penis led to a decline in the incidence of circumcision among many peoples that had previously practiced it. The writer of 1 Maccabees wrote that under the Seleucids, many Jewish men attempted to hide or reverse their circumcision so they could exercise in Greek gymnasia (see foreskin restoration). Similar cultural pressures operated throughout the Hellenistic world: when the Judean king John Hyrcanus conquered the Idumeans, he forced them to become circumcised and convert to Judaism, but their ancestors the Edomites had practiced circumcision in pre-Hellenistic times. In Egypt, only the priestly caste retained circumcision, and by the second century, the only circumcising groups in the Roman Empire were Jews, Egyptian priests, and the Nabatean Arabs. Circumcision was sufficiently rare among non-Jews that being circumcised was considered conclusive evidence of Judaism in Roman courts— Suetonius described a court proceeding in which a ninety-year-old man was stripped naked before the court to determine whether he was evading the head tax placed on Jews.

6.2 Circumcision in the 18th Century

Circumcision was not practiced amongst Christians in Europe in the 18th Century. It was regarded with repulsion.

Edward Gibbon had referred to it as a "singular mutilation" practised only by Jews and Turks and as "a painful and often dangerous rite" ...(R. Darby) [24]

In 1753 in London there was a proposal for Jewish emancipation. It was furiously opposed by the pamphleteers of the time, who spread the fear that Jewish emancipation meant universal circumcision. Men were urged to protect:

"the best of Your property" and guard their threatened foreskins. It was an extraordinary outpouring of popular beliefs about sex, fears about masculinity and misconceptions about Jews, but also a striking indication of how central to their sexual identity men considered their foreskins at that time. (R.Darby) [25]

6.3 Circumcision in the 19th Century and beyond

Until well into the Nineteenth Century, the same sentiments prevailed.

Richard Burton observed that "Christendom practically holds circumcision in horror". This attitude is reflected in the ninth edition of the Encyclopaedia Britannica (1876) which discusses the practice as a religious rite among Jews, Moslems, the ancient Egyptians and tribal peoples in various parts of the world. The author of the entry rejected sanitary explanations of the procedure in favour of a religious one: "like other body mutilations ... [it is] of the nature of a representative sacrifice". (R. Darby) [26]

Then, a change of attitude began, something that was reflected in successive editions of the Encyclopaedia Britannica:

By 1910 the entry had been turned on its head: "This surgical operation, which is commonly prescribed for purely medical reasons, is also an initiation or religious ceremony among Jews and Mahommedans": now it was primarily a medical procedure and only after that a religious ritual. The entry explained that "in recent years the medical profession has been responsible for its considerable extension among other than Jewish children ... for reasons of health" (11th edition, Vol. 6). By 1929 the entry is much reduced in size and consists merely of a brief description of the operation, which is "done as a preventive measure in the infant" and "performed chiefly for purposes of cleanliness". Ironically, readers are then referred to the entries for "Mutilation" and "Deformation" for a discussion of circumcision in its religious context (14th edition, 1929, Vol. 5). (R. Darby) [27]

6.4 Anti-masturbation panic and circumcision

The movement of the skin layers of the foreskin provides a built-in form of lubrication, usually making it easy to masturbate without additional lubrication if a foreskin is present. Depending on its degree, this normal lubricating function can be absent after circumcision.

Non-religious circumcision in English-speaking countries arose in a climate of sexual fear, especially concerning masturbation. In her 1978 article The Ritual of Circumcision,[28] Karen Erickson Paige writes: "In the United States, the current medical rationale for circumcision developed after the operation was in wide practice. The original reason for the surgical removal of the foreskin, or prepuce, was to control 'masturbatory insanity' - the range of mental disorders that people believed were caused by the 'polluting' practice of 'self-abuse.'"

"Self-abuse" was a term commonly used to describe masturbation in the 19th century. According to Paige, "treatments ranged from diet, moral exhortations, hydrotherapy, and marriage, to such drastic measures as surgery, physical restraints, frights, and punishment. Some doctors recommended covering the penis with plaster of Paris, leather, or rubber; cauterization; making boys wear chastity belts or spiked rings; and in extreme cases, castration." Paige details how circumcision became popular as a masturbation remedy:

"In the 1890s, it became a popular technique to prevent, or cure, masturbatory insanity. In 1891 the president of the Royal College of Surgeons of England published On Circumcision as Preventive of Masturbation, and two years later another British doctor wrote Circumcision: Its Advantages and How to Perform It, which listed the reasons for removing the 'vestigial' prepuce. Evidently the foreskin could cause 'nocturnal incontinence,' hysteria, epilepsy, and irritation that might 'give rise to erotic stimulation and, consequently, masturbation.' Another physician, P.C. Remondino, added that 'circumcision is like a substantial and well-secured life annuity...it insures better health, greater capacity for labor, longer life, less nervousness, sickness, loss of time, and less doctor bills.' No wonder it became a popular remedy." [29]

At the same time circumcisions were advocated on men, clitoridectomies (removal of the clitoris) were also performed for the same reason (to treat female masturbators). The US "Orificial Surgery Society" for female "circumcision" operated until 1925, and clitoridectomies and infibulations would continue to be advocated by some through the 1930s.

One of the leading advocates of circumcision was John Harvey Kellogg, who is well known for his pseudoscientific views on human sexuality. He advocated the consumption of Kellogg's corn flakes to prevent masturbation, and he believed that circumcision would be an effective way to eliminate masturbation in males.

"Covering the organs with a cage has been practiced with entire success. A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should be performed by a surgeon without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. The soreness which continues for several weeks interrupts the practice, and if it had not previously become too firmly fixed, it may be forgotten and not resumed. If any attempt is made to watch the child, he should be so carefully surrounded by vigilance that he cannot possibly transgress without detection. If he is only partially watched, he soon learns to elude observation, and thus the effect is only to make him cunning in his vice."

Robert Darby, writing in the Australian Medical Journal, noted that 19th Century circumcision advocates—and their opponents—were both well aware of the sexual sensitivity of the foreskin:

In the 19th century the role of the foreskin in erotic sensation was well understood by physicians who wanted to cut it off precisely because they considered it the major factor leading boys to masturbation. The Victorian physician and venereologist William Acton (1814–1875) damned it as "a source of serious mischief", and most of his contemporaries concurred. Both opponents and supporters of circumcision agreed that the significant role the foreskin played in sexual response was the main reason why it should be either left in place or removed. William Hammond, a Professor of Mind in New York in the late 19th century, commented that "circumcision, when performed in early life, generally lessens the voluptuous sensations of sexual intercourse", and both he and Acton considered the foreskin necessary for optimal sexual function, especially in old age. Jonathan Hutchinson, English surgeon and pathologist (1828–1913), and many others, thought this was the main reason why it should be excised. [30]

7 Forced cultural and religious circumcisions

Adult men and women are sometimes forced to undergo circumcision, in particular as part of forced conversion s to Islam.[31] [32]

8 See also

• Foreskin
• Foreskin restoration
• Medical analysis of circumcision
• Circumcision in the Bible ( Mohel)
• Association for Genital Integrity

9 References

• John Harvey Kellogg Treatment for Self-Abuse and its Effects in Plain Fact for Old and Young, Burlington, Iowa: F. Segner & Co. (1888). P. 295.
• Goldman, Ronald Circumcision: The Hidden Trauma Boston 1997.
• Goldman, Ronald Questioning Circumcision: A Jewish Perspective Boston 1998.
• Wallerstein, E. Circumcision: The Uniquely American Medical Enigma, Urological Clinics of North America 12 (February 1985): 123-32.
• Walsh, Campbell's Urology, 7th ed. 1998
• Gollaher, David A., Circumcision: A History of the World's Most Controversial Surgery. New York: Basic Books, 2000. 253 pages. (BooksEnthsiast.com)

10 External links

10.1 Pro-circumcision

• Benefits of Circumcision - Informational website
• Circlist- Pro-circumcision website and discussion group. It is not a medical site.
• Medicirc - Website by circumcision advocate Dr. Edgar Schoen , who promotes circumcision because of its alleged health benefits
• ACT inc. - "Advocating Circumcision Today", a Jewish circumcision advocacy organization and mohel referral service.
• ICIRC - "International Circumcision Information Reference Center" - discussion and information about circumcision from The Gilgal Society. It is strongly in favor of circumcision
• Circumcision information pages - Pro-circumcision website.
• The First Cut - An Australian website about circumcision.
• Adhesions, Phimosis and Frenulum Breve - Medical information on potential penile conditions.

10.2 Anti-circumcision

• Circumcision Information and Resource Pages, a vast library website that hosts and comments on hundreds of articles and studies on various aspects of circumcision.
  • Circumcision FAQ by Geoffrey T. Falk
  • What Happens During Circumcision? - Describes the medical procedure itself in detail
  • Circumcision Status, HIV Infection and AIDS - Summarizes existing research into a possible link
• International Coalition for Genital Integrity - An alliance of genital integrity groups.
• Intactivism - A site which is strongly opposed to circumcision and collects arguments on the subject
• The Case for Labectomy by Jason Rohrer, a satirical anti-circumcision text.
• Doctors Opposing Circumcision - An organization of physicians and others who are opposed to routine neonatal circumcision.
• Circumcision Resource Center - Includes some perspectives on the religious aspects of circumcision, and the mothers' feelings following the procedure.
• NOHARMM - National Organization to Halt the Abuse and Routine Mutilation of Males.
• NORM-UK - Website of a registered British charity. Offers news, religious perspectives, advice on foreskin restoration, and more.
• NORM - National Organization of Restoring Men - non-profit support group for men who have concerns about being circumcised, are considering foreskin restoration, or are in the process of restoring their foreskins.
• Male Genital Mutilation Bill - Contains proposed state and federal bills for the United States to ban male circumcision in the way that female circumcision is banned. Also contains reasons not to circumcise and FAQs.

Andrology Body modification Jewish law and rituals

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