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Circumcision

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Circumcision is the surgical removal of some or all of the prepuce or foreskin. It is the most common form of penile body modification. The word circumcision comes from the Latin circum (="around") and cædere (="to cut").

Circumcision is an important religious and cultural practice in Judaism, Islam, several Pacific Islander cultures and widely across Africa. Additionally, during the late 19th century, it became widespread among English-speaking nations as an act of preventive medicine and hygiene. Today, there is a broad consensus in the medical community that the potential medical benefits of infant circumcision are about equal with the medical risks and harms. In the United States, the majority of males are still circumcised as infants. However in the other English-speaking nations the rate of infant circumcision has decreased.

The term female circumcision is somewhat loosely applied to a variety of controversial cultural practices, mostly practiced in sub-Saharan Africa and among a few minority groups in Asia, wherein parts of the external female genitalia are cut or removed. The remainder of this article concerns circumcision as practiced on males.

How circumcision is performed

Childhood circumcision is usually performed without anaesthesia or with a local anaesthetic. In infants and prepubescent boys, the inner surface of the foreskin is usually connected to the glans penis by tissue called the synechial membrane. Before circumcision can be performed, this membrane must be cut or torn, usually by means of a blunt probe, forceps, or scissors.

The loosened foreskin is then clamped using any of a variety of clamps, such as the Plastibell (the most common method in the United States), Gomco clamp, or Mogen clamp (frequently used in Jewish ritual circumcisions). The clamp stops blood flow through the prepuce, limiting or preventing bleeding, and also guards the rest of the penis from being accidentally cut. The part of the prepuce secured by the clamp is cut off, the clamp removed, and the wound bandaged without sutures. Alternatively, some varieties of clamp are designed to remain in place for several days, holding the wound closed until it heals.

File:Uncircumsized penis.gif File:Circumsized penis.gif
An uncircumcised penis, a circumcised penis

For adolescents and adults, medical circumcision is performed under general anaesthesia. The prepuce is removed using a surgical blade, with or without guiding tools such as foreceps or a Gomco clamp. The wound is then closed with dissolvable stitches and bandaged. Suturing is necessary to prevent the wound from reopening during erection. Post-operative pain is easily controlled with analgesics, but some discomfort occurs during erection. There is normally no requirement to stay overnight in a hospital. Healing takes a week and return to sexual activity is typically possible after two weeks.

Prevalence of Male Circumcision

Approximately one sixth of males worldwide are circumcised [1]; the vast majority for religious or cultural reasons. The United States is the only country that still practices circumcision routinely on a majority of infants for non-religious reasons.

The majority of males are circumcised in the following countries:

Afghanistan, Albania, Algeria, Azerbaijan, Bahrain, Bangladesh, Benin, Cameroon, Chad, Comoros, Djibouti, Egypt, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Indonesia, Iran, Iraq, Israel, Kazakhstan, Kenya, Kuwait, Lebanon, Libya, Madagascar, Malaysia, Maldives, Mali, Mauritania, Morocco, Nigeria, Niger, Pakistan, Philippines, Qatar, Republic of the Congo, Samoa. Tonga, Saudi Arabia, Sierra Leone, Somalia, 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.

Table 1
Circumcision Rates in Several English-Speaking Countries
CountryYearRoutine neonatal circumcisions (%)
United States200155.1% [2]
CanadaFY 1996/9717% [3]
Australia1995-9610.6% [4]
New Zealand19950.35%* [5]
United Kingdom19980.4% [6]
*Samoans, Tongans and Niueans in New Zealand continue to practice circumcision, but not in public hospitals, which this data refers to

Male 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.

Some liberal Jews oppose circumcision. Doctor Ronald Goldman (no relation to the murder victim of the same name) has argued against it 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 strictly follow Jewish law, have given it favorable reviews. A small number of Jews have joined a group called Jews Against Circumcision [7]. 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 [8]. Such alternative rituals are rejected by the mainstream Jewish community.

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[9] in 1442, held by Catholic theologians, 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. [10]

The modern Roman Catholic Church says little on the subject, suggesting a more ambivalent attitude, certainly not promoting the practice (as Christian scripture states that it is not necessary), but also not acting to stop it where it is routinely performed as a medical procedure.

Some African, Australian Aboriginal, and Polynesian societies continue to practice it. 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.

A few non-Western cultures practice circumcision, such as the Machapunga tribe of Native North Americans, some Australian Aborigines, some tribes in New Guinea, Tongans, Niueans, and Samoans.

Contemporary attitudes towards male circumcision

Just as circumcision rates vary widely between countries and even between different regions in countries, so attitudes towards circumcision vary widely. Most men are content with the state of their penis, whether circumcised or not. In the United States, most people give little thought to the practice, and parents routinely defer to the judgment of their doctor whether to circumcise their newborn sons.

Those parents who choose to have the procedure performed may cite some of the following reasons:

  • It is part of their religious tradition. (This also applies to Christians for whom it is not religiously necessary, but who consider it a reflection of their faith's roots in Jewish theology.)
  • (Muslim societies, The USA, Israel and a few others) Most other males in their country are circumcised, and they want their child to be "normal" rather than being perceived as "different" by his peers.
  • The father is circumcised, and they don't want the boy to be troubled that his penis is not like his father's.
  • They prefer the appearance of a circumcised penis.
  • They are concerned about the additional effort required for proper hygiene of an uncircumcised penis.
  • They are concerned about other possible health risks (such as cancer) associated with uncircumcised men.
  • They believe it will discourage inappropriate playing with the penis.

Those parents who choose not to have the procedure performed may cite some of the following reasons:

  • They want their child's penis to remain in its natural condition.
  • The father is uncircumcised, and they don't want the boy to be troubled that his penis is not like his father's.
  • They prefer the appearance of an uncircumcised penis.
  • They do not wish to inflict the discomfort of the procedure or the short-term risk of infection on their child.
  • They are not be able to pay, or may not wish to pay, for the procedure.
  • They are concerned about their child later objecting to the procedure, and resenting them for having performed it.
  • They have heeded the warnings in the New Testament against circumcision, (e.g. in Acts 15, Galatians 5:1-4, 6:13-15, Philippians 3:2)

Some adult men resent having been circumcised without their consent, especially after hearing of the heightened pleasure uncircumcised men claim to have. (A circumcised penis has fewer sensory nerve endings than one with a foreskin.) Some campaign against circumcision, arguing that it is a form of abuse, and should be discouraged or even criminalized. Most people in this anti-circumcision movement are not opposed to adults choosing circumcision, but regard neonatal circumcision as 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. Some make allowances in their arguments for religiously-motivated circumcision, either out of the principle of religious freedom, or to avoid giving the impression of an anti-semitic motivation or giving support to anti-semitism.

Some circumcised men seek to regain a foreskin through plastic surgery or through non-surgical 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. None of these methods restore the sensitive tissue that is removed by circumcision.

See also

Against circumcision

  • Circumcision Information and Resource Pages - Library website that hosts and comments on hundreds of articles and studies on various aspects of circumcision. Endorsed by the British Medical Journal.
  • International Coalition for Genital Integrity - An alliance of genital integrity groups.
  • Intactivism - A website collecting the arguments of those strongly opposed to circumcision.
  • Doctors Opposing Circumcision - Physicians and others who are opposed to routine neonatal circumcision.
  • Circumcision Resource Center - Includes 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/NORM-UK - 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.

In favor of circumcision

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