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The earliest pictures are from cave drawings of Ancient Egyptian tombs, though some pictures may be open to interpretation. Male circumcision is a religious commandment in Judaism as well as in Islam, and customary in some Oriental Orthodox and other Christian churches in Africa.
Circumcision is most common in the Middle East, the USA and parts of Africa and Asia. According to WHO 30% of men worldwide have had the procedure, mostly in developing countries where it is common for religious or cultural reasons. Opponents of circumcision condemn infant circumcision as being medically unjustified and an infringement upon individual bodily rights, while advocates of circumcision regard it as a worthwhile public health measure, particularly in the control of HIV in Sub-Saharan Africa.
In March 2007 the World Health Organization and UNAIDS stated that male circumcision is an effective intervention for HIV prevention, but also stated that male circumcision only provides partial protection and should not replace other interventions to prevent the heterosexual transmission of HIV.
Circumcision may also be used to treat inflammation of the glans.
- 1 Circumcision procedures
- 2 Cultures and religions
- 3 Ethical, emotional and legal considerations
- 4 Pain and pain relief during circumcision
- 5 Sexual effects
- 6 Medical aspects
- 7 History of circumcision
- 8 Prevalence of circumcision
- 9 See also
- 10 Notes
- 11 External links
- 12 See also
- 13 Further reading
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.
Cultures and religions
- See also: Circumcision in cultures and religions
- See also: Brit milah
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 the Muslim world, Israel, the United States, the Philippines, South Korea, Africa, and is commonly practised in the Jewish and Islamic faiths. It is less common in Europe, Latin America, China and India.
Circumcision 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 by a mohel on the eighth day after birth in a ceremony called a Brit milah (or Bris milah, colloquially simply bris) (Hebrew for "Covenant of circumcision").
While in most countries, Christians do not circumcise, 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 Nomiya church in Kenya, require circumcision for membership. Some Christian churches celebrate the Circumcision of Christ. 
In Islam, circumcision 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. While endorsing circumcision for males, scholars note that it is not a requirement for converting to Islam.
Circumcision in South Korea is largely the result of American cultural and military influence following the Korean War. 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.
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 practiced 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. 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.
Ethical, emotional and legal considerations
- Main article: Bioethics of neonatal circumcision
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.
Circumcision advocates argue that circumcision is a significant public health measure, preventing infections, and slowing down the spread of AIDS. Opponents of circumcision question the ethical validity of removing genital tissue from a minor, arguing that infant circumcision infringes upon individual autonomy and represents a human rights violation.
- Main article: Ethics of circumcision
Views differ on whether limits should be placed on caregivers having a child circumcised.
Some medical associations take the position that the parents should determine what is in the best interest of the infant or child, but the Royal Australasian College of Physicians (RACP) and the British Medical Association (BMA) observe that controversy exists on this issue.Template:Archive link The BMA state that in general, "the parents should determine how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices." They state that because the parents' interests and the child's interests sometimes differ, there are "limits on parents' rights to choose and parents are not entitled to demand medical procedures contrary to their child's best interests." They state that competent children may decide for themselves. UNAIDS states that "[m]ale circumcision is a voluntary surgical procedure and health care providers must ensure that men and young boys are given all the necessary information to enable them to make free and informed choices either for or against getting circumcised."
Some argue that the medical problems that have their risk reduced by circumcision are already rare, can be avoided, and, if they occur, can usually be treated in less invasive ways than circumcision. Somerville states that the removal of healthy genital tissue from a minor should not be subject to parental discretion and that physicians who perform the procedure are not acting in accordance with their ethical duties to the patient. Denniston states that circumcision is harmful and asserts that in the absence of the individual's consent, non-therapeutic child circumcision violates several ethical principles that govern medicine.
Others believe neonatal circumcision is permissible, if parents should so choose. Viens argues that, in a cultural or religious context, circumcision is of significant enough importance that parental consent is sufficient and that there is "an absence of sufficient evidence or persuasive argumentation" to support changing the present policy. Benatar and Benatar argue that circumcision can be beneficial to a male before he would be able to otherwise provide consent, that "it is far from obvious that circumcision reduces sexual pleasure," and that "it is far from clear that non-circumcision leaves open a future person’s options in every regard."
Moses et al. (1998) state that "scientific evidence is lacking" for psychological and emotional harm, and cite a longitudinal study finding no difference in developmental and behavioural indices. Goldman (1999) discussed the possible trauma of circumcision on children and parents, anxieties over the circumcised state, a tendency to repeat the trauma, and suggested a need on the part of circumcised doctors to find medical justifications for the procedure. Some organizations have been formed as support groups for men who are resentful about being circumcised.
- Main article: Circumcision and law
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, 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.” However, in 2006, the United States State Department stated, in a report on Sweden, that most Jewish mohels had been certified under the law and 3000 Muslim and 40-50 Jewish boys were circumcised each year. The Swedish National Board of Health and Welfare reviewed the law in 2005 and recommended that it be maintained.
In 2006, a Finnish court found that a parent's actions in having her 4-year-old son circumcised were illegal. The prosecutor claimed that, "part of healthy genitalia is removed without medical foundation, or competent consent". No punishment was assigned by the court.
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.” It therefore recommended using pain relief for circumcision. One of the supporting studies, Taddio 1997, found a correlation between circumcision and intensity of pain response during vaccination months later. While acknowledging that there may be "other factors" besides circumcision to account for different levels of pain response, they 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."  Other medical associations also cite evidence that circumcision without anesthetic is painful.  
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%).
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." Tannenbaum and Shechet, 2000, stated that an “authentic, traditional bris performed by a mohel does not use clamps, so there is no pain associated with crushing tissue.” 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.”
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)." 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. 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. Ng et al. found that EMLA cream, in addition to local anaesthetic, effectively reduces the sharp pain induced by needle puncture.
- Main article: Sexual effects of circumcision
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. [...] No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."
Boyle et al. (2002) stated that "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."
- Main article: Medical analysis of circumcision
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,[verification needed] 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
- Main article: Medical analysis 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 American Medical Association (AMA), blood loss and infection are the most common complications, and most bleeding is minor and can be stopped by applying pressure. Kaplan identified other complications, including urinary fistulas, meatal stenosis, 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.”
Complication rates ranging from 0.06% to 55% have been cited. Infant circumcision may result in skin bridges, and meatal stenosis may be a common longer-term complication from circumcision.   The RACP states that the penis is lost in 1 in 1,000,000 circumcisions.
Deaths have been reported. 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. Gairdner's 1949 study reported that an average of 16 children per year out of about 90,000 died following circumcision in the 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.
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.
HIV and other sexually transmitted diseases
The World Health Organization (WHO) stated that studies of three trials, one of which was completed, provide compelling evidence that male circumcision provides a 50-60% reduction in HIV transmission from female to male. In 2007, the WHO and UNAIDS recommended that male circumcision should now be recognized as an efficacious intervention for HIV prevention, but emphasised that it does not provide complete protection against HIV infection. They have stated that scientific findings regarding the role of male circumcision in preventing heterosexual HIV infection are particularly relevant in regions where the incidence of heterosexually acquired HIV infection is high, such as Sub-Saharan Africa, and stressed that the procedure must be carried out safely and under conditions of informed consent. Before there were any results from randomized controlled trials, reviews of observational data differed as to whether there was sufficient evidence for an intervention effect of circumcision against HIV.  
McCoombe et al. stated that a layer of keratin could provide protection from viral entry, and found that the keratin is thinner on the foreskin than the glans penis, and thinnest on the inner surface of the foreskin.
A meta-analysis found that circumcision is associated with lower rates of syphilis, chancroid and possibly genital herpes. 
Hygiene, and 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. The foreskin may harbor bacteria and become infected if it is not cleaned properly, but may become inflamed if it is cleaned too often with soap. Also, the forcible retraction of the foreskin in boys can lead to infections.
Circumcision is one treatment for balanitis. The usual treatment for balanoposthitis is to use topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams.
Several studies have shown that uncircumcised men are at greater risk of human papilloma virus (HPV) infection. One study found no statistically significant difference in the incidence of HPV infection between circumcised and uncircumcised men, but did note a higher prevalence of urethritis in the uncircumcised. Twelve studies have indicated that neonatal circumcision reduces the rate of Urinary tract infections (UTI's) in male infants by a factor of about 10. Some UTI studies have been criticized for not taking into account a high rate of UTI's among premature infants, who are usually not circumcised because of their fragile health status. The AMA stated that “depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI," and noted one decision analysis model that concluded that circumcision was not justified as a preventative measure against UTI.
Penile cancer affects from 0.82 per 100,000 in Denmark to 10.5 per 100,000 men per year in parts of India (0.9 to 1 per 100,000 in the United States). Studies have reported a rate of penile cancer from 3 to 22 times higher in uncircumcised than circumcised men.
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, because penile cancer is a rare disease, the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, remains low.
The American Cancer Society (2006) stated, "The current consensus of most experts is that circumcision should not be recommended as a prevention strategy for penile cancer."
Policies of various national medical associations
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.
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 only be performed on newborns who are stable and healthy.
The American Medical Association supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics.
The American Urological Association (2007) believes that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks. In the context of HIV studies carried out in Africa, the AUA states that while "the results of studies in African nations may not necessarily be extrapolated to men in the United States at risk for HIV infection," the AUA "recommends that circumcision should be presented as an option for health benefits."
The Fetus and Newborn Committee of the Canadian Paediatric Society posted "Circumcision: Information for Parents" in November 2004, 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."
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.”
The Royal Australasian College of Physicians states "there is no medical indication for routine neonatal circumcision". 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"
History of circumcision
- Main article: History of male 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 or to increase a man's attractiveness to women, or as an aid to hygiene where regular bathing was impractical, among other possibilities. Immerman et al. suggest that circumcision causes lowered sexual arousal of pubescent males, and hypothesize that this was a competitive advantage to tribes practicing circumcision, leading to its spread regardless of whether the people understood this. It is possible that circumcision arose independently in different cultures for different reasons.
The oldest documentary evidence for circumcision comes from ancient Egypt. Circumcision was common, although not universal, among ancient Semitic peoples.  In the aftermath of the conquests of Alexander the Great, however, Greek dislike of circumcision led to a decline in its incidence among many peoples that had previously practised it. 
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 germ theory of disease elicited an image of the human body as a conveyance for many dangerous germs, making the public "germ phobic" and suspicious of dirt and bodily secretions. Because of its function, the penis became "dirty" by association, and from this premise circumcision was seen as preventative medicine to be practiced universally. In the view of many practitioners at the time, circumcision was a method of treating and preventing masturbation. It was also said to protect against syphilis, phimosis, paraphimosis, balanitis, and "excessive venery" (which was believed to produce paralysis). Gollaher states that physicians advocating circumcision in the late nineteenth century expected public skepticism, and refined their arguments to overcome it.
Infant circumcision was taken up in the United States, Australia and the English-speaking parts of Canada, South Africa and to a lesser extent in the United Kingdom and New Zealand. Although it is difficult to determine historical circumcision rates, one estimate 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. 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, 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.
In some South African ethnic groups, circumcision has roots in several belief systems, and is performed most of the time on teenage boys.
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. 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.
Prevalence of circumcision
- Main article: Prevalence of circumcision
Estimates of the proportion of males that are circumcised worldwide vary from one sixth (16.7%) to one third (33.3%). According to one author, the practice is "a falling trend internationally",although another notes indications of increasing demand in Southern Africa. and Papua New Guinea, where the Malaysian-owned National newspaper headlines for its readers that "Circumcision stops HIV/AIDS spread."
It has been estimated on the basis of an academic medical survey that some 78% of South Korean men may be circumcised, possibly the largest absolute number of teenage or adult circumcisions anywhere in the world. For the United States, statistics from different sources give widely varying estimates of circumcision rates, from 55.9% to 79%
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 .
According to the Sydney Morning Herald, the infant circumcision rate in Australia was 12.9% in 2003. 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 .
- Brit milah
- Circumcision scar
- Foreskin restoration
- Genital integrity
- Genital modification and mutilation
- Holy Prepuce
- Preputioplasty, alternative to circumcision in the treatment for phimosis
- Autocircumcision, a method of keeping the foreskin pulled back to imitate circumcision
- Dictionary definitions of circumcision:
- "The act of cutting off the prepuce or foreskin of males, or the internal labia of females." Webster's Revised Unabridged Dictionary (1913) 
- "to remove the foreskin of (males) sometimes as a religious rite." The Macquarie Dicitionary (2nd Edition, 1991)
- "Cut off foreskin of (as Jewish or Mohammedan rite, or surgically), Concise Oxford Dictionary, 5th Edition, 1964
- "Male circumcision is the surgical removal of all or part of the foreskin of the penis." Information Package on Male Circumcision 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.
- http://www.cirp.org/library/history/hodges2 See 'Egyptians'
- Wrana, P. (1939). Historical review: Circumcision. Archives of Pediatrics 56: 385–392. as quoted in: Zoske, Joseph (Winter 1998). Male Circumcision: A Gender Perspective. The Journal of Men's Studies 6 (2): 189–208.
- Gollaher, David L. (February 2000). Circumcision: a history of the world’s most controversial surgery, 53–72, New York, NY: Basic Books. ISBN 978-0-465-04397-2 Template:LCCN.
- Circumcision. American-Israeli Cooperative Enterprise. URL accessed on 2006-10-03.
- Beidelman, T. (1987). "CIRCUMCISION". The Encyclopedia of religion Volume 3. Ed. Mircea Eliade. New York, NY: Macmillan Publishers. 511–514. Template:LCCN ISBN 978-0-02-909480-8. Retrieved on 2006-10-03.
- 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.
- (2007). Insert 2. Information Package on Male Circumcision and HIV Prevention. World Health Organization. URL accessed on 2007-08-15.
- Milos, Marilyn Fayre, 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, Till Bärnighausen (February 24, 2007). Male circumcision to cut HIV risk in the general population. The Lancet 369 (9562): 617–619.
- Bailey, Robert C, 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, 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.
- (March 28, 2007). "New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications" (PDF). World Health Organization. Retrieved on 2007-08-13.
- Holman, John R., 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, 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.; Grant C. Fowler  (July 21, 2003). Procedures for primary care, 2nd, Mosby. ISBN 978-0-323-00506-7 Template:LCCN.
- Reynolds, RD (July 1996). Use of the Mogen clamp for neonatal circumcision. American Family Physician 54 (1): 177–182. PMID 8677833.
- Glass, J.M. (January 1999). Religious circumcision: a Jewish view. BJU International 83 (Supplement 1): 17–21. PMID 10766529.
- 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). URL accessed 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."
- 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
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- Auvert, Bertran, 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.
- Somerville, Margaret (November 2000). "Altering Baby Boys’ Bodies: The Ethics of Infant Male Circumcision" The ethical canary: science, society, and the human spirit, 202–219, New York, NY: Viking Penguin Canada. Template:LCCN. URL accessed 2007-02-12.
- Van Howe, R.S., J.S. Svoboda, J.G. Dwyer, and C.P. Price (January 1999). Involuntary circumcision: the legal issues. BJU International 83 (Supp1): 63–73.
- (March 1999) Circumcision policy statement. American Academy of Pediatrics. Task Force on Circumcision. Pediatrics 103 (3): 686–93.
- Fetus and Newborn Committee (March 1996). Neonatal circumcision revisited. Canadian Medical Association Journal 154 (6): 769–780. “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.
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- Viens AM (2004). Value judgment, harm, and religious liberty. J Med Ethics 30 (3): 241–7.
- Benatar, David, Benatar, Michael (2003). How not to argue about circumcision. American Journal of Bioethics 3 (2): W1–W9.
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- Sweden restricts circumcisions. BBC Europe. URL accessed on 2006-10-18.
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- Bureau of Democracy, Human Rights, and Labor. Sweden. International Religious Freedom Report 2006. US Department of State. URL accessed on 2007-07-04.
- Court rules circumcision of four-year-old boy illegal. HELSINGIN SANOMAT, INTERNATIONAL EDITION. URL accessed on 2007-09-17.
- Taddio, Anna, Joel Katz, A Lane Ilersich, Gideon Koren (March 1997). Effect of neonatal circumcision on pain response during subsequent routine vaccination. The Lancet 349 (9052): 599–603.
- (2007). Circumcision: Position Paper on Neonatal Circumcision. American Academy of Family Physicians. URL accessed on 2007-01-30.
- (2004). Circumcision: Information for parents. Caring for kids. Canadian Paediatric Society. URL accessed on 2006-10-24.
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- Brady-Fryer, B, Wiebe N, Lander JA (July 2004). Pain relief for neonatal circumcision. The Cochrane Database of Systematic Reviews (3): Art. No.: CD004217. PMID 15495086.
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- Ng, WT, et al. (2001). The use of topical lidocaine/prilocaine cream prior to childhood circumcision under local anesthesia. Ambul Surg 9 (1): 9-12. PMID 11179706.
- 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., 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., 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, 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.
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- Christakis, Dmitry A., 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.
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- Kaplan, George W., M.D. (August 1983). Complications of Circumcision. UROLOGIC CLINICS OF NORTH AMERICA 10 (3): 543–549.
- Fetus and Newborn Committee (March 1996). Neonatal circumcision revisited. Canadian Medical Association Journal 154 (6): 769–780.
- Naimer, Sody A., Roni Peleg, Yevgeni Meidvidovski, Alex Zvulunov, Arnon Dov Cohen, and Daniel Vardy (November 2002). Office Management of Penile Skin Bridges with Electrocautery. Journal of the American Board of Family Practice 15 (6): 485–488. PMID 10605531.
- Yegane, Rooh-Allah, Abdol-Reza Kheirollahi, Nour-Allah Salehi, Mohammad Bashashati, Jamal-Aldin Khoshdel, and Mina Ahmadi (May 2006). Late complications of circumcision in Iran. Pediatric Surgery International 22 (5): 442–445. PMID 16649052.
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- Cite error: Invalid
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- WHO and UNAIDS Secretariat welcome corroborating findings of trials assessing impact of male circumcision on HIV risk. World Health Organization. URL accessed on 2007-02-23.
- (2007). WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention. World Health Organisation.
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- Weiss, HA, Quigley MA, Hayes RJ. (Oct 20 2000). Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis.. AIDS. 2000 14 (15): 2361-70.
- Siegfried, N, M Muller, J Volmink, J Deeks, M Egger, N Low, H Weiss, S Walker, P Williamson. Male circumcision for prevention of heterosexual acquisition of HIV in men. Cochrane Database of Systematic Reviews. CD003362.
- McCoombe SG, Cameron PU, Short RV (July 7, 2002). "The distribution of HIV-1 target cells and keratin in the human penis." (Abstract). International AIDS Society. Retrieved on 2006-07-09.
- Weiss, HA, 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.
- Fergusson, DM, 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, 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, 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, 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.
- Birley (October 1993). Clinical Features and management of recurrent balanitis; association with atopy and genital washing. Genitourinary Medicine 69 (5): 400–403. PMID 8244363.
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- Castellsagué, Xavier, et al. (April 11, 2002). Male circumcision, penile human papillomavirus infection, and cervical cancer. The New England Journal of Medicine 346 (15): 1105–1112. PMID 11948269.
- Lajous, Martín, Nancy Mueller, Aurelio Cruz-Valdéz, Luis Victor Aguilar, Silvia Franceschi, Mauricio Hernández-Ávila, and Eduardo Lazcano-Ponce (2005 July). Determinants of Prevalence, Acquisition, and Persistence of Human Papillomavirus in Healthy Mexican Military Men. Cancer Epidemiology Biomarkers and Prevention 14 (7): 1710–1716. PMID 16030106.
- Aynaud, O., D. Piron, G. Bijaoui, and JM Casanova (1999 July). Developmental factors of urethral human papillomavirus lesions: correlation with circumcision. BJU International 84 (1): 57–60. PMID 10444125.
- Singh-Grewal, D., J. Macdessi, and J. Craig (August 1, 2005). Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies. Archives of Disease in Childhood 90 (8): 853-858. PMID 15890696.
- Maden, C, et al (Jan 1993). History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J Natl Cancer Inst 85 (1): 19-24. PMID 8380060.
- Schoen, EJ, Oehrli, M; Colby, C; Machin, G (Mar 2000). The highly protective effect of newborn circumcision against invasive penile cancer. Pediatrics 105 (3): e36.
- Can Penile Cancer be Prevented?.
- (2007). Circumcision: Position Paper on Neonatal Circumcision. American Academy of Family Physicians. URL accessed on 2007-01-30.
- Task Force on Circumcision (March 1, 1999). Circumcision Policy Statement. Pediatrics 103 (3): 686–693. ISSN 0031-4005 PMID 10049981. “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.”
- American Urological Association. [ Circumcision]. URL accessed on 2007-08-26.
- Medical Ethics Committee (2006). The law and ethics of male circumcision - guidance for doctors. British Medical Association. URL accessed on 2006-07-01.
- Ronald Immerman and Wade Mackey (1997). A Biocultural Analysis of Circumcision. Social Biology 44: 265-275.
- Tomb artwork from the Sixth Dynasty (2345-2181 BCE) 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.
- The Book of Jeremiah, written in the sixth century BCE, lists the Egyptians, Jews, Edomites, Ammonites, and Moabites as circumcising cultures. Herodotus, writing in the fifth century BCE, would add the Colchians, Ethiopians, Phoenicians, and Syrians to that list.
- 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.
- Gollaher, David (Fall 1994). FROM RITUAL TO SCIENCE: THE MEDICAL TRANSFORMATION OF CIRCUMCISION IN AMERICA. Journal of Social History 28 (1): 5-36.
- (1855). On the influence of circumcision in preventing syphilis. Medical Times and Gazette NS Vol II: 542–3.
- Pang, MG, Kim DS (2002). Extraordinarily high rates of male circumcision in South Korea: history and underlying causes. BJU Int 89 (1): 48-54.
- Williams, N, L. Kapila (October 1993). Complications of circumcision [http://www.cirp.org/library/complications/williams-kapila/ (full text)]. British Journal of Surgery 80 (10): 1231–1236. PMID 8242285.
- Crawford DA. Circumcision: a consideration of some of the controversy. J Child Health Care. 2002 December;6(4):259-70. PMID 12503896
- StanWisniewski, Z. (2004). Circumcision in Western Australia. ANZ Journal of Surgery 74 (5): 387-388.
- (2006). Demand for male circumcision rises in a bid to prevent HIV. Bulletin of the World Health Organization 84 (7): 505-588.
- Gabriel Fito, "Circumcision stops [sic HIV/AIDS spread," The National (Papua New Guinea), 3 December 2007.] Retrieved 3 December 2007.
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- Skatssoon, Judy (2004). Circumcision rates rise for some. Sydney Morning Herald (reprint: CIRP.org).
- The Circumcision Information and Resource Pages by Geoffrey T. Falk
- Doctors Opposing Circumcision presided by George C. Denniston, MD, MPH
- Intact America
- Sex as Nature Intended It by Kristen O'Hara.
- Benefits of circumcision: medical, health and sexual by Professor Brian Morris
- Circumcision: a lifetime of medical benefits by Edgar Schoen, BSc., M.D.
- Description of an adult circumcision from the American Academy of Family Physicians.
- Description of a Plastibell circumcision from the Medical College of Georgia.
- Visualisation of amount of skin removed, showing 'styles' of circumcision.
- Circumcision by bone cutting method. Retrieved 13 February 2007.
- 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 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)
- Peter Charles Remondino. History of Circumcision from the Earliest Times to the Present. Philadelphia and London; F. A. Davis; 1891.
- 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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