Circumcision

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Circumcision is the 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 in many areas of Africa. During the late 19th century, it became widespread among several English-speaking nations as an act of preventive medicine and hygiene. In the United States, the majority of males are still circumcised as infants. However in 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 general anesthesia but increasingly with a combination of local anaesthetics. In infants and many prepubescent boys, the inner surface of the foreskin is usually connected to the glans penis by tissue called the synechial membrane. The foreskin is separated from the glans by means of a blunt probe, forceps, or scissors before the foreskin as the first step in the procedure.

The loosened foreskin is then cut off by a "freehand" procedure or clamped using any of a variety of circumcision 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 clamping cuts off the blood supply to the foreskin. The clamp is to prevent bleeding, and to guard the rest of the penis from being accidentally cut. The part of the foreskin secured by the clamp is cut off, the clamp removed, and the wound bandaged without sutures. Alternatively, some varieties of clamp such the Tara Klamp and Smart Klamp are designed to remain in place for several days, holding the wound closed until it heals. Sutureless circumcision through the use of surgical glue or bioadhesive compounds is gaining popularity as it contributes to a quicker procedure and a shorter duration and severity of postoperative pain.

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

For adolescents and adults, medical circumcision is usually performed under general anaesthesia. The foreskin is cut off with a surgical blade, often using 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 controlled with analgesics, but some discomfort can occur during erections. 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

Estimates vary as to the global prevalence of male circumcision. It could be somewhere between 20-25% with the vast majority for religious or cultural reasons. The United States with the Philippines, South Korea, a number of African countries and South Pacific Islands are significant in that circumcision is practiced on a majority of males for non-religious reasons. Canada and Australia have declining circumcision rates of between 10-20%. Islam remains the greatest influence upon circumcision practice globally.

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.

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 [1]. 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 [2]. 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 hospital.

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[3] 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. [4]

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. Many men are content with the state of their penis, whether circumcised or not. In the United States, many people give little thought to the practice.

Attitudes towards circumcision may differ according to the prevalence of circumcision within communities. Within non-circumcising communities circumcision may be viewed with surprise, disgust, horror or as a mutilation, while in circumcising communities the uncircumcised penis may be viewed as unclean, a health risk and even as being aesthetically ugly.

Parents may decide for or against circumcision to conform to local custom, because they believe that one state looks better or worse than the other or because the child should look like the father in having a foreskin or not.

Those parents who choose circumcision may say:

It is part of their religious tradition. (mainly Muslims and Jews)
They believe it is cleaner.
They believe there are health risks in having a foreskin.

Those parents who decide against circumcision may say:

They want their child's genitals to remain as nature made them.
They may not wish to inflict pain, risk infection or remove sexually sensitive tissue from their child.
They are concerned that their child may later object to the procedure, and resent his parents for having allowed it.

Some individuals who campaign against circumcision argue that it is a form of abuse, and should be discouraged or even criminalized. Anti-circumcision activists say are not opposed to adults choosing circumcision, but regard neonatal circumcision as sexual mutilation, and consider it barbaric, primitive, unnecessary, and dangerous. They 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.

External links

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.

In favor of circumcision

Benefits of Circumcision - Pro-circumcision information website
Circlist- Pro-circumcision website and discussion group. It is not a medical site and takes no stand on infant circumcision.
Medicirc - Website by Dr. Edgar Schoen, who promotes circumcision because of its alleged health benefits
ICIRC - International Circumcision Information Reference Center - Discussion and information from The Gilgal Society.
Circumcision information pages - Pro-circumcision website.