User:Dabljuh/My Circumcision

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Circumcision is the removal of some or all of the foreskin (prepuce) from the penis. The frenulum may also be removed at the same time, in a procedure called frenectomy. The word "circumcision" comes from Latin circum (meaning "around") and caedere (meaning "to cut"). Female circumcision is a term applied to a variety of procedures performed on the female genitalia. Except where specified, "circumcision" in this article should be regarded as "male circumcision".

Circumcision as a therapeutic medical procedure is indicated to treat a variety of conditions, such as pathological phimosis, sometimes chronic inflammations of the penis and rarely, penile cancer. The frequent use of the circumcision is often criticised, since the indicators for circumcision are regularly misdiagnosed, e.g. confusing natural, congenital infancy phimosis with pathological phimosis, and circumcision is often referred to when more conservative, less invasive treatments are available and effective. [1]

Routine, non-therapeutic infant circumcision is controversial. No major medical organization recommends infant circumcision, as the medical benefits do not outweight the risks of the procedure, and that it is performed for cultural, religious and aesthetic reasons only. Circumcision of male babies and children at the request of their parents is an increasingly controversial area of strongly opposing views. The genital integrity movement condemns non-therapeutic infant circumcision as a human rights violation on par with female genital cutting, while circumcision advocates usually stress the medical benefits of the procedure, or the religious rights of parents to circumcise their children.

thumb|right|Penis, circumcised flaccid and erect.


Contents

[edit] The procedures of circumcision

Circumcision is the removal of the foreskin from the penis. Clamps, such as the Gomco, Plastibell, and Mogen are commonly used for infant circumcision.[2] These are intended to protect the glans from harm, and crush the foreskin to achieve hemostasis. When the Gomco or Mogen clamp is used, a dorsal slit must be made before application of the clamp. In the case of the Mogen and Plastibell, the foreskin is then surgically removed, while when the Plastibell is used, the foreskin sloughs away along with the clamp in three to seven days.

Depending on how much of the foreskin was removed, it is possible to talk of "tight" and "loose" circumcisions. A circumcision scar remains. [3]

According to a 1998 study, anaesthesia is used by 45% of physicians performing infant circumcision.[4] Dorsal penile nerve block is the most commonly used form. Obstetricians were notable in the study for a significantly lower rate of anaesthesia use (25%) than pediatricians or family practicioners. Adult circumcisions are often performed without clamps, and require the following 4 to 6 weeks of abstenance from masturbation or intercourse to allow wound healing. [5]

[edit] Descriptions of circumcision techniques

[edit] Risks of circumcision

Circumcision is a surgical procedure, and, as all surgical procedures, has considerable risks. Significant blood loss, anaesthetic mishaps, infection and surgical malpractice are the most well known. All major medical associations assert that the risks of circumcision do not outweight the medical benefits, although overall, the risks of the procedure are low.

Surgical mishaps may damage the glans penis leading to meatitis or loss of the glans, infections may lead to removal of the glans or entire penis and death, and anaesthetic mishaps may lead to brain damage and death.

Several cases are known where, as a result from a botched circumcision on infants or young children, where the penis was lost due to the surgery, gender reassignment therapy was tried by removing the remaining genitals and raising the child as a girl, such as in the case of David Reimer. [6]

[edit] Risks specific to infants

The lack of anaesthetics with which infants are often circumcised is often criticised by the genital integrity movement, as well as the Royal Australasian College of Physicians, as being barbaric and traumatic, because circumcision is extremely painful, so much that infants may go into traumatic shock during the procedure with possible long term consequences. The AAP explicitely recommends that if the procedure is to be performed, anaesthethics are to be used. [7]. [8] [9]

The Canadian pediatric society as well as NOHARMM and the Royal Australasian College of Physicians assess the incidence rate of complications of infant circumcision to be most likely between 2% and 10%, with serious complications alone making up between 0.2% and 0.6% of circumcisions. [10]

Infant circumcision carries an additional risk for complications, however, as the circumcision is performed on a not yet fully developed penis, which may cause problems such as skin bridges or a tilted penis, when the foreskin does not just heal back together but instead attaches to the glans penis. [11]

Due to the relatively high prevalence of circumcision in some English-speaking countries, many doctors are not aware of the functions or the care of the foreskin, and children that are not circumcised may suffer from premature retraction from the side of the doctor or misadvised parents.

There is also risk of death. The 1949 UK Gairdner study [12] evaluated a death rate directly attributed to the procedure of circumcision of about 1 in 6'000 cases (16 children per year in 1940s UK). Most of these deaths occurred suddenly under anaesthesia, and couldn't be explained further.

Accurate figures of death rates in the United States are unknown, but estimates range from 1:50'000 to 1:25'000'000. The American Academy of Pediatrics estimates a lethality of 1:500'000. By comparison, cosmetic surgery in healthy adults has a lethality of 1:57'000, a rate the American Society for Aesthetic Plastic Surgery considers "extremely low". [13]

[edit] Cultures and Religions

For info on circumcision in the Bible, read Circumcision in the Bible.

It is generally agreed on that widespread circumcision is a social/cultural issue, as the indicators for therapeutic circumcision are fairly rare. Many cultures circumcise their males, either shortly after birth, or around puberty as an initiation rite. Most notable is the practice of circumcision among Muslims, Jews, and Americans.

[edit] Aesthetics

Circumcision may be undertaken as a body modification of the genitals to change the looks of the penis to appeal more to certain aesthetics. Circumcision is often a pre-requirement for other modifications of the penis, such as a split penis or a subincision.

The United States, the Philippines and South Korea are the only countries that circumcise a majority of young males for non-religious reasons. Routine circumcision practices in South Korea are largely the result of American cultural and military influence following the Korean War. The origin of the practice in the Philippines is uncertain according to one newspaper article [14]. However, Antonio de Morga's "History of the Philippine Islands" (1907) attributes circumcision to Islamic influence [15].

As infant or childhood circumcision is the norm for males in many cultures, people may consider an uncircumcised penis to be less preferrable sexually, visually or otherwise.

[edit] Coptic Christian

Circumcision is also customary in the Coptic Christian and Ethiopian Orthodox religious traditions. It is usually performed on the eighth day of life. '

[edit] Islam

Islam stresses cleanliness and considers circumcision a form of natural hygiene. Although circumcision is not mentioned in the Qur'an, it is mentioned in some parts of the Hadith. Fiqh scholars differ in their opinion about the compulsion of circumcision in Shariah, depending on which Hadith are accepted and how they are interpreted. According to Imam Abu Hanifa, Imam Malik and a majority of others it is a recommended practice (Sunnah), while some scholars including Imam Shafi, consider it obligatory. 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 between the ages of six and eleven 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, farmers in rural areas celebrate circumcision as a joyous occasion, while in urban populations, as in many industrialized countries such as the USA, the procedure is routinely performed at a hospital. Kamyar et al describe it as an 'obligatory custom', and note that it is not necessary for the circumciser to be a Muslim. Recently, the western world has grown increasingly critical of the practice of female circumcision, which is also widespread in Islamic cultures. [16]

[edit] Judaism

Circumcision is a religious practice traditionally required by Judaism, usually performed in a ceremony called a Brit (or Bris) milah (Hebrew for "Covenant of circumcision"). A mohel performs the ceremony on the eighth day after birth unless health reasons force a delay. According to the Torah (Genesis, chapter 17), Abraham circumcised himself and all the male members of his household in response to God's command. According to Jewish law, failure to follow the commandment carries the penalty of karet, or being cut off from the community by God. Brit milah is so important that should the eighth day fall on Shabbat, actions that would normally be forbidden because of the sanctity of the day are permitted in order to fulfill the requirement to circumcise. See also: Circumcision in the Bible

[edit] Tribal traditions

Circumcision is also common as an initiation rite in a number of African and Australian Aboriginal tribal traditions. 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 Nilotic peoples, such as the Nandi, 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. Aboriginal circumcision ceremonies, which also constitute a rite of passage, are noted for their painful nature, including subincision for some tribes.

[edit] Ethical Issues

Main article: Bioethics of neonatal circumcision
.

Circumcising infants as a public health measure is controversial. While it is sometimes misjudged as a medical practice by laypeople in cultures that experience widespread neonatal circumcision such as the USA, no national or international health organization recommends routine infant circumcision for medical reasons. Circumcision advocates stress that circumcision is a significant public health measure, preventing dozens of different infections, with the possibility of slowing down the AIDS epidemy significantly, while the genital integrity movement generally emphasizes that it is not a medically reasonable practice, thus constitutes a human rights violation and a sexual assault, and the practice of circumcising infants or children should be discouraged or banned. The International Coalition for Genital Integrity lists circumcision as a class 1 genital mutilation. The possible catastrophic complications of a poorly carried out circumcision, or of post-operative bleeding or infection, are not to be taken lightly. All surgery carries a risk. The medical consensus is that circumcision is not recommended as the medical benefits do not outweight the risks, and asserts that it is a cultural/social practice, not a medical one.

[edit] Consent

The issue of consent is of particular relevance to circumcision because it is often done to infants, who, naturally are unable to consent to this, or indeed any other, medical procedure. The decision, therefore, must fall to the child's caregiver(s).

If a man wants to be circumcised, he can agree to the procedure as a consenting adult. However, a man who is aggrieved at having been circumcised as an infant or child is unable to replace the removed foreskin, and restoration using extension of the remaining skin will not replace the missing specialized nerve endings of the original foreskin. The controversial ridged band with its thousands of Meissner's corpuscles is always missing and can never be replaced. This possible loss of sensation due to the removal of nerves, on top of the loss of sensation from the permanent uncovering of the glans, may increase difficulty in reaching high levels of sexual pleasure for an adult male.

Therefore, debate often focuses on what limits, if any, should be placed on a caregiver's ability to make a decision for a boy about a painful (and, some argue, mutilating) procedure with disputed immediate medical value that may be unwanted later in life. Some question the apparent inconsistency in allowing male circumcision but in prohibiting female genital cutting [17]. Some suggest that circumcision may cause emotional scarring later in life, and claim that the procedure should be left until the person is mature enough to make the choice for himself. Others believe that the procedure is less traumatic when performed in infancy and do not wish to disturb the traditional and religious rights of parents to make decisions on behalf of their child.

[edit] Emotional consequences

Much attention has been given to the emotional impact of female genital cutting. The emotional impact of circumcision will vary from person to person and depend on cultural context and other factors. Issues about the rights of the child are often overlooked, as is the possibility that circumcision causes emotional and physical harm to some males.

In the USA, most neonatal circumcisions are performed without anaesthesia.[18] It is now known, that circumcised infants do not forget the pain during circumcision easily, as a correlation between circumcision and intensity of pain response during vaccination months later could be established. Studies indicate that mother-child bonding and breast feeding may be adversely affected by newborn circumcision. [19]

There are a number of support groups for circumcised males that are dissatisfied with their circumcised state. These groups often advocate foreskin restoration.

[edit] Legality

Main article: Circumcision and law

The medical mainstream organizations, while acknowledging that infant circumcision is ethically problematic, do not consider circumcision to be a legal issue as long as the decision for circumcision was made by the legal guardians, and that they have given their informed consent.

Members of the genital integrity movement support the idea that, since the practice of neonatal circumcision is not medically recommendable, and additionally may curb sensual aspects of the later adult, that circumcision in fact constitutes a human rights violation, and that doctors may be variously liable to malpractice or sexual assault, and further, that the practice should be outlawed. A group called Attourneys for the Rights of the Child specialize in legal representation in cases where "genital integrity" was compromised.

[edit] Religious circumcision of minors

Main article: Religious circumcision

In some parts and cultures of the world, it is customary or obligatory for minors of both sexes to be circumcised for religious reasons. Many believe that this practice is protected by the principle of freedom of religion. Others disagree, arguing that no right has precedence over the rights of bodily integrity of a child. Still others contend that freedom of religion only applies to belief, not action involving others. Female circumcision is prohibited in most western countries, and Sweden as the first country world-wide, has restricted religious male infant circumcision. [20]

[edit] Medical Aspects

Main article: Medical analysis of circumcision

While most medical associations do not recommend non-therapeutic circumcision as the risks of the procedure outweight the medical benefits, circumcised men do enjoy a wide range of medical benefits.

[edit] HIV

A recent meta-study of The Lancet has concluded, that while the individual studies are of variable quality, there are clear indicators that circumcision can significantly reduce the chances of female-to-male HIV infection in an African population, when compared against an uncircumcised control group. [21] The World Health Organization stresses that the protective effect offered by male circumcision in africa has to be confirmed by further studies, and is not reliable enough to replace, or undermine, sex education and safer sex practice as a means to combat AIDS. Currently, several more studies are under way to investigate the protective effect of circumcision against HIV infections, but the results will not be available until 2007. [22]

The reason for the protective effect of circumcision is not yet fully determined, but a recent hypothesis is that the inner mucous of the foreskin contains a high number of so called Langerhans cells, which are part of the immune system and can be infected by various HIV strains.[23] Other aspects are decreased penile surface, and decreased retention of possibly contaminated bodily fluids under the foreskin. [[24]]

[edit] HPV

Several studies have shown that non-circumcised men are at greater risk of human papilloma virus (HPV) infection.[25] [26] [27] While most genital HPV strains are considered harmless, some can, but not necessarily do, cause genital warts or even cancer. One study found no statistically significant difference between men with foreskins for HPV infection than those who are circumcised, but did note a significantly higher incidence of HPV lesions and urethritis [28].

[edit] Hygiene

Circumcision reduces the amount of smegma produced by the body. Smegma, a transliteration of the greek word σμήγμα for soap, is a combination of exfoliated (shed) , epithelial cells, transudated skin oils and moisture that can accumulate under the foreskin of males and within the female vulva area, with a characteristic strong odor and taste. Smegma is common to all mammals, male and female. While smegma is generally not believed to be harmful to health, the strong odour may be considered to be a nuisance giving the impression of lacking hygiene. In rare cases, accumulating smegma may play into causing balanitis.

The Royal Australasian College of Physicians and the Canadian Pediatric Society emphasize that an uncircumcised infants penis should be left alone and requires no special care. Attempts to forcibly retract the foreskin, e.g. to clean it, are painful, often injure the foreskin, and can lead to scarring, infections and pathologic phimosis. It is recommended that, while there is no special age where the foreskin should be retractible, once the foreskin becomes retractible, the child should gently wash it with soap and water. It has been suggested, however, that excessive washing of the foreskin and the glans will make infections such as balanitis more likely.

[edit] Infections and chronical conditions

Uncircumcised children and men tend to have higher rates of various infections and inflammations of the penis, and quite obviously of the foreskin, than circumcised men. The reasons are unclear, but several hypothesises have emerged:

  • The foreskin may harbor bacteria and infect if it is not cleaned enough.[29]
  • The foreskin may become inflamed if it is cleaned too often with soap.[30]
  • The forcible retraction in boys can lead to infections.[31]

While less invasive treatments for posthitis (an inflamed foreskin) [32] and balanitis (inflammation of the glans) [33][34][35] exist, these are not as successful than circumcision in treating balanitis xerotica obliterans (BXO) [36] [37] [38].

Lichen sclerosus et atrophicus (LSA) is rare and produces a whitish-yellowish patch on the skin, and is not believed to be always harm- or painful, and may sometimes disappear without intervention. BXO is believed to be a form of LSA that happens to be on the foreskin, where it may cause pathologic phimosis. As BXO/LSA is a dermatologic problem, some studies indicate that it may be overdiagnosed by pediatricians unfamiliar with dermatology, or in fact, the foreskin. Circumcision is believed to reliably reduce the threat of BXO. [39]

[edit] Penile cancer

Penile cancer is cancer of the penis, i.e. on the glans or the foreskin. The lifetime risk is estimated to be 1:600 for an uncircumcised male, [40] and 80% of the cases are men over the age of 70. [41]

Circumcision and penectomy may be necessary to treat penile cancer. Less invasive treatments may include freezing of the tumor, chemical treatment, radiotherapy, and minimally invasive surgery. [42]

The American Cancer Society states about the relationship of circumcision with penile cancer:

  • However, the penile cancer risk is low in some uncircumcised populations, and the practice of circumcision is strongly associated with socio-ethnic factors, which in turn are associated with lessened risk. The consensus among studies that have taken these other factors into account is circumcision is not of value in preventing cancer of the penis. (1999, [43])
  • In the past, circumcision has been suggested as a way to prevent penile cancer. This suggestion was based on studies that reported much lower penile cancer rates among circumcised men than among uncircumcised men. However, most researchers now believe those studies were flawed because they failed to consider other factors that are now known to affect penile cancer risk. (2005, [44])

[edit] Phimosis and Paraphimosis

Pathological phimosis is a condition of a very tight foreskin as the result of an acute disease, that makes retraction over the glans painful or impossible. Paraphimosis is an acute condition where the tight foreskin is stuck behind the glans and cannot be moved back, and curbs the blood flow to the glans. Phimosis is often falsely diagnosed in infants and children, where the foreskin and the glans are naturally connected with each other, in a so called congenital (natural infancy) phimosis, making retraction painful even though the condition of a pathological phimosis is not met. Due to misconceptions about the anatomy of the infant penis, forcible premature retraction with possible long term adverse effects is common, and may actually lead to pathological phimosis. There is no special age at which the foreskin should be retractible. In adults, the occurence rates of pathological phimosis is below 1%, and about 2% have a nonretractible foreskin. Less invasive treatment with steroid creams and stretching exercises is available. A non retractable foreskin does not necessarily constitute pathological phimosis, and thus would not necessarily require treatment unless other conditions are present, or intercourse or masturbation are painful. [45]

[edit] Urinary tract infections

Several studies and statistics have indicated that neonatal circumcision reduces the occurence rate of UTI in male infants by a factor of about 10. However, those studies have been criticised in not taking other factors (especially for non-circumcision) into account. UTIs are very rare in uncircumcised boys already and are more of a danger to newborn girls. The chance to get an UTI for an uncircumcised boy is about 1%, and the mortality is 1:50'000. As it is probable that infant circumcision causes more complications and infant deaths than the UTIs they are supposed to prevent, no major health organization recommends circumcision to prevent UTIs. The Canadian Pediatric Society poses the question of whether increased UTI and balanitis rates in uncircumcised male infants may be caused by forced premature retraction. [46]

[edit] Sexual

Main article: Sexual effects of circumcision

The sexual effects of circumcision are distinctly under-researched in medical literature. Only few studies have been made about the sexual function of the foreskin, most importantly, the controversial ridged band. Surveys however indicate that the majority of circumcised males are satisfied with their state.

[edit] Cultural

In cultures where circumcision is the norm or the quasi-norm, potential partners not used to intact males may consider them unclean or otherwise less preferrable as partners. A 1988 study of randomly selected young mothers in Iowa, where most men are circumcised, found that 76% found the circumcised penis more visually arousing. [47] Although 88% of the women surveyed had only had experiences with circumcised penises, the pattern was repeated among the 24 women with dual experience.

[edit] Intercourse

CIRP and the genital integrity movement generally assert that circumcision reduces the sensitivity of the male during intercourse by removing the controversial ridged band, making him take a longer time to achieve orgasm. This is sometimes viewed as a benefit for males that suffer from premature ejaculation, which is believed to be one of the most common sexual problems. The missing gliding action of the foreskin however can make penetration more rigid and may make additional lubricant beneficial. [48]

[edit] Masturbation

Infant and childhood circumcision became popular in the English-speaking world during the late Victorian Age, mainly as a measure to prevent masturbation, which was believed to cause a wild variety of diseases, a view not shared by the modern medical community. (Read History of circumcision for further info) Circumcised men can masturbate, however, although the sensitive glans may make a lubricant necessary for many circumcised men. [49] Ironically, a 1410-man survey in the United States in 1992, Laumann found that circumcised men were more likely to report masturbating at least once a month.

[edit] 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, as an aid to hygiene where regular bathing was impractical, as a means of marking those of lower (or higher) social status, as a means of differentiating a circumcising group from their non-circumcising neighbors, as a means of discouraging masturbation or other socially proscribed sexual behaviors, to remove "excess" pleasure, to increase a man's attractiveness to women, as a symbolic castration, as a demonstration of one's ability to endure pain, or as a male counterpart to menstruation or the breaking of the hymen. It is possible that circumcision arose independently in different cultures for different reasons.

Köçeks at a fairKöçek troupe dancing at Sultan Ahmed III's 14-day celebration of his sons' circumcision in 1720. Miniature from the Surname-i Vehbi, Topkapi Palace, Istanbul.
Köçeks at a fair
Köçek troupe dancing at Sultan Ahmed III's 14-day celebration of his sons' circumcision in 1720. Miniature from the Surname-i Vehbi, Topkapi Palace, Istanbul.

[edit] Circumcision in the Ancient World

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 some with foreskins and others who were circumcised.

Circumcision was common, although not universal, among ancient Semitic peoples. The Book of Jeremiah, written in the sixth century 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.

In the aftermath of Alexander the Great's conquests, Greek dislike of circumcision led to a decline in its incidence among many peoples that had previously practiced it. The writer of the First Book of the 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 Jewish circumcision, and punished those who performed it - as well as the infants who underwent it - with death.

[edit] Medical circumcision in the 19th century and early 20th century

Several hypotheses have been raised in explaining the American public's acceptance of infant circumcision as preventive medicine. The success of the germ theory of disease had not only enabled physicians to combat many of the postoperative complications of surgery, but had made the wider public deeply suspicious of dirt and bodily secretions. Accordingly, the smegma that collects under the foreskin was viewed as unhealthy, and circumcision readily accepted as good penile hygiene.[50] Secondly, moral sentiment of the day regarded masturbation as not only sinful, but also physically and mentally unhealthy, stimulating the foreskin to produce the host of maladies of which it was suspected. In this climate, circumcision could be employed as a means of discouraging masturbation.[51] All About the Baby, a popular parenting book of the 1890s, recommended infant circumcision for precisely this purpose. With the proliferation of hospitals in urban areas, childbirth, at least among the upper and middle classes, was increasingly undertaken in the care of a physician in a hospital rather than that of a midwife in the home. It has been suggested that once a critical mass of infants were being circumcised in the hospital, circumcision became a class marker of those wealthy enough to afford a hospital birth.[52]

By the 1920s, advances in the understanding of disease had undermined much of the original medical basis for preventive circumcision. Doctors continued to promote it, however, as good penile hygiene and as a preventive for a handful of conditions local to the penis: balanitis, phimosis, and penile cancer.

Routine infant circumcision was taken up in the English-speaking parts of Canada, the United States and Australia, and to a lesser extent in New Zealand and the United Kingdom. Although it is difficult to determine historical circumcision rates, one estimate[53] 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.

[edit] Circumcision since 1950

In 1949, a lack of consensus in the medical community as to whether circumcision carried with it any notable health benefit motivated the United Kingdom's newly-formed National Health Service to remove routine infant circumcision from its list of covered services. One factor in this rejection of circumcision may have been Douglas Gardiner's famous paper, The fate of the foreskin, which revealed, that for the years 1942–1947, about 16 children per year had died because of circumcision in England and Wales, a rate of about 1 per 6'000 performed circumcisions. [54] 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. At present, only Manitoba pays for the procedure. The infant circumcision rate in Canada has fallen from roughly 50% in the 1970s to its present value of 13%, albeit with strong regional variations. [55]

In South Korea, circumcision was largely unknown before 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 [56].

In South Africa circumcision has roots in several belief systems, and is performed most of the time to teen aged males :

"...The young men in the eastern Cape belong to the Xhosa ethnic group for whom circumcision is considered part of the passage into manhood... A law was recently introduced requiring initiation schools to be licensed and only allowing circumcisions to be performed on youths aged 18 and older. But Eastern Cape provincial Health Department spokesman Sizwe Kupelo told Reuters news agency that boys as young as 11 had died. Each year thousands of young men go into the bush alone, without water, to attend initiation schools. Many do not survive the ordeal..." [57].

The major medical societies in Britain, Canada, Australia and New Zealand do not support routine non-therapeutic infant circumcision. Major medical organizations in the United States state that parents should decide what is in their child's best interests, explicitely not recommending the procedure for medical reasons. Neonatal circumcision remains the most common pediatric operation carried out in the U.S. today.

Table 1: International circumcision rates
Country Year Neonatal circumcisions (%)
United States 1999 65.3% [58]
Canada 2003 11.5% [59]
Australia 2004 12.7% [60]
New Zealand 1995 0.35%* [61]
United Kingdom 1972 0.41% [62]
*Samoans, Tongans and Niueans in New Zealand continue to practice circumcision, but not in public hospitals, to which these data refer.

[edit] Prevalence of circumcision worldwide

Estimates of the proportion of males that are circumcised worldwide vary from one sixth[63] to one third[64].

Except for Muslims and Jews, most males are not circumcised in:

India, South-East Asia, China, Europe and Latin America.

The majority of males are circumcised in the following countries, in most of which the predominant religion is Islam, which endorses circumcision:

Afghanistan, Albania, Algeria, Azerbaijan, Bahrain, Bangladesh, Benin, Bosnia and Herzegovina, 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, Niger, Nigeria, Oman, Pakistan, Qatar, Republic of the Congo, Saudi Arabia, Sierra Leone, Somalia, "Somaliland", Sudan, Syria, Tajikistan, Tunisia, Turkey, "Turkish Republic of Northern Cyprus", Turkmenistan, United Arab Emirates, Uzbekistan, and Yemen.

In other countries where circumcision predominates it is endorsed by religion (Israel) or by local customs and traditions:

Philippines, Samoa, South Africa, South Korea, Togo, Tonga, The United States and Vanuatu

[edit] United States

Statistics from different sources give a somewhat different picture of the prevalence of circumcision in the United States.

The National Center for Health Statistics stated that the overall rate of neonatal circumcision was 64.3% in 1979 and 65.3% in 1999. However, the rate for white infants was 0.3% lower in 1999 than 1979 and the circumcision rate for black infants increased by 6.5% over this time [65]. Also, strong regional differences developed. In the West, circumcision declined from 63.9% to 36.7%, but this was counterbalanced by rises in the Midwest and South. [66] The decline in the West has been partly attributed to increasing births among Latin Americans, who usually do not circumcise [67].

A recent study, which used data from the Nationwide Inpatient Sample (a sample of 5-7 million of the nation's total inpatient stays, and representing a 20% sample taken from 8 states in 1988 and 28 in 2000), stated that circumcisions rose from 48.3% in 1988 to 61.1% in 1997.[68]

Figures from the Nationwide Hospital Discharge Survey (a sample of 270,000 inpatient stays), state that circumcision rates declined from 64.7% in 1980 to 59.0% in 1990, then rose to 64.1% in 1995, and fell again to 60.1% in 2002. Overall, the West saw the most significant change, declining from 61.8% in 1980 to 32.6% in 2002 (see Table 44, page 51 of the National Hospital Discharge Survey, 2002) [69].

Sixteen states no longer pay for the procedure under Medicaid [70]. One study in the Midwest of the US found that this had no effect on the newborn circumcision rate but it did affect the demand for circumcision at a later time.[71]

[edit] Related practices

[edit] See also

[edit] External links

[edit] General information

[edit] Circumcision opposition

[edit] Circumcision promotion

[edit] References

  • Billy Ray Boyd. Circumcision Exposed: Rethinking a Medical and Cultural Tradition. Freedom, CA: The Crossing Press, 1998. (ISBN 0-89594-939-3)
  • Anne Briggs. Circumcision: What Every Parent Should Know. Charlottesville, VA: Birth & Parenting Publications, 1985. (ISBN 0-9615484-0-1)
  • Robert Darby. A surgical temptation: The demonization of the foreskin and the rise of circumcision in Britain. Chicago: University of Chicago Press, 2005. (ISBN 0-226-13645-0)
  • Aaron J. Fink, M.D. Circumcision: A Parent's Decision for Life. Kavanah Publishing Company, Inc., 1988. (ISBN 0-962-13470-8)
  • 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 0-446-67880-5)
  • Leonard B. Glick. Marked in Your Flesh: Circumcision from Ancient Judea to Modern America. New York: Oxford University Press, 2005. (ISBN 0-19-517674-X)
  • David L. Gollaher. Circumcision: A History of the World's Most Controversial Surgery. New York: Basic Books, 2000. (ISBN 0-456-04397-6)
  • Ronald Goldman, Ph.D. Circumcision: The Hidden Trauma. Boston: Vanguard, 1996. (ISBN 0-964-44895-3-8)
  • Brian J. Morris, Ph.D., D.Sc. In Favour of Circumcision. Sydney: UNSW Press, 1999. (ISBN 0-86840-537-X)
  • Rosemary Romberg. Circumcision: The Painful Dilemma. South Hadley, MA Bergan & Garvey, 1985. (ISBN 0-897-89073-6)
  • Edgar J Schoen, M.D. Ed Schoen, MD on Circumcision. Berkeley, CA: RDR Books, 2005. (ISBN 1-57143-123-3)
  • Edward Wallerstein. Circumcision: An American Heath Fallacy. New York: Springer, 1980 (ISBN 0-826-13240-5)
  • Gerald N. Weiss M.D. and Andrea W Harter. Circumcision: Frankly Speaking. Wiser Publications, 1998. (ISBN 0-966-72190-X)