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From Wikipedia, the free encyclopedia

Not to be confused with Female circumcision.

For the paintings, see The Circumcision.

Circumcision
Circumcision surgery with hemostats and scissors
ICD-10-PCSZ41.2
ICD-9-CMV50.2
MeSHD002944
OPS-301 code5–640.2
MedlinePlus002998
eMedicine1015820
[edit on Wikidata]

Circumcision is a surgical procedure that removes the foreskin from the human penis. In the procedure’s most common form, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. Topical or locally injected anesthesia is generally used to reduce pain and physiologic stress.[1] Circumcision is undertaken for religious, cultural, social, and medical reasons.[2] It may be medically necessary in cases of phimosis, chronic urinary tract infections (UTIs),[3][4] and other pathologies of the penis that do not resolve with other treatments. The procedure is contraindicated in cases of certain genital structure abnormalities or poor general health.[4][5]

The procedure is associated with reduced rates of sexually transmitted infections[6] and urinary tract infections.[1][7][8] This includes reducing the incidence of cancer-causing forms of human papillomavirus (HPV) and reducing HIV transmission among heterosexual men in high-risk populations by up to 60%;[9][10] its prophylactic efficacy against HIV transmission in the developed world or among men who have sex with men is debated.[11][12][13] Neonatal circumcision decreases the risk of penile cancer.[14] Complication rates increase significantly with age.[15] Bleeding, infection, and the removal of either too much or too little foreskin are the most common acute complications, while meatal stenosis is the most common long-term.[16] There are various cultural, social, legal, and ethical views on circumcision. Major medical organizations hold differing views on circumcision’s prophylactic efficacy in developed countries. Some medical organizations take the position that it carries prophylactic health benefits that outweigh the risks, while others hold that its medical benefits are not sufficient to justify it.[17][18][19][20]

Circumcision is one of the world’s most common and oldest medical procedures, with 37–39% of men globally circumcised.[2][21] Prophylactic usage originated in England during the 1850s and has since spread globally, becoming established as a way to prevent sexually transmitted infections.[22][23] Beyond use as a prophylactic or treatment option in healthcare, circumcision plays a major role in many of the world’s cultures and religions, most prominently Judaism and Islam. Circumcision is among the most important commandments in Judaism and considered obligatory.[24][25] In some African and Eastern Christian denominations male circumcision is required.[26][27] It is widespread in the United States, South Korea, Israel, Muslim-majority countries, and most of Africa.[2] It is relatively rare for non-religious reasons in Latin America, Europe, Australia, most of Asia, and parts of Southern Africa.[2] The origin of circumcision is not known with certainty, but the oldest documentation comes from ancient Egypt.[2][28][29][30]

Uses

Disease prevention

Approximately half of all circumcisions worldwide are performed for reasons of prophylactic healthcare.[4]

Prophylactic usage in high-risk populations

Actor Melusi Yeni became the 1 millionth VMMC against HIV/AIDS transmission in the province of KwaZulu-Natal, South Africa.[31]

There is a consensus among the world’s major medical organizations and in the academic literature that circumcision is an efficacious intervention for HIV prevention in high-risk populations if carried out by medical professionals under safe conditions.[32][12][9]

In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended adolescent and adult circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV, as long as the program includes “informed consent, confidentiality, and absence of coercion”—known as voluntary medical male circumcision, or VMMC.[32] In 2010, this expanded to routine neonatal circumcision, as long as the infant’s parents consented.[18] In 2020, the WHO again concluded that male circumcision is an efficacious intervention for HIV prevention and that male circumcision is an essential strategy, in addition to other measures, to prevent heterosexually acquired HIV infection in men. Eastern and southern Africa had a particularly low prevalence of circumcised males. This region has a disproportionately high HIV infection rate, with a significant number of infections stemming from heterosexual transmission. As a result, the promotion of prophylactic circumcision has been a priority intervention in that region since the WHO’s 2007 recommendations.[32][18] The International Antiviral Society–USA also suggests circumcision be discussed with men who have insertive anal sex with men, especially in regions where HIV is common.[33] There is evidence that circumcision is associated with a reduced risk of HIV infection for such men, particularly in low-income countries.[6]

The finding that circumcision significantly reduces female-to-male HIV transmission has prompted medical organizations serving communities affected by endemic HIV/AIDS to promote circumcision as a method of controlling the spread of HIV.[19]

Prophylactic usage in developed countries

Elizabeth Mataka, UN Secretary-General’s Special Envoy for AIDS in Africa, speaking at the session “From Evidence to Implementation: Promoting Male Circumcision in Africa” during the World Economic Forum on Africa 2009 in Cape Town, South Africa, 11 June 2009.

Major medical organizations hold varying positions on the prophylactic efficacy of the elective circumcision of minors in developed countries.[19] Literature on the matter is polarized, with the cost-benefit analysis highly dependent on the kinds and frequencies of health problems in the population under discussion and how circumcision affects them.[20][34][35]

The World Health Organization (WHO), UNAIDS, and American medical organizations take the position that its prophylactic health benefits outweigh the risks, while European, Australian, and New Zealand medical organizations generally hold that its medical benefits are insufficient to justify it.[17][18][19][20] Advocates of circumcision recommend performing it during the neonatal period when it is less expensive and has a lower risk of complications.[34] The American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Centers for Disease Control and Prevention have said that circumcision’s potential benefits outweigh the risks.[1][36][37]

In 2010, the World Health Organization said:[18]

There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men.[18]

Pathologies

Circumcision is also used to treat various pathologies. These include pathological phimosis, refractory balanoposthitis and chronic or recurrent urinary tract infections (UTIs).[3][4]

Contraindications

Circumcision is contraindicated in certain cases.[5][4][38]

These include infants with certain genital structure abnormalities, such as a misplaced urethral opening (as in hypospadias and epispadias), curvature of the head of the penis (chordee), or ambiguous genitalia, because the foreskin may be needed for reconstructive surgery. Circumcision is contraindicated in premature infants and those who are not clinically stable and in good health.[5][4][38]

If a person is known to have or has a family history of serious bleeding disorders such as hemophilia, it is recommended that the blood be checked for normal coagulation properties before the procedure is attempted.[4][38]

Technique

Main article: Circumcision surgical procedure

Before (left) and after (right) an adult circumcision that was undertaken to treat phimosis. After the operation, the glans is exposed even when the penis is flaccid.

The foreskin is the double-layered fold of tissue at the distal end of the human penis that covers the glans and the urinary meatus.[2] Different amounts of skin can be removed during circumcision. The practice is differentiated from other surgeries for the treatment of phimosis or treatment-resistant infection by the complete removal of the preputial orifice.

Erect comparison of the penis, one (left) is uncircumcised, while the other (right) is circumcised

For adult medical circumcision, superficial wound healing takes up to a week, and complete healing 4 to 6 months.[39] For infants, healing is usually complete within one week.[38]

Removal of the foreskin

Different circumcision results based on cut placement and skin tension (left to right): high & loose, high & tight, low & loose, low & tight.

For infant circumcision, devices such as the Gomco clamp, Plastibell and Mogen clamp are commonly used in the USA.[1] These follow the same basic procedure. First, the amount of foreskin to be removed is estimated. The practitioner opens the foreskin via the preputial orifice to reveal the glans underneath and ensures it is normal before bluntly separating the inner lining of the foreskin (preputial epithelium) from its attachment to the glans. The practitioner then places the circumcision device (this sometimes requires a dorsal slit), which remains until blood flow has stopped. Finally, the foreskin is amputated.[1] For older babies and adults, circumcision is often performed surgically without specialized instruments,[38] and alternatives such as Unicirc, Shang ring or stapler circumcision are available.[40]Depending on the specific surgical technique or anatomical requirements, the frenulum—an elastic band of tissue on the underside of the penis—may be either preserved or excised during the surgery. If this tissue is removed concurrently, the adjunctive procedure is known as a penile frenulectomy.[41][42]

Pain management

The circumcision procedure causes pain, and for neonates this pain may interfere with mother-infant interaction or cause other behavioral changes,[43] so the use of analgesia is advocated and required by law in some countries.[1][44] Ordinary procedural pain may be managed in pharmacological and non-pharmacological ways. Pharmacological methods, such as localized or regional pain-blocking injections and topical analgesic creams, are safe and effective.[1][45][46] The ring block and dorsal penile nerve block (DPNB) are the most effective at reducing pain, and the ring block may be more effective than the DPNB. They are more effective than EMLA (eutectic mixture of local anesthetics) cream, which is more effective than a placebo.[45][46] Topical creams have been found to irritate the skin of low birth weight infants, so penile nerve block techniques are recommended in this group.[1] Circumcision is contraindicated for premature babies partially because of complications with anesthesia.[4][5]

For infants, non-pharmacological methods such as the use of a comfortable, padded chair and a sucrose or non-sucrose pacifier are more effective at reducing pain than a placebo,[46] but the American Academy of Pediatrics (AAP) states that such methods are insufficient alone and should be used to supplement more effective techniques.[1] A quicker procedure reduces duration of pain; use of the Mogen clamp was found to result in a shorter procedure time and less pain-induced stress than the use of the Gomco clamp or the Plastibell.[46] The available evidence does not indicate that post-procedure pain management is needed.[1] Some doctors recommend the use of petroleum jelly to prevent blood from adhering the genitals to the diaper during healing. For adults, topical anesthesia, ring block, dorsal penile nerve block (DPNB) and general anesthesia are all options,[47] and the procedure requires four to six weeks of abstinence from masturbation or intercourse to allow the wound to heal.[38]

Healing and tissue remodeling

Before (left) and after (right) comparison of the penile appearance following the procedure. The healed state (right) illustrates the physical results of structural tissue remodeling.

Following the excision of the foreskin, the surgical wound undergoes the standard physiological phases of healing: hemostasis, inflammation, cellular proliferation, and tissue remodeling. Because circumcision severs the dense network of superficial blood vessels and lymphatic channels within the prepuce and dartos fascia, normal fluid drainage is temporarily interrupted. This disruption to the lymphatic system typically results in localized post-operative edema (swelling) around the incision line and the remaining mucosal collar.[48]

During the proliferative and remodeling phases of recovery, the body undergoes angiogenesis (the formation of new blood vessels) and lymphangiogenesis. The vascular and lymphatic networks are gradually reconstructed to establish new collateral drainage pathways across the surgical boundary.[49] As this structural tissue remodeling matures over the weeks following the procedure, the post-operative swelling resolves and physiological fluid balance is restored to the penile skin.[50]

Effects

Sexually transmitted infections

Human immunodeficiency virus

See also: Circumcision in Africa § Circumcision to prevent the spread of human immunodeficiency virus in Africa

This section is an excerpt from Circumcision and HIV.[edit]

Male circumcision reduces the risk of human immunodeficiency virus (HIV) transmission from HIV positive women to men in high risk populations.[51] In 2020, the World Health Organization (WHO) reiterated that male circumcision is an efficacious intervention for HIV prevention if carried out by medical professionals under safe conditions.[52] Circumcision reduces the risk that a man will acquire HIV and other sexually transmitted infections (STIs) from an infected female partner through vaginal sex.[53] The evidence regarding whether circumcision helps prevent HIV is not as clear among men who have sex with men (MSM).[52] The effectiveness of using circumcision to prevent HIV in the developed world is not determined.[52][54]

Human papillomavirus

Human papillomavirus (HPV) is the most commonly transmitted sexually transmitted infection, affecting both men and women. While most infections are asymptomatic and are cleared by the immune system, some types of the virus cause genital warts, and other types, if untreated, cause various forms of cancer, including cervical cancer and penile cancer. Genital warts and cervical cancer are the two most common problems resulting from HPV.[55]

Circumcision is associated with a reduced prevalence of oncogenic types of HPV infection, meaning that a randomly selected circumcised man is less likely to be infected with cancer-causing types of HPV than an uncircumcised man.[56][57] It also decreases the likelihood of multiple infections.[7] As of 2012, there was no strong evidence that it reduces the rate of new HPV infection,[8][7][58] but the procedure is associated with increased clearance of the virus by the body,[8][7] which can account for the finding of reduced prevalence.[7] HPV vaccination is the best method to prevent infection from HPV.[59]

Although genital warts are caused by a type of HPV, there is no statistically significant relationship between being circumcised and the presence of genital warts.[8][57][58]

Other infections

Studies evaluating the effect of circumcision on the rates of other sexually transmitted infections have, generally, found it to be protective. A 2006 meta-analysis found that circumcision was associated with lower rates of syphilis, chancroid, and possibly genital herpes.[60] A 2010 review found that circumcision reduced the incidence of HSV-2 (herpes simplex virus, type 2) infections by 28%.[61] The researchers found mixed results for protection against trichomonas vaginalis and chlamydia trachomatis, and no evidence of protection against gonorrhea or syphilis.[61] It may also possibly protect against syphilis in MSM.[62]

Phimosis, balanitis and balanoposthitis

Phimosis is the inability to retract the foreskin over the glans penis.[63] At birth, the foreskin cannot be retracted due to adhesions between the foreskin and glans, and this is considered normal (physiological phimosis).[63] Over time the foreskin naturally separates from the glans, and a majority of boys are able to retract the foreskin by age three.[63] Less than one percent are still having problems at age 18.[63] If the inability to do so becomes problematic (pathological phimosis) circumcision is a treatment option.[3][64] A preputioplasty, where the foreskin is surgically widened instead of removed, is another possible surgical treatment option for phimosis.[65][66] This pathological phimosis may be due to scarring from the skin disease balanitis xerotica obliterans (BXO), repeated episodes of balanoposthitis or forced retraction of the foreskin.[67] Steroid creams are also a reasonable option and may prevent the need for surgery including in those with mild BXO.[67][68] The procedure may also be used to prevent the development of phimosis.[4] Phimosis is also a complication that can result from circumcision.[69]

An inflammation of the glans penis and foreskin is called balanoposthitis, and the condition affecting the glans alone is called balanitis.[70][71] Most cases of these conditions occur in uncircumcised males,[72] affecting 4–11% of that group.[63] The moist, warm space underneath the foreskin is thought to facilitate the growth of pathogens, particularly when hygiene is poor. Yeasts, especially Candida albicans, are the most common penile infection and are rarely identified in samples taken from circumcised males.[72] Both conditions are usually treated with topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams.[70][71] Circumcision is a treatment option for refractory or recurrent balanoposthitis, but in the twenty-first century the availability of the other treatments has made it less necessary.[70][71]

Phimosis also greatly increases the relative risk of penile cancer, and neonatal circumcision has been show to nearly eliminate this risk;[14][63] however, risk-benefit considerations around the use of circumcision as a cancer-preventive measure are a source of debate.[73] Only 1% of males have phimosis by age 17.[63] The mitigating effect circumcision has on the risk factor introduced by the possibility of phimosis is secondary, in that the removal of the foreskin eliminates the possibility of phimosis. This can be inferred from study results that show uncircumcised men with no history of phimosis are equally likely to have penile cancer as circumcised men.[1][74]

Urinary tract infections

A UTI affects parts of the urinary system including the urethra, bladder, and kidneys. There is about a 1% risk of UTIs in boys under two years old, and most incidents occur in the first year of life. There is good but not ideal evidence that circumcision reduces the incidence of UTIs in boys under two, and there is fair evidence that the reduction in incidence is by a factor of 3 to 10 (100 circumcisions prevent one UTI).[1][75][conflicted source][76] Circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects[1] and may be used to treat recurrent UTIs.[3]

There is a plausible biological explanation for the reduction in UTI risk after circumcision. The orifice through which urine passes at the tip of the penis (the urinary meatus) hosts more urinary system disease-causing bacteria in uncircumcised boys than in circumcised boys, especially in those under six months of age. As these bacteria are a risk factor for UTIs, circumcision may reduce the risk of UTIs through a decrease in the bacterial population.[1][76]

Other cancer causes

The principal risks for penile cancer are HPV, Phimosis and smoking.[77] There is also an association between adult circumcision and an increased risk of invasive penile cancer; this is believed to be from men being circumcised as a treatment for penile cancer or a condition that is a precursor to cancer rather than a consequence of circumcision itself.[74]

There is some evidence that circumcision is associated with reduced risk of prostate cancer.[78][79]

Women’s health

A 2017 systematic review found consistent evidence that male circumcision before heterosexual contact was associated with a decreased risk of cervical cancer, cervical dysplasia, HSV-2, chlamydia, and syphilis among women. The evidence was less consistent in regard to an association of circumcision with women’s risk of HPV and HIV.[80]

Sexual effects

The accumulated data show circumcision has no adverse physiological effect on sexual pleasure, function, desire, or fertility.[81][82] There is some evidence that circumcision has no effect on pain with intercourse, premature ejaculation, intravaginal ejaculation latency time, erectile dysfunction, or difficulties with orgasm.[83] There are popular misconceptions that circumcision benefits or adversely affects the sexual pleasure of the circumcised person.[82]

According to a 2014 review, the effect of circumcision on sexual partners’ experiences is unclear as it has not been well studied.[84] According to a policy statement by the Canadian Paediatric Society that was reaffirmed in 2021,[85] “medical studies do not support circumcision as having an impact on sexual function or satisfaction for partners of circumcised individuals”.[82]

Adverse effects

Neonatal circumcision is generally a safe, low-risk procedure when done by an experienced practitioner.[86][87][88]

The most common acute complications are excessive bleeding, infection and the removal of either too much or too little foreskin.[1][89] These complications occur in approximately 0.13% of procedures, with bleeding being the most common acute complication in the United States.[89] Minor complications are reported to occur in approximately 3.8%.[90] Severe complications are rare.[69] A specific complication rate is difficult to determine due to inconsistencies in classification.[1] Complication rates are greater when the procedure is performed by an inexperienced operator, in unsterile conditions, and older patient age.[15] In patients circumcised after the neonatal period and into adolescence, minor complication rates rise from approximately 1.5% in neonates to about 6% in adolescents. This increase is believed to be a result of increased foreskin vascularity.[91] Significant acute complications happen rarely,[1][15] occurring in about 1 in 500 newborn procedures in the United States.[1] Severe to catastrophic complications, including death, are so rare that they are reported only as individual case reports.[1][88] Where a Plastibell device is used, the most common complication is the retention of the device occurring in around 3.5% of procedures.[16] Other possible complications include buried penis, chordee, phimosis, skin bridges, urethral fistulas, and meatal stenosis.[88] These complications may be partly avoided with proper technique, and are often treatable without requiring surgical revision.[88] The most common long-term complication is meatal stenosis, this is almost exclusively seen in circumcised children, it is thought to be caused by ammonia producing bacteria coming into contact with the meatus in circumcised infants.[16] It can be treated by meatotomy.[16]

Effective pain management should be used during the procedure.[1] Inadequate pain relief may carry the risks of heightened pain response for newborns.[43] Newborns that experience pain due to being circumcised have different responses to vaccines given afterwards, with higher pain scores observed.[92] For adult men who have been circumcised, there is a risk that the circumcision scar may be tender.[93] There is no good evidence that circumcision affects cognitive abilities.[94]

History

Main article: History of circumcision

Adult circumcision scene from the tomb of Ankhmahor, Saqqara, Egypt (c. 2345–2333 BCE). Oldest known depiction of circumcision.

The word circumcision is from Latin circumcidere, meaning “to cut around”.[2] Circumcision is the oldest known surgical procedure.[95] Depictions of circumcised penises are found in Paleolithic art,[96] predating the earliest signs of trepanation.[95][97]

The history of the migration and evolution of circumcision is known mainly from the cultures of two regions. In the lands south and east of the Mediterranean, starting with Central Sahara, Sudan and Ethiopia, the procedure was practiced by the ancient Egyptians and the Semites, and then by the Jews and Muslims. In Oceania, circumcision is practiced by the Australian Aboriginals and Polynesians.[98] There is also evidence that circumcision was practiced among the Aztec and Mayan civilizations in the Americas,[2] but little is known about that history.[28][29]

It has been speculated that circumcision originated as a substitute for castration of defeated enemies or as a religious sacrifice.[29] In many traditions, it acts as a rite of passage marking a boy’s entrance into adulthood.[29]

Middle East, Africa and Europe

Further information: Circumcision in Africa

Circumcision knife from the Congo; wood, iron; late 19th/early 20th century

At Oued Djerat, in Algeria, engraved rock art with masked bowmen, which feature male circumcision and may be a scene involving ritual, have been dated to earlier than 6000 BP amid the Bubaline Period;[99] more specifically, while possibly dating much earlier than 10,000 BP, rock art walls from the Bubaline Period have been dated between 9200 BP and 5500 BP.[100] The cultural practice of circumcision may have spread from the Central Sahara, toward the south in Sub-Saharan Africa and toward the east in the region of the Nile.[99] Based on engraved evidence found on walls and evidence from mummies, circumcision has been dated to at least as early as 6000 BCE in ancient Egypt.[101] Some ancient Egyptian mummies, which have been dated as early as 4000 BCE, show evidence of circumcision.[98]: 2–3 [102]

Evidence suggests that circumcision was practiced in the Middle East by the fourth millennium BCE, when the Sumerians and the Semites moved into the area that is modern-day Iraq from the North and West.[28] The earliest historical record of circumcision comes from Egypt, in the form of an image of the circumcision of an adult carved into the tomb of Ankh-Mahor at Saqqara, dating to about 2400–2300 BCE. Circumcision was possibly done by the Egyptians for hygienic reasons, but also was part of their obsession with purity and was associated with spiritual and intellectual development. No well-accepted theory explains the significance of circumcision to the Egyptians, but it appears to have been endowed with great honor and importance as a rite of passage, performed in a public ceremony emphasizing the continuation of family generations and fertility. It may have been a mark of distinction for the elite: the Egyptian Book of the Dead describes the sun god Ra as having circumcised himself.[29][98]

Detail of the Artemision Bronze; the Greeks abhorred circumcision, making life difficult for circumcised Jews living among the Greeks.

Circumcision is prominent in the Hebrew Bible.[103] In addition to proposing that circumcision was adopted by the Israelites purely as a religious mandate, scholars have suggested that Judaism’s patriarchs and their followers adopted circumcision to make penile hygiene easier in hot, sandy climates; as a rite of passage into adulthood; or as a form of blood sacrifice.[28][98][104]

Historical campaigns of ethnic, cultural, and religious persecution frequently included bans on circumcision as a means of forceful assimilation, conversion, and ethnocide.[105] Alexander the Great conquered the Middle East in the fourth century BCE, and in the following centuries ancient Greek cultures and values came to the Middle East. The Greeks abhorred circumcision, making life for circumcised Jews living among the Greeks and later the Romans very difficult.[105] Restrictions on the Jewish practice by European governments have occurred several times in world history, including the Seleucid Empire under Antiochus IV and the Roman Empire under Hadrian, where it was used as a means of forceful assimilation and conversion.[105] Antiochus IV’s restriction on Jewish circumcision was a major factor in the Maccabean Revolt.[105] Hadrian‘s prohibition has also been considered by some to have been a contributing cause of the Bar Kokhba revolt.[105] According to Silverman (2006), these restrictions were part of a “broad campaign” by the Romans to “civilize” the Jewish people, viewing the practice as repulsive and analogous to castration.[105] His successor, Antoninus Pius, altered the edict to permit Brit Milah.[105] During this period in history, Jewish circumcision called for the removal of only a part of the prepuce, and Hellenized Jews often attempted to look uncircumcised and potentially restore their foreskins by stretching the extant parts of their foreskins with a specialized device called a pondus Judaeus. This was considered by the Jewish leaders to be a serious problem, and during the second century CE they changed the requirements of Jewish circumcision to call for the complete removal of the foreskin,[106] emphasizing the Jewish view of circumcision as intended to be not just the fulfillment of a Biblical commandment but also an essential and permanent mark of membership in a people.[98][104]

The Circumcision of Jesus Christ, by Ludovico Mazzolino

A narrative in the Christian Gospel of Luke makes a brief mention of the circumcision of Jesus, but physical circumcision is not part of the received teachings of Jesus. Circumcision has played an important role in Christian history and theology. Paul the Apostle reinterpreted circumcision as a spiritual concept, arguing literal circumcision to be unnecessary for Gentile converts to Christianity. The teaching that circumcision was unnecessary for membership in a divine covenant was instrumental to the separation of Christianity from Judaism.[107][108] While the circumcision of Jesus is celebrated as a feast day in the liturgical calendar of many Christian denominations.[108]

Although it is not explicitly mentioned in the Quran (early seventh century CE), circumcision is considered essential to Islam, and it is nearly universally performed among Muslims. The practice of circumcision spread across the Middle East, North Africa, and Southern Europe with Islam.[109]

Genghis Khan and the following Yuan Emperors in China forbade Islamic practices such as halal butchering and circumcision.[110][111]

The practice of circumcision is thought to have been brought to the Bantu-speaking tribes of Africa by either the Jews after one of their many expulsions from European countries, or by Muslim Moors escaping after the 1492 reconquest of Spain. In the second half of the first millennium CE, inhabitants from the Northeast of Africa moved south and encountered groups from Arabia, the Middle East, and West Africa. These people moved south and formed what is known today as the Bantu. Bantu tribes were observed to be upholding what was described as Jewish law, including circumcision, in the 16th century. Circumcision and elements of Jewish dietary restrictions are still found among Bantu tribes.[28]

Indigenous peoples of the Americas and Oceania

Slate blade circumcision knife with bone handle, North America. Wellcome Collection .

Circumcision is practiced by some groups amongst Australian Aboriginal peoples, Polynesians, and Native Americans.[2][28]

For Aboriginal Australians and Polynesians, circumcision likely started as a blood sacrifice and a test of bravery and became an initiation rite with attendant instruction in manhood in more recent centuries. Often seashells were used to remove the foreskin, and the bleeding was stopped with eucalyptus smoke.[28][112]

Christopher Columbus reported circumcision being practiced by Native Americans.[29] It probably started among South American tribes as a blood sacrifice or ritual to test bravery and endurance, and later evolved into a rite of initiation.[28]

East and Southeast Asia

An 18th-century print depicting the circumcision of the king of Bantam (in present-day Indonesia). Engraving by Jakob van der Schley, published by Pieter de Hondt, 1747. Atlas of Mutual Heritage.

In Japan, the pre-Yamato indigenous inhabitants, the Ainu, practiced circumcision, though the practice did not persist among the broader Japanese population, possibly due to Buddhist influence.[113]

In Southeast Asia, evidence suggests that indigenous forms of genital cutting predate the arrival of Islam. In the Indonesian archipelago, a traditional incision practice existed prior to Islamization; scholarly research has shown that this was progressively replaced by full circumcision following the adoption of Islam, a process accelerated in the late 19th century when Meccan jurists issued fatwas disapproving of the older local practice. In the Philippines, the traditional practice of tuli historically involved a dorsal slit rather than full circumcision, a form similar to practices among Pacific Islanders, suggesting an indigenous origin distinct from Islamic influence. The antiquity of circumcision in the region is further evidenced by the fact that Makassan traders from Sulawesi are recorded as having introduced circumcision to Aboriginal communities in Arnhem Land, Australia. With the spread of Islam across the archipelago from the 13th century onward, indigenous cutting practices were largely absorbed into or replaced by Islamic circumcision.[114][115]

Prophylactic circumcision

Anglophonic adoption (1855–1918)

The first medical professional to recommend circumcision as a prophylaxis against disease was the British physician Jonathan Hutchinson in 1855. By the late 19th century, the belief that circumcision acted as an effective prophylactic against disease was held by a majority of the core Anglosphere‘s medical communities and doctors, such as the prominent Lewis Sayre, president of the American Medical Association, subsequently leading to its widespread adoption.[22]

Circumcision began to be advocated as a means of prophylaxis in 1855, primarily as a means of preventing the transmission of sexually transmitted infections. At this time, British physician Jonathan Hutchinson published his findings that, among his venereal disease patients, Jews had a lower prevalence of syphilis.[116][117] Hutchinson suggested that circumcision lowers the risk of contracting syphilis.[117] He also believed that circumcision would prevent masturbation. In an 1893 article, On circumcision as a preventive of masturbation he wrote: “I am inclined to believe that [circumcision] may often accomplish much, both in breaking the habit [of masturbation] as an immediate result, and in diminishing the temptation to it subsequently.”[118] Pursuing a successful career as a general practitioner, Hutchinson went on to advocate circumcision for the next fifty years,[116] eventually earned a knighthood for his contributions to medicine. His viewpoint that circumcision was prophylactic against disease was adopted by other medical professionals.[119]

In 1870, orthopedic surgeon Lewis Sayre, a founder of the American Medical Association, introduced circumcision in the United States as a purported cure for several cases of young boys presenting with paralysis and other significant gross motor problems. He thought the procedure ameliorated such problems based on the then prominent “reflex neurosis” theory of disease, thinking that a tight foreskin inflamed the nerves and caused systemic problems.[120] The use of circumcision to promote good health also fit the germ theory of disease, which saw validation during the same period: the foreskin was thought to harbor infection-causing smegma.[121]: 106  Sayre published works on the subject and promoted it in speeches.[120] Many contemporary physicians also believed it could cure, reduce, or otherwise prevent a wide-ranging array of perceived medical problems and social ills. Its popularity spread with publications such as Peter Charles Remondino’s History of Circumcision.[121][122][123] By the late 19th century, circumcision had become common throughout the Anglophonic world—Australia, Canada, the United States, and the United Kingdom—as well as the Union of South Africa. In the United Kingdom and United States, it was universally recommended.[22][121]

Interwar period and World War II (1918–1945)

During the interwar period, medical organizations and doctors in mainland Europe experimented with the idea of routine circumcision for prophylactic reasons as well, alongside developments in the Anglophonic world. In France, the medical profession went so far as to recommend universal routine circumcision. However, prevalence in France and mainland Europe remained low.[19] There is a lack of consensus in the academic literature on why this occurred.[19]

The Cohen family gathered to celebrate a Brit Milah in Eveleth, Minnesota, United States, 1908. The mohel wears a tallit and kippah.

Yosha & Bolnick & Koyle (2012) have suggested that a factor in its Anglophonic adoption and dismissal in mainland Europe relates to attitudes towards Judaism and Jewish practices. While many of these Anglophonic polities would not be considered tolerant by modern standards: the United Kingdom had Benjamin Disraeli—a Jew—as Prime Minister; Jews in the United States were prominent and generally well-respected; while in Australia “the racial issues of the time involved primarily Aborigines and Chinese immigration, and Jews were essentially below the radar”. They argue that once “a substantial proportion of the male population [was] circumcised, the idea that it [was] a Jewish practice [became] no longer relevant. In Britain this was aided by the fact that circumcision was well known to be as much a practice of the nobility as a Jewish religious rite, so that the racial-religious nexus was broken.” These factors were absent in continental Europe.[19]

Rates in the Anglophonic world began to sharply diverge after 1945.[29]

Mid-20th century (1945–1985)

After the end of World War II, Britain implemented a National Health Service. Douglas Gairdner‘s 1949 article “The Fate of the Foreskin” argued that the evidence showed that the risks outweighed the benefits, leading to a significant reduction in circumcision incidence within the United Kingdom.[124][non-primary source needed]

Pediatrician and political activist Benjamin Spock originally recommended circumcision in his influential work The Common Sense Book of Baby and Child Care, one of the best-selling books of the twentieth century.[125]

In contrast to Gairdner, American pediatrician Benjamin Spock argued in favor of circumcision in his popular The Common Sense Book of Baby and Child Care which led to rates in the United States significantly rising. In the 1970s, national medical associations in Australia and Canada issued recommendations against routine infant circumcision, leading to drops in the rates of both of those countries. The United States made similar statements in the 1970s but stopped short of recommending against it.[29]

During the same period, South Korea underwent one of the most rapid and distinctive shifts in circumcision practice recorded anywhere in the world. Throughout their long history, Koreans did not circumcise males until 1945, when Korea gained its independence after 36 years of Japanese occupation. Independence brought trusteeship by the American military in the southern half of the country, and 1950 can be safely regarded as the year when widescale circumcision started in South Korea.[126]

Modernity (since 1985)

An association between circumcision and reduced heterosexual HIV infection rates was first suggested in 1986.[29]

Experimental evidence was needed to establish a causal relationship, so three randomized controlled trials were commissioned to exclude other confounding factors.[12] Trials took place in South Africa, Kenya and Uganda.[12] All three trials were stopped early by their monitoring boards because those in the circumcised group had a substantially lower rate of HIV contraction than the control group, so it was considered unethical to withhold the procedure, in light of strong evidence of prophylactic efficacy.[12][127] WHO assessed these as “gold standard” studies and found “strong and consistent” evidence from later studies that confirmed the results of the studies.[32] A scientific consensus subsequently developed that circumcision reduces heterosexual HIV infection rates in high-risk populations;[13][9][128] the WHO, along with other major medical organizations, have since promoted circumcision of high-risk populations as part of the program to reduce the spread of HIV.[32] The Male Circumcision Clearinghouse website was created in 2009 by WHO, UNAIDS, FHI and AVAC to provide evidence-based guidance, information, and resources to support the delivery of safe male circumcision services in countries that choose to scale up the procedure as one component of comprehensive HIV prevention services.[129][130]

Society and culture

A circumcision being performed in Central Asia, c. 1865–1872

Circumcision is one of the oldest surgical procedures in human history, and remains a highly emotional and controversial issue.[131] Many societies hold a wide ranging perspectives and different cultural, ethical, or social views on circumcision.[19] In some cultures, males are generally required to be circumcised shortly after birth, during childhood or around puberty as part of a rite of passage.[132]

Religious views on circumcision

See also: Religious male circumcision

Circumcision is commonly practiced in the Jewish,[132] Islamic,[133][134] and Druze faiths, and among the members of Coptic Church, the Ethiopian Orthodox Church and the Eritrean Orthodox Tewahedo Church.[135][136][137] In contrast, other religions, such as Mandaeism, Hinduism and Sikhism, strongly prohibit the practice of routine circumcision.[138][139][140]

Judaism

Main article: Brit milah

Circumcision set and trunk belonging to Gershom Mendes Seixas‘s family, ca. eighteenth century

Circumcision is near-universal among Jews.[141] The mitzvah of circumcision on the eighth day of life is considered among the most important commandments in Judaism. Barring extraordinary circumstances, failure to undergo the rite is seen by followers of Judaism as leading to a state of Kareth: the extinction of the soul and denial of a share in the world to come.[24][25][105] Reasons for biblical circumcision include to show off “patrilineal descent, sexual fertility, male initiation, cleansing of birth impurity, and dedication to God”.[142]

The basis for its observance is found in the Torah of the Hebrew Bible, in Genesis chapter 17, in which a covenant of circumcision is made with Abraham household and his descendants. Jewish circumcision is part of the brit milah ritual, to be performed by a trained ritual circumciser, a mohel, on the eighth day of a newborn son’s life, with certain exceptions for poor health. Jewish law requires that circumcision leaves the glans bare when the penis is flaccid. Mainstream Judaism foresees serious negative spiritual consequences if it is neglected.[132][143]

Preparing for a Jewish ritual circumcision

In Genesis 17:10-12 God specifies that even slaves must be circumcised. But Rabbinic judaism condemns forced conversion so the Gentiles are only required to get circumcised if they show genuine interest in joining the Jewish nation. If an improper circumcision has already been performed it is required that a drop of blood be drawn as a symbolic circumcision.[144] Though there are certain exceptions for those with poor health.[145] The Reform and Reconstructionist movements generally do not require a circumcision as part of the conversion process.[144] According to traditional Jewish law, in the absence of an adult free Jewish male expert, a woman, a slave, or a child who has the required skills is also authorized to perform the circumcision, provided that they are Jewish.[146] However, most streams of non-Orthodox Judaism allow female mohels, called mohalot (Hebrew: מוֹהֲלוֹת, the plural of מוֹהֶלֶת mohelet, feminine of mohel), without restriction. In 1984 Deborah Cohen became the first certified Reform mohelet; she was certified by the Berit Mila program of Reform Judaism.[147] All major rabbinical organizations recommend that male infants should be circumcised. The issue of converts remains controversial in Reform and Reconstructionist Judaism.[148][149]

Brit shalom (Hebrew: ברית שלום; “Covenant of Peace”), also called alternative brit to the practice of brit milah, is a naming ceremony for Jews that does not involve circumcision. The first known ceremony is said to have been celebrated around 1970 by Rabbi Sherwin Wine, the founder of the Society for Humanistic Judaism.[150] Although increasingly many U.S. Jews have chosen not to circumcise their sons, a study by The Jewish Journal in the Greater Los Angeles area found brit shalom to be extremely rare.[151][152]

Islam

Main article: Khitan (circumcision)

Khitan in the Dutch East Indies (present-day Indonesia), colonial era.
Circumcision celebration in Skopje, North Macedonia, 2013

Islamic scholars have diverse opinions on the obligatory nature of male circumcision, with some considering it mandatory (wājib), while others view it as only being recommended (sunnah).[153] According to historians of religion and scholars of religious studies, the Islamic tradition of circumcision was derived from the Pagan practices and rituals of pre-Islamic Arabia.[154] Although there is some debate within Islam over whether it is a religious requirement or mere recommendation, circumcision (called khitan) is practiced nearly universally by Muslim males. Islam bases its practice of circumcision on the Genesis 17 narrative, the same Biblical chapter referred to by Jews. The procedure is not explicitly mentioned in the Quran, however, it is a tradition established by Islam’s prophet Muhammad directly (following Abraham), and so its practice is considered a sunnah (prophet’s tradition) and is very important in Islam. For Muslims, circumcision is also a matter of cleanliness, purification and control over one’s baser self (nafs).[133][134][155]

There is no agreement across the many Islamic communities about the age at which circumcision should be performed. It may be done from soon after birth up to about age 15; most often it is performed at around six to seven years of age. The timing can correspond with the boy’s completion of his recitation of the whole Quran, with a coming-of-age event such as taking on the responsibility of daily prayer or betrothal. Circumcision may be celebrated with an associated family or community event. Circumcision is recommended for, but is not required of, converts to Islam.[133][134][155]

Quranists (less than 1% of all Muslims) reject hadith, and because circumcision is not mentioned in the Quran they do not consider it to be an Islamic practice.[156][better source needed]

Christianity

Main article: Religious male circumcision § In Christianity

Traditionally, circumcision has not been practiced by Christians for religious reasons. The practice was viewed as succeeded by Baptism and the New Testament chapter Acts 15 recorded that Christianity did not require circumcision from new converts.[157] Christian denominations generally hold a neutral position on circumcision for prophylactic, cultural, and social reasons, while strongly opposing it for religious reasons. This includes the Catholic Church, which explicitly banned the practice of religious circumcision in the Council of Florence,[158] and maintains a neutral position on the practice of circumcision for other reasons.[159] A majority of other Christian denominations take a similar position on circumcision, prohibiting it for religious observance, but neither explicitly supporting or forbidding it for other reasons.[159]

Coptic Children wearing traditional circumcision costumes

Thus, circumcision rates of Christians are predominately determined by the surrounding cultures which they live in. In some African and Eastern Christian denominations circumcision is an established practice,[26][160] and generally boys undergo circumcision shortly after birth as part of a rite of passage.[26] Circumcision is near-universal among Coptic Christians,[161] and they practice circumcision as a rite of passage.[2][135][137][162] The Ethiopian Orthodox Church calls for circumcision, with near-universal prevalence among Orthodox men in Ethiopia.[2] Eritrean Orthodox practice circumcision as a rite of passage, and they circumcise their sons “anywhere from the first week of life to the first few year”.[163] Some Christian churches in South Africa disapprove of the practice, while others require it of their members.[2]

Circumcision is practiced in many predominantly Christian countries.[164][165][166] Christian communities in Africa,[167][168] some Anglosphere countries, the Philippines, the Middle East,[169][170] South Korea and Oceania have high circumcision rates,[171][172] while Christian communities in Europe and South America have low circumcision rates, although none of these are performed out of perceived religious obligation.[26][173] Scholar Heather L. Armstrong writes that, as of 2021, about half of Christian males worldwide are circumcised, with most of them being located in Africa, Anglosphere countries, and the Philippines.[174]

Druze faith

Preparing for a ritual circumcision to a Druze child

Circumcision is widely practiced by the Druze,[175] who practice Druzism, an Abrahamic,[176][177] monotheistic, syncretic, and ethnic religion. The procedure is a cultural tradition and has no religious significance in Druzism.[178][179] There is no special date for it; male infants are usually circumcised shortly after birth,[180] but some remain uncircumcised until age ten or older.[180] Some Druze do not circumcise their male children and refuse to observe this “common Muslim practice”.[181]

Samaritanism

Like Judaism, the religion of Samaritanism requires ritual circumcision on the eighth day of life.[182]

Mandaeism

Circumcision is forbidden in Mandaeism,[138] and Mandaeans consider it abhorrent.[183] According to Mandaean doctrine, a circumcised man cannot serve as a Mandaean priest.[184]

Yazidism

Circumcision is not required in Yazidism, but is practised by some Yazidis due to regional customs.[185] The ritual is usually performed soon after birth; it takes place on the knees of the kerîf (approximately “godfather”), with whom the child will have a lifelong formal relationship.[186]

Indian religions

See also: Indian religions

Hinduism

Sculptural representation of lingam, male sex organ-placed on yoni, female sex organ. In Hinduism, lingam and yoni represent the masculine and the feminine creative principles respectively.[187]

In Hinduism, the Upanishads say that the nature of the higher self (Brahman), in essence, is bliss (ānanda), which the self in each being (Atman) experiences during dreamless deep sleep but remains unconscious of, consciously experiencing it during sensual activity.[188]: 48  The Upanishads say that in humans, just as eyes correspond to the experience of sight, nose with smell, ears with sound, and tongue with taste, the genitals correspond to “bliss, delight and procreation”.[188] The Brihadaranyaka Upanishad says that in humans, genitals are the “single locus of pleasure (ānanda)”.[189] In Sanskrit literature, the penis is called Upastha (“that which stands up”) and is traditionally considered a “source of great power or vitality (ojas).”[190] In Yoga physiology, the penis corresponds with svadhishthana chakra, and channels the flow of nadis, which enable higher sensations and consciousness.[191] Consequently, circumcision, or even an interference with a tight foreskin, is strictly forbidden in Hindu traditions.[192]

Sikhism

Sikhism does not require circumcision of its followers and strongly criticizes the practice.[140][193] The Guru Granth Sahib criticizes circumcision in a hymn.[194] The holy book of Sikhs, dating to 1708, bans circumcision as an Islamic custom, saying: “If God wished me to be a Muslim, it would be cut off by itself.”[195]

Buddhism

Buddhism neither requires nor prohibits circumcision, and it contains no canonical injunction regarding circumcision; the Pali Vinaya, which governs monastic conduct in detail, makes no mention of the practice. The 10th of the 32 attributes of an enlightened person is possibly a reference to circumcision: “His sexual organs are concealed in a sheath and exude a pleasant odor similar to vanilla.”[195]

Cultural views on circumcision

Main article: Cultural views on circumcision

African cultures

Freshly circumcised boys in Mali celebrating the event.
Boys in white clothing with bonnets at Tireli market, just after circumcision, Mali, 1990

This section is an excerpt from Circumcision in Africa.[edit]

Circumcision in Africa, and the rites of initiation in Africa, as well as “the frequent resemblance between details of ceremonial procedure in areas thousands of kilometres apart, indicate that the circumcision ritual has an old tradition behind it and in its present form is the result of a long process of development.”[196]

Australian cultures

Some Aboriginal Australian groups use circumcision as a test of bravery and self-control as a part of a rite of passage into manhood, which results in full societal and ceremonial membership. It may be accompanied by body scarification and the removal of teeth, and may be followed by penile subincision. Circumcision is one of many trials and ceremonies required before a youth is considered to have become knowledgeable enough to maintain and pass on the cultural traditions. During these trials, the maturing youth bonds in solidarity with the men. Circumcision is also strongly associated with a man’s family, and it is part of the process required to prepare a man to take a wife and produce his own family.[136]

Turkic cultures

Among Turkic peoples, circumcision (sünnet in Turkish, sünnət in Azerbaijani, sunnat in Uzbek, сүндет/sündet in Kazakh) is viewed as both a religious obligation and a significant rite of passage for boys. The practice is nearly universal among Turkic Muslim populations in Turkey, Azerbaijan, Uzbekistan, Kazakhstan, Kyrgyzstan, Turkmenistan, and among Turkic minorities such as the Uyghurs in China.[197][198]

Children in Turkey wearing traditional circumcision costumes

The ceremony, known as sünnet düğünü (circumcision celebration) in Turkey, is typically one of the most important events in a boy’s life, often rivaling weddings in scale and expense. Boys are usually circumcised between the ages of 2 and 14, with the timing varying by region and family preference. The celebration commonly includes the boy wearing special ceremonial attire, often resembling a prince’s costume or military uniform, and parading through the community on horseback or in a decorated vehicle.[199][200] Among the Uyghurs, the tradition is called xetne toyi and remains an important rite of passage. In traditional practice, the ceremony was accompanied by feasting, music, and gift-giving, serving as an important occasion for community bonding and the affirmation of cultural identity.[201]

Exterior of the Circumcision Room in Topkapı Palace

Filipino culture

Main article: Tuli (rite)

In the Philippines, circumcision is known as “tuli” and is generally viewed as a rite of passage.[202] An overwhelming majority of Filipino men are circumcised.[202][a] Often this occurs in April and May, when Filipino boys are taken by their parents. The practice dates back to the arrival of Islam in 1450. Pressure to be circumcised is even in the language: one Tagalog profanity for “uncircumcised” is supot, meaning “coward”. A circumcised eight- or ten-year-old is no longer considered a boy and is given more adult roles in the family and society.[204]

Ethics

Main article: Ethics of circumcision

This section is an excerpt from Ethics of circumcision.[edit]

This article is written like a personal reflection, personal essay, or argumentative essay that states a Wikipedia editor’s personal feelings or presents an original argument about a topic. Please help improve it by rewriting it in an encyclopedic style. (January 2025) (Learn how and when to remove this message)

There is substantial disagreement amongst bioethicists and theologians over the practice of circumcision, with many believing that the routine circumcision of neonates for health purposes is a cost-ineffective and ethically-problematic intervention in developed countries, while circumcision on a consenting adult is generally viewed as a morally permissible action. Positions taken on the issue are heavily influenced by prevalence in the given area, religion, and culture.[205] Some medical associations take the position that circumcision is an infringement of the child’s autonomy and should be deferred until they are capable of making the decision themselves. Others state that parents should be allowed to determine what is in their best interest.[206][207][208]

Regulations

Worldwide, most polities have no laws about circumcision of males,[2] with religious infant circumcision legal in every country.[141][209] A few countries have passed legislation on the procedure: Germany allows routine circumcision,[210] while non-religious routine neonatal circumcision is regulated in South Africa and Sweden.[2][209] No major medical organization recommends circumcising all males, and no major medical organization recommends banning the procedure.[19][211][141]

In the academic literature, there is general agreement among both supporters and opponents of the practice that an outright ban would be predominately ineffective and “harmful”.[19][141][212][211] A consensus to keep the procedure within the purview of medical professionals is found across all major medical organizations, which advise medical professionals to yield to some degree to parental preferences in their decision to circumcise.[19][141] The Royal Dutch Medical Association, which expresses some of the strongest opposition to routine neonatal circumcision, argues that while there are valid reasons for banning it, doing so could lead parents who insist on it to turn to poorly trained practitioners instead of medical professionals.[19][209]

During the 2010s, several right-wing nationalist parties prominently called for the banning of circumcision.[213] Randi Gressgård, Researcher at the Centre for Women’s and Gender Research (SKOK) at the University of Bergen, argued that politicians that supported Norway’s proposed circumcision ban debated circumcision in a manner which constituted “ethnocentrism“.[214]

Economic considerations

The cost-effectiveness of circumcision has been studied to determine whether a policy of circumcising all newborns or a policy of promoting and providing inexpensive or free access to circumcision for all adult men who choose it would result in lower overall societal healthcare costs. As HIV/AIDS is an incurable disease that is expensive to manage, significant effort has been spent studying the cost-effectiveness of circumcision to reduce its spread in parts of Africa that have a relatively high infection rate and low circumcision prevalence.[215] Several analyses have concluded that circumcision programs for adult men in Africa are cost-effective and in some cases cost-saving.[216][217] In Rwanda, circumcision has been found to be cost-effective across a wide range of age groups from newborn to adult,[58][218] with the greatest savings achieved when it is performed in the newborn period due to the lower cost per procedure and greater timeframe for HIV infection protection.[219][218] Circumcision to prevent HIV transmission in adults has also been found to be cost-effective in South Africa, Kenya, and Uganda, with cost savings estimated in the billions of US dollars over 20 years.[215] Hankins et al. (2011) estimated that a $1.5 billion investment in circumcision for adults in 13 high-priority African countries would yield $16.5 billion in savings.[220]

The overall cost-effectiveness of neonatal circumcision has also been studied in the United States, which has a different cost setting from Africa in areas such as public health infrastructure, availability of medications, and medical technology and the willingness to use it.[221] A CDC study suggests that newborn circumcision is societally cost-effective in the U.S., based on its efficacy against the transmission of HIV alone during coitus, without considering any other benefits.[1] The American Academy of Pediatrics (2012) recommends that neonatal circumcision in the U.S. be covered by third-party payers such as Medicaid and insurance.[1] A 2014 review that considered reported benefits of circumcision such as reduced risks of HIV, HPV, and HSV-2 stated that circumcision is cost-effective in the U.S. and Africa and may result in health care savings.[222] A 2014 literature review found significant gaps in the literature on male and female sexual health that must be addressed for the literature to be applicable to North American populations.[84]

References

  1.  American Academy of Pediatrics Task Force on Circumcision (September 2012). “Male circumcision”. Pediatrics. 130 (3): e756–e785. doi:10.1542/peds.2012-1990. PMID 22926175.
  2.  Weiss H, Polonsky J, Bailey R, Hankins C, Halperin D, Schmid G (2007). Male circumcision: global trends and determinants of prevalence, safety, and acceptability (PDF). Geneva: World Health Organization. ISBN 978-92-4-159616-9. OCLC 425961131. Archived (PDF) from the original on 22 December 2015.
  3.  Lissauer T, Clayden G (October 2011). Illustrated Textbook of Paediatrics, Fourth edition. Elsevier. pp. 352–353. ISBN 978-0-7234-3565-5.
  4.  Hay W, Levin M (25 June 2012). Current Diagnosis and Treatment Pediatrics 21/E. McGraw Hill Professional. pp. 18–19. ISBN 978-0-07-177971-5. Archived from the original on 18 January 2016.
  5.  Rudolph C, Rudolph A, Lister G, First L, Gershon A (18 March 2011). Rudolph’s Pediatrics (22nd ed.). McGraw-Hill Companies, Incorporated. p. 188. ISBN 978-0-07-149723-7. Archived from the original on 18 January 2016.
  6.  Yuan T, Fitzpatrick T, Ko NY, Cai Y, Chen Y, Zhao J, et al. (April 2019). “Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data”. The Lancet. Global Health (Mata-analysis). 7 (4): e436–e447. doi:10.1016/S2214-109X(18)30567-9. PMC 7779827. PMID 30879508.
  7.  Rehmeyer CJ (March 2011). “Male circumcision and human papillomavirus studies reviewed by infection stage and virus type”. The Journal of the American Osteopathic Association. 111 (3 Suppl 2): S11–S18. PMID 21415373.
  8.  Larke N, Thomas SL, Dos Santos Silva I, Weiss HA (November 2011). “Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis”. The Journal of Infectious Diseases. 204 (9): 1375–1390. doi:10.1093/infdis/jir523. PMID 21965090.
  9. For sources on this, see:
    • Bell K (2016). Health and Other Unassailable Values: Reconfigurations of Health, Evidence and Ethics. Taylor & Francis. p. 106. ISBN 978-1-317-48203-1. …defending the casual relation between male circumcision and reduced HIV transmission has become essentially hegemonic in the academic literature.
    • Merson M, Inrig S (2017). The AIDS Pandemic: Searching for a Global Response. Springer International Publishing. p. 379. ISBN 978-3-319-47133-4.
  10.  Sharma AL, Hokello J, Tyagi M (25 June 2021). “Circumcision as an Intervening Strategy against HIV Acquisition in the Male Genital Tract”. Pathogens. 10 (7): 806. doi:10.3390/pathogens10070806. ISSN 2076-0817. PMC 8308621. PMID 34201976.
  11.  Manual for early infant male circumcision under local anaesthesia. Geneva: World Health Organization. 2010. Archived from the original on 14 April 2022. Retrieved 14 April 2022. There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men.
  12.  Siegfried N, Muller M, Deeks JJ, Volmink J (April 2009). Siegfried N (ed.). “Male circumcision for prevention of heterosexual acquisition of HIV in men”. The Cochrane Database of Systematic Reviews. 2013 (2) CD003362. doi:10.1002/14651858.CD003362.pub2. PMC 11666075. PMID 19370585.
  13.  Merson M, Inrig S (2017). The AIDS Pandemic: Searching for a Global Response. Springer Publishing. p. 379. ISBN 978-3-319-47133-4. This led to a [medical] consensus that male circumcision should be a priority for HIV prevention in countries and regions with heterosexual epidemics and high HIV and low male circumcision prevalence.
  14.  Thomas A, Necchi A, Muneer A, Tobias-Machado M, Tran AT, Van Rompuy AS, et al. (February 2021). “Penile cancer”. Nature Reviews. Disease Primers (Review). 7 (1) 11. doi:10.1038/s41572-021-00246-5. PMID 33574340. S2CID 231877615.
  15.  Weiss HA, Larke N, Halperin D, Schenker I (February 2010). “Complications of circumcision in male neonates, infants and children: a systematic review”. BMC Urology. 10 2. doi:10.1186/1471-2490-10-2. PMC 2835667. PMID 20158883.
  16.  Selekman R, Copp H (2020). “Urologic Evaluation of the Child”. In Partin A (ed.). Campbell Walsh Wein Urology (12th ed.). Elsevier. pp. 388–402. ISBN 978-0-323-67227-6.
  17.  Gable L, Gamharter K, Gostin L, Hodge Jr J, Puymbroeck R (2007). “1.12 Male Circumcision”. Legal Aspects of HIV/AIDS: A Guide for Policy and Law Reform. World Bank Publications. pp. 38–39. ISBN 978-0-8213-7105-3.
  18.  Manual for early infant male circumcision under local anaesthesia. Geneva: World Health Organization. 2010. Archived from the original on 14 April 2022. Retrieved 14 April 2022. There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men.
  19.  Jacobs M, Grady R, Bolnick DA (2012). “Current Circumcision Trends and Guidelines”. In Bolnick DA, Koyle M, Yosha A (eds.). Surgical Guide to Circumcision. London: Springer. pp. 3–8, 255–257. doi:10.1007/978-1-4471-2858-8_1. ISBN 978-1-4471-2857-1. Outside of strategic regions in sub-Saharan Africa, no call for routine circumcision has been made by any established medical organizations or governmental bodies. Positions on circumcision include “some medical benefit/parental choice” in the United States, “no medical benefit/parental choice” in Great Britain, and “no medical benefit/physical and psychological trauma/parental choice” in the Netherlands.
  20.  Caga-anan EC, Thomas AJ, Diekema DS, Mercurio MR, Adam MR (8 September 2011). Clinical Ethics in Pediatrics: A Case-Based Textbook. Cambridge University Press. p. 43. ISBN 978-0-521-17361-2. Archived from the original on 18 January 2016.
  21.  Morris BJ, Wamai RG, Henebeng EB, Tobian AA, Klausner JD, Banerjee J, et al. (2016). “Estimation of country-specific and global prevalence of male circumcision”. Population Health Metrics. 14 4. doi:10.1186/s12963-016-0073-5. ISSN 1478-7954. PMC 4772313. PMID 26933388.
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  23.  Afshar K, Kazemi B, MacNeily A (2018). “The Role of Circumcision in Preventing Sexually Transmitted Infections”. In Singh S (ed.). Diagnostics to Pathogenomics of Sexually Transmitted Infections. Wiley. pp. 28–34. ISBN 978-1-119-38084-9.
  24.  Mark E (2003). “Frojmovic/Travelers to the Circumcision”. The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite. Brandeis University Press. p. 141. ISBN 978-1-58465-307-3. Circumcision became the single most important commandment… the one without which… no Jew could attain the world to come.
  25.  Hamilton V (1990). The Book of Genesis, Chapters 1-17. Eerdmans Publishing Company. p. 473. ISBN 978-0-8028-2521-6. In fact, circumcision is only one of two performative commands, the neglect of which bring the kareth penalty. (The other is the failure to be cleansed from corpse contamination, umb. 19:11-22.)
  26.  Stearns PN (2008). The Oxford Encyclopedia of the Modern World. Oxford University Press. p. 179. ISBN 978-0-19-517632-2. Uniformly practiced by Jews, Muslims, and the members of Coptic, Ethiopian, and Eritrean Orthodox Churches, male circumcision remains prevalent in many regions of the world, particularly Africa, South and East Asia, Oceania, and Anglosphere countries.
  27.  Pitts-Taylor V (2008). Cultural Encyclopedia of the Body [2 volumes]. ABC-CLIO. p. 394. ISBN 978-1-56720-691-3. For most part, Christianity does not require circumcision of its followers. Yet, some Orthodox and African Christian groups do require circumcision. These circumcisions take place at any point between birth and puberty.
  28.  Doyle D (October 2005). “Ritual male circumcision: a brief history” (PDF). The Journal of the Royal College of Physicians of Edinburgh. 35 (3): 279–285. doi:10.1177/1478271520053503005. PMID 16402509. Archived (PDF) from the original on 14 March 2023. Retrieved 16 January 2023.
  29.  Alanis MC, Lucidi RS (May 2004). “Neonatal circumcision: a review of the world’s oldest and most controversial operation”. Obstetrical & Gynecological Survey. 59 (5): 379–395. doi:10.1097/00006254-200405000-00026. PMID 15097799. S2CID 25226185.
  30.  Morris BJ, Wamai RG, Henebeng EB, Tobian AA, Klausner JD, Banerjee J, et al. (1 March 2016). “Estimation of country-specific and global prevalence of male circumcision”. Population Health Metrics. 14 (1) 4: 1–13. doi:10.1186/s12963-016-0073-5. ISSN 1478-7954. PMC 4772313. PMID 26933388.
  31.  Seeth A (1 June 2018). “‘It’s hassle-free,’ says actor Melusi Yeni about his medical circumcision”. News24. Archived from the original on 5 May 2022. Retrieved 5 May 2022. Actor Melusi Yeni was the millionth man to undergo voluntary male medical circumcision at the Sivananda Clinic in KwaZulu-Natal.
  32.  “Preventing HIV Through Safe Voluntary Medical Male Circumcision For Adolescent Boys And Men In Generalized HIV Epidemics”. World Health Organization. 2020. Archived from the original on 22 November 2021. Retrieved 24 May 2021.
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  35.  Wapner J (24 February 2015). “The Troubled History of Foreskin”. Mosaic Science. Archived from the original on 26 December 2021. Retrieved 3 February 2022. In the decades since, medical practice has come to rely increasingly on evidence from large research studies, which, as many American doctors see it, have supported the existing rationale… How can experts who have undergone similar training evaluate the same studies and come to opposing conclusions? I’ve spent months scrutinising the medical literature in an attempt to decide which side is right. The task turned out to be nearly impossible. That’s partly because there is so much confused thinking around the risks and benefits of circumcision, even among trained practitioners.
  36.  Press B, Jalfon M, Solomon D, Hittelman AB (July 2024). “Clinical and environmental considerations for neonatal, office-based circumcisions compared with operative circumcisions”. Frontiers in Urology. 4 1380154. doi:10.3389/fruro.2024.1380154. ISSN 2673-9828. PMC 12327250. PMID 40777091. Neonatal circumcision is supported by both the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) due to the belief that the health benefits outweigh the minimal risk of the procedure.
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    • Livingston M (2021). Dreamworld or Dystopia: The Nordic Model and Its Influence in the 21st Century. Cambridge University Press. p. 87. ISBN 978-1-108-75726-3. In Jewish history, the banning of circumcision (brit mila) has historically been a first step toward more extreme and violent forms of persecution.
    • Wilson R (2018). The Contested Place of Religion in Family Law. Cambridge University Press. p. 174. ISBN 978-1-108-41760-0. Jews have a long history of suffering punishment at the hands of government authorities for engaging in circumcision. Muslims have also experienced suppression of their identities through suppression of this religious practice.
    • Miller GP (Spring 2002). “Circumcision: Cultural-Legal Analysis”. Virginia Journal of Social Policy & the Law. 9: 497–585. doi:10.2139/ssrn.201057. SSRN 201057.
    • Silverman E (2006). “Circumcision, Anti-Semitism, and Christ’s Foreskin”. From Abraham to America: A History of Jewish Circumcision. Rowman & Littlefield. pp. 161–162. ISBN 978-0-7425-1669-4. Ancient [Greek and Roman] authors praised Jewish wisdom, courage, temperance, and justice. Still, they always denounced circumcision. The anonymous authors of Historiae Augustae, writing in the late fourth century, ttributed a Jewish revolt against Rome in 132-135, called the Bar Kokhba rebellion, to a ban on circumcision enacted by the emperor Hadrian… The prohibition was part of a broad campaign to “civilize” ethnic groups…
    • Rosner F (2003). Encyclopedia of Jewish Medical Ethics. Feldheim Publishers. p. 196. ISBN 978-1-58330-592-8. Several eras in subsequent Jewish history were associated with forced conversions and with prohibitions against ritual circumcision… Jews endangered their lives during such times and exerted strenuous efforts to nullify such edicts. When they succeeded, they celebrated by declaring a holiday. Throughout most of history, Jews never doubted their obligation to observe circumcision… [those who attempted to reverse it or failed to perform the ritual were called] voiders of the covenant of Abraham our father, and they have no portion in the World to Come.
  106.  Hirsch EG, Kohler K, Jacobs J, Friedenwald A, Broydé I (1906). “Circumcision”. Jewish Encyclopedia. Archived from the original on 4 August 2011. Retrieved 8 March 2018. In order to prevent the obliteration of the ‘seal of the covenant’ on the flesh, as circumcision was henceforth called, the Rabbis, probably after the war of Bar Kokba (see Yeb. l.c.; Gen. R. xlvi.), instituted the ‘peri’ah’ (the laying bare of the glans), without which circumcision was declared to be of no value (Shab. xxx. 6).
  107.  Jacobs A (2012). Christ Circumcised: A Study in Early Christian History and Difference. United States: University of Pennsylvania Press. ISBN 978-0-8122-0651-7.
  108.  Bolnick D, Koyle M, Yosha A (2012). “Circumcision in the Early Christian Church: The Controversy That Shaped a Continent”. Surgical Guide to Circumcision. United Kingdom: Springer. pp. 290–298. ISBN 978-1-4471-2858-8. In summary, circumcision has played a surprisingly important role in Western history. The circumcision debate forged a Gentile identity to the early Christian church which allowed it to survive the Jewish Diaspora and become the dominant religion of Western Europe. Circumcision continued to have a major cultural presence throughout Christendom even after the practice had all but vanished…. the circumcision of Jesus… celebrated as a religious holiday… [has been] examined by many of the greatest scholars and artists of the Western tradition.
  109.  Gollaher D (February 2001). “Chapter 2: Christians and Muslims”. Circumcision: A History of the World’s Most Controversial Surgery. Basic Books. pp. 31–52. ISBN 978-0-465-02653-1. Archived from the original on 18 January 2016.
  110.  Leslie DD (1998). “The Integration of Religious Minorities in China: The Case of Chinese Muslims” (PDF). The Fifty-ninth George Ernest Morrison Lecture in Ethnology. p. 12. Archived from the original (PDF) on 17 December 2010. Retrieved 30 November 2010.
  111.  Johan E (2010). Buddhism and Islam on the Silk Road (illustrated ed.). University of Pennsylvania Press. pp. 228. ISBN 978-0-8122-4237-9. Retrieved 28 June 2010.
  112.  Gollaher D (February 2001). “Chapter 3: Symbolic Wounds”. Circumcision: A History of the World’s Most Controversial Surgery. Basic Books. pp. 53–72. ISBN 978-0-465-02653-1. Archived from the original on 18 January 2016.
  113.  Bolnick DA, Koyle M, Yosha A, eds. (12 March 2012). Surgical Guide to Circumcision. doi:10.1007/978-1-4471-2858-8.
  114.  Lee RB (2006). “Filipino experience of ritual male circumcision: knowledge and insights for anti-circumcision advocacy”. Culture, Health & Sexuality. 8 (3): 225–234. doi:10.1080/13691050600761243. ISSN 1369-1058. PMID 16801224.
  115.  Lee R (1 May 2006). “Filipino experience of ritual male circumcision: Knowledge and insights for anti-circumcision advocacy”. Culture, Health and Sexuality. 8 (3): 225–234. doi:10.1080/13691050600761243.
  116.  Darby R (2005). A surgical temptation: the demonization of the foreskin and the rise of circumcision in Britain. Chicago: University of Chicago Press. pp. 262–. ISBN 978-0-226-13645-5.
  117.  Hutchinson J (1855). “On the influence of circumcision in preventing syphilis”. Medical Times and Gazette. 32: 542–543.
  118.  “On circumcision as a preventive of masturbation”, Archives of surgery, Vol. II, 1890, p. 267-9
  119.  Matthew HC (2004). Oxford dictionary of national biography: in association with the British Academy: from the earliest times to the year 2000. Oxford New York: Oxford University Press. ISBN 978-0-19-861411-1.
  120.  Chubak B (1 April 2013). “1101 the orthopedic origin of popular male circumcision in america”. Journal of Urology. 189 (4S): e451. doi:10.1016/j.juro.2013.02.693. Male circumcision was first popularized in late 19th-century America by Lewis Sayre, a renowned orthopedic surgeon, public-health activist, and creator of the Journal of the American Medical Association. On the basis of a few orthopedic case reports, Sayre used his influence to promote male circumcision as systemic therapy, rather than a local anatomic alteration. This redefinition was consistent with the contemporary reflex neurosis theory of disease, as well as the historic humoral-mechanical understanding of the human body.
  121.  Gollaher D (February 2001). “Chapter 4: From Ritual to Science”. Circumcision: A History of the World’s Most Controversial Surgery. Basic Books. pp. 73–108. ISBN 978-0-465-02653-1. Archived from the original on 18 January 2016.
  122.  Darby R (Spring 2003). “The Masturbation Taboo and the Rise of Routine Male Circumcision: A Review of the Historiography”. Journal of Social History. 36 (3): 737–757. doi:10.1353/jsh.2003.0047. JSTOR 3790737. S2CID 72536074.
  123.  Laumann EO, Masi CM, Zuckerman EW (April 1997). “Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice”. JAMA. 277 (13): 1052–1057. doi:10.1001/jama.1997.03540370042034. PMID 9091693.
  124.  Gairdner D (December 1949). “The fate of the foreskin, a study of circumcision”. British Medical Journal. 2 (4642): 1433–7, illust. doi:10.1136/bmj.2.4642.1433. PMC 2051968. PMID 15408299.
  125.  Paige J, Paige K (2021). “Summary and Implications for Complex Societies”. The Politics of Reproductive Ritual. University of California Press. p. 263. ISBN 978-0-520-30674-5.
  126.  “Male circumcision: a South Korean perspective”. www.cirp.org. Retrieved 17 March 2026.
  127.  Hankins C, Forsythe S, Njeuhmeli E (November 2011). “Voluntary medical male circumcision: an introduction to the cost, impact, and challenges of accelerated scaling up”. PLOS Medicine. 8 (11) e1001127. doi:10.1371/journal.pmed.1001127. PMC 3226452. PMID 22140362.
  128.  Bell K (2016). Health and Other Unassailable Values: Reconfigurations of Health, Evidence and Ethics. Taylor & Francis. p. 106. ISBN 978-1-317-48203-1. …defending the casual relation between male circumcision and reduced HIV transmission has become essentially hegemonic in the academic literature.
  129.  McNeil Jr DG (3 March 2009). “AIDS: New Web Site Seeks to Fight Myths About Circumcision and H.I.V.” The New York Times. p. D6. Archived from the original on 8 January 2014. Retrieved 1 February 2012.
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  131.  Bolnick DA, Koyle M, Yosha A, eds. (2012). Surgical Guide to Circumcision. Springer Science & Business Media. p. xxi. ISBN 978-1-4471-2857-1.
  132.  Glass JM (January 1999). “Religious circumcision: a Jewish view”. BJU International. 83 (Suppl 1): 17–21. doi:10.1046/j.1464-410x.1999.0830s1017.x. PMID 10349410. S2CID 2888024.
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  134.  al-Sabbagh, Muhammad Lutfi (1996). Islamic ruling on male and female circumcision. World Health Organization. p. 16. ISBN 978-92-9021-216-4.
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  136.  “Circumcision”. Encyclopedia of Religion (2 ed.). Gale. 2005.
  137.  Riggs T (2006). “Christianity: Coptic Christianity”. Worldmark Encyclopedia of Religious Practices: Religions and denominations. Thomson Gale. ISBN 978-0-7876-6612-5. Archived from the original on 18 January 2016.
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  139.  Clarence-Smith WG (2008). “Islam and Female Genital Cutting in Southeast Asia: The Weight of the Past” (PDF). Finnish Journal of Ethnicity and Migration. 3 (2: Special Issue: Female Genital Cutting in the Past and Today): 14–22. Archived from the original (PDF) on 6 March 2009.
  140.  Cherry M (2013). Religious Perspectives on Bioethics. Taylor & Francis. p. 213. ISBN 978-90-265-1967-3.
  141.  Cohen-Almagor R (9 November 2020). “Should liberal government regulate male circumcision performed in the name of Jewish tradition?”. SN Social Sciences. 1 (1) 8. doi:10.1007/s43545-020-00011-7. ISSN 2662-9283. S2CID 228911544. Protagonists and critics of male circumcision agree on some things and disagree on many others… They also do not underestimate the importance of male circumcision for the relevant communities…. Even the most critical voices of male circumcision do not suggest putting a blanket ban on the practice as they understand that such a ban, very much like the 1920–1933 prohibition laws in the United States, would not be effective… Protagonists and critics of male circumcision debate whether the practice is morally acceptable… They assign different weights to harm as well as to medical risks and to non-medical benefits. The different weights to risks and benefits conform to their underlying views about the practices… Protagonists and critics disagree about the significance of medical reasons for circumcision…
  142.  Hendel R (2005). Remembering Abraham: Culture, Memory, and History in the Hebrew Bible. Oxford University Press. pp. 3–30. ISBN 978-0-19-978462-2.
  143.  Bolnick DA, Katz KE (2012). “Jewish Ritual Circumcision”. In Bolnick DA, Koyle M, Yosha A (eds.). Surgical Guide to Circumcision. London: Springer. pp. 265–274. doi:10.1007/978-1-4471-2858-8_23. ISBN 978-1-4471-2857-1.
  144.  Epstein L (2007). “The Conversion Process”. Calgary Jewish Community Council. Archived from the original on 27 December 2008. Retrieved 3 November 2007.
  145.  Levine A, Zvi Brettler M (2017). The Jewish Annotated New Testament. Oxford University Press. p. 673. With rare exceptions (e.g. matters of health), Judaism requires circumcision for all male children on their eighth day of birth.
  146.  Talmud Avodah Zarah 26b; Menachot 42a; Maimonides’ Mishneh Torah, Milah, ii. 1; Shulkhan Arukh, Yoreh De’ah, l.c.
  147.  “Berit Mila Program of Reform Judaism”. 7 October 2013. Archived from the original on 7 October 2013. Retrieved 20 July 2022.
  148.  Glickman M (12 November 2005). “B’rit Milah: A Jewish Answer to Modernity”. Reform Judaism. Reform Judaism. Archived from the original on 12 March 2017. Retrieved 11 March 2017.
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  150.  Lowenfeld J (2 August 2011). “Little-known non-cutting ritual appeals to some who oppose circumcision”. The Jewish Journal of Greater Los Angeles. LA. Archived from the original on 25 August 2018. Retrieved 11 March 2020. According to Gottfried, the earliest known brit shalom ceremony was performed around 1970 by her mentor, Rabbi Sherwin Wine, the founder of the Society for Humanistic Judaism.
  151.  Chernikoff H (3 October 2007). “Jewish “intactivists” in U.S. stop circumcising”. Reuters. Archived from the original on 27 December 2008. Retrieved 3 November 2007.
  152.  Lowenfeld J (2 August 2011). “Little-known non-cutting ritual appeals to some who oppose circumcision”. Jewish Journal. Retrieved 7 February 2026.
  153.  Dabbagh H (December 2022). “Is Circumcision “Necessary” in Islam? A Philosophical Argument Based on Peer Disagreement”. Journal of Religion and Health. 61 (6): 4871–4886. doi:10.1007/s10943-022-01635-0. PMC 9569283. PMID 36006531.
  154.  Abu-Sahlieh SA (1994). “To mutilate in the name of Jehovah or Allah: legitimization of male and female circumcision”. Medicine and Law. 13 (7–8). World Association for Medical Law: 575–622. PMID 7731348.; Aldeeb Abu-Sahlieh SA (1995). “Islamic Law and the Issue of Male and Female Circumcision”. Third World Legal Studies. 13. Valparaiso University School of Law: 73–101. Archived from the original on 12 November 2019. Retrieved 13 February 2020.
  155.  El-Sheemy MS, Ziada AM (2012). “Islam and Circumcision”. In Bolnick DA, Koyle M, Yosha A (eds.). Surgical Guide to Circumcision. London: Springer. pp. 275–280. doi:10.1007/978-1-4471-2858-8_24. ISBN 978-1-4471-2857-1.
  156.  Siraj Islam (13 December 2024). “Circumcision is an unquranic practice of genital mutilation”.
  157.  Mark E (2003). The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite. Brandeis University Press. p. xxiii. ISBN 978-1-58465-307-3.
  158.  Pope Eugenius IV (1990) [1442]. “Ecumenical Council of Florence (1438–1445): Session 11—4 February 1442; Bull of union with the Copts”. In Tanner NP (ed.). Decrees of the ecumenical councils. 2 volumes (in Greek and Latin). Washington, D.C.: Georgetown University Press. ISBN 978-0-87840-490-2. LCCN 90003209. Archived from the original on 25 April 2009. Retrieved 25 April 2007. it denounces all who after that time observe circumcision
  159.  Slosar JP, O’Brien D (2003). “The ethics of neonatal male circumcision: a Catholic perspective”. The American Journal of Bioethics. 3 (2): 62–64. doi:10.1162/152651603766436306. PMID 12859824. S2CID 38064474.
  160.  Pitts-Taylor V (2008). Cultural Encyclopedia of the Body [2 volumes]. ABC-CLIO. p. 394. ISBN 978-1-56720-691-3. For most part, Christianity does not require circumcision of its followers. Yet, some Orthodox and African Christian groups do require circumcision. These circumcisions take place at any point between birth and puberty.
  161.  Sharkey HJ (2015). American Evangelicals in Egypt: Missionary Encounters in an Age of Empire. Princeton University Press. p. 30. ISBN 978-0-691-16810-4.
  162.  Adams G, Adams K (2012). “Circumcision in the Early Christian Church: The Controversy That Shaped a Continent”. In Bolnick DA, Koyle M, Yosha A (eds.). Surgical Guide to Circumcision. London: Springer. pp. 291–298. doi:10.1007/978-1-4471-2858-8_26. ISBN 978-1-4471-2857-1.
  163.  DeMello M (2007). Encyclopedia of Body Adornment. ABC-Clio. p. 66. ISBN 978-0-313-33695-9. Coptic Christians, Ethiopian Orthodox, and Eritrean Orthodox churches on the other hand, do observe the ordainment, and circumcise their sons anywhere from the first week of life to the first few years.
  164.  Gruenbaum E (2015). The Female Circumcision Controversy: An Anthropological Perspective. University of Pennsylvania Press. p. 61. ISBN 978-0-8122-9251-0. Christian theology generally interprets male circumcision to be an Old Testament rule that is no longer an obligation … though in many countries (especially the United States and Sub-Saharan Africa, but not so much in Europe) it is widely practiced among Christians
  165.  Hunting K (2012). Essential Case Studies in Public Health: Putting Public Health Into Practice. Jones & Bartlett Publishers. pp. 23–24. ISBN 978-1-4496-4875-6. Neonatal circumcision is the general practice among Jews, Christians, and many, but not all Muslims.
  166.  Wylie KR (2015). ABC of Sexual Health. John Wiley & Sons. p. 101. ISBN 978-1-118-66569-5. Although it is mostly common and required in male newborns with Moslem or Jewish backgrounds, certain Christian-dominant countries such as the United States also practice it commonly.
  167.  Creighton S, Liao LM (2019). Female Genital Cosmetic Surgery: Solution to What Problem?. Cambridge University Press. p. 63. ISBN 978-1-108-43552-9. Christians in Africa, for instance, often practise infant male circumcision.
  168.  Nga A (30 December 2019). “The Ritual of Circumcision in Africa: The Case of South Africa”. Africanews. Archived from the original on 6 December 2022. Retrieved 8 November 2022. This practice is old and widespread among African Christians with very close links to their beliefs. It can be executed traditionally or in hospital.
  169.  Bakos GT (2011). On Faith, Rationality, and the Other in the Late Middle Ages:: A Study of Nicholas of Cusa’s Manuductive Approach to Islam. Wipf and Stock Publishers. p. 228. ISBN 978-1-60608-342-0. Although it is stated that circumcision is not a sacrament necessary for salvation, this rite is accepted for the Ethiopian Jacobites and other Middle Eastern Christians.
  170.  Sharkey HJ (2017). A History of Muslims, Christians, and Jews in the Middle East. Cambridge University Press. p. 63. ISBN 978-0-521-76937-2. On the Coptic Christian practice of male circumcision in Egypt, and on its practice by other Christians in western Asia.
  171.  “Circumcision protest brought to Florence”. Associated Press. 30 March 2008. Archived from the original on 26 March 2023. Retrieved 2 August 2022. However, the practice is still common among Christians in the United States, Oceania, South Korea, the Philippines, the Middle East and Africa. Some Middle Eastern Christians actually view the procedure as a rite of passage.
  172.  Ross JI (2015). Religion and Violence: An Encyclopedia of Faith and Conflict from Antiquity to the Present. Routledge. p. 169. ISBN 978-1-317-46109-8. For instance, the majority of South Koreans, Americans, and Filipinos, as well as African Christians, practice circumcision.
  173.  Peteet JR (2017). Spirituality and Religion Within the Culture of Medicine: From Evidence to Practice. Oxford University Press. pp. 97–101. ISBN 978-0-19-027243-2. male circumcision is still observed among Ethiopian and Coptic Christians, and circumcision rates are also high today in the Philippines and the US.
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  175.  Ubayd A (2006). The Druze and Their Faith in Tawhid. Syracuse University Press. p. 150. ISBN 978-0-8156-3097-5. Male circumcision is standard practice, by tradition, among the Druze
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  178.  Jacobs D (1998). Israel and the Palestinian Territories: The Rough Guide. Rough Guides. p. 147. ISBN 978-1-85828-248-0. Circumcision is not compulsory and has no religious significance.
  179.  Silver MM (2022). The History of Galilee, 1538–1949: Mysticism, Modernization, and War. Rowman & Littlefield. p. 97. ISBN 978-1-7936-4943-0. Muslim men are circumcised, whereas this is not a religious obligation among the Druze
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Notes

  1.  The most commonly-done procedure is in actuality not a circumcision but a dorsal slit, where no foreskin is actually removed. When the foreskin is removed, it is commonly known locally as a “German cut” in reference to the introduction of the modern surgical technique by the founder of plastic and reconstructive surgery, Johann Friedrich Dieffenbach.[203]

Circumcisionat Wikipedia’s sister projects

vteCircumcision
vteRites of passage
vteTests and procedures involving the male reproductive system
vteInfants and their care
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