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Circumcision

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Circumcision is the surgical removal of some or all of the prepuce or foreskin (including the ridged band), a highly sensitive part of the penis. Female circumcision is a term applied to a variety of mutilations performed on female genitalia, of which only one, the removal of the clitoral hood, is comparable to male circumcision. Only the operation on males is discussed in the remainder of this article. The word circumcision comes from Latin circum (="around") and caedere (="to cut"). Another form of surgery practiced on the penis in some cultures is subincision.

Circumcision may be considered for medical reasons in a small number of cases, such as phimosis. However, the majority of circumcisions are performed for religious or cultural reasons, and when medical benefits are claimed, these are of a preventive rather than therapeutic nature; that is, the procedure is supposed to reduce certain risks later in life and not supposed to be a cure. The practice is the source of considerable controversy.

Table of contents
1 How circumcision is performed
2 Prevalence
3 Circumcision for religious purposes
4 Contemporary attitudes towards circumcision
5 Origins of circumcision
6 Circumcision in the Greco-Roman World
7 Circumcision in the 18th Century
8 Circumcision in the 19th Century and beyond
9 Anti-masturbation panic and circumcision
10 Forced circumcisions
11 See also
12 References
13 External links

How circumcision is performed

In infants, a variety of methods are used. In the great majority of cases, there is either no anaesthetic or only a local anaesthetic. All methods have in common the tearing away of the skin covering the glans penis (these are still attached in infants), and the removal of a varying amount of skin. The extent of the removal, the precise location of the removal, and the cosmetic result all vary a great deal: some circumcised males retain a significant proportion of their nerve-rich penile skin and have an amount of mobile skin remaining on the erect penis, while others do not. In some cases the scar is small and unnoticeable; in others it is large, jagged and obvious.

Image:Uncircumsized_penis.gif image:Circumsized_penis.gif
An uncircumcised penis, a circumcised penis

In adults, circumcision is sometimes performed under general anaesthetic. The foreskin is removed with a sharp-bladed instrument of some kind. The remaining skin is then stitched back using dissolvable stitches. The penis is then wrapped in protective bandages and a jockstrap style harness to keep it in place.

The glans, which was previously protected by the foreskin, is very sensitive; some people are prone to bleeding. After the circumcision, the pain is controllable and goes away quickly during the day. Normally there is no distress when the penis is flaccid, but the penis becomes partially or fully erect one or more times each night. Thus, for the first week or two after an adult circumcision, the patient can experience a significant amount of pain during the erection. Some patients stay in a hospital for 1-2 nights after the operation. The glans slowly becomes desensitized during the following month.

Prevalence

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

The majority of males are circumcised in the following countries:

Afghanistan, Albania, Algeria, Azerbaijan, Bahrain, Bangladesh, Benin, Cameroon, Chad, Comoros, Djibouti, Egypt, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Indonesia, Iran, Iraq, Israel, Kazakhstan, Kenya, Kuwait, Lebanon, Libya, Madagascar, Malaysia, Maldives, Mali, Mauritania, Morocco, Nigeria, Niger, Pakistan, Philippines, Qatar, Republic of the Congo, Samoa. Tonga, Saudi Arabia, Sierra Leone, Somalia, South Africa, South Korea, Sudan, Syria, Tajikistan, Togo, Tunisia, Turkey, Turkmenistan, United Arab Emirates, the United States of America, Uzbekistan, Vanuatu, and Yemen.

In most of these countries the predominant religion endorses circumcision, such as Islam or Judaism.

Historically, routine neonatal circumcision was promoted during late Victorian times in the English-speaking parts of Canada, Australia, New Zealand, the United States and the United Kingdom and was widely practiced during the first part of the 20th century in these countries. However, the practice declined sharply in the United Kingdom after the Second World War, and somewhat later in Canada, Australia and New Zealand. It has been argued (e.g., Goldman 1997) that the practice did not spread to other European countries because others considered the arguments for it fallacious. In South Korea, circumcision was largely unknown before the establishment of the United States trusteeship in 1945. More than 90% of South Korean high school boys are now circumcised, but the average age of circumcision is 12 years, which makes South Korea a unique case [1].

From the late Victorian era, circumcision became more common in the higher classes in the United Kingdom. Queen Victoria had the notion that her family was descended from King David of Israel, and mandated that her sons, including the future King Edward VII be circumcised. King Edward continued the practice, and among the English royal family, the practice is still widespread: Prince Charles, Prince Andrew, and Prince Edward, were all circumcised. Reportedly, the late Diana, Princess of Wales rebelled against the royal tradition and refused to allow her sons, Prince William and Prince Harry, to be circumcised.

Routine infant circumcision has been abandoned in New Zealand and Britain, and is now much less common in Australia and in Canada (see table 1). The decline in circumcision in the United Kingdom followed the decision by the National Health Service (NHS) in 1948 not to cover the procedure following an influential article by Douglas Gardiner which claimed that circumcision resulted in the deaths of about 16 children under 5 each year in the United Kingdom. [1]. In most of the rest of the world, circumcision is done either as a religious or cultural practice.

Routine neonatal circumcision in the United States grew out of a widespread fear that masturbation caused various diseases, a view now universally rejected by the medical community. Circumcision was thought to reduce masturbation and other sexual behavior considered undesirable. Circumcision, depending on how it is practiced, can have a significant impact on masturbation; see masturbation for a detailed discussion.

Circumcision is now also dwindling in the United States. The rate has been steadily decreasing from near universality in the 1960s to approximately 55% today. While some states no longer pay for the procedure under Medicaid, more than 75% of the states still do.

Many medical claims have been made about circumcision. These included the prevention of epilepsy, penile cancer and phimosis. Circumcision advocates today claim that it reduces urinary tract infections and HIV infection, but these claims are strongly disputed and argued against. (See medical analysis of circumcision.)

The major medical societies in Great Britain, Canada, Australia and New Zealand do not support routine infant circumcision. All major medical organizations in the United States now judge the benefits of the procedure to be too small to justify the risks associated with performing it routinely. Neonatal circumcision nonetheless still remains the most common pediatric operation carried out in the U.S. today.

Table 1
International circumcision rates
CountryYearRoutine neonatal circumcisions (%)
United States200155.1% [1]
CanadaFY 1996/9717% [1]
Australia1995-9610.6% [1]
New Zealand19950.35%* [1]
United Kingdom19980.4% [1]
*Samoans, Tongans and Niueans in New Zealand continue to practice circumcision, but not in public hospitals, which this data refers to

Circumcision for religious purposes

Circumcision of males is a religious practice traditionally required by Judaism. The Jewish ceremony of circumcision is called a Brit milah or Bris Milah (Hebrew for "Covenant of circumcision"). The ceremony is to be performed on the eighth day of life of the newborn boy unless health reasons force a delay. See also Circumcision in the Bible.

According to nearly all Muslim religious leaders, circumcision is an important element of Islam. Although circumcision is not mentioned in the Quran (and the mutilation of the body is expressly forbidden therein), it is mentioned in some parts of the Hadith, a set of texts explaining Islamic law that most Muslims view as authoritative. Most Muslims believe that Mohammed was born circumcised. Moreover, Hadiths describe that the ritual of circumcision was started by Abraham, who is seen as the founder of Islam. Muslim custom on circumcision varies. Some Muslim communities perform circumcision on the eighth day of life, as the Jews do, while others perform the rite at a different time. Turkish, Balkan, and Central Asian Muslims typically circumcise boys at between six and eleven years of age, and the event is viewed communally as a joyous occasion and celebrated with sweets and feasting. In contrast, Iranian Muslims are typically circumcised in the hospital at birth without much ado. In Egypt, rural areas celebrate circumcision as a joyous occasion, while urban populations have it done in the hostpital.

Circumcision is also customary in the Coptic Christian religious tradition. It is usually performed on the eighth day of life, as the Jews do. This practice was condemned by the Council of Florence[1] in 1442, held by leading theologians of the Roman Catholic Church, which said in part:

Therefore it strictly orders all who glory in the name of Christian, not to practise circumcision either before or after baptism, since whether or not they place their hope in it, it cannot possibly be observed without loss of eternal salvation. [1]

Some African, Australian Aboriginal, and Polynesian societies continue to practice it. Circumcision practices among these societies vary, including at what age the procedure is done, whether women may be present, what celebrations are attendant on the procedure, and whether the procedure is viewed as an initiation.

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

Contemporary attitudes towards circumcision

Many men have no problem with or prefer being circumcised. Besides cultural or religious motivations for circumcision, many believe that circumcised penises are more attractive. They believe that being circumcised as an infant is better than at a later time, when they might remember the pain that would be associated with the procedure. Other men resent having been circumcised without their consent, especially after hearing of the heightened pleasure uncircumcised men claim to have. Some campaign against circumcision. A few seek to regain their foreskin through medical or non-medical procedures.

Several groups have developed in the past twenty years to oppose circumcision. Most of the groups are not opposed to adults choosing circumcision but regard neonatal circumcision as a sexual mutilation, and consider it barbaric, primitive, unnecessary, and dangerous. Most oppose infant circumcision in all cases but many are particularly concerned when the procedure is done without pain relief, still a common practice. Many of these groups try to avoid vocabulary like "anti-circumcision" in order to avoid confusion with the adult circumcision issue; the critics of the movement, however, often use such vocabulary.

The goal of most of these groups is to end, and possibly even criminalize, the forced circumcision of male and female individuals. Anti-circumcision groups take a varying approach toward Judaism and Islam. Some make no distinction between differently motivated types of circumcision, while others ask for reform instead of criminalization [1]. Among Jews and Muslims, circumcision is religiously prescribed for all baby boys, and in those countries where the population is mostly Jewish or Muslim, circumcision is prevalent. Most Jewish and Muslim groups oppose the anti-circumcision movement, as they fear that it could stigmatize or criminalize a key practice of their religions.

Some of the anti-circumcision groups include: NOCIRC (National Organization of Circumcision Information Resource Centers), ARC (Attorneys for the Rights of the Child), NOHARMM (the National Organization to Halt the Abuse and Routine Mutilation of Males), D.O.C. (Doctors Opposing Circumcision), and NRC (Nurses for the Rights of the Child). One of the positions held by opponents of circumcision is that a significant part of the infant's body is unnecessarily and permanently removed without the subject's consent, the same argument used by opponents of female genital mutilation. Some have tried to challenge the legal status of circumcision. An umbrella organization, the International Coalition for Genital Integrity [1], is unilaterally opposed to any forced genital cutting, whether on males, females or the intersexed. Many of the previously mentioned anti-circumcision organizations are members of ICGI.

However, some liberal Jews oppose circumcision. Doctor Ronald Goldman (no relation to the murder victim of the same name) has collected arguments against circumcision in his book Questioning Circumcision: A Jewish Perspective. Based on many of the above arguments, he argues that circumcision is unnecessary and dangerous, and claims that foregoing the practice would be consistent with traditional and reform Jewish ethics, while continuing it would not. The book has been strongly condemned by the Jewish community. Several Reconstructionist and Reform rabbis, who no longer follow Jewish law, have given it favorable reviews. A small number of Jews have joined a group called Jews Against Circumcision [1]. People in this group and some other Jews opposed to the Brit Milah practice an alternative ritual called Brit Shalom that does not involve circumcision [1]. Such alternative rituals are rejected by the mainstream Jewish community.

Those who try to restore their foreskin non-medically use methods such as stretching the skin covering the distal penile shaft down over the glans penis through techniques such as wearing weights on it, or taping the skin over a small cap worn over the glans. This process is known as epispasm or foreskin restoration and is mentioned as far back as the Maccabees, over 2000 years ago (1 Macc 1:15). Those attempting to restore their foreskins have reported some success, although a great deal of patience and consistency is required to have any permanent effect. Cosmetic surgical procedures to repair the foreskin also exist. None of these methods can restore the sexually sensitive tissue that is removed by circumcision.

Origins of circumcision

The origin of circumcision is hidden in the mists of pre-history. It is possible that it arose as a religious ritual, as a form of sympathetic magic, as a health control measure, as a way to control the sexuality of children and adults, or as a way to prevent masturbation. It is almost certain that it independently developed in different cultures for different reasons.

Documentary evidence shows the first references to circumcision in Egypt no later than 2300 B.C. Artwork showing the rite being performed on a standing adult male adorns tombs of this period. It is argued that the hieroglyphic sign for "penis" in the Egyptian Book of the Dead is a circumcised organ (Source: Gerald Weiss, MD, A Perspective on Controversies Over Neonatal Circumcision, Clinical Pediatrics, Vol 33 No 12, December 1994), however it is just as plausible that the penis is erect.

All the male mummies belonging to the ancient Egyptian royal families are circumcised [1], with the only exception being Ahmose [1], the founder of the Eighteenth dynasty of Egypt, and some unidentified boys [1] who did not reach adulthood.

Herodotus wrote that Colchians, Ethiopians, Phoenicians, Syrians, and Macroni practiced circumcision. In reference specifically to the Egyptians, and reflecting the prevalent Greek view that an uncircumcised penis was more attractive than a circumcised one, mused that "They practice circumcision for the sake of cleanliness, considering it better to be clean than comely." (Herodotus, Book 2, 37:2).

Some philosophers, including the Jewish philosophers Maimonides and Philo believed that the reason circumcision was commanded was to control the male's sexual impulses. Other Jewish philosophers hold that the reason is to seal in one's flesh a symbol of the covenant between God and the Jewish people.

Many, possibly hundreds, of explanations have been offered. For example, Desmond Morris offers this speculation: "The Egyptians believed that when the snake shed its skin, and emerged shiny and new again, it was undergoing rebirth. They reasoned that if, by shedding skin, the snake could become apparently immortal, then humans should follow suit. They made the simple equation: snakeskin = foreskin, and the operation began."

Dunsmuir and Gordon write "Nineteenth century historians suggested that the ritual is an ancient form of social control. They conceive that the slitting of a man's penis to cause bleeding and pain is to remind him of the power of the Church, i.e., 'We have control over your distinction to be a man, your pleasure and your right to reproduce'. The ritual is a warning and the timing dictates who is warned; for the newborn it is the parents who accede to the Church: 'We mark your son, who belongs to us, not to you'. For the young adolescent, the warning accompanies the aggrandizement of puberty; the time when growing strength give independence, and the rebellion of youth."

Other theories advanced include that circumcision was instituted to mark slaves or captured prisoners, to distinguish the people practicing circumcision from other groups as means of preventing dilution of the bloodline or intermarriage, to be attractive to the opposite sex, for hygienic purposes, for the symbolic freedom from motherly care, for increased sexual feelings, as a test of bravery, as entry into adulthood, as self-sacrifice to promote longevity or rebirth, as symbolic castration, and as simulated menstruation. [1]

Some believe that in some cultures, circumcision was developed, and is still used, to control a child's sexuality, that this is the core motive behind circumcision, and that any other explanation is secondary or a pretext.

Circumcision in the Greco-Roman World

According to ancient Greek aesthetics of the human form, circumcision was a mutilation of a previously perfectly shaped organ. Greek artwork of the period portrayed penises as covered by the foreskin (sometimes in exquisite detail), except in the portrayal of satyrs, lechers, and barbarians.

This prejudice against the appearance of the circumcised penis led to a decline in the incidence of circumcision among many peoples that had previously practiced it throughout Hellenistic times, except among Jews. By the second century, circumcision was sufficiently rare among non-Jews that being circumcised was considered conclusive evidence of Judaism in Roman courts—Suetonius described a court proceeding in which a ninety-year-old man was stripped naked before the court to determine whether he was evading the head tax placed on Jews. The first-century Alexandrian Apion denounced circumcision as a barbaric custom in his diatribe against the Jews, notwithstanding that it was still practised among the Egyptian priestly caste.

Roman satirists including Horace and Juvenal equated the exposure of the glans that results from circumcision to its exposure during erection, and they caricatured Jewish men as being lustful or lecherous, sometimes in an incestuous or homosexual sense, often implying that Jewish men had unusually large penises and were of great sexual potency.

Techniques for restoring the appeareance of an uncircumcised penis were known by the 2nd century B.C. In one such technique, a copper weight (called the Judeum pondum) was hung from the remnants of the circumcised foreskin until, in time, they became sufficiently stretched to cover the glans. The first-century writer Celsus described two surgical techniques for foreskin restoration in his medical treatise De Medicina. In one of these, the skin of the penile shaft was loosened by cutting in around the base of the glans. The skin was then stretched over the glans and allowed to heal, giving the appearance of an uncircumcised penis. Jewish religious writers denounced such practices as abrogating the covenant of Abraham in 1 Maccabees and the Talmud.

Circumcision in the 18th Century

Circumcision was not practiced amongst Christians in Europe in the 18th Century. It was regarded with repulsion.

Edward Gibbon had referred to it as a "singular mutilation" practised only by Jews and Turks and as "a painful and often dangerous rite" ...(R. Darby) [1]

In 1753 in London there was a proposal for Jewish emancipation. It was furiously opposed by the pamphleteers of the time, who spread the fear that Jewish emancipation meant universal circumcision. Men were urged to protect:

"the best of Your property" and guard their threatened foreskins. It was an extraordinary outpouring of popular beliefs about sex, fears about masculinity and misconceptions about Jews, but also a striking indication of how central to their sexual identity men considered their foreskins at that time. (R.Darby) [1]

Circumcision in the 19th Century and beyond

Until well into the Nineteenth Century, the same sentiments prevailed.

Richard Burton observed that "Christendom practically holds circumcision in horror". This attitude is reflected in the ninth edition of the Encyclopaedia Britannica (1876) which discusses the practice as a religious rite among Jews, Moslems, the ancient Egyptians and tribal peoples in various parts of the world. The author of the entry rejected sanitary explanations of the procedure in favour of a religious one: "like other body mutilations ... [it is] of the nature of a representative sacrifice". (R. Darby) [1]

Then, a change of attitude began, something that was reflected in successive editions of the Encyclopaedia Britannica:

By 1910 the entry had been turned on its head: "This surgical operation, which is commonly prescribed for purely medical reasons, is also an initiation or religious ceremony among Jews and Mahommedans": now it was primarily a medical procedure and only after that a religious ritual. The entry explained that "in recent years the medical profession has been responsible for its considerable extension among other than Jewish children ... for reasons of health" (11th edition, Vol. 6). By 1929 the entry is much reduced in size and consists merely of a brief description of the operation, which is "done as a preventive measure in the infant" and "performed chiefly for purposes of cleanliness". Ironically, readers are then referred to the entries for "Mutilation" and "Deformation" for a discussion of circumcision in its religious context (14th edition, 1929, Vol. 5). (R. Darby) [1]

Anti-masturbation panic and circumcision

The movement of the skin layers of the foreskin provides a built-in form of lubrication, usually making it easy to masturbate without additional lubrication if a foreskin is present. Depending on its degree, this normal lubricating function can be absent after circumcision.

Non-religious circumcision in English-speaking countries arose in a climate of sexual fear, especially concerning masturbation. In her 1978 article The Ritual of Circumcision,[1] Karen Erickson Paige writes: "In the United States, the current medical rationale for circumcision developed after the operation was in wide practice. The original reason for the surgical removal of the foreskin, or prepuce, was to control 'masturbatory insanity' - the range of mental disorders that people believed were caused by the 'polluting' practice of 'self-abuse.'"

"Self-abuse" was a term commonly used to describe masturbation in the 19th century. According to Paige, "treatments ranged from diet, moral exhortations, hydrotherapy, and marriage, to such drastic measures as surgery, physical restraints, frights, and punishment. Some doctors recommended covering the penis with plaster of Paris, leather, or rubber; cauterization; making boys wear chastity belts or spiked rings; and in extreme cases, castration." Paige details how circumcision became popular as a masturbation remedy:

"In the 1890s, it became a popular technique to prevent, or cure, masturbatory insanity. In 1891 the president of the Royal College of Surgeons in Great Britain published On Circumcision as Preventive of Masturbation, and two years later another British doctor wrote Circumcision: Its Advantages and How to Perform It, which listed the reasons for removing the 'vestigial' prepuce. Evidently the foreskin could cause 'nocturnal incontinence,' hysteria, epilepsy, and irritation that might 'give rise to erotic stimulation and, consequently, masturbation.' Another physician, P.C. Remondino, added that 'circumcision is like a substantial and well-secured life annuity...it insures better health, greater capacity for labor, longer life, less nervousness, sickness, loss of time, and less doctor bills.' No wonder it became a popular remedy." [1]

At the same time circumcisions were advocated on men, clitoridectomies (removal of the clitoris) were also performed for the same reason (to treat female masturbators). The US "Orificial Surgery Society" for female "circumcision" operated until 1925, and clitoridectomies and infibulations would continue to be advocated by some through the 1930s.

One of the leading advocates of circumcision was John Harvey Kellogg, who is well known for his pseudoscientific views on human sexuality. He advocated the consumption of Kellogg's corn flakes to prevent masturbation, and he believed that circumcision would be an effective way to eliminate masturbation in males.

"Covering the organs with a cage has been practiced with entire success. A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should be performed by a surgeon without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. The soreness which continues for several weeks interrupts the practice, and if it had not previously become too firmly fixed, it may be forgotten and not resumed. If any attempt is made to watch the child, he should be so carefully surrounded by vigilance that he cannot possibly transgress without detection. If he is only partially watched, he soon learns to elude observation, and thus the effect is only to make him cunning in his vice."

Robert Darby, writing in the Australian Medical Journal, noted that 19th Century circumcision advocates—and their opponents—were both well aware of the sexual sensitivity of the foreskin:

In the 19th century the role of the foreskin in erotic sensation was well understood by physicians who wanted to cut it off precisely because they considered it the major factor leading boys to masturbation. The Victorian physician and venereologist William Acton (1814–1875) damned it as "a source of serious mischief", and most of his contemporaries concurred. Both opponents and supporters of circumcision agreed that the significant role the foreskin played in sexual response was the main reason why it should be either left in place or removed. William Hammond, a Professor of Mind in New York in the late 19th century, commented that "circumcision, when performed in early life, generally lessens the voluptuous sensations of sexual intercourse", and both he and Acton considered the foreskin necessary for optimal sexual function, especially in old age. Jonathan Hutchinson, English surgeon and pathologist (1828–1913), and many others, thought this was the main reason why it should be excised. [1]

Forced circumcisions

In addition to infants, children or adolescents being circumcised for cultural (mostly religious) reasons, adult men and women are sometimes forced to undergo circumcision, in particular as part of forced conversions to
Islam.[1] [1]

See also

References

External links

Against circumcision

In favor of circumcision

General