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Estimates of the worldwide prevalance of male circumcision vary between 20-30%; the vast majority for religious or cultural reasons. Only in the United States, are the majority of male infants circumcised for non-religious reasons. In some tribal rituals, such as those practiced by the Maasai of Eastern Africa and the Tongans, the foreskin is cut so that it no longer covers the glans, but no tissue is actually removed. Especially when performed before puberty, such methods of body modification yield a penis that appears very similar to one that has been circumcised, and many authors describe these rituals as circumcision even though no part of the foreskin is removed. Circumcision may be recommended in cases, such as phimosis (a very tight foreskin), or posthitis (an inflamed foreskin) for which circumcision is an effective treatment. However, the majority of circumcisions are performed for religious or cultural reasons. 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. Although a majority of newborn males are circumcised in the United States, it is often performed only when a consent form is signed by a parent. If this consent form is not signed, the child is usually not circumcised.
Methods of circumcision
When performed on infants or young boys, circumcision is performed either without anesthesia or using a local anesthetic; the use of local anesthetic is increasingly common. Infant circumcison is almost always performed with the aid of a clamping device. Although several variations exist, most serve the same two purposes. First, the clamp crushes the foreskin so that no blood can pass through it, limiting or eliminating bleeding during the operation. Second, the clamp acts as a shield to protect the remainder of the penis from being accidentally cut. Common varieties of clamp include the Gomco clamp [1] (http://www.circlist.com/instrstechs/gomco.html), the Plastibell (a disposable device commonly used in the United States)[2] (http://www.circlist.com/instrstechs/plastibell.html), the Mogen clamp (the most common device used in Jewish ritual circumcisions)[3] (http://www.circlist.com/instrstechs/mogen.html), and the Tara KLamp [4] (http://www.circlist.com/instrstechs/taraklamp.html). In infants, the foreskin is usually connected to the glans penis by one or more bridges of tissue called the synechial membrane or preputial adhesions. Prior to circumcision, these must be broken or torn by means of a blunt probe, forceps, or scissors. The loosened foreskin is then clamped, and the portion of the foreskin held in the clamp cut off. Unless the clamped edges of skin come loose, childhood circumcisions are usually dressed in a light bandage without sutures. Alternatively, some styles of clamp are designed to stay in place for several days, holding the wound closed until it heals. In adults, where circumcision is performed for medical or personal reasons in a hospital setting it is normally performed under general anaesthesia. Surgery under local anesthesia is also commonplace. While some varieties of the clamps used for infant circumcision are also made in adults sizes, adulthood circumcisions are most commonly performed "freehand" using a surgical blade. This requires more skill on the part of the surgeon, but gives the surgeon precise control over how much skin is removed and where it is removed from, the placement and appearance of the resulting scar, and other cosmetic factors. For adulthood circumcisions, the surgical wound is sutured to prevent it from reopening during erection, and then bandaged. Following circumcision, the pain is controllable using oral analgesics. Normally there is no distress when the penis is flaccid, but erections can cause significant discomfort for several days following the operation. Urination is normal during healing, and sexual functions can usually be resumed after 2-3 weeks. Some men report unpleasant sensitivity of their glans after adult circumcision, but this settles down within the first month as the glans becomes used to being in contact with clothing. Alternative treatmentsFor many disorders, such as phimosis, alternative conservative treatments exist. A dorsal slit or the use of steroid creams often resolve phimosis. Urinary tract infections, while much less common in circumcised boys than in either girls or uncircumcised boys, can often be effectively treated with antibiotics.[5] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10742321&dopt=Abstract) PrevalenceApproximately one sixth of males worldwide are circumcised [6] (http://www.cirp.org/library/complications/williams-kapila/); the vast majority for religious or cultural reasons. The United States is the only country that still practices circumcision routinely on a majority of male infants for non-religious reasons. The majority of males are circumcised in the following countries:
In most of these countries the predominant religion (usually Islam or Judaism) endorses circumcision. Historically, routine infant 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 [7] (http://www.cirp.org/library/cultural/pang1/). 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 the age of five every year in the United Kingdom [8] (http://www.cirp.org/library/general/gairdner/). In most of the rest of the world, circumcision is done either as a religious or cultural practice. Before the 1870s, circumcision in the United States was performed to treat phimosis and cancerous lesions. During the last few decades of the nineteenth century, in accord with the accepted reflex neurosis theory of the time, circumcision came to be used to treat diseases that were not localized to the penis, especially those that affected the nervous system. In addition, circumcision was performed to prevent chronic masturbation, which was then believed to cause various diseases. Social considerations helped make the procedure widespread. During the Victorian era a great emphasis was placed on cleanliness and secretions such as smegma were treated with suspicion. In the end, however, routine neonatal circumcision eventually came to be practiced on a majority of males around the turn of the century because of the hygienic and preventive benefits of the procedure, the same justification that is still used today. In the United States, statistics collected by the National Center for Health Statistics show that the overall rate of neonatal circumcision has remained near 65% since data collection began in 1979 [9] (http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions_race.htm). However, strong regional differences in the circumcision rates have developed during this time. While more than 80% of newborn boys are circumcised in the Midwest and South, circumcision rates have declined to about 37% in the West [10] (http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions_region.htm). This has been attributed in part to increasing births among Latin Americans, who usually do not circumcise [11] (http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions.htm). Thirteen states no longer pay for the procedure under Medicaid; the other 37 still do. The medical benefits of circumcision are a controversial topic. Some argue that circumcision is an essential public health measure, while others believe that there are no benefits to the procedure (see medical analysis of circumcision). The major medical societies in 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.
Circumcision for religious purposesCircumcision 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[17] (http://www.newadvent.org/cathen/06111a.htm) in 1442, held by leading theologians of the Roman Catholic Church, which said in part:
A number non-Western cultures practice circumcision, such as the Machapunga tribe of Native North Americans, some Australian Aborigines, some tribes in New Guinea, Tongans, Niueans, Samoans and widley across Africa. 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. Contemporary attitudes toward circumcisionJust as circumcision rates vary widely between circumcising countries, and even between different regions in countries, so attitudes toward circumcision vary widely. Besides cultural or religious motivations for circumcision, some people believe that circumcised penises are more attractive, while others do not. A 1988 study of new mothers found that 71% preferred a circumcised partner for sexual intercourse, and 83% for giving fellatio. When asked why, 92% responded that it stays cleaner and 90% that it looks sexier. Although 78% of the women had not had direct contact with an uncircumcised penis, those who did expressed the same preference.[19] (http://health.groups.yahoo.com/group/independentreference/message/4) Most men, whether circumcised or not, are content with their circumcision status. Many circumcised men believe that being circumcised as an infant is better than later, so they cannot remember the pain of the procedure. Other men resent having been circumcised without their consent, especially after hearing of alleged loss of sensitivity. Despite evidence that circumcision does not lead to increased keratinization [20] (http://bmj.bmjjournals.com/cgi/content/full/320/7249/1592) or reduction in sensitivity of the glans [21] (http://health.groups.yahoo.com/group/independentreference/message/5) anti-circumcision activists continue to make such unsupported claims. Some campaign against circumcision. A few seek to regain their foreskin through surgical or non-surgical foreskin restoration procedures after being told by anti-circumcision activists that it will lead to improved penile sensitivity. However, despite the evidence to the contrary some men who undergo foreskin restoration claim that the procedure really does improve glans sensitivity. It is therefore probable that much of this perceived "improved sensitivity" of the glans reported by foreskin restorers is psychosexual and psychosomatic and an example of the placebo effect, with no real change in glans sensitivity.[22] (http://bmj.bmjjournals.com/cgi/content/full/309/6955/679/a) [23] (http://bmj.bmjjournals.com/cgi/eletters/309/6955/679/a#43129) Over the past twenty years there has been a growing movement against circumcision. The goal of this movement is to end, and possibly even criminalize, the forced circumcision of males and females. History of circumcisionThe origin of circumcision is hidden in the mists of pre-history. Many, possibly hundreds, of hypotheses have been advanced as to the origin of the practice. Some of propose that circumcision began as a religious sacrifice, as a rite of passage marking a boy's entrance into adulthood, as a form of sympathetic magic to ensure virility, as a means of suppressing (or enhancing) male sexual pleasure, as an aid to hygiene where regular bathing was impractical, as a means of marking those of lower (or higher) social status, as a means of differentiating a circumcising group from their non-circumcising neighbors, as a means of discouraging masturbation or other socially proscribed sexual behaviors, to increase a man's attractiveness to women, as a symbolic castration, as a demonstration of one's ability to endure pain, or as a male counterpart to menstruation or the breaking of the hymen. It is probable that circumcision arose independently in different cultures for different reasons. The oldest documentary evidence for circumcision comes from Egypt. Tomb artwork from the Sixth Dynasty (2345 - 2181 BC) shows men with circumcised penises, and one relief from this period shows the rite being performed on a standing adult male. The Egyptian hieroglyph for "penis" depicts either a circumcised or an erect organ. The examination of Egyptian mummies has found both circumcised and uncircumcised men. Circumcision in the Ancient WorldCircumcision was common, although not universal, among ancient Semitic peoples. The Book of Jeremiah, written in the sixth century BC, lists the Egyptians, Jews, Edomites, Ammonites, and Moabites as circumcising people. Herodotus, writing in the fifth century BC, would add the Colchians, Ethiopians, Phoenicians, and Syrians to that list. The ancient Greeks, however, considered an unmodified penis far more aesthetic than a circumcised one. Ancient Greek artwork portrayed penises as covered by the foreskin (sometimes in exquisite detail), except in the portrayal of satyrs, lechers, and barbarians.[24] (http://www.cirp.org/library/history/hodges2/) The Greek preference for the uncircumcised penis is reflected in Herodotus' comment on the Egyptians: "They practice circumcision for the sake of cleanliness, considering it better to be clean than comely." (Herodotus, Book 2, 37:2). In the aftermath of Alexander the Great's conquests, the Greek 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. The writer of 1 Maccabees wrote that under the Seleucids, many Jewish men attempted to hide or reverse their circumcision so they could exercise in Greek gymnasia (see foreskin restoration). Similar cultural pressures operated throughout the Hellenistic world: when the Judean king John Hyrcanus conquered the Idumeans, he forced them to become circumcised and convert to Judaism, but their ancestors the Edomites had practiced circumcision in pre-Hellenistic times. In Egypt, only the priestly caste retained circumcision, and by the second century, the only circumcising groups in the Roman Empire were Jews, Egyptian priests, and the Nabatean Arabs. 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. Circumcision in the 18th CenturyCircumcision was not practiced amongst Christians in Europe in the 18th Century. It was regarded with repulsion.
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:
Circumcision in the 19th Century and beyondUntil well into the Nineteenth Century, the same sentiments prevailed.
Then, a change of attitude began, something that was reflected in successive editions of the Encyclopaedia Britannica:
Anti-masturbation panic and circumcisionThe 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,[29] (http://www.noharmm.org/paige.htm) 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:
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.
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:
Forced CircumcisionsForcible circumcisions occasionally happen in circumcising cultures. It may happen because of a drunken assault [32] (http://www.cirp.org/news/1997.10.08_Australia/), mob violence [33] (http://www.cirp.org/news/thenation08-23-02/) or when cultural norms are forced on unwilling members of the group [34] (http://allafrica.com/stories/200408250493.html). In one case a young Rastafarian South African was captured by his Xhosa relatives and forcibly circumcised against his will [35] (http://www.iol.co.za/index.php?set_id=1&click_id=139&art_id=vn20040704124240917C136839) . The outcry that followed this alarmed the Jewish and Muslim communities in case all circumcisions were made illegal [36] (http://www.clevelandjewishnews.com/articles/2004/07/22/news/world/aaa.txt). There are also cases where men have responded violently to being circumcised against their will [37] (http://www.cirp.org/news/eastafricanstandard08-15-02/) or because of being taunted because of their circumcision status. [38] (http://www.cirp.org/news/heraldsun08-15-02/) Forced circumcisions and conversions are not supported by moderate Muslim leaders. However, Muslim extremists forcibly circumcised men, women and children in the Moluccas Islands (Indonesia) in January 2001 [39] (http://old.smh.com.au/news/0101/27/review/review9.html) [40] (http://www.cirp.org/news/morningherald01-27-01/) [41] (http://www.domini.org/openbook/ind20010119.htm) [42] (http://www.csw.org.uk/CSWnews.asp?item=171) [43] (http://www.csw.org.uk/CSWnews.asp?item=164) [44] (http://www.cwnews.com/Browse/2000/12/14545.htm) . Forced circumcisions and forced conversions to Islam also occurred in the Sudan [45] (http://www.cirp.org/news/frontpage11-25-03/) [46] (http://www.newsmax.com/archives/articles/2001/6/6/205759.shtml)and in Pakistan [47] (http://www.asianews.it/view.php?l=en&art=1583). Circumcision as an identifying markIn non-circumcising cultures, circumcision can be seen as evidence of being Muslim or Jewish. Nazis used this to find out who was Jewish in a massacre at Pushkin, near St Petersburg, in 1941 [48] (http://www.fjc.ru/news/newsArticle.asp?AID=212660). This also occurred in India on several occasions, such as in 1992 following the destruction of the Babri mosque in Ayodhya, Hindu mobs would undress men in the street and kill any circumcised people they find, assuming they are Muslims. In the Moscow theatre hostage crisis in 2003, the Russian forces undressed the corpses to identify who are Muslims. Similarly, following the massacre of children at Beslan, enraged people turned on any men with a foreign accent, undressed them to see if they were circumcised and if they were, they were determined to be Muslim. One man was torn apart by the angry mob and police were barely able to rescue four others [49] (http://www.kommersant.com/page.asp?id=505415). See also
References
External linksPro-circumcision
Neutral
Anti-circumcision
de:Zirkumzision fr:circoncision ja:割礼 nl:Besnijdenis pl:Obrzezanie es:circuncisión
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