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{{Otheruses4|male circumcision|female circumcision|Female genital cutting|Islam's circumcision ritual|Khitan (circumcision)|Judaism's circumcision ritual|Brit milah}}
Male '''circumcision''' is the removal of some or all of the [[foreskin]] (prepuce) from the [[penis]].<ref>Dictionary definitions of circumcision:
*"The act of cutting off the prepuce or foreskin of males, or the internal labia of females." Webster's Revised Unabridged Dictionary (1913) [http://www.dictionary.net/circumcision]
* "to remove the foreskin of (males) sometimes as a religious rite." The Macquarie Dictionary (2nd Edition, 1991)
*"Cut off foreskin of (as Jewish or Mohammedan rite, or surgically), Concise Oxford Dictionary, 5th Edition, 1964
Circumcision defined in a medical context:
*"Male circumcision is the surgical removal of all or part of the foreskin of the penis." [http://www.who.int/hiv/mediacentre/infopack_en_1.pdf Information Package on Male Circumcision and HIV Prevention:Insert 1], [[World Health Organization]]
*"Circumcision, surgical removal of all or part of the foreskin of the human male...", "Circumcision", [[Microsoft Encarta]], 2007.
*"Male circumcision is an elective surgery to remove the foreskin..." [http://www.bchealthguide.org/kbase/topic/special/hw142449/sec1.htm Circumcision], [[British Columbia]] Health Guide, June 2, 2006. Retrieved July 18, 2007.
*"Circumcision is surgery..." [http://www.med.umich.edu/1libr/yourchild/paininf.htm Pain and Your Infant: Medical Procedures, Circumcision and Teething], [[University of Michigan]] Health System, February 2007. Retrieved July 18, 2007.
*" Circumcision is cutting away part of the foreskin... When this surgery is performed..." [http://www.danburyhospital.org/dh_birth_layout.cfm?id=699 Newborn Care], [[Danbury Hospital]] website. Retrieved July 18, 2007.</ref> The word "circumcision" comes from [[Latin]] ''{{lang|la|circum}}'' (meaning "around") and ''{{lang|la|cædere}}'' (meaning "to cut").


[[Category:Films by year]]
Early depictions of circumcision are found in [[cave drawing]]s and [[Ancient Egypt]]ian [[tomb]]s, though some pictures may be open to interpretation.<ref>{{cite journal |last=Hodges |first=F.M. |authorlink= |coauthors= |year=2001 |month=Fall |title=The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme. |journal=The Bulletin of the History of Medicine |volume=75 |issue=3 |pages=375–405 |pmid= 11568485 |url= |accessdate= |quote= |doi=10.1353/bhm.2001.0119 }}</ref><ref>{{cite journal
|last = Wrana
|first = P.
|year = 1939
|title = Historical review: Circumcision
| journal = Archives of Pediatrics
| volume = 56
| issue =
| pages = 385&ndash;392
}} as quoted in: {{cite journal | last = Zoske | first = Joseph | month = Winter | year = 1998 | title = Male Circumcision: A Gender Perspective | journal = [[The Journal of Men's Studies]] | volume = 6 | issue = 2 | pages = 189&ndash;208 | url = http://www.noharmm.org/zoske.htm|accessdate = 2006-06-14}} </ref><ref name = "Gollaher">{{cite book
| last = Gollaher
| first = David L.
| title = Circumcision: a history of the world’s most controversial surgery
| year = 2000
| month = February
| publisher = [[Basic Books]]
| location = [[New York, NY]]
| language =
| id = ISBN 978-0-465-04397-2 {{LCCN|99|0|40015}}
| doi =
| pages = 53&ndash;72
| chapter =
| chapterurl =
| quote =
}}
</ref> Male circumcision is a commandment from God in [[Judaism]].<ref>{{cite web
| url = http://www.jewishvirtuallibrary.org/jsource/Judaism/circumcision.html
| title = Circumcision
| accessdate = 2006-10-03
| publisher = [[Jewish Virtual Library|American-Israeli Cooperative Enterprise]]
}}
</ref> In [[Islam]], though not discussed in the [[Qur'an]], circumcision is widely practiced and most often considered to be a [[sunnah]].<ref>{{cite journal
| last = S.A.H Rizvi, S.A A Naqvi, M Hussain, A.S Hasan
| year = 1999
| title = Religious circumcision: a Muslim view
| journal = BJU International
| volume = 83
| issue = s1
| pages = 13&ndash;16
| doi = 10.1046/j.1464-410x.1999.0830s1013.x
| url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1013.x
| format = PDF
}}
</ref> It is also customary in some Christian churches in Africa, including some [[Oriental Orthodox]] Churches.<ref name=Christian><small>Customary in some Coptic and other churches:
*"The Coptic Christians in Egypt and the Ethiopian Orthodox Christians— two of the oldest surviving forms of Christianity— retain many of the features of early Christianity, including male circumcision. Circumcision is not prescribed in other forms of Christianity.…Some Christian churches in South Africa oppose the practice, viewing it as a pagan ritual, while others, including the Nomiya church in Kenya, require circumcision for membership and participants in focus group discussions in Zambia and Malawi mentioned similar beliefs that Christians should practice circumcision since Jesus was circumcised and the Bible teaches the practice." [http://www.unaids.org/en/MediaCentre/PressMaterials/FeatureStory/20070226_MC_pt1.asp Male Circumcision: context, criteria and culture (Part 1)], [[Joint United Nations Programme on HIV/AIDS]], February 26, 2007.
*"The decision that Christians need not practice circumcision is recorded in Acts 15; there was never, however, a prohibition of circumcision, and it is practiced by Coptic Christians." [http://www.bartleby.com/65/ci/circumci.html "circumcision"], The Columbia Encyclopedia, Sixth Edition, 2001-05.</small></ref>
According to the [[World Health Organization]] (WHO), global estimates suggest that 30% of males are circumcised, of whom 68% are Muslim.<ref>{{cite web
| url = http://www.who.int/hiv/topics/malecircumcision/JC1320_MaleCircumcision_Final_UNAIDS.pdf
| title = Male circumcision: Global trends and determinants of prevalence, safety and acceptability
| accessdate = 2008-08-20
| year = 2007
| publisher = [[World Health Organization]]
|format=PDF}}
</ref> The prevalence of circumcision varies widely between cultures. For example, estimates of the rate of circumcision among boys include nearly all in the [[Middle East]]<ref name="WHO-Info-2">{{cite web
|url = http://www.who.int/hiv/mediacentre/infopack_en_2.pdf
|title = Insert 2
|accessdate = 2007-08-15
|year = 2007
|work = Information Package on Male Circumcision and HIV Prevention
|publisher = [[World Health Organization]]
}}
</ref>, 2% in [[Scandinavia]] and less than 5% in [[United Kingdom|Britain]].<ref>{{cite journal
| last = A M K Rickwood, S E Kenny, S C Donnell
| year = 2000
| title = Towards evidence based circumcision of English boys: survey of trends in practice
| journal = BMJ
| volume = 321
| issue = 7264
| pages = 792&ndash;793
| doi = 10.1136/bmj.321.7264.792
| url = http://www.bmj.com/cgi/reprint/321/7264/792.pdf
| format = PDF
}}
</ref> Recent estimates of the infant circumcision rate include 56% in the United States,<ref name="USAcircratefall">{{cite news |first= |last= |title=U.S. circumcision rates vary by region |url=http://www.upi.com/Health_News/2008/01/21/US_circumcision_rates_vary_by_region/UPI-23421200949956/ |work= |publisher=UPI |date=January 21, 2008 |accessdate=2008-08-19 }}</ref> less than 14% in Canada,<ref>{{cite web | url =http://www.canadiancrc.com/Newspaper_Articles/Gazette_Rates_circumcision_slashed_30_years_23MAR06.aspx | title = Rates of circumcision slashed in past 30 years | accessdate = 2008-10-02 | publisher = The Gazette |date= march 23, 2006}}</ref> and less than 15% in Australia.<ref name= "richters"/> Neonatal circumcision is thought to have become common in English-speaking countries in the mid-nineteenth century;<ref>{{cite journal | first = Robert | last = Darby | year = 2003 | month = Spring | title = The masturbation taboo and the rise of routine male circumcision: A review of the historiography - Review Essay | journal = Journal of social history | volume = 27 | issue = 1 | pages = 737&ndash;757 | url = http://www.cirp.org/library/history/darby4/}}</ref> more recently, the rate is reported to have declined in Australia and Canada.<ref>{{cite journal |author=Spilsbury K, Semmens JB, Wisniewski ZS, Holman CD |title=Routine circumcision practice in Western Australia 1981-1999 |journal=ANZ J Surg |volume=73 |issue=8 |pages=610–4 |year=2003 |month=August |pmid=12887531 |doi= |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=1445-1433&date=2003&volume=73&issue=8&spage=610}}</ref> In the United States, reports variously state that it is falling,<ref>{{cite journal |author=Mor Z, Kent CK, Kohn RP, Klausner JD |title=Declining rates in male circumcision amidst increasing evidence of its public health benefit |journal=PLoS ONE |volume=2 |issue=9 |pages=e861 |year=2007 |pmid=17848992 |pmc=1955830 |doi=10.1371/journal.pone.0000861 |url=}}</ref> stable,<ref>{{cite news |first= |last= |title=U.S. circumcision rates vary by region |url=http://www.hcup-us.ahrq.gov/reports/statbriefs/sb45.pdf |publisher=Agency for Healthcare Research and Quality |date=January, 2008 |accessdate=2008-08-19 }}</ref> or increasing.<ref>{{cite journal |author=Nelson CP, Dunn R, Wan J, Wei JT |title=The increasing incidence of newborn circumcision: data from the nationwide inpatient sample |journal=J. Urol. |volume=173 |issue=3 |pages=978–81 |year=2005 |month=March |pmid=15711354 |doi=10.1097/01.ju.0000145758.80937.7d |url=}}</ref>


[[ar:تصنيف:أفلام إنتاج 2003]]
There is scientific evidence supporting both sides of the circumcision controversy. [[Genital integrity|Opponents of circumcision]] claim that it violates the individual's bodily rights, is medically unnecessary, adversely affects sexual pleasure and performance, and is a practice defended by myths.<ref name = "Milos">{{cite journal
[[az:Kateqoriya:2003 filmləri]]
| last = Milos
[[bs:Kategorija:2003 film]]
| first = Marilyn Fayre
[[bg:Категория:Филми от 2003 година]]
| coauthors = Donna Macris
[[ca:Categoria:Pel·lícules del 2003]]
| year = 1992
[[cs:Kategorie:Filmy roku 2003]]
| month = March&ndash;April
[[cy:Categori:Ffilmiau 2003]]
| title = Circumcision: A medical or a human rights issue?
[[da:Kategori:Film fra 2003]]
| journal = Journal of Nurse-Midwifery
[[de:Kategorie:Filmtitel 2003]]
| volume = 37
[[et:Kategooria:2003. aasta filmid]]
| issue = 2 S1
[[es:Categoría:Películas de 2003]]
| pages = S87–S96
[[eo:Kategorio:Filmoj aperintaj en 2003]]
| pmid = 1573462
[[eu:Kategoria:2003ko filmak]]
| doi = 10.1016/0091-2182(92)90012-R
[[fa:رده:فیلم‌های سال ۲۰۰۳ (میلادی)]]
| url = http://www.cirp.org/library/ethics/milos-macris/
[[fr:Catégorie:Film sorti en 2003]]
| accessdate = 2007-04-06
[[gl:Categoría:Cine 2003]]
}}
[[ko:분류:2003년 영화]]
</ref> [[Circumcision advocacy|Advocates for circumcision]] claim that it provides important health advantages which outweigh the risks, that it has no substantial effects on sexual function, has a complication rate of less than 0.5% when carried out by an experienced physician, and is best performed during the neonatal period.<ref name="Schoen">{{cite journal
[[id:Kategori:Film tahun 2003]]
| last = Schoen
[[is:Flokkur:Kvikmyndir frumsýndar 2003]]
| first = Edgar J
[[he:קטגוריה:סרטי 2003]]
| year = 2007
[[ka:კატეგორია:2003 წლის ფილმები]]
| title = Should newborns be circumcised? Yes
[[lt:Kategorija:2003 filmai]]
| journal = Can Fam Physician
[[lv:Kategorija:2003. gada filmas]]
| volume = 53
[[hu:Kategória:2003 filmjei]]
| issue = 12
[[mk:Категорија:Филмови од 2003]]
| pages = 2096&ndash;8, 2100&ndash;2
[[ms:Kategori:Filem 2003]]
| pmid = 18077736
[[nl:Categorie:Film uit 2003]]
| url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18077736
[[ja:Category:2003年の映画]]
| accessdate = 2008-05-02
[[no:Kategori:Filmer fra 2003]]
}}
[[nn:Kategori:Filmar frå 2003]]
</ref>
[[pl:Kategoria:Filmy z 2003 roku]]

[[pt:Categoria:Filmes de 2003]]
The [[American Medical Association]] stated in 1999: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."<ref>{{cite web
[[ro:Categorie:Filme din 2003]]
|url=http://www.ama-assn.org/ama/pub/category/13585.html
[[ru:Категория:Фильмы 2003 года]]
|title=Neonatal Circumcision
[[sq:Category:Filma 2003]]
|accessdate=2008-04-20}}</ref>
[[simple:Category:2003 movies]]

[[sk:Kategória:Filmy z 2003]]
The World Health Organization (WHO; 2007), the [[Joint United Nations Programme on HIV/AIDS]] (UNAIDS; 2007), and the [[Centers for Disease Control and Prevention]] (CDC; 2008) state that evidence indicates male circumcision significantly reduces the risk of [[HIV]] acquisition by men during penile-vaginal sex, but also state that circumcision only provides partial protection and should not replace other interventions to prevent transmission of HIV.<ref name="WHO-C&R"/><ref name="CDC-2008">{{cite web |title=Male Circumcision and Risk for HIV Transmission and Other Health Conditions: Implications for the United States |publisher=Centers for Disease Control and Prevention |year=2008 |url=http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm}}</ref>
[[sl:Kategorija:Filmi leta 2003]]

[[sr:Категорија:Филмови 2003.]]
==Modern circumcision procedures==
[[fi:Luokka:Vuoden 2003 elokuvat]]
For infant circumcision, modern devices such as the [[Gomco clamp]], [[Plastibell]], and [[Mogen clamp]] are available.<ref>{{cite journal
[[sv:Kategori:Filmer 2003]]
| last = Holman
[[th:หมวดหมู่:ภาพยนตร์ที่ออกฉายในปี พ.ศ. 2546]]
| first = John R.
[[vi:Thể loại:Phim 2003]]
| coauthors = Evelyn L. Lewis, Robert L. Ringler
[[tr:Kategori:2003 filmleri]]
| year = 1995
[[uk:Категорія:Фільми 2003]]
| month = August
[[zh:Category:2003年电影]]
| title = Neonatal circumcision techniques &ndash; includes patient information sheet
| journal = American Family Physician
| volume = 52
| issue = 2
| pages = 511&ndash;520
| id = {{ISSN|0002-838X}} PMID 7625325
| url = http://www.findarticles.com/p/articles/mi_m3225/is_n2_v52/ai_17281985
| accessdate = 2006-06-29
}}
</ref>

All devices follow the same basic procedure. First the amount of foreskin to be removed is estimated. Then the foreskin is opened via the preputial orifice to reveal the [[glans penis | glans]] underneath and ensure it is normal. The inner lining of the foreskin (preputial epithelium) is then bluntly separated from its attachment to the glans. The device is then placed (this sometimes requires a dorsal slit) and remains there until [[Hemostasis | bleeding has stopped]]. Finally, the foreskin is amputated.<ref name = "AAP1999"/>
* With the Plastibell, adhesions between the glans and inner preputial epithelium separated with a probe, the foreskin is cut longitudinally, the Plastibell is placed over the glans and the foreskin is placed over the Plastibell. A [[ligature]] is then tied firmly around the foreskin and tightened into a groove in the Plastibell to achieve hemostasis. Foreskin distal to the ligature is excised and the handle is snapped off of the Plastibell device. The Plastibell falls off of the penis after the wound has healed, typically in three to seven days.<ref>{{cite journal
| last = Herbert
| first = Barrie
| coauthors = ''et al''
| title = The Plastibell Technique for Circumcision
| journal = Br Med J
| volume = 2
| issue = 5456
| pages = 273–275
| year = 1965
| url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1845746
| pmid = 14310205}}</ref>
* With a Gomco clamp, a section of skin is dorsally crushed with a [[hemostat]] and then slit with scissors. The foreskin is drawn over the bell shaped portion of the clamp and inserted through a hole in the base of the clamp. The clamp is tightened, "crushing the foreskin between the bell and the base plate." The crushed blood vessels provide hemostasis. The flared bottom of the bell fits tightly against the hole of the base plate, so the foreskin may be cut away with a scalpel from above the base plate. <ref>{{cite journal
| last = Peleg
| first = David
| coauthors = Ann Steiner
| year = 1998
| month = September 15,
| title = The Gomco Circumcision: Common Problems and Solutions
| journal = American Family Physician
| volume = 58
| issue = 4
| pages = 891&ndash;898
| id = {{ISSN|0002-838X}} PMID 9767725
| url = http://www.aafp.org/afp/980915ap/peleg.html
| accessdate = 2006-06-29
}}
</ref>
* With a Mogen clamp, the foreskin is pulled dorsally with a straight hemostat, and lifted. The Mogen clamp is then slid between the glans and hemostat, following the angle of the corona to "avoid removing excess skin ventrally and to obtain a superior cosmetic result" to Gomco or Plastibell circumcisions. The clamp is locked, and a scalpel is used to cut the skin from the flat (upper) side of the clamp.<ref name="Pfenninger">{{cite book
| last = Pfenninger
| first = John L.
| coauthors = Grant C. Fowler
| title = Procedures for primary care
| origyear = 1994
| origmonth =
| url =
| format =
| accessdate =
| accessyear =
| accessmonth =
| edition = 2nd
| date = July 21, 2003
| year =
| month =
| publisher = Mosby
| location =
| language =
| id = ISBN 978-0-323-00506-7 {{LCCN|2003|0|56227}}
| doi =
| pages =
| chapter =
| chapterurl =
| quote =
}}
</ref><ref name="Reynolds">{{cite journal
| last = Reynolds
| first = RD
| year = 1996
| month = July
| title = Use of the Mogen clamp for neonatal circumcision
| journal = American Family Physician
| volume = 54
| issue = 1
| pages = 177&ndash;182
| doi =
| pmid = 8677833
| url =
| format = Abstract
| accessdate = 2006-07-18
}}
</ref>

Adult circumcisions are often performed without clamps and require 4 to 6 weeks of abstinence from [[masturbation]] or intercourse after the operation to allow the wound to heal.<ref>{{cite journal |last=Holman |first=J.R. |authorlink= |coauthors=K.A. Stuessi |year=1999 |month=March |title=Adult circumcision |journal=American Family Physician |volume=59 |issue=6 |pages=1514-1518 |pmid=10193593 |url=http://www.aafp.org/afp/990315ap/1514.html |accessdate= |quote= }}</ref> In poor [[Africa]]n countries, male circumcision is often performed by non-medical personnel under unsterile conditions.<ref>{{cite web |url=http://www.iht.com/articles/2007/02/27/news/health.php |title=In Africa, a problem with circumcision and AIDS}}</ref>
After circumcision, the disposition of the [[foreskin]] varies. After hospital circumcision, the foreskin may be used in biomedical research,<ref>{{cite journal |last=Hovatta |first=O. |coauthors=M. Mikkola1, K. Gertow, A.-M. Strömberg, J. Inzunza1, J. Hreinsson1, B. Rozell, E. Elisabeth Blennow, M. Andäng, L. Ährlund-Richter |year=2003 |month=July |title=A culture system using human foreskin fibroblasts as feeder cells allows production of human embryonic stem cells |journal=Human Reproduction |volume=18 |issue=7 |pages=1404-1409 |pmid=12832363 |url= }}</ref> consumer skin-care products.<ref>{{cite web |url=http://www.nbc10.com/health/1808693/detail.html |title=The Skinny On 'Miracle' Wrinkle Cream|year=2002|month=November|publisher=NBC Universal, Inc|work=NBC10.com|accessdate=2008-08-20}}</ref>, skin grafts<ref>{{cite web|url=http://www.wired.com/science/discoveries/news/1999/02/17912|title=High-Tech Skinny on Skin Grafts|date=02.16.99|publisher=CondéNet, Inc|work=www.wired.com:science:discoveries|accessdate=2008-08-20}}</ref><ref>{{cite web|url=http://www.emedicine.com/derm/TOPIC867.HTM|title=Skin Grafting|publisher=WebMD|work=www.emedicine.com|accessdate=2008-08-20}}</ref><ref>{{cite web|first=Catherine|last=Amst|coauthors=Carey, John|url=http://www.businessweek.com/1998/30/b3588001.htm|title=Biotech Bodies|date=July 27, '98|publisher=The McGraw-Hill Companies Inc|work=www.businessweek.com|accessdate=2008-08-20}}</ref>, for [[interferon|β-interferon]]-based drugs,<ref>{{cite web |author=Cowan, Alison Leigh|url=http://query.nytimes.com/gst/fullpage.html?res=9E0CE6D81E38F93AA25757C0A964958260&partner |title=Wall Street; A Swiss Firm Makes Babies Its Bet|date=April 19, 1992|publisher=New York Times|work=New York Times:Business|accessdate=2008-08-20}}</ref>. In parts of Africa, the foreskin may be dipped in brandy and eaten by the patient, eaten by the circumciser, or fed to animals.<ref>{{cite journal | last = Anonymous (editorial)| title = A ritual operation| journal = BRITISH MEDICAL JOURNAL| volume = 2| pages = 1458-1459| date = 1949-12-24| pmc = 2051965 |quote=<small>"...in parts of West Africa, where the operation is performed at about 8 years of age, the prepuce is dipped in brandy and eaten by the patient; in other districts the operator is enjoined to consume the fruits of his handiwork, and yet a further practice, in Madagascar, is to wrap the operation specifically in a banana leaf and feed it to a calf."</small>| accessdate = 2008-09-26}}</ref> According to [[halakha|Jewish law]], after a ''[[Brit milah]]'', the foreskin should be buried.<ref>''[[Shulchan Aruch]]'', ''[[Yoreh Deah]]'', 265:10</ref>

==Cultures and religions {{Anchor|Cultures and religions}}==
[[Image:Covenant of Abraham.JPG|thumb|right|Jewish [[Brit milah |ritual circumcision]].]]
{{see also|Circumcision in cultures and religions}}
{{see also|Brit milah}} ("covenant of circumcision" is ritual circumcision in [[Judaism]])
{{see also|Khitan (circumcision)}} (circumcision as carried out in [[Islam]])

Circumcising cultures may circumcise their males either shortly after birth, during childhood, or around puberty as part of a rite of passage. Circumcision is most prevalent in the [[Muslim world]], parts of [[South East Asia]], [[Africa]], the [[United States]], [[The Philippines]], [[Israel]], and [[South Korea]]. It is relatively rare in [[Europe]], [[Latin America]], parts of [[Southern Africa]], and most of [[Asia]] and [[Oceania]]. It is commonly practised in the [[Jewish]] and [[Islamic]] faiths. [[Christianity]], [[Hinduism]], [[Buddhism]], and [[Sikhism]] do not require the practise of circumcision.

[[Halakha|Jewish law]] states that circumcision is a '''[[613 mitzvot|mitzva aseh]]'' ("positive commandment" to perform an act) and is obligatory for Jewish-born males and some Jewish male converts. It is only postponed or abrogated in the case of threat to the life or health of the child.<ref name="GlassJM">{{cite journal
| last = Glass
| first = J.M.
| year = 1999
| month = January
| title = Religious circumcision: a Jewish view
| journal = BJU International
| volume = 83
| issue = Supplement 1
| pages = 17–21
| doi = 10.1046/j.1464-410x.1999.0830s1017.x
| pmid = 10766529
| url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1017.x
| format = PDF
| accessdate = 2006-10-18
}}
</ref> It is usually performed by a ''[[mohel]]'' on the eighth day after birth in a ceremony called a ''[[Brit milah]]'' (or ''Bris milah'', colloquially simply ''bris''), which means "Covenant of circumcision" in [[Hebrew language|Hebrew]].
It is considered of such religious importance that the body of an uncircumcised Jewish male will sometimes be circumcised before burial.<ref>{{cite book
|last = Lamm
|first = Maurice
|title = The Jewish Way in Death and Mourning
|origdate = 1969
|url = http://www.chabad.org/library/article_cdo/aid/281541/jewish/The-Jewish-Way-in-Death-and-Mourning.htm
|publisher = Jonathan David
|location = New York
|pages = 239&ndash;240
}}
</ref>

In [[Islam]], circumcision is mentioned in some ''[[hadith]]'', but not in the [[Qur'an]]. Some ''[[Fiqh]]'' scholars state that circumcision is recommended (''[[Sunnah]]''); others that it is obligatory.<ref>{{cite web
| url = http://www.islam-qa.com/index.php?ln=eng&ds=qa&lv=browse&QR=9412&dgn=4
| title = Question #9412: Circumcision: how it is done and the rulings on it
| accessdate = 2006-07-01
| last = Al-Munajjid
| first = Muhammed Salih
| publisher = Islam Q&A
}}
</ref> Some have quoted the ''hadith'' to argue that the requirement of circumcision is based on the covenant with [[Abraham]].<ref>{{cite web
| url = http://www.islam-qa.com/index.php?ln=eng&ds=qa&lv=browse&QR=7073&dgn=3
| title = Question #7073: The health and religious benefits of circumcision
| accessdate = 2006-07-01
| last = Al-Munajjid
| first = Muhammed Salih
| publisher = Islam Q&A
}}
</ref> While endorsing circumcision for males, scholars note that it is not a requirement for converting to Islam.<ref>{{cite book
| last =al-Sabbagh
| first = Muhammad Lutfi
| title =Islamic ruling on male and female circumcision
| publisher = [[World Health Organization]]
| year = 1996
| location = [[Alexandria]]
| pages = 16
| isbn = }}</ref>
[[Image:Koceks - Surname-i Vehbi.jpg|thumb|right|Illustrated account of the circumcision ceremony of Sultan Ahmed III's three sons.]]
Circumcision is customary among the [[Coptic Christian|Coptic]], [[Ethiopian Orthodox|Ethiopian]], and [[Eritrean Orthodox]] Churches, and also some other African churches.<ref name=Christian/> Some Christian churches in South Africa oppose circumcision, viewing it as a pagan ritual, while others, including the Nomiya church in Kenya,<ref name=Christian/><ref>{{cite journal |last=Mattson |first=C.L. |authorlink= |coauthors=R.C. Bailey, R. Muga, R. Poulussen, T. Onyango |year=2005 |month=February |title=Acceptability of male circumcision and predictors of circumcision preference among men and women in Nyanza Province, Kenya |journal=AIDS Care |volume=17 |issue=2 |pages=182–194 |pmid=15763713 |url= |accessdate= |quote= |doi=10.1080/09540120512331325671 }}</ref> require circumcision for membership. Some Christian churches celebrate the [[Circumcision of Christ]].<ref>{{cite web|url=http://www.goarch.org/en/chapel/calendar.asp?Y=2007&M=1|title=Greek Orthodox Archdiocese calendar of Holy Days}}</ref><ref>{{cite web|url=http://www.holytrinityorthodox.com/calendar/los/January/01-01.htm|title=Russian Orthodox Church, Patriarchate of Moscow}}</ref> The vast majority of Christians do not practise circumcision as a religious requirement.

Circumcision in South Korea is largely the result of American cultural and military influence following the [[Korean War]]. In West Africa infant circumcision may have had tribal significance as a rite of passage or otherwise in the past; today in some non-Muslim [[Nigeria]]n societies it is medicalised and is simply a cultural norm.<ref>Ajuwon et al., "Indigenous surgical practices in rural southwestern Nigeria: Implications for disease," Health Educ. Res..1995; 10: 379&ndash;384 Health Educ. Res..1995; 10: 379&ndash;384 Retrieved 3 October 2006</ref>
[[Image:Circoncision-vers1460misselclermontferrand-bmms72fo356.jpg|thumb|left|Circumcision of Jesus. Illumination from a missal, ca 1460. <ref>Municipal Library of Clermont-Ferrand, France</ref>]]
Circumcision is part of [[rite of passage|initiation rites]] in some African, Pacific Islander, and Australian aboriginal [[traditions]] in areas such as [[Arnhem Land]],<ref>{{cite paper
| author = Aaron David Samuel Corn
| title = Ngukurr Crying: Male Youth in a Remote Indigenous Community
| version = Working Paper Series No. 2
| publisher = [[University of Wollongong]]
| year= 2001
| url = http://www.uow.edu.au/arts/sealcp/wkgpapers/wp2.pdf
| format = PDF
| accessdate = 2006-10-18
}}
</ref> where the practice was introduced by Makassan traders from [[Sulawesi]] in the [[Indonesia]]n Archipelago.<ref>{{cite web
| url = http://www.mfgsc.vic.edu.au/greenturtledreaming/EKmigrate.htm
| title = Migration and Trade
| accessdate = 2006-10-18
| publisher = Green Turtle Dreaming
| quote = In exchange for turtles and trepang the Makassans introduced tobacco, the practice of circumcision and knowledge to build sea-going canoes.
}}
</ref> Circumcision ceremonies among certain Australian aboriginal societies are noted for their painful nature: [[subincision]] is practised amongst some aboriginal peoples in the Western Desert.<ref>{{cite journal
| last = Jones
| first = IH
| year = 1969
| month = June
| title = Subincision among Australian western desert Aborigines
| journal = British Journal of Medical Psychology
| volume = 42
| issue = 2
| pages = 183&ndash;190
| doi =
| id = {{ISSN|0007-1129}} PMID 5783777
}}
</ref>
In the Pacific, ritual circumcision is nearly universal in the Melanesian islands of [[Fiji]] and [[Vanuatu]];<ref>{{cite web
| url = http://www.aids.net.au/aids-png-project-20060403.htm
| title = RECENT GUEST SPEAKER
| accessdate = 2006-07-01
| year = 2006
| publisher = Australian AIDS Fund Incorporated
}}
</ref> participation in the traditional land diving on [[Pentecost Island]] is reserved for those who have been circumcised.<ref>{{cite web
| url = http://www.getaway.co.nz/destination.asp?id=34
| title = Weird & Wonderful
| accessdate = 2006-07-01
| publisher = United Travel
}}
</ref>

Circumcision is also commonly practiced in the Polynesian islands of [[Samoa]], [[Tonga]], [[Niue]], and [[Tikopia]]. In Samoa it is accompanied by a celebration.

Among some West African animist groups, such as the [[Dogon]] and Dowayo, circumcision is taken to represent a removal of "feminine" aspects of the male, turning boys into fully masculine males.<ref>{{cite web
| url = http://www.necep.net/articles.php?id_soc=12&id_article=84
| title = Circumcision amongst the Dogon
| accessdate = 2006-09-03
| year = 2006
| publisher = The Non-European Components of European Patrimony (NECEP) Database
}}
</ref> Among the Urhobo of southern Nigeria it is symbolic of a boy entering into manhood. The ritual expression, ''Omo te Oshare'' ("the boy is now man"), constitutes a rite of passage from one age set to another.<ref>{{cite journal
| last = Agberia
| first = John Tokpabere
| year = 2006
| title = Aesthetics and Rituals of the Opha Ceremony among the Urhobo People
| journal = Journal of Asian and African Studies
| volume = 41
| issue = 3
| pages = 249&ndash;260
| doi = 10.1177/0021909606063880
| url = http://jas.sagepub.com/cgi/reprint/41/3/249.pdf
| format = PDF
| accessdate = 2006-10-18
}}
</ref> For [[Nilotic]] peoples, such as the [[Kalenjin]] and [[Maasai]], circumcision is a rite of passage observed collectively by a number of boys every few years, and boys circumcised at the same time are taken to be members of a single [[age set]].<ref>{{cite web
| url = http://www.masaikenya.org/
| title = Masai of Kenya
| accessdate = 2007-04-06
| quote = <small>Authority derives from the age-group and the age-set. Prior to circumcision a natural leader or olaiguenani is selected; he leads his age-group through a series of rituals until old age, sharing responsibility with a select few, of whom the ritual expert (oloiboni) is the ultimate authority. Masai youths are not circumcised until they are mature, and a new age-set is initiated together at regular intervals of twelve to fifteen years. The young warriors (ilmurran) remain initiates for some time, using blunt arrows to hunt small birds which are stuffed and tied to a frame to form a head-dress.</small>
}}
</ref>

==Ethical, psychological and legal considerations==
===Ethical issues===
[[Image:Activist.jpg|thumb|upright|A protest against routine infant circumcision]]
{{main|Bioethics of neonatal circumcision}}

[[genital integrity|Opponents of circumcision]] question the ethical validity of removing healthy, functioning genital tissue from a minor, arguing that infant circumcision infringes upon individual autonomy and represents a [[human rights|human rights violation]].<ref name = "Somerville">{{cite book
| last = Somerville
| first = Margaret
| title = The ethical canary: science, society, and the human spirit
| url =
| accessdate = 2007-02-12
| year = 2000
| month = November
| publisher = [[Viking Press|Viking Penguin Canada]]
| location = [[New York, NY]]
| isbn = 0670893021
| id = {{LCCN|2001||369341}}
| pages = 202–219
| chapter = Altering Baby Boys’ Bodies: The Ethics of Infant Male Circumcision

| chapterurl = http://www.intact.ca/canary.htm
| quote =
}}
</ref><ref name = "VanHoweLegal">{{cite journal
| last = Van Howe
| first = R.S.
| coauthors = J.S. Svoboda, J.G. Dwyer, and C.P. Price
| year = 1999
| month = January
| title = Involuntary circumcision: the legal issues
| journal = BJU International
| volume = 83
| issue = Supp1
| pages = 63–73
| pmid = 10349416
| doi = 10.1046/j.1464-410x.1999.0830s1063.x
| id =
| url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1063.x
| language =
| format = PDF
| accessdate = 2007-02-12
}}
</ref>
[[Circumcision advocacy|Proponents of circumcision]] argue that circumcision prevents infections and slows down the spread of [[AIDS]].<ref name = "ANRS">{{cite journal
| last = Auvert
| first = B.
| coauthors = D. Taljaard, E. Lagarde, J. Sobngwi-Tambekou, R. Sitta and A. Puren
| year = 2005
| month = November
| title = Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial
| journal = PLoS Medicine
| volume = 2
| issue = 11
| pages = 1112&ndash;1122
| doi =
| pmid = 16231970
| url = http://medicine.plosjournals.org/archive/1549-1676/2/11/pdf/10.1371_journal.pmed.0020298-S.pdf
| format =
| quote = <small>There were 20 HIV infections (incidence rate = 0.85 per 100 person-years) in the intervention group and 49 (2.1 per 100 person-years) in the control group, corresponding to an RR of 0.40 (95% CI: 0.24%-0.68%; p < 0.001). This RR corresponds to a protection of 60% (95% CI: 32%-76%).</small>
| accessdate =
}}
</ref>

====Consent====
Views differ on whether limits should be placed on caregivers having a child circumcised.

Some medical associations take the position that the parents should determine what is in the best interest of the infant or child,<ref name = "AAP1999">{{cite journal
| last = American Academy of Pediatrics Task Force on Circumcision
| coauthors =
| year = 1999
| month = March 1,
| title = Circumcision Policy Statement
| journal = Pediatrics
| volume = 103
| issue = 3
| pages = 686&ndash;693
| doi = 10.1542/peds.103.3.686
| id = {{ISSN|0031-4005}} PMID 10049981
| url = http://pediatrics.aappublications.org/cgi/reprint/pediatrics;103/3/686.pdf
| format = PDF
| accessdate = 2006-07-01
}}
</ref><ref name = "CSA:I-99" /><ref name="CMAJ2"/> but the [[Royal Australasian College of Physicians]] (RACP) and the [[British Medical Association]] (BMA) observe that controversy exists on this issue.<ref name = "RACPSumm">{{cite web
| url = http://www.racp.edu.au/download.cfm?DownloadFile=A453CFA1-2A57-5487-DF36DF59A1BAF527
| title = Policy Statement On Circumcision
| accessdate = 2007-02-28
| year = 2004
| month = September
| format = PDF
| publisher = [[Royal Australasian College of Physicians]]
| pages =
| language =
| archiveurl =
| archivedate =
| quote = <small>The Paediatrics and Child Health Division, The Royal Australasian College of Physicians (RACP) has prepared this statement on routine circumcision of infants and boys to assist parents who are considering having this procedure undertaken on their male children and for doctors who are asked to advise on or undertake it. After extensive review of the literature the RACP reaffirms that '''there is no medical indication for routine neonatal circumcision.''' Circumcision of males has been undertaken for religious and cultural reasons for many thousands of years. It remains an important ritual in some religious and cultural groups.…In recent years there has been evidence of possible health benefits from routine male circumcision. The most important conditions where some benefit may result from circumcision are urinary tract infections, HIV and later cancer of the penis.…The complication rate of neonatal circumcision is reported to be around 1% to 5% and includes local infection, bleeding and damage to the penis. Serious complications such as bleeding, septicaemia and meningitis may occasionally cause death. The possibility that routine circumcision may contravene human rights has been raised because circumcision is performed on a minor and is without proven medical benefit. Whether these legal concerns are valid will be known only if the matter is determined in a court of law. If the operation is to be performed, the medical attendant should ensure this is done by a competent operator, using appropriate anaesthesia and in a safe child-friendly environment. In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents. Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate.</small>
}}</ref><ref name = "BMAGuide">{{cite web
| url = http://www.bma.org.uk/ap.nsf/Content/malecircumcision2006?OpenDocument&Highlight=2,circumcision
| title = The law and ethics of male circumcision &ndash; guidance for doctors
| accessdate = 2006-07-01
| author = Medical Ethics Committee
| year = 2006
| month = June
| publisher = [[British Medical Association]]
}}
</ref>
The BMA state that in general, "the parents should determine how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices." They state that because the parents' interests and the child's interests sometimes differ, there are "limits on parents' rights to choose and parents are not entitled to demand medical procedures contrary to their child's best interests." They state that competent children may decide for themselves.<ref name = "BMAGuide" /> [[UNAIDS]] states that "[m]ale circumcision is a voluntary surgical procedure and health
care providers must ensure that men and young boys are given all the necessary information to
enable them to make free and informed choices either for or against getting circumcised."<ref>{{cite web
|url = http://data.unaids.org/pub/InformationNote/2007/mc_briefing_pack1_en.pdf
|title = Information Package on Male Circumcision and HIV Prevention
}}</ref>

Some argue that the medical problems that have their risk reduced by circumcision are already rare, can be avoided, and, if they occur, can usually be treated in less invasive ways than circumcision. [[Margaret Somerville|Somerville]] states that the removal of healthy genital tissue from a minor should not be subject to parental discretion and that physicians who perform the procedure are not acting in accordance with their ethical duties to the patient.<ref name = "Somerville" /> Denniston contends that circumcision is harmful and asserts that in the absence of the individual's consent, non-therapeutic child circumcision violates several ethical principles that govern medicine.<ref>{{cite web|url=http://www.humanehealthcare.com/Article.asp?art_id=620|title=Circumcision and the Code of Ethics, George C. Denniston, Humane Health Care Volume 12, Number 2}}</ref>

Others believe neonatal circumcision is permissible, if parents should so choose. Viens argues that, in a cultural or religious context, circumcision is of significant enough importance that parental consent is sufficient and that there is "an absence of sufficient evidence or persuasive argumentation" to support changing the present policy.<ref>{{cite journal |title=Value judgment, harm, and religious liberty |author=Viens AM |journal=J Med Ethics |volume=30 |pages=241–7 |year=2004 |doi=10.1136/jme.2003.003921}}</ref> Benatar and Benatar argue that circumcision can be beneficial to a male before he would be able to otherwise provide consent, that "it is far from obvious that circumcision reduces sexual pleasure," and that "it is far from clear that non-circumcision leaves open a future person’s options in every regard."<ref>{{cite journal |url=http://bioethics.net/journal/pdf/3_2_LT_w01_Benetar.pdf |first=David |last=Benatar |coauthors=Benatar, Michael |title=How not to argue about circumcision |journal=American Journal of
Bioethics |volume=3 |issue=2 |year=2003 |pages=W1&ndash;W9 |doi=10.1162/152651603102387820|format=PDF}}</ref>

====Acknowledgment of pain====
Williams (2003) argued that human attitudes toward the pain that animals (including humans) experience may not be based on [[speciesism]]; developing an analogy between attitudes toward the pain pigs endure while having their tails "docked", and "our culture's indifference to the pain that male human infants experience while being circumcised."<ref>{{cite journal
| last = Williams
| first = R. M.
| authorlink =
| coauthors =
| title = On the Tail-Docking of Pigs, Human Circumcision, and their Implications for Prevailing Opinion Regarding Pain
| journal = Journal of Applied Philosophy
| volume = 20
| issue = 1
| pages = 89–93
| publisher =
| location =
| date = 2003-01
| url = http://www.blackwell-synergy.com/doi/abs/10.1111/1468-5930.00237
| doi = 10.1111/1468-5930.00237
| id =
| accessdate = 2008-06-24}}</ref>

===Psychological and emotional consequences===
The British Medical Association (2006) state that "it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks."<ref name = "BMAGuide" /> Goldman (1999) discussed the possible trauma of circumcision on children and parents, anxieties over the circumcised state, a tendency to repeat the trauma, and suggested a need on the part of circumcised doctors to find medical justifications for the procedure.<ref>{{cite journal
| last = Goldman
| first = R.
| year = 1999
| month = January
| title = The psychological impact of circumcision
| journal = BJU International
| volume = 83
| issue = S1
| pages = 93&ndash;102
| doi = 10.1046/j.1464-410x.1999.0830s1093.x
| id =
| url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1093.x
| format = PDF
| accessdate = 2006-07-02
}}
</ref> [[Marilyn Milos|Milos]] and Macris (1992) argue that circumcision encodes the perinatal brain with violence and negatively affects infant-maternal bonding and trust.<ref name="Milos"/> Moses ''et al.'' (1998) state that "scientific evidence is lacking" for psychological and emotional harm, and cite a longitudinal study which did not find a difference in developmental and behavioural indices.<ref>{{cite journal |author=Moses, S |coauthors=Bailey, RC; Ronald AR |title=Male circumcision: assessment of health benefits and risks |journal=Sex Transm Infect |year=1998 |volume=74 |pages=368&ndash;73}}</ref> In the United States, the [[Centers for Disease Control and Prevention]] stated: "In a study of adolescents¸ only 69% of circumcised and 65% of uncircumcised young men correctly identified their circumcision status as verified by physical exam."<ref>{{cite web |url=http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm |title=Male Circumcision and Risk for HIV Transmission and Other Health Conditions: Implications for the United States}}</ref>

===Legality===
{{main|Circumcision and law}}

In 2001, [[Sweden]] allowed only persons certified by the National Board of Health to circumcise infants, requiring a medical doctor or an anesthesia nurse to accompany the circumciser and for anaesthetic to be applied beforehand. Jews and Muslims in Sweden objected to the law,<ref>{{cite web
| url = http://news.bbc.co.uk/2/hi/europe/1572483.stm
| title = Sweden restricts circumcisions
| accessdate = 2006-10-18
| date = October 1, 2001
| publisher = [[BBC|BBC Europe]]
| quote = Swedish Jews and Muslims object to the new law, saying it violates their religious rights.
}}
</ref> and in 2001, the [[World Jewish Congress]] stated that it was “the first legal restriction on Jewish religious practice in Europe since the Nazi era.”<ref>{{cite web
| url = http://www.canadiancrc.com/articles/Jews_Protest_Swedish_Circumcision_Restriction_07JUN01.htm
| title = Jews protest Swedish circumcision restriction
| accessdate = 2006-10-18
| author = [[Reuters]]
| date = June 7, 2001
| publisher = Canadian Children's Rights Council
| quote = A WJC spokesman said, ‘This is the first legal restriction placed on a Jewish rite in Europe since the Nazi era. This new legislation is totally unacceptable to the Swedish Jewish community.’
}}
</ref> In 2005, the Swedish National Board of Health and Welfare reviewed the law and recommended that it be maintained. In 2006, the U.S. State Department's report on Sweden stated that most Jewish [[mohel]]s had been certified under the law and 3000 Muslim and 40&ndash;50 Jewish boys were circumcised each
year.<ref>{{cite web
| url = http://www.state.gov/g/drl/rls/irf/2006/71410.htm
| title = Sweden
| accessdate = 2007-07-04
| author = Bureau of Democracy, Human Rights, and Labor
| date = September 15, 2006
| work = International Religious Freedom Report 2006
| publisher = US Department of State
}}
</ref>

In 2006, a Finnish court found that a parent's actions in having her 4-year-old son circumcised was illegal. The prosecutor argued that, "part of healthy genitalia is removed without medical foundation, or competent consent". No punishment was assigned by the court.<ref>{{cite web
|url=http://www.hs.fi/english/article/Court+rules+circumcision+of+four-year-old+boy+illegal/1135220958830
|title=Court rules circumcision of four-year-old boy illegal
|accessdate=2007-09-17
|date=2006-08-07
|publisher=HELSINGIN SANOMAT, INTERNATIONAL EDITION}}</ref> In 2008, the Finnish government was reported to be considering a new law to legalize ritual circumcision if the practitioner is a doctor and if the child or parents consents.<ref>{{cite web
|url=http://www.yle.fi/news/left/id97605.html
|title=Finland Considers Legalising Male Circumcision
|accessdate=2008-08-05
|date=2008-07-31
|publisher=Ylesiradio
}}</ref>

==Medical analysis==
{{main|Medical analysis of circumcision}}
[[Medical analysis of circumcision#Costs and Benefits|Medical cost-benefit analyses of circumcision]] have varied. Some found a small net benefit of circumcision,<ref>{{cite journal
| last = Schoen
| first = Edgar J.
| coauthors = Christopher J. Colby, Trinh T. To
| year = 2006
| month = March
| title = Cost Analysis of Neonatal Circumcision in a Large Health Maintenance Organization
| journal = The Journal of Urology
| volume = 175
| issue = 3
| pages = 1111&ndash;1115
| doi = 10.1016/S0022-5347(05)00399-X
| pmid = 16469634
| url = http://www.jurology.com/article/PIIS002253470500399X/abstract
| format = Abstract
| accessdate = 2006-07-01
}}
</ref><ref>{{cite journal
| last = Alanis
| first = Mark C.
| coauthors = Richard S. Lucidi
| year = 2004
| month = May
| title = Neonatal Circumcision: A Review of the World’s Oldest and Most Controversial Operation
| journal = Obstetrical & Gynecological Survey
| volume = 59
| issue = 5
| pages = 379&ndash;395
| doi =
| pmid = 15097799
| url = http://www.obgynsurvey.com/pt/re/obgynsurv/abstract.00006254-200405000-00026.htm;jsessionid=FbJT6LYnQxr66KhvWNsBW0msy7shpJgL39wbFTGLnQpzJ82BGLVQ!1096339265!-949856144!8091!-1
| format = Abstract
| accessdate = 2006-09-27
}}
</ref>{{Verify source|date=November 2007}} some found a small net decrement,<ref>{{cite journal
| last = Van Howe
| first = Robert S.
| year = 2004
| month = November
| title = A Cost-Utility Analysis of Neonatal Circumcision
| journal = Medical Decision Making
| volume = 24
| issue = 6
| pages = 584&ndash;601
| doi = 10.1177/0272989X04271039
| pmid = 15534340
| url = http://mdm.sagepub.com/cgi/content/abstract/24/6/584
| format = Abstract
| accessdate = 2006-07-01
}}
</ref><ref>{{cite journal
| last = Ganiats
| first = TG
| coauthors = Humphrey JB, Taras HL, Kaplan RM.
| year = 1991
| month = Oct&ndash;Dec
| title = Routine neonatal circumcision: a cost-utility analysis
| journal = Medical Decision Making
| volume = 11
| issue = 4
| pages = 282&ndash;293
| doi =
| pmid = 1766331
| url =
| format =
| accessdate = 2006-07-01
}}
</ref> and one found that the benefits and risks balanced each other out and suggested that the decision could "most reasonably be made on nonmedical factors."<ref>{{cite journal
| last = Lawler
| first = FH
| coauthors = Bisonni RS, Holtgrave DR.
| year = 1991
| month = Nov&ndash;Dec
| title = Circumcision: a decision analysis of its medical value.
| journal = Family Medicine
| volume = 23
| issue = 8
| pages = 587&ndash;593
| doi =
| pmid = 1794670
| url =
| format =
| accessdate = 2006-07-01
}}
</ref>

===Pain and pain relief during circumcision===
According to the [[American Academy of Pediatrics]]' 1999 Circumcision Policy Statement, “There is considerable evidence that newborns who are circumcised without analgesia experience pain and psychologic stress.”<ref name="AAP1999"/> It therefore recommended using pain relief for circumcision.<ref name="AAP1999"/> One of the supporting studies, Taddio 1997, found a correlation between circumcision and intensity of pain response during vaccination months later. While acknowledging that there may be "other factors" besides circumcision to account for different levels of pain response, they stated that they did not find evidence of such. They concluded "[[p]]retreatment and postoperative management of neonatal circumcision pain is recommended based on these results."<ref name = "Taddio">{{cite journal
| last = Taddio
| first = Anna
| coauthors = Joel Katz, A Lane Ilersich, [[Gideon Koren]]
| year = 1997
| month = March
| title = Effect of neonatal circumcision on pain response during subsequent routine vaccination
| journal = [[The Lancet]]
| volume = 349
| issue = 9052
| pages = 599&ndash;603
| doi = 10.1016/S0140-6736(96)10316-0
| id =
| url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673696103160.pdf
| format = PDF &mdash; free registration required
| accessdate = 2007-08-08
}}
</ref> Other medical associations also cite evidence that circumcision without anesthetic is painful.<ref name = "AAFP">{{cite web
| url = http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html
| title = Circumcision: Position Paper on Neonatal Circumcision
| accessdate = 2007-01-30
| year = 2007
| publisher = [[American Academy of Family Physicians]]
}}
</ref><ref name="CPSIFP2"/>

Stang, 1998, found 45% of physicians used anaesthesia &ndash; most commonly a dorsal penile nerve block &ndash; for infant circumcisions. Obstetricians used anaesthesia significantly less often (25%) than family practitioners (56%) or pediatricians (71%).<ref name = "Stang">{{cite journal
| last = Stang
| first = Howard J.
| coauthors = Leonard W. Snellman
| year = 1998
| month = June
| title = Circumcision Practice Patterns in the United States
| journal = [[Pediatrics (journal)|Pediatrics]]
| volume = 101
| issue = 6
| pages = e5&ndash;
| doi = 10.1542/peds.101.6.e5
| id = {{ISSN|1098-4275}}
| url = http://pediatrics.aappublications.org/cgi/reprint/101/6/e5.pdf
| format = PDF
| accessdate = 2006-06-29
}}
</ref> Howard ''et. al'' (1998) surveyed US medical doctor residency programs and directors, and found that 26% of the programs that taught the circumcision procedure "failed to provide instruction in anesthesia/analgesia for the procedure."<ref>{{cite journal
| last = Howard
| first = C.R.
| authorlink =
| coauthors = F.M. Howard, L.C. Garfunkel, E.A. de Blieck, M. Weitzman
| title = Neonatal Circumcision and Pain Relief: Current Training Practices
| journal = Pediatrics
| volume = 101
| issue = 3
| pages = 423–428
| publisher =
| location =
| date = 1998
| url = http://pediatrics.aappublications.org/cgi/content/abstract/101/3/423
| doi =
| id =
| accessdate = 2008-06-19}}</ref> A 2006 follow-up study revealed that the percentage of programs that taught circumcision and also taught administration of topical or local anesthetic had increased to 97%.<ref name=Yawman>{{cite journal
| last = Yawman
| first = D.
| authorlink =
| coauthors = C.R. Howard, P. Auinger, L.C. Garfunkel, M. Allan and M. Weitzman
| title = Pain relief for neonatal circumcision: a follow-up of residency training practices
| journal = Ambulatory Pediatrics
| volume = 6
| issue = 4
| pages = 210–214
| publisher =
| location =
| date = 2006
| url =
| doi =
| pmid = 16843252
| accessdate = }}</ref> However, the authors of the follow-up study also noted that only 84% of these programs used anesthetic "frequently or always" when the procedure was conducted.<ref name=Yawman/>

J.M. Glass, 1999, stated that Jewish ritual circumcision is so quick that "most ''mohelim'' do not routinely use any anaesthesia as they feel there is probably no need in the neonate. However, there is no Talmudic objection and should the parents wish for local anaesthetic cream to be applied there is no reason why this cannot be done."<ref name="GlassJM"/> Tannenbaum and Shechet, 2000, stated that an “authentic, traditional [[Brit milah|bris]] performed by a [[mohel]] does not use clamps, so there is no pain associated with crushing tissue.”<ref name = "Shechet">{{cite journal
| last = Shechet
| first = Jacob
| coauthors = Barton Tanenbaum
| year = 2000
| title = Circumcision&mdash;The Debates Goes On
| journal = [[Pediatrics (journal)|Pediatrics]]
| volume = 105
| issue = 3
| pages = 682–683
| pmid = 10733391
| doi = 10.1542/peds.105.3.681
| url = http://pediatrics.aappublications.org/cgi/reprint/105/3/681.pdf
| format = PDF
| accessdate = 2007-04-06
}}
</ref> They also asserted that due to the speed of the procedure and rarity of complication, it is “more humane not to subject the infant to a local anesthetic.”<ref name = "Shechet" />

Lander ''et al.'' demonstrated that babies circumcised without anesthesia showed behavioral and physiological signs of pain and distress.<ref>{{cite journal |last=Lander |first=J. |coauthors=Brady-Fryer, B., Metcalfe, J.B., Nazarali, S. and S. Muttitt |year=1997 |month= |title=Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision: a randomized controlled trial |journal=JAMA |volume=278 |issue=24 |pages=2157-2162 |pmid=9417009 |url= |accessdate= |quote= }}</ref> Comparisons of the dorsal penile nerve block and [[EMLA]] (lidocaine/prilocaine) topical cream methods of pain control have revealed that while both are safe,<ref name=Brady-Fryer/><ref>{{cite journal | last =Lehr | first =V.T. | coauthors =E. Cepeda, D.A. Frattarelli, R. Thomas, J. LaMothe and J.V. Aranda | year = 2005 | month = | title =Lidocaine 4% cream compared with lidocaine 2.5% and prilocaine 2.5% or dorsal penile block for circumcision | journal =Am J Perinatol | volume =22 | issue =5 | pages =231-237 | pmid =16041631 | url = | format = | accessdate = }} </ref> the dorsal nerve block controls pain more effectively than topical treatments,<ref name=garry>{{cite journal | last =Garry | first =D.J. | coauthors =E. Swoboda, A. Elimian and R. Figueroa | year = 2006 | month = | title =A video study of pain relief during newborn male circumcision | journal =J Perinatology | volume =26 | issue =2 | pages =106-110 | pmid =16292334 | url = | format = | accessdate = }} </ref> but neither method eliminates pain completely.<ref name=Brady-Fryer>{{cite journal | last = Brady-Fryer | first = B | coauthors = Wiebe N, Lander JA | year = 2004 | month = July | title = Pain relief for neonatal circumcision | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = Art. No.: CD004217 | doi = | pmid = 15495086 | url = | format = | accessdate = 2006-06-29 }} </ref> Razmus ''et al.'' reported that newborns circumcised with the dorsal block and the ring block in combination with the concentrated oral sucrose had the lowest pain scores.<ref>{{cite journal |author=Razmus I, Dalton M, Wilson D |title=Pain management for newborn circumcision |journal=Pediatr Nurs |volume=30 |issue=5 |pages=414&ndash;7, 427 |year= |pmid=15587537}}</ref> Ng ''et al.'' found that EMLA cream, in addition to local anaesthetic, effectively reduces the sharp pain induced by needle puncture.<ref>{{cite journal |first=WT |last=Ng |coauthors=''et al.''|title=The use of topical lidocaine/prilocaine cream prior to childhood circumcision under local anesthesia |journal=Ambul Surg |volume=9 |issue=1 |pages=9&ndash;12 |year=2001 |pmid=11179706|doi=10.1016/S0966-6532(00)00061-5}}</ref>

===Sexual effects of circumcision===
{{main|Sexual effects of circumcision}}

The sexual effects of circumcision are the subject of much debate. The American Academy of Pediatrics (1999) stated "There are anecdotal reports that penile sensation and sexual satisfaction are decreased for circumcised males", however they also stated that "[a] survey of adult males using self-report suggests more varied sexual practice and less sexual dysfunction in circumcised adult men." They continued, "[[Masters and Johnson]] noted no difference in exteroceptive and light tactile discrimination on the ventral or dorsal surfaces of the glans penis between circumcised and uncircumcised men."<ref name = "AAP1999" /> In January 2007, The American Academy of Family Physicians (AAFP) stated "The effect of circumcision on penile sensation or sexual satisfaction is unknown. Because the epithelium of a circumcised glans becomes cornified, and because some feel nerve over-stimulation leads to desensitization, many believe that the glans of a circumcised penis is less sensitive. [...] No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."<ref name = "AAFP" /> Payne ''et al.'' reported that direct measurement of penile sensation during sexual arousal failed to support the hypothesised sensory differences associated with circumcision status.<ref name = "Payne2007"> {{cite journal | last = Payne | first = Kimberley | coauthors = Lea Thaler, Tuuli Kukkonen, Serge Carrier, Yitzchak Binik | year = 2007 | month = April | title = Sensation and Sexual Arousal in Circumcised and Uncircumcised Men | journal = Journal of Sexual Medicine | volume = 4 | issue = 3 | pages = 667 - 674 | pmid = 17419812 | doi = 10.1111/j.1743-6109.2007.00471.x | url = http://www3.interscience.wiley.com/journal/118496134/abstract | accessdate = 2008-09-07}}</ref> In a 2008 study, Krieger ''et al.'' stated that "Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm."<ref name = "Krieger2008">{{cite journal
| last = Krieger
| first = JN
| coauthors = Mehta SD, Bailey RC, Agot K, Ndinya-Achola JO, Parker C, Moses S
| year = 2008
| month = August
| title = Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya
| journal = The Journal of Sexual Medicine
| volume = Epub ahead of print
| issue =
| pages =
| publisher =
| location =
| issn =
| pmid = 18761593
| pmc =
| doi =
| bibcode =
| oclc =
| id =
| url =
| language =
| format =
| accessdate =
| laysummary =
| laysource =
| laydate =
| quote =
}}
</ref>

Conversely a 2002 review by Boyle ''et al.'' stated that "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings&mdash;many of which are lost to circumcision, with an inevitable reduction in sexual sensation experienced by circumcised males." They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."<ref>{{cite web |url=http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1036&context=hss_pubs |title=Male circumcision: pain, trauma, and psychosexual sequelae |first=Gregory J |last=Boyle |coauthors=Svoboda, J Steven; Goldman, Ronald; Fernandez, Ephrem |publisher=Bond University Faculty of Humanities and Social Sciences |year=2002}}</ref> Sorrells ''et al.'', using monofilament touch-test mapping, found that the foreskin contains the most sensitive parts of the penis, noting that these parts are lost to circumcision. They also found that "the glans of the circumcised penis is less sensitive to fine-touch than the glans of the uncircumcised penis."<ref>{{cite journal | last = Sorrells | first = M.L. | coauthors = J.L. Snyder, M.D. Reiss, C. Eden, M.F. Milos, N. Wilcox and R.S. Van Howe | year = 2007 | month = May | title = Fine-touch pressure thresholds in the adult penis | journal = BJU International | volume = 99 | issue = 4 | pages = 864-869 | pmid = 17378847 }}</ref>

Reports detailing the effect of circumcision on [[erectile dysfunction]] have been mixed. Studies have shown that circumcision can result in a statistically significant increase,<ref name = "Fink2002"> {{cite journal | last = Fink | first = K.S. | coauthors = C.C. Carson, R.S. DeVellis | year = 2002 | month = May | title = Adult Circumcision Outcomes Study: Effect on Erectile Dysfunction, Penile Sensitivity, Sexual Activity and Satisfation | journal = Journal of Urology | volume = 167 | issue = 5 | pages = 2113&ndash;2116 | pmid = 11956453 | url = http://www.cirp.org/library/sex_function/fink1/ | accessdate = 2008-06-28}}</ref><ref>{{cite journal | last = Shen | first = Z. | coauthors = S. Chen, C. Zhu, Q. Wan and Z. Chen | title = Erectile function evaluation after adult circumcision (in Chinese) | journal = Zhonghua Nan Ke Xue | volume = 10 | issue = 1 | pages = 18–19 | year = 2004 | pmid = 14979200}}</ref> or decrease,<ref name=Laumann>{{cite journal | last = Laumann | first = E. | coauthors = C. Masi and F. Zuckerman | title = Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice | journal = JAMA | volume = 277 | issue = 13 | pages = 1052–1057 | year = 1997 | pmid = 9091693 | url = http://www.circs.org/library/laumann/index.html}}</ref><ref>{{cite journal |author=Richters J, Smith AM, de Visser RO, Grulich AE, Rissel CE |title=Circumcision in Australia: prevalence and effects on sexual health |journal=Int J STD AIDS |volume=17 |issue=8 |pages=547–54 |year=2006 |month=August |pmid=16925903 |doi=10.1258/095646206778145730 |url=}}</ref> in erectile dysfunction among circumcised men, while other studies have shown little to no effect.<ref>{{cite journal | last = Senkul | first = T. | coauthors = C. IşerI, B. şen, K. KarademIr, F. Saraçoğlu and D. Erden | title = Circumcision in adults: effect on sexual function | journal = Urology | volume = 63 | issue = 1 | pages = 155–8 | year = 2004 | pmid = 14751371}}</ref><ref>{{cite journal | author = Collins S, Upshaw J, Rutchik S, Ohannessian C, Ortenberg J, Albertsen P | title = Effects of circumcision on male sexual function: debunking a myth? | journal = J Urol | volume = 167 | issue = 5 | pages = 2111–2 | year = 2002 | pmid = 11956452}}</ref><ref>{{cite journal | author = Masood S, Patel H, Himpson R, Palmer J, Mufti G, Sheriff M | title = Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly? | journal = Urol Int | volume = 75 | issue = 1 | pages = 62–6 | year = 2005 | pmid = 16037710}}</ref>

===Complications from circumcision===

Complication rates ranging from 0.06% to 55% have been cited,<ref name = "CMAJ">{{cite journal
| last = Fetus and Newborn Committee
| year = 1996
| month = March
| title = Neonatal circumcision revisited
| journal = Canadian Medical Association Journal
| volume = 154
| issue = 6
| pages = 769&ndash;780
| doi =
| id =
| url = http://www.cps.ca/english/statements/FN/fn96-01.htm
| format =
| accessdate = 2006-07-02
}}</ref> though a 1993 [[Survey article|survey]] of circumcision complications by Williams and Kapilla put the rate at 2-10%.<ref name="WillKap"/> Another major survey of circumcision complications was conducted by G.W Kaplan in 1983.<ref name="kaplan">{{cite journal
| last = Kaplan
| first = G.W.
| coauthors =
| year = 1983
| month = August
| title = Complications of Circumcision
| journal = Urologic Clinics of North America
| volume = 10
| issue = 3
| pages = 543&ndash;549
| pmid =6623741
| url = http://www.cirp.org/library/complications/kaplan/
| format = HTML
| accessdate = 2006-09-29
}}
</ref>

According to the [[American Medical Association]] (AMA), blood loss and [[infection]] are the most common complications, but most bleeding is minor and can be stopped by applying pressure.<ref name = "CSA:I-99" /> In studies reviewed by Kaplan, the rate of bleeding complications was between 0.1% and 35%.<ref name="kaplan"/>
A 1999 study of 48 boys who had complications from traditional male circumcision in Nigeria found that [[haemorrhage]] occurred in 52% of boys, infection in 21% and one child had his penis amputated.<ref>{{cite journal
| last = Ahmed A,
| first = A
| coauthors = Mbibi NH, Dawam D, Kalayi GD
| year = 1999
| month = March
| title = Complications of traditional male circumcision
| journal = Annals of Tropical Paediatrics
| volume = 19
| issue = 1
| pages = 113&ndash;117
| doi =
| pmid = 10605531 {{ISSN|0272-4936}}
| url =
| format =
| accessdate = 2006-07-01
}}
</ref>

[[Image:Flaccid-erect.jpg|right|thumb|A penis that has been circumcised (a [[skin bridge]] is present in this example).]]<!-- Image is at http://en.wikipedia.org/wiki/Image:Flaccid-erect.jpg in case the tag needs an administrator's touch. -->
[[Image:Erection Homme.jpg|right|thumb|A penis that has not been circumcised.]]

[[Meatal stenosis]] (a narrowing of the urethral opening) may be a longer-term complication of circumcision. It is thought that because the foreskin no longer protects the [[Urinary meatus | meatus]], [[ammonia]] formed from [[urine]] in wet diapers irritates and [[inflammation|inflames]] the exposed urethral opening. Meatal stenosis can lead to discomfort with urination, [[incontinence]], bleeding after urination and [[urinary tract infections]].<ref>{{cite journal
| last = Yegane
| first = Rooh-Allah
| coauthors = Abdol-Reza Kheirollahi, Nour-Allah Salehi, Mohammad Bashashati, Jamal-Aldin Khoshdel, and Mina Ahmadi
| year = 2006
| month = May
| title = Late complications of circumcision in Iran
| journal = Pediatric Surgery International
| volume = 22
| issue = 5
| pages = 442&ndash;445
| doi = 10.1007/s00383-006-1672-1
| pmid = 16649052
| url = http://www.springerlink.com/content/l62453357073k7mn/
| format = Abstract
| accessdate = 2008-09-25
}}
</ref><ref>{{cite web
| url = http://www.emedicine.com/PED/topic2356.htm
| title = Meatal Stenosis
| accessdate = 2006-07-02
| last = Angel
| first = Carlos A.
| date = June 12, 2006
| work = eMedicine
| publisher = WebMD
}}
</ref>

One study looking at 354,297 births in [[Washington| Washington State]] from 1987-1996 found that immediate post-birth complications occurred at a rate of 0.2% in the circumcised babies and at a rate of 0.01% in the uncircumcised babies. The study warned though that this was a conservative estimate because it did not capture the very rare but serious delayed complications associated with circumcisions (eg, [[necrotizing fasciitis]], [[cellulitis]]) and the less serious but more common complications such as the [[circumcision scar]] or a less than ideal cosmetic result. It also warned that the risks of circumcision "do not seem to be mitigated by the hands of more experienced physicians".<ref name="UWstudy">{{cite journal
| last = Christakis
| first = Dmitry A.
| coauthors = Eric Harvey, Danielle M. Zerr, Chris Feudtner, Jeffrey A. Wright, and Frederick A. Connell
| year = 2000
| month = January
| title = A Trade-off Analysis of Routine Newborn Circumcision
| journal = Pediatrics
| volume = 105
| issue = 1
| pages = 246&ndash;249
| doi = 10.1542/peds.105.1.S2.246
| pmid = 10617731
| url = http://pediatrics.aappublications.org/cgi/content/full/105/1/S2/246
| accessdate = 2006-07-01
| doi_brokendate = 2008-06-26
}}
</ref>

Circumcisions may remove too much or too little skin.<ref name="WillKap"/> If insufficient skin is removed, true [[phimosis]] can result.<ref name="WillKap"/> Cathcart ''et al.'' report that 0.5% of boys required a procedure to revise the circumcision.<ref name="cathcart">{{cite journal |author=Cathcart P, Nuttall M, van der Meulen J, Emberton M, Kenny SE |title=Trends in paediatric circumcision and its complications in England between 1997 and 2003 |journal=Br J Surg |volume=93 |issue=7 |pages=885–90 |year=2006 |month=July |pmid=16673355 |doi=10.1002/bjs.5369 |url=}}</ref>

Other complications include concealed penis<ref>{{cite journal
| last = Trier
| first = William C.
| coauthors = George W. Drach
| year = 1973
| month = February
| title = Concealed Penis: Another Complication of Circumcision
| journal = American Journal of diseases of children
| volume = 125
| issue = 2
| pages = 276-277
| pmid = 4685840
| url = http://www.cirp.org/library/complications/trier1/
| format =
| accessdate = 2008-09-25
}}
</ref><ref>{{cite journal
| last = Bergeson
| first = Paul S.
| coauthors = Robert J. Hopkin, Robert B. Bailey, Leigh C. MCGill, Janice P. Piatt
| year = 1993
| month = December
| title = The inconspicuous penis
| journal = Pediatrics
| volume = 92
| issue = 6
| pages = 794-799
| pmid =
| url = http://www.cirp.org/library/complications/bergeson/
| format =
| accessdate = 2008-09-25
}}
</ref>, urinary [[fistulas]], [[chordee]], [[cyst]]s, [[lymphedema]], [[ulceration]] of the glans, [[necrosis]] of all or part of the penis, [[hypospadias]], [[epispadias]] and [[impotence]].<ref name="kaplan"/> Kaplan stated “Virtually all of these complications are preventable with only a modicum of care" and "most such complications occur at the hands of inexperienced operators who are neither urologists nor surgeons.”<ref name="kaplan"/>

Infant circumcision may result in [[skin bridge| skin bridges]], whereby the end of the severed part of the foreskin fuses to other parts of the penis (normally the [[glans]]) on repair.<ref>{{cite journal
| last = Naimer
| first = Sody A.
| coauthors = Roni Peleg, Yevgeni Meidvidovski, Alex Zvulunov, Arnon Dov Cohen, and Daniel Vardy
| year = 2002
| month = November
| title = Office Management of Penile Skin Bridges with Electrocautery
| journal = Journal of the American Board of Family Practice
| volume = 15
| issue = 6
| pages = 485&ndash;488
| pmid = 10605531
| url = http://www.jabfm.org/cgi/reprint/15/6/485
| format = PDF
| accessdate = 2006-07-01
}}
</ref>

Although [[death| deaths]] have been reported<ref name="kaplan"/><ref>{{cite web
| url = http://www.pulsus.com/Paeds/12_04/Pdf/zwol_ed.pdf
| title = Coroner's Corner Circumcision: A minor procedure?
| author = Paediatric Death Review Committee: Office of the Chief Coroner of Ontario
| accessdate = 2007-06-17
| year = 2007
| month = April
| work = Paediatric Child Health Vol 12 No 4, April 2007 pages 311&ndash;312
| publisher = Pulsus Group Inc.
|format=PDF}}
</ref>, the [[American Academy of Family Physicians]] states that death is rare, and cites an estimated death rate of 1 infant in 500,000 from circumcision.<ref name = "AAFP" /> Gairdner's 1949 study<ref name = "Gairdner">{{cite journal
| last = Gairdner
| first = Douglas
| year = 1949
| month = December
| title = The Fate of the Foreskin
| journal = British Medical Journal
| volume = 2
| issue = 4642
| pages = 1433&ndash;1437
| doi =
| pmid = 15408299
| url = http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2051968&blobtype=pdf
| format =
| accessdate = 2006-07-01
}}
</ref> reported that an average of 16 children per year out of about 90,000 died following circumcision in the [[United Kingdom|UK]]. He found that most deaths had occurred suddenly under anaesthesia and could not be explained further, but hemorrhage and infection had also proven fatal. Deaths attributed to phimosis and circumcision were grouped together, but Gairdner argued that such deaths were probably due to the circumcision operation. The penis is thought to be lost in 1 in 1,000,000 circumcisions.<ref name = "RACPComp">{{cite web
| url = http://www.racp.edu.au/hpu/paed/circumcision/complications.htm
| title = Complications Of Circumcision
| accessdate = 2006-07-11
| year = 2004
| month = October
| work = Paediatric Policy &ndash; Circumcision
| publisher = The Royal Australasian College of Physicians
}}
</ref>

===Sexually transmitted diseases===

====Human immunodeficiency virus====

The origin of the theory that circumcision can lower the risk of a man contracting HIV is disputed.<ref>{{cite web
| last = Alcena
| first = Valiere
| title = AIDS in Third World countries [letter]
| work = response to "Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial"
| publisher = PLos Medicine
| date = 2006-10-16
| url = http://medicine.plosjournals.org/perlserv/?request=read-response&doi=10.1371/journal.pmed.0020298#r1326
| format =
| doi =
| accessdate = 2008-08-24 }}</ref><ref>{{cite journal
| last = Alcena
| first = Valiere
| title = AIDS in Third World countries [letter]
| journal = New York State Journal of Medicine
| volume = 86
| issue = 8
| pages = 446
| year = 1986
| month = August
| url = http://www.popline.org/docs/057476
| doi =
| id =
| accessdate =2008-08-24 }}.</ref><ref>{{cite journal |last=Fink |first=Aaron J. |authorlink=Aaron J. Fink |year=1986 |month=October |title=A possible explanation for heterosexual male infection with AIDS. |journal=New England Journal of Medicine |volume=315 |issue=18 |pages=1167 |pmid = 3762636 |url=http://www.ncbi.nlm.nih.gov/pubmed/3762636?dopt=Abstract |accessdate=2008-08-24 |quote= }}</ref> Since the idea was first mooted, over 40 epidemiological studies have been conducted to investigate the relationship between circumcision and HIV infection.<ref>{{cite journal
|last=Szabo
|first=R.
|coauthors=R.V. Short
|year=2000
|month=June
|title=How does male circumcision protect against HIV infection?
|journal=BMJ
|volume=320
|issue=
|pages=1592-1594
|id=
|url=http://www.bmj.com/cgi/content/full/320/7249/1592?
|accessdate=
|quote= }}</ref> Reviews of these studies have reached differing conclusions about whether circumcision could be used as a [[AIDS#Prevention |prevention method against HIV]].<ref name="VanHoweHIVmeta">{{cite journal
|last= Van Howe
|first=R.S.
|authorlink=
|coauthors=
|year= 1999
|month= January
|title=Circumcision and HIV infection: review of the literature and meta-analysis
|journal=International Journal of STD's and AIDS
|volume=10
|issue=
|pages=8-16
|id=
|doi=
|url=http://www.cirp.org/library/disease/HIV/vanhowe4/
|accessdate= 2008-09-23
|quote=<small>Thirty-five articles and a number of abstracts have been published in the medical literature looking at the relationship between male circumcision and HIV infection. Study designs have included geographical analysis, studies of high-risk patients, partner studies and random population surveys. Most of the studies have been conducted in Africa. A meta-analysis was performed on the 29 published articles where data were available. When the raw data are combined, a man with a circumcised penis is at greater risk of acquiring and transmitting HIV than a man with a non-circumcised penis (odds ratio (OR)=1.06, 95% confidence interval (CI)=1.01-1.12). Based on the studies published to date, recommending routine circumcision as a prophylactic measure to prevent HIV infection in Africa, or elsewhere, is scientifically unfounded.</small>}}</ref><ref>{{cite journal
|last= O'Farrell
|first=R.S.
|authorlink=
|coauthors=M. Egger
|year=2000
|month= March
|title=Circumcision in men and the prevention of HIV infection: a 'meta-analysis' revisited
|journal=International Journal of STD's and AIDS
|volume=11
|issue=3
|pages=137-142
|id=
|doi=
|url=http://www.ncbi.nlm.nih.gov/pubmed/10726934
|accessdate= 2008-09-25
|quote=<small>The results from this re-analysis thus support the contention that male circumcision may offer protection against HIV infection, particularly in high-risk groups where genital ulcers and other STDs 'drive' the HIV epidemic. A systematic review is required to clarify this issue. Such a review should be based on an extensive search for relevant studies, published and unpublished, and should include a careful assessment of the design and methodological quality of studies. Much emphasis should be given to the exploration of possible sources of heterogeneity. In view of the continued high prevalence and incidence of HIV in many countries in sub-Saharan Africa, the question of whether circumcision could contribute to prevent infections is of great importance, and a sound systematic review of the available evidence should be performed without delay.</small> }}</ref><ref name="Siegfriedmeta">{{cite journal
|last=Siegfried
|first=N
|authorlink=
|coauthors=M Muller, J Volmink, J Deeks, M Egger, N Low, H Weiss, S Walker, P Williamson
|year= 2003
|month= July
|title=Male circumcision for prevention of heterosexual acquisition of HIV in men
|journal=Cochrane Database of Systematic Reviews
|volume=
|issue= 3
|pages=
|id=CD003362
|doi=10.1002/14651858.CD003362
|url=http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003362/frame.html
|accessdate= 2007-12-27
|quote=<small>We found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men. The results from existing observational studies show a strong epidemiological association between male circumcision and prevention of HIV, especially among high-risk groups. However, observational studies are inherently limited by confounding which is unlikely to be fully adjusted for. In the light of forthcoming results from RCTs, the value of IPD analysis of the included studies is doubtful. The results of these trials will need to be carefully considered before circumcision is implemented as a public health intervention for prevention of sexually transmitted HIV.</small> }}</ref><ref>{{cite journal
|last=Weiss
|first=HA
|authorlink=
|coauthors=Quigley MA, Hayes RJ.
|year=2000
|month=Oct 20
|title=Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis.
|journal= AIDS. 2000
|volume=14
|issue=15
|pages=2361&ndash;70
|id=
|url=http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=11089625
|accessdate= 2007-12-27
|quote=<small>Male circumcision is associated with a significantly reduced risk of HIV infection among men in sub-Saharan Africa, particularly those at high risk of HIV. These results suggest that consideration should be given to the acceptability and feasibility of providing safe services for male circumcision as an additional HIV prevention strategy in areas of Africa where men are not traditionally circumcised.</small> }}</ref>

Because experimental evidence was needed to establish a causal relationship between lack of circumcision and HIV,<ref name = "ANRS"/> 3 [[randomized controlled trials]] were commissioned as a means to reduce the effect of any [[Confounding | confounding factors]].<ref name="Siegfriedmeta"/> Trials took place in [[South Africa]],<ref name = "ANRS"/> [[Kenya]]<ref name="baileyrct">{{cite journal
| last = Bailey
| first = Robert C.
| coauthors = Stephen Moses, Corette B Parker, Kawango Agot, Ian Maclean, John N Krieger, Carolyn F M Williams, Richard T Campbell, Jeckoniah O Ndinya-Achola
| date = february 24, 2007
| year = 2007
| title = Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial
| journal = [[The Lancet]]
| volume = 369
| issue = 9562
| pages = 643–656
| publisher = [[Elsevier]]
| location = [[London]]
| issn = 0140-6736
| pmid = 17321310
| doi = 10.1016/S0140-6736(07)60312-2
| oclc = 1755507
| url = http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673607603122.pdf
| format = PDF (free registration required)
| accessdate = 2008-09-04
| quote = <small>The 2-year HIV incidence was 2.1% (95% CI 1.2-3.0) in the circumcision group and 4.2% (3.0-5.4) in the control group (p=0.0065); the relative risk of HIV infection in circumcised men was 0.47 (0.28-0.78), which corresponds to a reduction in the risk of acquiring an HIV infection of 53% (22-72).</small>
}}
</ref> and [[Uganda]].<ref>{{cite journal
|last=Gray
|first=R.H.
|authorlink=
|coauthors=''et al.''
|year=2007
|month=February
|title=Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial
|journal=Lancet
|volume=369
|issue=9562
|pages=657-666
|pmid=17321311
|url=
|accessdate=
|quote=<small>In the modified intention-to-treat analysis, HIV incidence over 24 months was 0.66 cases per 100 person-years in the intervention group and 1.33 cases per 100 person-years in the control group (estimated efficacy of intervention 51%, 95% CI 16-72; p=0.006). The as-treated efficacy was 55% (95% CI 22-75; p=0.002); efficacy from the Kaplan-Meier time-to-HIV-detection as-treated analysis was 60% (30-77; p=0.003).</small> }}</ref> All three trials were stopped early by their monitoring boards on ethical grounds, because those in the circumcised group had a lower rate of HIV contraction than the control group.<ref name="baileyrct" /> The results showed that circumcision reduced vaginal-to-penile transmission of HIV by 60%, 53%, and 51%, respectively. A meta-analysis of the African randomised controlled trials found that the risk in circumcised males was 0.44 times that in uncircumcised males, and reported that 72 circumcisions would need to be performed to prevent one HIV infection. The authors concluded that using circumcision as a means to reduce HIV infection would, on a national level, require consistently safe sexual practices to maintain the protective benefit.<ref>{{cite journal |author= E.Mills |coauthors= C.Cooper, A.Anema, G.Guyatt |year=2008 |month=July |title=Male circumcision for the prevention of heterosexually acquired HIV infection: a meta-analysis of randomized trials involving 11050 men |journal=HIV Medicine |volume=9 |issue=6 |pages=332-335 |doi=10.1111/j.1468-1293.2008.00596.x |url=http://www3.interscience.wiley.com/journal/120747249/abstract |accessdate=2008-08-24 |quote= }}</ref>

As a result of these findings, the [[WHO]] and the Joint United Nations Programme on HIV/AIDS ([[UNAIDS]]) stated that male circumcision is an efficacious intervention for HIV prevention but should be carried out by well trained medical professionals and under conditions of informed consent.<ref name="WHO-C&R">{{cite paper
| title = New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications
| publisher = [[World Health Organization]]
| date = March 28, 2007
| url = http://www.who.int/hiv/mediacentre/MCrecommendations_en.pdf
| format = PDF
| id =
| accessdate = 2007-08-13
}}
</ref><ref name="WHOpr0307">{{cite web |title=WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention |publisher=World Health Organisation |month=March |year=2007 |url=http://www.who.int/hiv/mediacentre/news68/en/index.html}}</ref><ref>{{cite web |title=Male circumcision: Global trends and determinants of prevalence, safety and acceptability |publisher=World Health Organisation/UNAIDS |month=February |year=2007 |url=http://www.who.int/hiv/topics/malecircumcision/JC1320_MaleCircumcision_Final_UNAIDS.pdf}}</ref> Both the WHO and [[Centers for Disease Control and Prevention |CDC]] indicate that circumcision may not reduce HIV transmission from men to women, and that data is lacking for the transmission rate of men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner.<ref name="WHO-C&R">{{cite paper
| title = New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications
| publisher = [[World Health Organization]]
| date = March 28, 2007
| url = http://www.who.int/hiv/mediacentre/MCrecommendations_en.pdf
| format = PDF
| id =
| accessdate = 2007-08-13
}}
</ref><ref name="CDC-2008">{{cite web |title=Male Circumcision and Risk for HIV Transmission and Other Health Conditions: Implications for the United States |publisher=Centers for Disease Control and Prevention |year=2008 |url=http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm}}</ref> The joint WHO/UNAIDS recommendation also notes that circumcision only provides partial protection from HIV and should never replace known methods of HIV prevention.<ref name="WHOpr0307">{{cite web |title=WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention |publisher=World Health Organisation |month=March |year=2007 |url=http://www.who.int/hiv/mediacentre/news68/en/index.html}}</ref>

Some earlier reports had expressed the position that circumcision has little to no effect on HIV transmission.<ref>{{cite journal |last=Carael |first=M. |coauthors=P.H. Van de Perre, P.H. Lepage, S. Allen, F. Nsengumuremyi, C. Van Goethem, M. Ntahorutaba, D. Nzaramba, N. Clumeck |year=1988 |month=June |title=Human immunodeficiency virus transmission among heterosexual couples in Central Africa. |journal=AIDS |volume=2 |issue=3 |pages=201-205 |pmid=3134914 |url= |accessdate= |quote= }}</ref><ref>{{cite journal |last=Grosskurth |first=H. |coauthors=F. Mosha, J. Todd, K. Senkoro, J. Newell, A. Klokke, J. Changalucha, B. West, P. Mayaud, A. Gavyole A, ''et al.'' |year=1995 |month=August |title=A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results. |journal=AIDS |volume=9 |issue=8 |pages=927-934 |pmid=7576329 |url= |accessdate= |quote= }}</ref><ref>{{cite journal |last=Barongo |first=L.R. |coauthors=M.W. Borgdorff, F.F. Mosha, A. Nicoll, H. Grosskurth, K.P. Senkoro, J.N. Newell, J. Changalucha, A.H. Klokke, J.Z. Killewo JZ, ''et al.'' |year=1992 |month=December |title=The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania. |journal=AIDS |volume=6 |issue=12 |pages=1521-1528 |pmid=1492935 |url= |accessdate= |quote= }}</ref> Furthermore, some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy.<ref>{{cite journal |last=Mills |first=J. |coauthors=N. Siegfried |year=2006 |month=October |title=Cautious optimism for new HIV/AIDS prevention strategies. |journal=Lancet |volume=368 |issue=9543 |pages=1236 |pmid=17027724 |url= |accessdate= |quote= <small>"The inferences drawn from the only completed randomised controlled trial (RCT) of circumcision could be weak because the trial stopped early. In a systematic review of RCTs stopped early for benefit, such RCTs were found to overestimate treatment effects. When trials with events fewer than the median number (n=66) were compared with those with event numbers above the median, the odds ratio for a magnitude of effect greater than the median was 28 (95% CI 11--73). The circumcision trial recorded 69 events, and is therefore at risk of serious effect overestimation. We therefore advocate an impartial meta-analysis of individual patients' data from this and other trials underway before further feasibility studies are done.</small> }}</ref><ref>{{cite journal |last=Dowsett |first=G.W. |coauthors=M. Couch |year=2007 |month=May |title=Male circumcision and HIV prevention: is there really enough of the right kind of evidence? |journal=Reproductive Health Matters |volume=15 |issue=29 |pages= 33-44 |pmid=17512372 |url=http://download.journals.elsevierhealth.com/pdfs/journals/0968-8080/PIIS0968808007293024.pdf |accessdate= |quote= }}</ref>

====Human papilloma virus====

In several studies, uncircumcised men were found to have a greater incidence of [[human papilloma virus]] (HPV) infection than circumcised men.<ref>{{cite journal
| last = Castellsagué
| first = Xavier
| coauthors = et al.
| year = 2002
| month = April 11,
| title = Male circumcision, penile human papillomavirus infection, and cervical cancer
| journal = The New England Journal of Medicine
| volume = 346
| issue = 15
| pages = 1105&ndash;1112
| doi = 10.1056/NEJMoa011688
| pmid = 11948269
| url = http://content.nejm.org/cgi/reprint/346/15/1105.pdf
| format = PDF &mdash; free registration required
| accessdate = 2006-07-09
}}
</ref><ref>{{cite journal
| last = Lajous
| first = Martín
| coauthors = Nancy Mueller, Aurelio Cruz-Valdéz, Luis Victor Aguilar, Silvia Franceschi, Mauricio Hernández-Ávila, and Eduardo Lazcano-Ponce
| year = 2005
| month = July
| title = Determinants of Prevalence, Acquisition, and Persistence of Human Papillomavirus in Healthy Mexican Military Men
| journal = Cancer Epidemiology Biomarkers and Prevention
| volume = 14
| issue = 7
| pages = 1710&ndash;1716
| doi = 10.1158/1055-9965.EPI-04-0926
| pmid = 16030106
| url = http://cebp.aacrjournals.org/cgi/reprint/14/7/1710.pdf
| format = PDF
| accessdate = 2006-07-09
}}
</ref><ref>{{cite journal
| last = Hernandez
| first = B.Y.
| coauthors = L.R. Wilkens, X. Zhu, K. McDuffie, P. Thompson, Y.B. Shvetsov, L. Ning and M.T. Goodman
| date = March
| month = 2008
| title = Circumcision and Human Papillomavirus Infection in Men: A Site-Specific Comparison
| journal = The Journal of Infectious Diseases
| volume = 197
| issue = 6
| pages = 787–794
| doi = 10.1086/528379
| pmid = 18284369
| url =
| format =
| accessdate =
}}
</ref> One study did not find a statistically significant difference in the incidence of HPV infection between circumcised and uncircumcised men, but did note a higher prevalence of urethritis in the uncircumcised.<ref>{{cite journal
| last = Aynaud
| first = O.
| coauthors = D. Piron, G. Bijaoui, and JM Casanova
| date = July
| month = 1999
| title = Developmental factors of urethral human papillomavirus lesions: correlation with circumcision
| journal = BJU International
| volume = 84
| issue = 1
| pages = 57&ndash;60
| doi = 10.1046/j.1464-410x.1999.00104.x
| pmid = 10444125
| url = http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.00104.x
| format = PDF
| accessdate = 2006-07-09
}}
</ref> A meta-analysis by Van Howe in 2006 found that there was no significant association between circumcision status and HPV infection and that "the medical literature does not support the claim that circumcision reduces the risk for genital HPV infection".<ref>{{cite journal
| last = Van Howe
| first = Robert S.
| month = May
| year = 2007
| title = Human papillomavirus and circumcision: A meta-analysis
| journal = Journal of Infection
| volume = 54
| issue = 5
| pages = 490&ndash;496
| doi =
| pmid = 16997378
| url = http://www.cirp.org/library/disease/cancer/vanhowe2006b/
| accessdate = 2008-09-18
}}
</ref> However, Castellsagué ''et al.'' maintain that this meta-analysis was flawed, and further note that a re-analysis of the same data "... clearly shows, no matter how the studies are grouped, a moderate to strong protective effect of circumcision on penile HPV and related lesions."<ref>{{cite journal
| last = Castellsagué
| first = X.
| coauthors = G. Albero, R. Clèries and F. Bosch
| date = 2007
| month =
| title = HPV and circumcision: A biased, inaccurate and misleading meta-analysis
| journal = Journal of Infection
| volume = 55
| issue = 1
| pages = 91-93
| doi =
| pmid = 17433445
| url =
| accessdate =
}}
</ref>

Two studies have shown that circumcised men report, or were found to have, a higher prevalence of [[genital warts]] than uncircumcised men.<ref>{{cite journal |last=Dinh |first=T.H. |authorlink= |coauthors=M. Sternberg, E.F. Dunne and L.E. Markowitz |year=2008 |month=April |title=Genital Warts Among 18- to 59-Year-Olds in the United States, National Health and Nutrition Examination Survey, 1999-2004 |journal=Sexually Transmitted Diseases |volume=35 |issue=4 |pages=357–360 |pmid=18360316 |url= |accessdate= |quote=The percentage of circumcised men reporting a diagnosis of genital warts was significantly higher than uncircumcised men, 4.5% (95% CI, 3.6%–5.6%) versus 2.4% (95% CI, 1.5%–4.0%) |doi=10.1097/OLQ.0b013e3181632d61 }}</ref><ref>{{cite journal |last=Cook |first=L.S |authorlink= |coauthors=L A Koutsky, K K Holmes |year=1993 |month=August |title=Clinical Presentation of Genital Warts Among Circumcised and Uncircumcised Heterosexual Men Attending an Urban STD Clinic |journal=[[Genitourinary medicine]] |volume=69 |issue=4 |pages=262-264 |pmid=1195083 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1195083}}</ref>

====Other sexually transmitted infections====
In a [[meta-analysis]] of data from twenty-six studies, circumcision was associated with lower rates of syphilis, [[chancroid]] and possibly genital herpes.<ref name = "Weiss">{{cite journal |title=Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis |first=HA |last=Weiss |coauthors=Thomas, SL; Munabi SK; Hayes RJ |journal=Sex Transm Infect |year=2006 |month=Apr |volume=82 |issue=2 |pages=101&ndash;9 |pmid=16581731 |url=http://sti.bmj.com/cgi/content/full/82/2/101 |doi=10.1136/sti.2005.017442}}</ref>

Other studies have failed to find a prophylactic benefit to circumcision. One study found circumcision offered no protective benefit against herpes simplex virus type 2, syphilis, or [[gonorrhea]].<ref>{{cite journal |title=Male circumcision and risk of HIV-1 and other sexually transmitted infections in India |first= |last= |coauthors= S. Reynolds, M. Shepherd , A. Risbud , R. Gangakhedkar , R. Brookmeyer , A. Divekar , S. Mehendale , R. Bollinger |journal=The Lancet |year=2004 |month=March |volume=363 |issue=9414 |pages=1039&ndash;1040 |pmid=15051285 |url=http://www.ncbi.nlm.nih.gov/pubmed/15051285 |doi=}}</ref> A clinical study of 5,925 women from Uganda, Zimbabwe and Thailand found that the circumcision status of their partner did not significantly affect the incidence of [[Chlamydia]], [[gonorrhea]] or [[trichomoniasis]].<ref name = "Turner">{{cite journal |title=Male circumcision and women's risk of incident chlamydial, gonococcal, and trichomonal infections |first=A.N. |last=Turner |coauthors=C.S. Morrison, N.S. Padian, J.S. Kaufman, F.M. Behets, R.A. Salata, F.A. Mmiro, T. Chipato, D.D. Celentano, S. Rugpao and W.C. Miller |journal=Sexually Transmitted Diseases |year=2008 |month=July |volume=35 |issue=7 |pages=689-695 |pmid=18418300}}</ref>

Laumann ''et al'' found that circumcised men were "slightly more likely to have had both a bacterial and a viral STD in their lifetime", noting that the difference in the case of chlamydia were quite large. However, these findings were not statistically significant. They stated: "[w]e find no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases".<ref name=Laumann/>

===Hygiene, and infectious and chronic conditions===

The [[American Academy of Pediatrics]] (1999) stated: "Circumcision has been suggested as an effective method of maintaining penile hygiene since the time of the Egyptian dynasties, but there is little evidence to affirm the association between circumcision status and optimal penile hygiene." <ref name = "AAP1999" /> Some studies found that boys with foreskins had higher rates of various infections and inflammations of the penis than those who were circumcised.<ref name = "Ferg">{{cite journal
| last = Fergusson
| first = DM
| coauthors = JM Lawton and FT Shannon
| year = 1988
| month = April
| title = Neonatal circumcision and penile problems: an 8-year longitudinal study
| journal = Pediatrics
| volume = 81
| issue = 4
| pages = 537&ndash;541
| doi =
| pmid = 3353186
| url = http://www.circs.org/library/fergusson/index.html
| format =
| accessdate = 2007-07-18
}}</ref><ref>{{cite journal |last=Fakjian |first=N |coauthors=S Hunter, GW Cole and J Miller |year=1990 |month=August |title=An argument for circumcision. Prevention of balanitis in the adult |journal=Arch Dermatol |volume=126 |issue=8 |pages=1046&ndash;7 |pmid=2383029 |doi=10.1001/archderm.126.8.1046 }}</ref><ref>{{cite journal |last=Herzog |first=LW |coauthors=SR Alvarez |year=1986 |month=March |title=The frequency of foreskin problems in uncircumcised children |journal=Am J Dis Child |volume=140 |issue=3 |pages=254&ndash;6 |pmid=3946358}}</ref>

One study looked at 75 circumcised and 150 non-circumcised men at a [[sexually transmitted infections]] (STI) [[Sexual health clinic|clinic]] at [[Ealing Hospital]], [[London]]. It found that circumcised men were more likely than non-circumcised men to wash the genital area more than once a day.<ref name="OF1">{{cite journal
| last = O’Farrel
| first = Nigel
| coauthors = Maria Quigley and Paul Fox
| year = 2005
| month = August
| title = Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study
| journal = International Journal of STD & AIDS
| volume = 16
| issue = 8
| pages = 556–588(4)
| doi = 10.1258/0956462054679151
| pmid = 16105191
| url = http://ijsa.rsmjournals.com/cgi/content/abstract/16/8/556
| format = Abstract
| accessdate = 2008-09-06
}}
</ref> However, a follow-up study of 480 men attending the same London clinic, found a very low incidence of the [[subpreputial wetness|subpreputial penile wetness]] that is associated poor genital hygiene and an increased risk of HIV infection<ref name="OF2">{{cite journal
| last = O’Farrel
| first = Nigel
| coauthors = et al
| year = 2007
| month = June
| title = Low prevalence of penile wetness among male sexually transmitted infection clinic attendees in London.
| journal = Sexually Transmitted Diseases
| volume = 36
| issue = 06
| pages = 408-9
| pmid = PMID: 17016235
| url = http://ijsa.rsmjournals.com/cgi/content/abstract/16/8/556
| format = Abstract
| accessdate = 2008-09-06
}}
</ref><ref name="OF3">{{cite journal
| last = O’Farrel
| first = Nigel
| coauthors = et al
| year = 2006
| month = Sept
| title = Association Between HIV and Subpreputial Penile Wetness in Uncircumcised Men in South Africa.
| journal = Journal of Acquired Immune Deficiency Syndromes.
| volume = 43
| pages = 69-77
| url = http://www.jaids.com/pt/re/jaids/abstract.00126334-200609000-00012.htm;jsessionid=LC4RdvbXNsKNz36RWGjMvb51QnYJyp7yy1GhhhJdYDHjh1yQrsmp!-1004083789!181195629!8091!-1
| format = Abstract
| accessdate = 2008-09-06
}}
</ref>.

The foreskin may harbor bacteria and become infected if it is not cleaned properly,<ref name="OF1">{{cite journal
| last = O’Farrel
| first = Nigel
| coauthors = Maria Quigley and Paul Fox
| year = 2005
| month = August
| title = Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study
| journal = International Journal of STD & AIDS
| volume = 16
| issue = 8
| pages = 556–588(4)
| doi = 10.1258/0956462054679151
| pmid = 16105191
| url = http://ijsa.rsmjournals.com/cgi/content/abstract/16/8/556
| format = Abstract
| accessdate = 2008-09-06
}}
</ref> but may become inflamed if it is cleaned too often with soap.<ref name="birley">{{cite journal
| last = Birley
| initial = HDL
| year = 1993
| month = October
| title = Clinical Features and management of recurrent balanitis; association with atopy and genital washing
| journal = Genitourinary Medicine
| volume = 69
| issue = 5
| pages = 400&ndash;403
| doi = 10.1136/jme.2002.001313
| pmid = 8244363
| url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=8244363
| accessdate = 2008-04-12
}}
</ref>

[[Forcible retraction of the foreskin]] in boys can lead to infection<ref name ="CMAJ" /> and [[Phimosis#Acquired_phimosis|acquired phimosis]]. Furthermore, developmentally non-retractile foreskin may be misdiagnosed as phimosis and lead to unnecessary circumcision.<ref name="Rickwood">{{cite journal
| last = Rickwood
| initial = A. M. K.
| year = 1989
| month = September
| title = Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence?
| journal = Annals of the royal college of surgery
| volume = 71
| issue = 5
| pages = 275-277
| url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2499015
}}
</ref>

The usual treatment for [[balanoposthitis]] is to use topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams, but circumcision is another option.<ref>{{cite web
| url = http://www.emedicine.com/derm/topic615.htm
| title = Balanoposthitis
| accessdate = 2006-11-20
| last = Osipov
| first = Vladimir O.
| authorlink =
| coauthors = Scott M. Acker
| date = November 14, 2006
| work = Reactive and Inflammatory Dermatoses
| publisher = [[EMedicine]]
}}
</ref>

====Urinary tract infections====
A meta-analysis of 12 studies (one [[randomised controlled trial]], four [[cohort studies]] and seven [[case-control studies]]) representing 402,908 children determined that circumcision was associated with a significantly reduced risk of [[urinary tract infection]] (UTI). However, the authors noted that only 1% of boys with normal urinary tract function experience a UTI, and the number-needed-to treat (number of circumcisions necessary) to prevent one urinary tract infection was calculated to be 111. Because haemorrhage and infection are the commonest complications of circumcision, occurring at rate of about 2%, assuming equal utility of benefits and harms, the authors concluded that the net clinical benefit of circumcision is only likely in boys at high risk of urinary tract infection (such as those with high grade [[vesicoureteral reflux]] or a history of recurrent UTIs, where the number needed to treat declined to 11 and 4, respectively).<ref name="singhgrewal2005">{{cite journal | last = Singh-Grewal | first = D. | coauthors = J. Macdessi, and J. Craig | date = August 1, 2005 | title = Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies | journal = Archives of Disease in Childhood | volume = 90 | issue = 8 | pages = 853&ndash;858 | doi = 10.1136/adc.2004.049353 | pmid = 15890696 | url = http://adc.bmjjournals.com/cgi/reprint/90/8/853.pdf | format = PDF | accessdate = 2006-09-21 | quote = Circumcision was associated with a significantly reduced risk of UTI (OR = 0.13; 95% CI, 0.08 to 0.20; p<0.001) with the same odds ratio (0.13) for all three types of study design.}}</ref>

Some UTI studies have been criticized for not taking into account a high rate of UTI's among premature infants, who are usually not circumcised because of their fragile health status.<ref name = "AAP1999" /> The AMA stated that “depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI," and noted one decision analysis model that concluded that circumcision was not justified as a preventative measure against UTI.<ref name = "CSA:I-99" />

===Penile cancer===
The [[American Cancer Society]] (2006) stated, "The current consensus of most experts is that circumcision should not be recommended as a prevention strategy for penile cancer."<ref>{{cite web |title=Can Penile Cancer be Prevented? |url=http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_penile_cancer_be_prevented_35.asp}}</ref>

The [[American Academy of Pediatrics]] (1999) stated that studies suggest that neonatal circumcision confers some protection from penile cancer, but circumcision at a later age does not seem to confer the same level of protection. Further, because penile cancer is a rare disease, the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, remains low.<ref name = "AAP1999" />

The age-adjusted annual incidence of penile cancer is 0.82 per 100,000 in Denmark, 2.9-6.8 per 100,000 in Brazil, 0.9 to 1 per 100,000 in the USA, and 2.0-10.5 per 100,000 in India.<ref name = "AAP1999" /> Two studies have reported that the rate of penile cancer is 3 to 22 times higher in men who were not circumcised.<ref>{{cite journal |title=History of circumcision, medical conditions, and sexual activity and risk of penile cancer |first=C |last=Maden |coauthors=''et al'' |journal=J Natl Cancer Inst |year=1993 |month=Jan |volume=85 |issue=1 |pages=19&ndash;24 |pmid=8380060 |doi=10.1093/jnci/85.1.19}}</ref><ref>{{cite journal |url=http://pediatrics.aappublications.org/cgi/content/full/105/3/e36 |title=The highly protective effect of newborn circumcision against invasive penile cancer |first=EJ |last=Schoen |coauthors=Oehrli, M; Colby, C; Machin, G | journal=Pediatrics |year=2000 |month=Mar |volume=105 |issue=3 |pages=e36 |doi=10.1542/peds.105.3.e36}}</ref>

==Policies of various national medical associations==
Most guidelines make a distinction between therapeutic and non-therapeutic circumcision. Therapeutic circumcision (where there is a medical need to circumcise) is rarely controversial. Neonatal circumcision is not considered medically necessary and is therefore categorised as non-therapeutic.

====United States====
The [[American Medical Association]] defines “non-therapeutic” circumcision as the non-religious, non-ritualistic, not medically necessary, elective circumcision of male newborns. It states that medical associations in the US, United Kingdom, Australia, and Canada do not recommend the routine non-therapeutic circumcision of newborns.<ref name = "CSA:I-99">{{cite web
| year = 1999
| month = December
| url = http://www.ama-assn.org/ama/pub/category/13585.html
| title = Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision
| format =
| work = 1999 AMA Interim Meeting: Summaries and Recommendations of Council on Scientific Affairs Reports
| pages = 17
| publisher = [[American Medical Association]]
| accessdate = 2006-06-13
}}
</ref> The medical harms or benefits of non-threapeutic have not been unequivocally proven but there are clear risks of harm if the procedure is done inexpertly.<ref>{{cite news |first=L. |last=MacInnis |authorlink= |coauthors= |title=Circumcision problems impair HIV prevention: study |url=http://africa.reuters.com/top/news/usnBAN155719.html |work= |publisher=Reuters |date=September 1, 2008 |accessdate=2008-09-01 }} </ref> Reasons for non-therapeutic circumcision include religious beliefs as well as cultural and family conformity.<ref name = "BMAGuide" />

The [[American Academy of Pediatrics]] (1999) does not recommend routine neonatal circumcision.<ref name = "AAP1999" /> If parents choose to circumcise, the AAP also recommends using analgesia to reduce pain associated with circumcision, and that circumcision only be performed on newborns who are stable and healthy.<ref name = "AAP19992">{{cite journal
| last = Task Force on Circumcision
| coauthors =
| year = 1999
| month = March 1,
| title = Circumcision Policy Statement
| journal = Pediatrics
| volume = 103
| issue = 3
| pages = 686&ndash;693
| doi = 10.1542/peds.103.3.686
| id = {{ISSN|0031-4005}} PMID 10049981
| url = http://pediatrics.aappublications.org/cgi/reprint/pediatrics;103/3/686.pdf
| format = PDF
| accessdate = 2006-07-01
}}
<small>“Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided. If circumcision is performed in the newborn period, it should only be done on infants who are stable and healthy.”</small>
</ref> The American Medical Association echoes the 1999 Circumcision Policy Statement of the American Academy of Pediatrics.<ref name = "CSA:I-99" />

The [[American Academy of Family Physicians]] (2007) recognizes the controversy surrounding circumcision and recommends that physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering circumcision for newborn boys.<ref name = "AAFP2">{{cite web
| url = http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html
| title = Circumcision: Position Paper on Neonatal Circumcision
| accessdate = 2007-01-30
| year = 2007
| publisher = [[American Academy of Family Physicians]]
| quote = <small>Considerable controversy surrounds neonatal circumcision. Putative indications for neonatal circumcision have included preventing UTIs and their sequelae, preventing the contraction of STDs including HIV, and preventing penile cancer as well as other reasons for adult circumcision. Circumcision is not without risks. Bleeding, infection, and failure to remove enough foreskin occur in less than 1% of circumcisions. Evidence-based complications from circumcision include pain, bruising, and meatitis. More serious complications have also occurred. Although numerous studies have been conducted to evaluate these postulates, only a few used the quality of methodology necessary to consider the results as high level evidence.<br />
<br />
The evidence indicates that neonatal circumcision prevents UTIs in the first year of life with an absolute risk reduction of about 1% and prevents the development of penile cancer with an absolute risk reduction of less than 0.2%. The evidence suggests that circumcision reduces the rate of acquiring an STD, but careful sexual practices and hygiene may be as effective. Circumcision appears to decrease the transmission of HIV in underdeveloped areas where the virus is highly prevalent. No study has systematically evaluated the utility of routine neonatal circumcision for preventing all medically-indicated circumcisions in later life. Evidence regarding the association between cervical cancer and a woman’s partner being circumcised or uncircumcised, and evidence regarding the effect of circumcision on sexual functioning is inconclusive. If the decision is made to circumcise, anesthesia should be used.<br />
<br />
The American Academy of Family Physicians recommends physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering this procedure for their newborn son.</small>
}}</ref>

The American Urological Association (2007) believes that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks.<ref name="AUApolicy"> {{cite web |url=http://www.auanet.org/about/policy/services.cfm#circumcision |title=Circumcision |accessdate=2007-08-26 |author=American Urological Association |format= |work= }} </ref>

====Canada====
The Fetus and Newborn Committee of the [[Canadian Paediatric Society]] posted "Circumcision: Information for Parents" in November 2004,<ref name = "CPSIFP2">{{cite web
| url = http://www.cps.ca/caringforkids/pregnancy&babies/Circumcision.htm
| title = Circumcision: Information for parents
| accessdate = 2006-10-24
| year = 2004
| month = November
| work = Caring for kids
| publisher = [[Canadian Paediatric Society]]
| quote = <small>Circumcision is a “non-therapeutic” procedure, which means it is not medically necessary. Parents who decide to circumcise their newborns often do so for religious, social or cultural reasons. To help make the decision about circumcision, parents should have information about risks and benefits. It is helpful to speak with your baby’s doctor. After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.</small>
}}
</ref> and "Neonatal circumcision revisited" in 1996. The 1996 position statement says that "circumcision of newborns should not be routinely performed," (a statement with which the Royal Australasian College of Physicians concurs,) and the 2004 advice to parents says it "does not recommend circumcision for newborn boys. Many
pediatricians no longer perform circumcisions."<ref name = "CMAJ2">
{{cite journal
| last = Fetus and Newborn Committee
| year = 1996
| month = March
| title = Neonatal circumcision revisited
| journal = Canadian Medical Association Journal
| volume = 154
| issue = 6
| pages = 769&ndash;780
| doi =
| id =
| url = http://www.cps.ca/english/statements/FN/fn96-01.htm
| format =
| accessdate = 2006-07-02
}}
<small>“We undertook this literature review to consider whether the CPS should change its position on routine neonatal circumcision from that stated in 1982. The review led us to conclude the following. There is evidence that circumcision results in an approximately 12-fold reduction in the incidence of UTI during infancy. The overall incidence of UTI in male infants appears to be 1% to 2%. The incidence rate of the complications of circumcision reported in published articles varies, but it is generally in the order of 0.2% to 2%. Most complications are minor, but occasionally serious complications occur. There is a need for good epidemiological data on the incidence of the surgical complications of circumcision, of the later complications of circumcision and of problems associated with lack of circumcision. Evaluation of alternative methods of preventing UTI in infancy is required. More information on the effect of simple hygienic interventions is needed. Information is required on the incidence of circumcision that is truly needed in later childhood. There is evidence that circumcision results in a reduction in the incidence of penile cancer and of HIV transmission. However, there is inadequate information to recommend circumcision as a public health measure to prevent these diseases. When circumcision is performed, appropriate attention needs to be paid to pain relief. The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns. There is therefore no indication that the position taken by the CPS in 1982 should be changed. When parents are making a decision about circumcision, they should be advised of the present state of medical knowledge about its benefits and harms. Their decision may ultimately be based on personal, religious or cultural factors.</small>
</ref>

====United Kingdom====
There is a spectrum of views within the [[British Medical Association]]'s (BMA) membership about whether non-therapeutic male circumcision is a beneficial, neutral or harmful procedure or whether it is superfluous, and whether it should ever be done on a child who is not capable of deciding for himself. Moreover, the Association states that “there is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research.”<ref name = "BMAGuide" /> As a general rule, the BMA believe that "parents should be entitled to make choices about how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices." They also state that "both parents...must give consent for non-therapeutic circumcision", and that parents and children should be provided with up-to-date written information about the risks involved.<ref name = "BMAGuide" />

According to the BMA, circumcision for medical purposes should only be used where less invasive procedures are either unavailable or not as effective. They state that "to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate." Furthermore, the BMA believe that children who are capable of expressing a view should be involved in the decision making process with regard to their own circumcision, and their views should be taken into account. The BMA state that they "cannot envisage a situation in which it is ethically acceptable to circumcise a competent, informed young person who consistently refuses the procedure."<ref name = "BMAGuide" />

The BMA state that parents should be informed about the lack of consensus within the medical profession with regard to the potential health benefits of non-therapeutic circumcision, adding that they consider the evidence for such benefits to be insufficient as the sole reason for carrying out a circumcision.<ref name = "BMAGuide" />

====Australasia====
The [[Royal Australasian College of Physicians]] (RACP) state that "after extensive review of the literature" they "reaffirm that there is no medical indication for routine neonatal circumcision". They also state that "if the operation is to be performed, the medical attendant should ensure this is done by a competent operator, using appropriate anaesthesia and in a safe child-friendly environment." Additionally, the RACP state that there is an obligation to provide parents who request a circumcision for their child with accurate, up-to-date and unbiased information about the risks and benefits of circumcision, adding that "there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate."<ref name = "RACPSumm" />

The Tasmanian President of the Australian Medical Association (AMA), Haydn Walters, has stated that the AMA would support a call to ban circumcision for non-medical, non-religious reasons.<ref>{{cite news |url=http://www.abc.net.au/news/stories/2007/12/09/2113665.htm |title=Doctors back call for circumcision ban |date=2007-12-09 |publisher=ABC News}}</ref>

==History of circumcision==
{{main|History of male circumcision}}

[[Image:Circumcision Precinct of Mut.png|thumb|right|Ancient Egyptian carved scene of circumcision, from the inner northern wall of the Temple of [[Khonspekhrod]] at the [[Precinct of Mut]], [[Luxor]], Egypt. [[Eighteenth dynasty of Egypt|Eighteenth dynasty]], [[Amenhotep III]], c. 1360 BC.]]
It has been variously proposed that circumcision began as a religious [[sacrifice]], as a [[rite of passage]] marking a boy's entrance into adulthood, as a form of [[magical thinking|sympathetic magic]] to ensure virility, as a means of suppressing sexual pleasure or to increase a man's attractiveness to women, or as an aid to [[hygiene]] where regular [[bathing]] was impractical, among other possibilities. Immerman ''et al.'' suggest that circumcision causes lowered sexual arousal of pubescent males, and hypothesize that this was a competitive advantage to tribes practicing circumcision, leading to its spread regardless of whether the people understood this.<ref>{{cite journal |last=Immerman |first=R.S. |authorlink= |coauthors=W.C. Mackey |year=1997 |month=Fall-Winter |title=A biocultural analysis of circumcision |journal=Social Biology |volume=44 |issue=3-4 |pages=265–275 |pmid=9446966 |url=http://www.cirp.org/library/psych/immerman2/ |accessdate= |quote= |doi=10.1111/j.1467-9744.1976.tb00285.x }}</ref>
It is possible that circumcision arose independently in different cultures for different reasons.
[[Image:Circumcision set.jpg|right|thumb|Family circumcision set and trunk, ca. eighteenth century
Wooden box covered in cow hide with silver implements: silver trays, clip, pointer, silver flask, spice vessel.]]
The oldest documentary evidence for circumcision comes from [[ancient Egypt]].<ref> Tomb artwork from the [[Sixth Dynasty]] (2345&ndash;2181 BCE) shows men with circumcised penises, and one [[relief]] from this period shows the rite being performed on a standing adult male. The [[Egyptian hieroglyph]] for "penis" depicts either a circumcised or an erect organ. The examination of Egyptian mummies has found some with foreskins and others who were circumcised.</ref> Circumcision was common, although not universal, among ancient [[Semitic]] peoples.<ref> The [[Book of Jeremiah]], written in the sixth century BCE, lists the Egyptians, Jews, [[Edomites]], [[Ammon]]ites, and [[Moabites]] as circumcising cultures. [[Herodotus]], writing in the fifth century BCE, would add the [[Colchis|Colchians]], [[Ethiopia]]ns, [[Phoenicians]], and [[Syria]]ns to that list.</ref> In the aftermath of the conquests of [[Alexander the Great]], however, Greek dislike of circumcision (they regarded a man as truly "naked" only if his prepuce was retracted) led to a decline in its incidence among many peoples that had previously practiced it.<ref>The writer of the [[1 Maccabees]] wrote that under the [[Seleucid]]s, many Jewish men attempted to hide or reverse their circumcision so they could exercise in Greek [[Gymnasium (ancient Greece)|gymnasia]], where nudity was the norm. First Maccabees also relates that the Seleucids forbade the practice of [[brit milah]] (Jewish circumcision), and punished those who performed it&ndash;as well as the infants who underwent it&ndash;with death.</ref>

Circumcision has ancient roots among several ethnic groups in sub-equatorial Africa, and is still performed on adolescent boys to symbolize their transition to warrior status or adulthood.<ref>{{cite journal |last=Marck |first=J |year=1997 |month= |title=Aspects of male circumcision in sub-equatorial African culture history |journal=Health Transit Review |volume=7 |issue=supplement |pages=337-360 |pmid=10173099 }}</ref>

===Circumcision in the English-speaking world===
Infant circumcision was taken up in the [[United States]], [[Australia]] and the English-speaking parts of [[Canada]], [[South Africa]] and to a lesser extent in the [[United Kingdom]] and [[New Zealand]].
There are several hypotheses to explain why infant circumcision was accepted in the United States about the year 1900. The [[germ theory of disease]] elicited an image of the human body as a conveyance for many dangerous germs, making the public "germ phobic" and suspicious of dirt and bodily secretions. Because of its function, the penis became "dirty" by association, and from this premise circumcision was seen as preventative medicine to be practiced universally.<ref name="Gollaher1994">{{cite journal
| last = Gollaher
| first = David
| coauthors =
| year = 1994
| month = Fall
| title = From ritual to science: the medical transformation of circumcision in America
| journal = Journal of Social History
| volume = 28
| issue = 1
| pages = 5&ndash;36
| pmid =
| doi =
| url = http://www.cirp.org/library/history/gollaher/
| accessdate = 2007-12-06
}}</ref> In the view of many practitioners at the time, circumcision was a method of treating and preventing masturbation.<ref name="Gollaher1994"/> It was also said to protect against [[syphilis]],<ref>{{cite journal | title=On the influence of circumcision in preventing syphilis | journal=Medical Times and Gazette | volume=NS Vol II | year=1855 | pages=542&ndash;3 | unused_data=Hutchinson J }}</ref> phimosis, paraphimosis, balanitis, and "excessive [[venery]]" (which was believed to produce [[paralysis]]).<ref name="Gollaher1994" /> Gollaher states that physicians advocating circumcision in the late nineteenth century expected public skepticism, and refined their arguments to overcome it.<ref name="Gollaher1994" />

Although it is difficult to determine historical circumcision rates, one estimate of infant circumcision rates in the United States holds that 32% of newborn American boys were being circumcised in 1933.<ref name=Laumann/> Laumann ''et al.'' reported that the prevalence of circumcision among US-born males was approximately 70%, 80%, 85%, and 77% for those born in 1945, 1955, 1965, and 1971 respectively.<ref name=Laumann/> Xu ''et al.'' reported that the prevalence of circumcision among US-born males was 91% for males born in the 1970s and 84% for those born in the 1980s.<ref>{{cite journal |author=Xu F, Markowitz LE, Sternberg MR, Aral SO |title=Prevalence of circumcision and herpes simplex virus type 2 infection in men in the United States: the National Health and Nutrition Examination Survey (NHANES), 1999-2004 |journal=Sex Transm Dis |volume=34 |issue=7 |pages=479–84 |year=2007 |month=July |pmid=17413536 |doi=10.1097/01.olq.0000253335.41841.04 |url=}}</ref> Between 1981 and 1999, National Hospital Discharge Survey data from the [[National Center for Health Statistics]] demonstrated that the infant circumcision rate remained relatively stable within the 60% range, with a minimum of 60.7% in 1988 and a maximum of 67.8% in 1995.<ref>{{cite web |url=http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions.htm |title=Trends in circumcisions among newborns |accessdate=2008-08-19 |work=National Hospital Discharge Survey |publisher=National Center for Health Statistics |date=January 11, 2007}}</ref> A 1987 study found that the most prominent reasons US parents choose circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns.<ref>{{cite journal |last=Brown |first=M.S. |coauthors=C.A. Brown |year=1987 |month=August |title=Circumcision decision: prominence of social concerns |journal=Pediatrics |volume=80 |issue=2 |pages=215-219 |pmid=3615091 |url= |accessdate= |quote= }}</ref> However, a later study speculated that an increased recognition of the potential benefits of neonatal circumcision may have been responsible for the observed increase in the US rate between 1988 and 2000.<ref>{{cite journal |last=Nelson |first=C.P. |coauthors=R. Dunn, J. Wan, J.T. Wei |year=2005 |month=March |title=The increasing incidence of newborn circumcision: data from the nationwide inpatient sample |journal=Journal of Urology |volume=173 |issue=3 |pages=978-981 |pmid=15711354 |url= |accessdate= |quote= }}</ref> A report by the [[Agency for Healthcare Research and Quality]] placed the 2005 national circumcision rate at 56%.<ref>{{cite news |first= |last= |title=U.S. circumcision rates vary by region |url=http://www.hcup-us.ahrq.gov/reports/statbriefs/sb45.pdf
|work= |publisher=Agency for Healthcare Research and Quality |date=January, 2008 |accessdate=2008-08-19 }}</ref>

Circumcision grew in popularity in [[South Korea]] following the establishment of the United States trusteeship in 1945 and the spread of American influence. More than 90% of South Korean high school boys are now circumcised, and the average age of circumcision is 12 years.<ref>{{cite journal |url=http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410X.2002.02545.x |first=MG |last=Pang |coauthors=Kim DS |title=Extraordinarily high rates of male circumcision in South Korea: history and underlying causes |journal=BJU Int |year=2002 |volume=89 |issue=1 |pages=48&ndash;54 |doi=10.1046/j.1464-410X.2002.02545.x}}</ref>

In 1949, the United Kingdom's newly-formed [[National Health Service]] removed infant circumcision from its list of covered services, and circumcision has since been an [[Out-of-pocket expenses|out-of-pocket cost]] to parents. As a result, prevalence in the UK is age-graded, with 12% of those aged 16-19 years circumcised and 20% of those aged 40-44 years,<ref name="Davis">{{cite journal
|title=Male circumcision in Britain: findings from a national probability sample survey
|author=Dave, SS
|coauthors=''et al''
|journal=Sex Transm Infect
|year=2003
|volume=79
|pages=499–500
|url=http://sti.bmj.com/cgi/content/full/79/6/499
|doi=10.1136/sti.79.6.499
}}</ref> and the proportion of newborns circumcised in England and Wales has fallen to less than one percent.

The circumcision rate has declined sharply in [[Australia]] since the 1970s, leading to an age-graded fall in prevalence, with a 2000-01 survey finding 32% of those aged 16-19 years circumcised, 50% for 20-29 years and 64% for those aged 30-39 years.<ref>"In Australia and New Zealand, the circumcision rate has fallen considerably in recent years and it is estimated that currently only 10%-20% of male infants are routinely circumcised." (RACP: 2004)</ref><ref name=richters>{{cite journal
|title=Circumcision in Australia: prevalence and effects on sexual health
|author=Richters, J
|coauthors=''et al.''
|journal=Int J STD AIDS
|year=2006
|volume=17
|pages=547–554
|pmid=16925903
|quote=Neonatal circumcision was routine in Australia until the 1970s … In the last generation, Australia has changed from a country where most newborn boys are circumcised to one where circumcision is the minority experience.
|url=http://www.cirp.org/library/general/richters1/
|doi=10.1258/095646206778145730
}}</ref>

In Canada, individual provincial health services began delisting circumcision in the 1980s.{{Fact|date=August 2008}}

==Prevalence of circumcision==
{{main|Prevalence of circumcision}}
[[Image:Global Map of Male Circumcision Prevalence at Country Level.png|thumb|300px|Map published by the United Nations ([[World Health Organization|WHO]]/[[UNAIDS]]) showing percentage of males who have been circumcised, at a country level. Data was provided by [[Demographic and Health Surveys| MEASURE DHS]] [http://www.measuredhs.com/countries/] and other sources. [http://www.who.int/hiv/pub/malecircumcision/infopack_en_2.pdf] ]]
Estimates of the proportion of males that are circumcised worldwide vary from one-sixth<ref name="WillKap">{{cite journal
| last = Williams
| first = N
| coauthors = L. Kapila
| year = 1993
| month = October
| title = Complications of circumcision
| journal = British Journal of Surgery
| volume = 80
| issue = 10
| pages = 1231&ndash;1236
| doi = 10.1002/bjs.1800801005
| url = http://www.cirp.org/library/complications/williams-kapila/
| accessdate = 2006-07-11
}}</ref> to a third.<ref name="crawford2002">Crawford DA. Circumcision: a consideration of some of the controversy. ''J Child Health Care.'' 2002 December;6(4):259&ndash;70.

PMID 12503896</ref> WHO has estimated that 664,500,000 males aged 15 and over are circumcised (30% global prevalence), with almost 70% of these being Muslim.<ref

name="WHOpr0307" /> Prevalence is near universal in the Middle East and Central Asia.<ref name="WHOpr0307"/> WHO states that "there is generally little non-religious circumcision in Asia, with the exceptions of the Republic of Korea and the Philippines".<ref name="WHOpr0307"/> WHO presents a map of estimated prevalence in which the level is generally low (< 20%) across Europe,<ref name="WHOpr0307"/> and Klavs et al. report findings that "support the notion that the prevalence is low in Europe".<ref name="KlavsHamers">{{cite journal
|author=Klavs I, Hamers FF
|title=Male circumcision in Slovenia: results from a national probability sample survey
|journal=Sex Transm Infect
|volume=84
|issue=1
|pages=49–50
|year=2008
|month=February
|pmid=17881413
|doi=10.1136/sti.2007.027524
}}</ref> In Latin America, prevalence is universally low.<ref name="Drain">{{cite journal
|last=Drain
|first=PK
|coauthors= ''et al''
|year=2006
|month=November
|title=Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries
|journal=BMC Infect Dis
|volume=30
|issue=6 |pages=172
|doi=10.1186/1471-2334-6-172
|pmid=17137513
|url=http://www.biomedcentral.com/1471-2334/6/172
|accessdate=2008-04-25
}}</ref> Estimates for individual countries include [[Spain]]<ref name="castellsague" />, [[Colombia]]<ref name="castellsague">{{cite journal
|title=Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners
|author=Castellsagué, X |coauthors=''et al''
|journal= N Engl J Med
|year=2002
|volume=346
|issue=15
|pages=1105–12
|pmid=11948269
|doi=10.1056/NEJMoa011688
}}</ref> and [[Denmark]]<ref>{{cite journal
|title=Falling incidence of penis cancer in an uncircumcised population (Denmark 1943-90)
|author=Frisch, M |coauthors=''et al''
|journal=BMJ |year=1995
|volume=311
|pages=1471
|url=http://bmj.bmjjournals.com/cgi/content/full/311/7018/1471
|pmid=8520335
}}</ref> less than 2%, [[Finland]]<ref>{{cite journal
|title=Cost analysis of neonatal circumcision in a large health maintenance organization
|author=Schoen, E J
|coauthors=Colby, C J; Trinh, T To
|journal=J Urol
|volume=175
|pages=1111–1115
|doi=10.1016/S0022-5347(05)00399-X
|year=2006}}</ref> and [[Brazil]]<ref name="castellsague" /> 7%, [[Taiwan]]<ref>{{cite journal
|last=Ko
|first=MC
|coauthors=''et al''
|year=2007
|month=April
|title=Age-specific prevalence rates of phimosis and circumcision in Taiwanese boys
|journal=J Formos Med Assoc
|volume=106
|issue=4
|pages=302–7
|pmid=17475607
|quote=… the prevalence of circumcision slightly increased with age from 7.2% (95% CI, 5.3-10.8%) for boys aged 7 years to 8.7% (95% CI, 6.5-13.3%) for boys aged 13 years.
}}</ref> 9%, [[Thailand]]<ref name="castellsague" /> 13%, New Zealand<ref name="WHO-Info-2"/> less than 20% and Australia<ref name=richters/> 58.7%.

WHO estimates prevalence in the [[United States]] and [[Canada]] at 75% and 30%, respectively.<ref name="WHOpr0307" /> Prevalence in [[Africa]] varies from less than 20% in some southern African countries to near universal in North and West Africa.<ref name="Drain" />

==See also==
*[[Brit milah]]
*[[Circumcision scar]]
*[[Foreskin restoration]]
*[[Frenectomy]]
*[[Genital integrity]]
*[[Genital modification and mutilation]]
*[[Holy Prepuce]]
*[[Preputioplasty]], alternative to circumcision in the treatment for phimosis

==Further reading==
<!-- The following references should be moved into cite tags as in [[#Risks of circumcision]], above. -->
* Billy Ray Boyd. ''Circumcision Exposed: Rethinking a Medical and Cultural Tradition.'' Freedom, CA: The Crossing Press, 1998. (ISBN 978-0-89594-939-4)
* Anne Briggs. ''Circumcision: What Every Parent Should Know.'' Charlottesville, VA: Birth & Parenting Publications, 1985. (ISBN 978-0-9615484-0-7)
* Robert Darby. ''A surgical temptation: The demonization of the foreskin and the rise of circumcision in Britain.'' Chicago: University of Chicago Press, 2005. (ISBN 978-0-226-13645-5)
* Aaron J. Fink, M.D. ''Circumcision: A Parent's Decision for Life''. Kavanah Publishing Company, Inc., 1988. (ISBN 978-0-9621347-0-8)
* Paul M. Fleiss, M.D. and Frederick Hodges, D. Phil. ''What Your Doctor May'' Not ''Tell You About Circumcision.'' New York: Warner Books, 2002. (ISBN 978-0-446-67880-3)
* Leonard B. Glick. ''Marked in Your Flesh: Circumcision from Ancient Judea to Modern America.'' New York: Oxford University Press, 2005. (ISBN 978-0-19-517674-2)
* [[David Gollaher]]. ''Circumcision: A History of the World's Most Controversial Surgery.'' New York: Basic Books, 2000. (ISBN 0465026532)
* Ronald Goldman, Ph.D. ''Circumcision: The Hidden Trauma.'' Boston: Vanguard, 1996. (ISBN 978-0-9644895-3-0)
* [[Paysach Krohn|Paysach J. Krohn]], Rabbi. ''Bris Milah. Circumcision&mdash;The Covenant Of Abraham/A Compendium of Laws, Rituals, And Customs From Birth To Bris, Anthologized From Talmudic, And Traditional Sources.'' New York: Mesorah Publications, 1985, 2005.
* Brian J. Morris, Ph.D., D.Sc. ''In Favour of Circumcision.'' Sydney: UNSW Press, 1999. (ISBN 978-0-86840-537-7)
* Peter Charles Remondino. ''[http://www.gutenberg.org/etext/23135 History of Circumcision from the Earliest Times to the Present].'' Philadelphia and London; F. A. Davis; 1891.
* Holm Putzke, Ph.D. ''Die strafrechtliche Relevanz der Beschneidung von Knaben. Zugleich ein Beitrag über die Grenzen der Einwilligung in Fällen der Personensorge'', in: H. Putzke u.a. (Hrsg.), ''Strafrecht zwischen System und Telos'', Festschrift für Rolf Dietrich Herzberg zum siebzigsten Geburtstag am 14. Februar 2008 , Mohr Siebeck: Tübingen 2008, p. 669–709 (ISBN 978-3161495700)
* Holm Putzke, Ph.D., Maximilian Stehr, Ph.D., and Hans-Georg Dietz, Ph.D. ''Strafbarkeit der Zirkumzision von Jungen. Medizinrechtliche Aspekte eines umstrittenen ärztlichen Eingriffs'' (''Liability to penalty for circumcision in boys. Medico-legal aspects of a controversial medical intervention''), in: Monatsschrift Kinderheilkunde 8/2008, p. 783–788
* Rosemary Romberg. ''Circumcision: The Painful Dilemma.'' South Hadley, MA Bergan & Garvey, 1985. (ISBN 978-0-89789-073-1)
* Edgar J Schoen, M.D. ''Ed Schoen, MD on Circumcision.'' Berkeley, CA: RDR Books, 2005. (ISBN 978-1-57143-123-3)
* Edward Wallerstein. ''Circumcision: An American Health Fallacy.'' New York: Springer, 1980 (ISBN 978-0-8261-3240-6)
* Gerald N. Weiss M.D. and Andrea W Harter. ''Circumcision: Frankly Speaking.'' Wiser Publications, 1998. (ISBN 978-0-9667219-0-4)
* Yosef David Weisberg, Rabbi. ''Otzar Habris. Encyclopedia of the laws and customs of Bris Milah and Pidyon Haben.'' Jerusalem: Hamoer, 2002.

==Notes and references==
{| class="messagebox" style="background: {{{#666666}}};"
|-
||Some referenced articles are available on-line only in the Circumcision Information and Resource Page’s (CIRP) library or in The Circumcision Reference Library (CIRCS). CIRP articles are chosen from an anti-circumcision point of view, and text in support of this position is often highlighted on-screen using [[HTML]]. CIRCS articles are chosen from a pro-circumcision point of view. If documents are not freely available on-line elsewhere, links to articles in one or other of these two websites may be provided.
|}
{{reflist|colwidth=30em}}

==External links==
{{commonscat}}
===Circumcision opposition===
* [http://www.cirp.org The Circumcision Information and Resource Pages] by Geoffrey T. Falk
* [http://www.doctorsopposingcircumcision.org Doctors Opposing Circumcision] presided by George C. Denniston, MD, MPH
* [http://www.nocirc.org National Organization of Circumcision Information Resource Centers] by Marilyn Milos, RN

===Circumcision promotion===
* [http://www.circinfo.net/ Benefits of circumcision: medical, health and sexual] by Professor Brian Morris
* [http://medicirc.org/ Circumcision: a lifetime of medical benefits] by Edgar Schoen, BSc., M.D.
* [http://www.aish.com/literacy/lifecycle/Bris_Milah_Beautiful_or_Barbaric$.asp Bris Milah: Beautiful or Barbaric] by Rabbi [[Shraga Simmons]]

===Circumcision techniques and videos===
* [http://www.aafp.org/afp/990315ap/1514.html Description of an adult circumcision] from the [[AAFP|American Academy of Family Physicians]].
* Video demonstrations of infant circumcision: using a [http://newborns.stanford.edu/Plastibell.html Plastibell], a [http://newborns.stanford.edu/Gomco.html Gomco clamp] and a [http://newborns.stanford.edu/Mogen.html Mogen clamp].

<!-- Categorization -->
{{Urogenital surgical procedures}}

[[Category:Circumcision]]
[[Category:Body modification]]
[[Category:Penis]]
[[Category:Sexuality]]
[[Category:Surgical removal procedures]]

[[ar:ختان]]
[[bm:Bolokoli]]
[[br:Trodroc'hañ]]
[[bg:Обрязване]]
[[ca:Circumcisió]]
[[cs:Obřízka]]
[[da:Omskæring]]
[[de:Zirkumzision]]
[[et:Ümberlõikamine]]
[[el:Περιτομή]]
[[es:Circuncisión]]
[[eo:Cirkumcido]]
[[fa:ختنه]]
[[fr:Circoncision]]
[[ko:포경수술]]
[[hi:ख़तना]]
[[hr:Obrezivanje]]
[[id:Sunat]]
[[it:Circoncisione]]
[[he:מילה (ניתוח)]]
[[kk:Сүндеттеу]]
[[la:Circumcisio]]
[[lt:Apipjaustymas]]
[[hu:Körülmetélés]]
[[mk:Машко обрежување]]
[[ml:ചേലാകര്‍മ്മം]]
[[ms:Khatan]]
[[nl:Circumcisie]]
[[ja:割礼]]
[[nn:Omskjering]]
[[pl:Obrzezanie]]
[[pt:Circuncisão]]
[[ro:Circumcizie]]
[[ru:Обрезание]]
[[simple:Circumcision]]
[[sk:Obriezka]]
[[sl:Obrezovanje moških]]
[[fi:Ympärileikkaus]]
[[sv:Manlig omskärelse]]
[[th:การขริบหนังหุ้มปลายอวัยวะเพศ]]
[[vi:Cắt bao quy đầu]]
[[tr:Sünnet (tıp)]]
[[uk:Обрізання]]
[[zh:割禮]]

Revision as of 18:05, 11 October 2008

This category is for Films originally released in the year 2003.
The main article for this category is 2003 in film.
See also: Category:Films set in 2003
Retrieved from "https://en.wikipedia.org/w/index.php?title=Circumcision&oldid=244608714"