Circumcision

[21][22] Beyond use as a prophylactic or treatment option in healthcare, circumcision plays a major role in many of the world's cultures and religions, most prominently Judaism and Islam.

[30][12][9] In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that they recommended adolescent and adult circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV, as long as the program includes "informed consent, confidentiality, and absence of coercion" — known as voluntary medical male circumcision, or VMMC.

[19] Literature on the matter is polarized, with the cost-benefit analysis being highly dependent on the kinds and frequencies of health problems in the population under discussion and how circumcision affects them.

[5][4][37] These include infants with certain genital structure abnormalities, such as a misplaced urethral opening (as in hypospadias and epispadias), curvature of the head of the penis (chordee), or ambiguous genitalia, because the foreskin may be needed for reconstructive surgery.

[5][4][37] If an individual is known to have or has a family history of serious bleeding disorders such as hemophilia, it is recommended that the blood be checked for normal coagulation properties before the procedure is attempted.

[41][42] Topical creams have been found to irritate the skin of low birth weight infants, so penile nerve block techniques are recommended in this group.

[47][48] In 2020, the World Health Organization (WHO) reiterated that male circumcision is an efficacious intervention for HIV prevention if carried out by medical professionals under safe conditions.

[61][62] This pathological phimosis may be due to scarring from the skin disease balanitis xerotica obliterans (BXO), repeated episodes of balanoposthitis or forced retraction of the foreskin.

In the lands south and east of the Mediterranean, starting with Central Sahara, Sudan and Ethiopia, the procedure was practiced by the ancient Egyptians and the Semites, and then by the Jews and Muslims.

[89]: 2–3 [93] Evidence suggests that circumcision was practiced in the Middle East by the fourth millennium BCE, when the Sumerians and the Semites moved into the area that is modern-day Iraq from the North and West.

No well-accepted theory explains the significance of circumcision to the Egyptians, but it appears to have been endowed with great honor and importance as a rite of passage, performed in a public ceremony emphasizing the continuation of family generations and fertility.

[27][89][95] Historical campaigns of ethnic, cultural, and religious persecution frequently included bans on circumcision as a means of forceful assimilation, conversion, and ethnocide.

[99] Although it is not explicitly mentioned in the Quran (early seventh century CE), circumcision is considered essential to Islam, and it is nearly universally performed among Muslims.

[101][102] The practice of circumcision is thought to have been brought to the Bantu-speaking tribes of Africa by either the Jews after one of their many expulsions from European countries, or by Muslim Moors escaping after the 1492 reconquest of Spain.

[2][27] For Aboriginal Australians and Polynesians, circumcision likely started as a blood sacrifice and a test of bravery and became an initiation rite with attendant instruction in manhood in more recent centuries.

[105] Pursuing a successful career as a general practitioner, Hutchinson went on to advocate circumcision for health reasons for the next fifty years,[104] eventually earned a knighthood for his contributions to medicine.

[106] In 1870, orthopedic surgeon Lewis Sayre, a founder of the American Medical Association, introduced circumcision in the United States as a purported cure for several cases of young boys presenting with paralysis and other significant gross motor problems.

[107] The use of circumcision to promote good health also fit the germ theory of disease, which saw validation during the same period: the foreskin was thought to harbor infection-causing smegma.

[107] Although later discredited, many contemporary physicians believed it could cure, reduce, or otherwise prevent a wide-ranging array of perceived medical problems and social ills, including that of epilepsy, hernia, headache, masturbation, clubfoot, alcoholism and gout.

[109]: 752 Historian David Gollaher proposes that "Americans found circumcision appealing not merely on medical grounds, but also for its connotations of science, health, and cleanliness—newly important class distinctions" in a country where 17 million immigrants arrived between 1890 and 1914.

[108]: 106 During the interwar period, medical organizations and doctors in mainland Europe experimented with the idea of routine circumcision for prophylactic reasons as well, alongside developments in the Anglophonic world.

[19] Yosha & Bolnick & Koyle (2012) have suggested that a factor in its Anglophonic adoption and dismissal in mainland Europe relates to attitudes towards Judaism and Jewish practices.

Douglas Gairdner's 1949 article "The Fate of the Foreskin" argued that the evidence showed that the risks outweighed the benefits, leading to a significant reduction in circumcision incidence within the United Kingdom.

[112] In contrast to Gairdner, American pediatrician Benjamin Spock argued in favor of circumcision in his popular The Common Sense Book of Baby and Child Care which led to rates in the United States significantly rising.

Barring extraordinary circumstances, failure to undergo the rite is seen by followers of Judaism as leading to a state of Kareth: the extinction of the soul and denial of a share in the world to come.

[23][24][96] Reasons for biblical circumcision include to show off "patrilineal descent, sexual fertility, male initiation, cleansing of birth impurity, and dedication to God".

[25][157] Scholar Heather L. Armstrong writes that, as of 2021,[update] about half of Christian males worldwide are circumcised, with most of them being located in Africa, Anglosphere countries, and the Philippines.

"[179] In Buddhism, the number 10 of the overall 32 attributes of the enlightened individual is possibly a reference to circumcision, which says: "His sexual organs are concealed in a sheath and exude a pleasant odor similar to vanilla."

[179] Some Australian Aborigines use circumcision as a test of bravery and self-control as a part of a rite of passage into manhood, which results in full societal and ceremonial membership.

[198][197] Circumcision for the prevention of HIV transmission in adults has also been found to be cost-effective in South Africa, Kenya, and Uganda, with cost savings estimated in the billions of US dollars over 20 years.

Actor Melusi Yeni became the 1 millionth VMMC against HIV/AIDS transmission in the province of KwaZulu-Natal , South Africa. [ 29 ]
Before (left) and after (right) an adult circumcision that was undertaken to treat phimosis . After the operation, the glans is exposed even when the penis is flaccid .
Circumcision knife from the Congo; wood, iron; late 19th/early 20th century
Detail of the Artemision Bronze ; the Greeks abhorred circumcision, making life difficult for circumcised Jews living among the Greeks.
The Circumcision of Jesus Christ, by Ludovico Mazzolino
The first medical professional to recommend circumcision as a prophylaxis against disease was the British physician Jonathan Hutchinson in 1855. By the late 19th century, the belief that circumcision acted as an effective prophylactic against disease was held by a majority of the core Anglosphere 's medical communities and doctors, such as the prominent Lewis Sayre , president of the American Medical Association , subsequently leading to its widespread adoption. [ 21 ]
Pediatrician and political activist Benjamin Spock recommended circumcision in his influential work The Common Sense Book of Baby and Child Care , one of the best-selling books of the twentieth century. [ 111 ]
A circumcision being performed in Central Asia, c. 1865–1872
Preparing for a Jewish ritual circumcision
Children in Turkey wearing traditional circumcision costumes
Boys in white clothing with bonnets at Tireli market, just after circumcision, Mali, 1990
Coptic Children wearing traditional circumcision costumes
Preparing for a ritual circumcision to a Druze child
Sculptural representation of lingam , male sex organ-placed on yoni , female sex organ. In Hinduism, lingam and yoni represent the masculine and the feminine creative principles respectively. [ 172 ]