Male circumcision is the surgical removal of the foreskin. It usually involves cutting some or all of the fold of the skin that covers the glans (head) of the penis.

The foreskin is a sensitive part of the male genitals with nerve endings that enhance sexual pleasure. Its removal is sometimes associated with a reduction in sensitivity.

Circumcision is primarily carried out for religious or cultural reasons. It is sometimes done for health, hygiene and aesthetic reasons or to treat disease.

Medical opinion, particularly in the United States, is divided over its benefits. The majority of newborn babies in America are still circumcised. But most circumcisions are not carried out for religious reasons, making the US the last developed nation in the world to perform the procedure for non-religious and non-medical reasons.

Some doctors have branded circumcision a "barbaric act" and see it as an unnecessary mutiliation. The International Coalition for Genital Integrity, for example, has classified circumcision as type 1 genital mutilation.

At the other end of the spectrum are those who believe that circumcision helps to reduce cancer of the penis, HIV, and infections such as thrush and herpes.

Circumcision in religion

Circumcision is an initiation rite for Jewish newborn babies. It is also practised by Muslims who see it as a sign of purification and perform the rite within the early years of a child's life.

Followers of Christianity, Hinduism and Sikhism are against the ritual being carried out for religious reasons.

About one in six men worldwide are circumcised and it is estimated that 15 million post-infancy operations are performed each year, making circumcision the most commonly practised medical procedure in the world.

Amongst Jews and Muslims where circumcision is mandatory or desirable, numbers are higher. Each year approximately 100,000 Jews are circumcised and 10 million Muslims.

Rates of circumcision vary between countries. In parts of Africa where circumcision is a tribal custom, the number is around nine million.

In Britain, the rest of Europe, Central and South America and Asia, the rate is as low as one per cent.

Circumcision in Judaism

Circumcision is most associated with the Jewish commmunity although there are more circumcised Muslims in the world than Jews.

The Jewish circumcision ritual is an ancient practice that has been carried out by Jewish parents for more than 3,000 years. Circumcision is seen as a covenant with God and a requirement for all Jewish males.

Circumcision in Islam

Muslims are still the largest single religious group to circumcise boys. The main reason given for the ritual is cleanliness. For the majority of Muslims, circumcision is seen as an introduction to the Islamic faith and a sign of belonging.

Circumcision is not mentioned in the Qur'an but it is highlighted in the Prophet Muhammad's recorded words and actions.

Circumcision and Christianity

In the Old Testament circumcision is clearly defined as a covenant between God and all Jewish males. But circumcision is not laid down as a requirement in the New Testament.


Social customs

Social and cultural circumcision

Today circumcision is not a religious issue for Christian families. But in the United States, where Christianity is the main religion, the majority of newborn baby boys are routinely circumcised after birth.

The practice, however, has nothing to do with religion and everything to do with social convention.

The American custom has its roots in Victorian Britain. At the turn of the 20th century, doctors began to promote circumcision as a way to prevent masturbation.

By 1940, up to half of British men were circumcised. The practice lost ground in the 1950s after circumcision was declared "medically untenable". Today under three per cent of British men are circumcised.

United States

In the United States, though, the British practice was enthusiastically embraced. Circumcision was practised widely until the early 1970s.

In 1971 the American Academy of Pediatrics (AAP) ruled that there were no medical reasons to justify infant circumcision in the US. The ruling was reinforced in 1975.

The American College of Obstetrics and Gynaecology also declared circumcision as unnecessary. By the late 1970s the circumcision rate had hit an all-time low of 59%.

However in 1989, the AAP reversed its position, recommending the "potential medical benefits" to circumcision such as a lower rate of urinary tract infection in circumcised men.

The circumcision rate began to climb again. More than 60% of American men are circumcised today, the majority for non-religious reasons.

According to the National Center of Health Statistics, circumcision rates are the lowest in Western US (34%) and the highest in the Midwest (80%), where some hospitals routinely circumcise more than 95% of newborns.

Although the majority of American men are circumcised, there is a growing groundswell of opinion against the operation in the US. Some men have even undergone procedures to have their foreskin reinstated.

Controversy

Circumcision is a divisive issue in some parts of the US.

Critics believe circumcision is unethical and unnecessary. They argue that the removal of the foreskin increases the risk of infection and, in some cases, death. They also argue that circumcision is linked to conformity and the 'locker room syndrome' where uncircumcised men risk being ridiculed by their peers.

But supporters claim circumcision has important health benefits and reject arguments that the surgical removal of the foreskin is nothing more than a tribal mark, badge of honour or sign of belonging.

Tribal tradition

Opponents of circumcision point to its tribal origins, arguing that the practice is barbaric and outdated.

Circumcision is part of the initiation rite in a number of African countries. It is also a rite of passage among some Aboriginal tribes in Australia.

It has been suggested that circumcision began as a religious sacrifice and the oldest documentary evidence was found in ancient Egypt.

African HIV studies

Circumcision has been recommended to fight HIV in Africa. The South Africa Orange Farm Intervention Trial, published in 2005, suggested that male circumcision reduces the risk of contracting HIV by 50-60% in heterosexual men.

The United Nations Programme on HIV/Aids recommended that circumcision "be recognised as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men" (2007 press release).

Male circumcision does not reduce the risk of the woman becoming infected.

Swedish law

Sweden passed a law restricting circumcision in 2001, after two Muslim boys died while being circumcised.

Under the Circumcision Act, circumcisions can only be carried out in the presence of a doctor and with an appropriate painkiller.

Some Jewish and Muslim Swedes said the restrictions would undermine religious practices or violate their religious rights.

Stockholm's Jewish community claimed the law would present difficulties in finding medical personnel willing to carry out the operation. Many health professionals in Sweden view circumcision as a form of mutilation.

In the UK

There is a spectrum of views within the BMA’s 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. The medical harms or benefits have not been unequivocally proven but there are clear risks of harm if the procedure is done inexpertly. The Association has no policy on these issues.
British Medical Association - The law and ethics of male circumcision - guidance for doctors
Non-therapeutic circumcision (circumcision not performed for a medical reason) has been generally accepted as legal under UK law. The British Medical Association gives guidance for doctors on the legal and ethical aspects of male circumcision.

The BMA guidelines say the interests of the child must be paramount, require the child to be involved in the decision-making if old enough, and require both parents' consent for non-therapeutic circumcision.

Male circumcision in cases where there is a clear clinical need is not normally controversial. Nevertheless, normal anatomical and physiological characteristics of the infant foreskin have in the past been misinterpreted as being abnormal. The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision.
British Medical Association - The law and ethics of male circumcision - guidance for doctors
Doctors are not under any obligation to circumcise a child and can refuse for reasons of conscience.


Source:BBC