Просмотр кода страницы Английская Википедия:Circumcision

{{Английская Википедия/Панель перехода}}
{{Short description|Removal of the human foreskin}}
{{Distinguish|female circumcision}}
{{For|the paintings|The Circumcision (disambiguation){{!}}The Circumcision}}
{{pp|reason=Restoring indef semi|small=yes}}
<!-- Definition, technique, and reasons -->
{{Use dmy dates|date=February 2022}}
{{Infobox medical intervention
 | Name        = Circumcision
 | Image       = Circumcision illustration.jpg
 | Caption     = Circumcision surgery with hemostats and scissors
 | ICD10       = Z41.2
 | ICD9        = {{ICD9|V50.2}}
 | ICD9_mult   = 
 | MeshID      = D002944
 | OPS301      = {{OPS301|5–640}}.2
 | OtherCodes  = 
 | MedlinePlus = 002998
 | eMedicine   = 1015820
}}

<!-- Note to editors: This article has a long history of intense debates, particularly over the wording of the lead, sexual function section, and describing the positions of major medical organizations. Please review the talk page before making changes to lines to see if there is a previous established consensus or compromise. Thank you. -->
'''Circumcision''' is a [[Medical procedure|procedure]] that removes the [[foreskin]] from the [[human penis]]. In the most common form of the operation, the foreskin is extended with [[forceps]], then a circumcision device may be placed, after which the foreskin is [[wikt:excise|excised]]. Topical or locally injected [[anesthesia]] is generally used to reduce pain and [[stress (physiology)|physiologic stress]].<ref name=AAP_2012>{{cite journal | author = American Academy of Pediatrics Task Force on Circumcision | title = Male circumcision | journal = Pediatrics | volume = 130 | issue = 3 | pages = e756–e785 | date = September 2012 | pmid = 22926175 | doi = 10.1542/peds.2012-1990 | url = http://pediatrics.aappublications.org/content/130/3/e756.full | url-status = live | doi-access = free | archive-url = https://web.archive.org/web/20120920054623/http://pediatrics.aappublications.org/content/130/3/e756.full | archive-date = 20 September 2012 }}</ref> Circumcision is generally [[elective surgery|electively performed]], most commonly done as a form of [[preventive healthcare]], as a [[Religious law|religious obligation]], or as a [[Culture|cultural practice]].<ref name=WHO_2007_GTDPSA>{{cite book |vauthors=Weiss H, Polonsky J, Bailey R, Hankins C, Halperin D, Schmid G |title=Male circumcision: global trends and determinants of prevalence, safety, and acceptability. |publisher=World Health Organization |publication-place=Geneva |date=2007 |isbn=978-92-4-159616-9 |oclc=425961131 |url=http://www.unaids.org/sites/default/files/media_asset/jc1360_male_circumcision_en_0.pdf |url-status=live |archive-url=https://web.archive.org/web/20151222194858/http://www.unaids.org/sites/default/files/media_asset/jc1360_male_circumcision_en_0.pdf |archive-date=22 December 2015 }}</ref> It is also an option for cases of [[phimosis]], other [[Pathology|pathologies]] that do not resolve with other treatments, and chronic [[urinary tract infection]]s (UTIs).<ref name="lissauer_2012">{{cite book|title=Illustrated Textbook of Paediatrics, Fourth edition|vauthors=Lissauer T, Clayden G|date=October 2011|publisher=Elsevier|isbn=978-0-7234-3565-5|pages=352–353|quote=}}</ref><ref name=hay_2012/> The procedure is [[contraindicated]] in cases of certain genital structure abnormalities or poor general health.<ref name="hay_2012">{{cite book |vauthors=Hay W, Levin M |title=Current Diagnosis and Treatment Pediatrics 21/E |pages=18–19 |date=25 June 2012 |publisher=McGraw Hill Professional |isbn=978-0-07-177971-5 |url=https://books.google.com/books?id=V8lMJniWK_QC |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=V8lMJniWK_QC |archive-date=18 January 2016 }}</ref><ref name=rudolph_2011>{{cite book |vauthors=Rudolph C, Rudolph A, Lister G, First L, Gershon A |title=Rudolph's Pediatrics, 22nd Edition |page=188 |date=18 March 2011 |publisher=McGraw-Hill Companies, Incorporated |isbn=978-0-07-149723-7 |url=https://books.google.com/books?id=or15PgAACAAJ |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=or15PgAACAAJ |archive-date=18 January 2016 }}</ref>

<!-- Evidence, side effects, and positions -->
The procedure is associated with reduced rates of [[sexually transmitted infection]]s<ref name="yuan" /> and [[urinary tract infection]]s.<ref name="AAP_2012" /><ref name="rehmeyer_2011">{{cite journal | vauthors = Rehmeyer CJ | title = Male circumcision and human papillomavirus studies reviewed by infection stage and virus type | journal = The Journal of the American Osteopathic Association | volume = 111 | issue = 3 Suppl 2 | pages = S11–S18 | date = March 2011 | pmid = 21415373 }}</ref><ref name="larke_HPV_2011">{{cite journal | vauthors = Larke N, Thomas SL, Dos Santos Silva I, Weiss HA | title = Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis | journal = The Journal of Infectious Diseases | volume = 204 | issue = 9 | pages = 1375–1390 | date = November 2011 | pmid = 21965090 | doi = 10.1093/infdis/jir523 | doi-access = free }}</ref> This includes reducing the incidence of [[Carcinogenesis|cancer-causing]] forms of [[human papillomavirus]] (HPV) and significantly reducing [[HIV infection|HIV transmission]] among [[heterosexual men]] in high-risk populations;<ref name="Chikutsa-2015" /> its prophylactic efficacy against HIV transmission in the [[Developed country|developed world]] or among [[men who have sex with men]] is debated.<ref name="WHO-2010b">{{Cite book |url=http://apps.who.int/iris/bitstream/handle/10665/44478/9789241500753_eng.pdf;jsessionid=53B12CB197A3AE365211417D2C812B5F?sequence=1 |title=Manual for early infant male circumcision under local anaesthesia |publisher=[[World Health Organization]] |year=2010 |location=Geneva |language=English |quote=There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men. |access-date=14 April 2022 |archive-date=14 April 2022 |archive-url=https://web.archive.org/web/20220414143741/http://apps.who.int/iris/bitstream/handle/10665/44478/9789241500753_eng.pdf;jsessionid=53B12CB197A3AE365211417D2C812B5F?sequence=1 |url-status=live }}</ref><ref name="siegfried_Cochrane_2009">{{cite journal | vauthors = Siegfried N, Muller M, Deeks JJ, Volmink J | title = Male circumcision for prevention of heterosexual acquisition of HIV in men | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD003362 | date = April 2009 | pmid = 19370585 | doi = 10.1002/14651858.CD003362.pub2 | veditors = Siegfried N }}</ref><ref name="Merson-2017">{{Cite book |last1=Merson |first1=Michael |title=The AIDS Pandemic: Searching for a Global Response |last2=Inrig |first2=Stephen |publisher=[[Springer Publishing]] |year=2017 |isbn=9783319471334 |pages=379 |quote=This led to a [medical] consensus that male circumcision should be a priority for HIV prevention in countries and regions with heterosexual epidemics and high HIV and low male circumcision prevalence.}}</ref> Neonatal circumcision decreases the risk of [[penile cancer]].<ref name="pc">{{cite journal |display-authors=5 |vauthors=Thomas A, Necchi A, Muneer A, Tobias-Machado M, Tran AT, Van Rompuy AS, Spiess PE, Albersen M |date=February 2021 |title=Penile cancer |journal=Nat Rev Dis Primers |type=Review |volume=7 |issue=1 |pages=11 |doi=10.1038/s41572-021-00246-5 |pmid=33574340 |s2cid=231877615}}</ref> Complication rates increase significantly with age.<ref name="weiss_2010_complications">{{cite journal |vauthors=Weiss HA, Larke N, Halperin D, Schenker I |date=February 2010 |title=Complications of circumcision in male neonates, infants and children: a systematic review |journal=BMC Urology |volume=10 |pages=2 |doi=10.1186/1471-2490-10-2 |pmc=2835667 |pmid=20158883 |doi-access=free }}</ref> Bleeding, infection, and the removal of either too much or too little foreskin are the most common acute complications, while [[meatal stenosis]] is the most common long-term.<ref name="Selekman-2020">{{Cite book| vauthors = Selekman R, Copp H |title=Campbell Walsh Wein Urology|publisher=Elsevier|year=2020|isbn=9780323672276| veditors = Partin A |edition=12th |pages=388–402 |chapter=Urologic Evaluation of the Child}}</ref> Major medical organizations hold variant views on the strength of circumcision's prophylactic efficacy in developed countries. Some medical organizations take the position that it carries prophylactic health benefits which outweigh the risks, while other medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk.<ref name="Gable-2007">{{Cite book|last1=Gable|first1=Lance|title=Legal Aspects of HIV/AIDS: A Guide for Policy and Law Reform|last2=Gamharter|first2=Katharina|last3=Gostin|first3=Lawrence|last4=Hodge Jr.|first4=James|last5=Puymbroeck|first5=Rudolf|publisher=World Bank Publications|year=2007|isbn=978-0821371053|pages=38–39|chapter=1.12 Male Circumcision}}</ref><ref name="WHO-2010a">{{Cite book|title=Manual for early infant male circumcision under local anaesthesia|publisher=[[World Health Organization]]|year=2010|url=http://apps.who.int/iris/bitstream/handle/10665/44478/9789241500753_eng.pdf;jsessionid=53B12CB197A3AE365211417D2C812B5F?sequence=1|location=Geneva|language=English|quote=There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men.|access-date=14 April 2022|archive-date=14 April 2022|archive-url=https://web.archive.org/web/20220414143741/http://apps.who.int/iris/bitstream/handle/10665/44478/9789241500753_eng.pdf;jsessionid=53B12CB197A3AE365211417D2C812B5F?sequence=1|url-status=live}}</ref><ref name="Bolnick_2012_ch1">{{cite book |title=Surgical Guide to Circumcision |vauthors=Jacobs M, Grady R, Bolnick DA |publisher=Springer |year=2012 |isbn=978-1-4471-2857-1 |veditors=Bolnick DA, Koyle M, Yosha A |location=London |pages=3–8, 255–257 |chapter=Current Circumcision Trends and Guidelines |doi=10.1007/978-1-4471-2858-8_1 |quote=Outside of strategic regions in sub-Saharan Africa, no call for routine circumcision has been made by any established medical organizations or governmental bodies. Positions on circumcision include "some medical benefit/parental choice" in the United States, "no medical benefit/parental choice" in Great Britain, and "no medical benefit/physical and psychological trauma/parental choice" in the Netherlands. |author2-link=<!--Not the Olympic athlete. Do not link-->}}</ref><ref name="caga-anan_2011">{{cite book |url=https://books.google.com/books?id=C1T6NrSPD_AC&pg=PA43 |title=Clinical Ethics in Pediatrics: A Case-Based Textbook |vauthors=Caga-anan EC, Thomas AJ, Diekema DS, Mercurio MR, Adam MR |date=8 September 2011 |publisher=Cambridge University Press |isbn=978-0-521-17361-2 |page=43 |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=C1T6NrSPD_AC&pg=PA43 |archive-date=18 January 2016 |url-status=live}}</ref>  <!-- Epidemiology, history, and culture -->

Circumcision is one of the world's most common and oldest medical procedures.<ref name="WHO_2007_GTDPSA" /> Prophylactic usage originated in [[England]] during the 1850s and subsequently widely spread, becoming predominately established as a way to prevent sexually transmitted infections.<ref name="Al-Salem-2016" /><ref>{{Cite book |last1=Afshar |first1=Kourosh |title=Diagnostics to Pathogenomics of Sexually Transmitted Infections |last2=Kazemi |first2=Behnam |last3=MacNeily |first3=Andrew |publisher=[[Wiley (publisher)|Wiley]] |year=2018 |isbn=9781119380849 |editor-last=Singh |editor-first=Sunit |pages=28–34 |chapter=The Role of Circumcision in Preventing Sexually Transmitted Infections}}</ref> 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]]. Circumcision is among the [[613 commandments|most important commandments in Judaism]].<ref name="Mark-2003a">{{Cite book |last=Mark |first=Elizabeth |title=The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite |publisher=[[Brandeis University Press]] |year=2003 |isbn=9781584653073 |pages=141 |chapter=Frojmovic/Travelers to the Circumcision |quote=Circumcision became the single most important commandment... the one without which... no Jew could attain the world to come.}}</ref><ref name="Hamilton-1990">{{Cite book |last=Hamilton |first=Victor |title=The Book of Genesis, Chapters 1-17 |publisher=[[William B. Eerdmans Publishing Company|Eerdmans Publishing Company]] |year=1990 |isbn=9780802825216 |pages=473 |quote=In fact, circumcision is only one of two performative commands, the neglect of which bring the kareth penalty. (The other is the failure to be cleansed from corpse contamination, umb. 19:11-22.) |author-link=Victor P. Hamilton}}</ref> It is widespread in Australia, Canada, the United States, South Korea, most of Africa, and parts of Asia.<ref name="WHO_2007_GTDPSA" /> It is relatively rare for non-religious reasons in parts of Southern Africa, Latin America, Europe, and parts of Asia.<ref name="WHO_2007_GTDPSA" /> The origin of circumcision is not known with certainty; the oldest documentation comes from [[ancient Egypt]].<ref name="WHO_2007_GTDPSA" /><ref name="Doy2005">{{Cite journal |last=Doyle |first=D. |date=October 2005 |title=Ritual male circumcision: a brief history |journal=The Journal of the Royal College of Physicians of Edinburgh |volume=35 |issue=3 |pages=279–285 |issn=1478-2715 |pmid=16402509 |url=https://www.rcpe.ac.uk/sites/default/files/doyle_circumcision.pdf |access-date=16 January 2023 |archive-date=14 March 2023 |archive-url=https://web.archive.org/web/20230314204243/https://www.rcpe.ac.uk/sites/default/files/doyle_circumcision.pdf |url-status=live }}</ref><ref name="alanis_2004">{{cite journal |vauthors=Alanis MC, Lucidi RS |date=May 2004 |title=Neonatal circumcision: a review of the world's oldest and most controversial operation |journal=Obstetrical & Gynecological Survey |volume=59 |issue=5 |pages=379–395 |doi=10.1097/00006254-200405000-00026 |pmid=15097799 |s2cid=25226185}}</ref>

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== Uses ==

=== Elective ===
Around half of all circumcisions worldwide are performed for reasons of prophylactic healthcare.<ref name="hay_2012" />

==== Prophylactic usage in high-risk populations ====
[[File:South Africa 1 millionth Voluntary Medical Male Circumcision (40944402290).jpg|thumb|Actor [[Melusi Yeni]] became the 1 millionth [[Circumcision and HIV|VMMC against HIV/AIDS transmission]] in the [[Provinces of South Africa|province]] of [[KwaZulu-Natal]], South Africa.<ref>{{Cite web |last=Seeth |first=Avantika |date=June 1, 2018 |title='It's hassle-free,' says actor Melusi Yeni about his medical circumcision |url=https://www.news24.com/citypress/news/its-hassle-free-says-actor-melusi-yeni-about-his-medical-circumcision-20180601 |access-date=May 5, 2022 |website=[[News24 (website)|News24]] |language=en-US |quote=Actor Melusi Yeni was the millionth man to undergo voluntary male medical circumcision at the Sivananda Clinic in KwaZulu-Natal. |archive-date=5 May 2022 |archive-url=https://web.archive.org/web/20220505072202/https://www.news24.com/citypress/news/its-hassle-free-says-actor-melusi-yeni-about-his-medical-circumcision-20180601 |url-status=live }}</ref>]]
There is a consensus among the world's major medical organizations and in the academic literature that circumcision is an efficacious intervention for HIV prevention in high-risk populations if carried out by medical professionals under safe conditions.<ref name="WHO-PrevHIV">{{cite web |year=2020 |title=Preventing HIV Through Safe Voluntary Medical Male Circumcision For Adolescent Boys And Men In Generalized HIV Epidemics |url=https://www.who.int/publications/i/item/978-92-4-000854-0 |url-status=live |archive-url=https://web.archive.org/web/20211122140037/https://www.who.int/publications/i/item/978-92-4-000854-0 |archive-date=22 November 2021 |access-date=24 May 2021 |publisher=[[World Health Organization]]}}</ref><ref name="siegfried_Cochrane_2009" /><ref name="Chikutsa-2015">For sources on this, see:

*{{Cite journal |last1=Chikutsa |first1=Antony |last2=Maharaj |first2=Pranitha |date=July 2015 |title=Social representations of male circumcision as prophylaxis against HIV/AIDS in Zimbabwe |journal=BMC Public Health |language=en |volume=15 |issue=1 |pages=603 |doi=10.1186/s12889-015-1967-z |issn=1471-2458 |pmc=4489047 |pmid=26133368 |quote=It is now generally accepted in public health spheres that medical male circumcision is efficacious in the prevention of HIV infection. |doi-access=free }}
*{{Cite book |last=Bell |first=Kirsten |title=Health and Other Unassailable Values: Reconfigurations of Health, Evidence and Ethics |publisher=Taylor & Francis |year=2016 |isbn=9781317482031 |pages=106 |quote=...defending the casual relation between male circumcision and reduced HIV transmission has become essentially hegemonic in the academic literature.}}
*{{Cite book |last1=Merson |first1=Michael |title=The AIDS Pandemic: Searching for a Global Response |last2=Inrig |first2=Stephen |publisher=[[Springer International Publishing]] |year=2017 |isbn=9783319471334 |pages=379}}</ref>

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.<ref name="WHO-PrevHIV" /> In 2010, this was expanded to routine neonatal circumcision, as long as those undergoing the procedure received assent from their parents.<ref name="WHO-2010a" /> In 2020, the World Health Organization again concluded that male circumcision is an efficacious intervention for HIV prevention and that the promotion of male circumcision is an essential strategy, in addition to other preventive measures, for the prevention of heterosexually acquired HIV infection in men. Eastern and southern Africa had a particularly low prevalence of circumcised males. This region has a disproportionately high HIV infection rate, with a significant number of those infections stemming from heterosexual transmission. As a result, the promotion of prophylactic circumcision has been a priority intervention in that region since the WHO's 2007 recommendations.<ref name="WHO-PrevHIV" /><ref name="WHO-2010a" />

The International Antiviral Society–USA also suggests circumcision be discussed with [[Men who have sex with men|men who have insertive anal sex with men]], especially in regions where HIV is common.<ref name="Marrazzo et al. 2014" /> There is evidence that circumcision is associated with a reduced risk of HIV infection for such men, particularly in low-income countries.<ref name=yuan>{{cite journal |vauthors=Yuan T, Fitzpatrick T, Ko NY, Cai Y, Chen Y, Zhao J, Li L, Xu J, Gu J, Li J, Hao C, Yang Z, Cai W, Cheng CY, Luo Z, Zhang K, Wu G, Meng X, Grulich AE, Hao Y, Zou H |title=Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data |journal=Lancet Glob Health |volume=7 |issue=4 |pages=e436–e447 |date=April 2019 |pmid=30879508 |pmc=7779827 |doi=10.1016/S2214-109X(18)30567-9 |type=Mata-analysis}}</ref>

The finding that circumcision significantly reduces female-to-male HIV transmission has prompted medical organizations serving communities affected by endemic HIV/AIDS to promote circumcision as an additional method of controlling the spread of HIV.<ref name="Bolnick_2012_ch1" />

==== Prophylactic usage in developed countries ====
Major medical organizations hold varying positions on the [[Preventive healthcare|prophylactic efficacy]] of the elective circumcision of minors in the context of [[Developed country|developed countries]].<ref name="Bolnick_2012_ch1" /> 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.<ref name="caga-anan_2011" /><ref name="pinto_2012" /><ref name="Wapner-2015">{{Cite web|last=Wapner|first=Jessica|date=24 February 2015|title=The Troubled History of Foreskin|url=https://mosaicscience.com/story/troubled-history-foreskin/|website=Mosaic Science|quote=In the decades since, medical practice has come to rely increasingly on evidence from large research studies, which, as many American doctors see it, have supported the existing rationale... How can experts who have undergone similar training evaluate the same studies and come to opposing conclusions? I've spent months scrutinising the medical literature in an attempt to decide which side is right. The task turned out to be nearly impossible. That's partly because there is so much confused thinking around the risks and benefits of circumcision, even among trained practitioners.|access-date=3 February 2022|archive-date=26 December 2021|archive-url=https://web.archive.org/web/20211226154538/https://mosaicscience.com/story/troubled-history-foreskin/|url-status=live}}</ref>

The [[World Health Organization]] (WHO), [[Joint United Nations Programme on HIV/AIDS|UNAIDS]], and American medical organizations take the position that it carries prophylactic health benefits which outweigh the risks, while European medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk.<ref name="Gable-2007" /><ref name="WHO-2010a" /><ref name="Bolnick_2012_ch1" /><ref name="caga-anan_2011" /> Advocates of circumcision consider it to have a net health benefit, and therefore feel that increasing the circumcision rate is "imperative".<ref>{{Cite journal|last=Morris|first=Brian J.|date=November 2007|title=Why circumcision is a biomedical imperative for the 21(st) century|url=https://pubmed.ncbi.nlm.nih.gov/17935209/|journal=BioEssays: News and Reviews in Molecular, Cellular and Developmental Biology|volume=29|issue=11|pages=1147–1158|doi=10.1002/bies.20654|issn=0265-9247|pmid=17935209|access-date=26 December 2021|archive-date=26 December 2021|archive-url=https://web.archive.org/web/20211226154518/https://pubmed.ncbi.nlm.nih.gov/17935209/|url-status=live}}</ref> They recommend performing it during the neonatal period when it is less expensive and has a lower risk of complications.<ref name="pinto_2012">{{cite journal|vauthors=Pinto K|date=August 2012|title=Circumcision controversies|journal=Pediatric Clinics of North America|volume=59|issue=4|pages=977–986|doi=10.1016/j.pcl.2012.05.015|pmid=22857844}}</ref> The [[American Academy of Pediatrics]] and [[Centers for Disease Control and Prevention]] stated that the potential benefits of circumcision outweigh the risks.<ref name="AAP_2012" /><ref>{{Cite web |title=Background, Methods, and Synthesis of Scientific Information Used to Inform "Information for Providers to Share with Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV Infection, Sexually Transmitted Infections, and other Health Outcomes" |url=https://stacks.cdc.gov/view/cdc/58457 |access-date=2023-10-12 |website=stacks.cdc.gov |archive-date=22 October 2023 |archive-url=https://web.archive.org/web/20231022115215/https://stacks.cdc.gov/view/cdc/58457 |url-status=live }}</ref>
<!-- 
Similarly, the World Health Organization in 2010 stated:<ref name="WHO-2010a" />

{{Blockquote|There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men.<ref name="WHO-2010a" /> }}
 -->

=== Pathologies ===
Circumcision is also used to treat various pathologies. These include pathological [[phimosis]], refractory [[balanoposthitis]] and chronic or recurrent [[urinary tract infection]]s (UTIs).<ref name="lissauer_2012" /><ref name="hay_2012" />

== Contraindications ==
Circumcision is [[Contraindication|contraindicated]] in certain cases.<ref name="rudolph_2011" /><ref name="hay_2012" /><ref name="Jhpiego-2009" />

These include infants with certain [[Sex organ|genital]] structure abnormalities, such as a misplaced [[External urethral orifice (male)|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. Circumcision is contraindicated in [[Preterm birth|premature]] infants and those who are not clinically stable and in good health.<ref name="rudolph_2011" /><ref name="hay_2012" /><ref name="Jhpiego-2009" /> 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.<ref name="hay_2012" /><ref name="Jhpiego-2009" />

==Technique==
{{Main|Circumcision surgical procedure}}

[[File:Adult circumcision before and after.jpg|thumb|Before (left) and after (right) an adult circumcision that was undertaken to treat [[phimosis]]. After the operation, the [[Glans penis|glans]] is exposed even when the penis is [[Tumescence|flaccid]].]]

The [[foreskin]] is the double-layered fold of tissue at the distal end of the [[human penis]] that covers the [[Glans penis|glans]] and the [[urinary meatus]].<ref name=WHO_2007_GTDPSA/> For adult medical circumcision, superficial wound healing takes up to a week, and complete healing 4 to 6 months. For infants, healing is usually complete within one week.<ref name="Jhpiego-2009">{{cite web |last1=World Health Organization |last2=UNAIDS |last3=Jhpiego |date=December 2009 |title=Manual for Male Circumcision Under Local Anaesthesia |url=https://www.who.int/hiv/pub/malecircumcision/who_mc_local_anaesthesia.pdf |archive-url=https://web.archive.org/web/20120115175057/http://www.who.int/hiv/pub/malecircumcision/who_mc_local_anaesthesia.pdf |archive-date=January 15, 2012 |publisher= |quote=...there are many myths about male circumcision that circulate. For example, some people think that circumcision can cause impotence (failure of erection) or reduce sexual pleasure. Others think that circumcision will cure impotence. Let me assure you that none of these is true. |author1-link=World Health Organization |author2-link=UNAIDS |author3-link=Jhpiego }} [https://www.scribd.com/document/186396682/Who-Mc-Local-Anaesthesia Alt URL] {{Webarchive|url=https://web.archive.org/web/20230330035156/https://www.scribd.com/document/186396682/Who-Mc-Local-Anaesthesia |date=30 March 2023 }}</ref>

===Removal of the foreskin===
For infant circumcision, [[Circumcision clamp|devices]] such as the [[Gomco clamp]], [[Plastibell]] and [[Mogen clamp]] are commonly used in the USA.<ref name=AAP_2012/>  These follow the same basic procedure. First, the amount of foreskin to be removed is estimated. The practitioner opens the foreskin via the preputial [[Body orifice|orifice]] to reveal the glans underneath and ensures it is normal before bluntly separating the inner lining of the foreskin ([[Preputial mucosa|preputial epithelium]]) from its attachment to the glans. The practitioner then places the circumcision device (this sometimes requires a [[dorsal slit]]), which remains until blood flow has stopped. Finally, the foreskin is [[Amputation|amputated]].<ref name=AAP_2012/> For older babies and adults, circumcision is often performed surgically without specialized instruments,<ref name="Jhpiego-2009" /> and alternatives such as [[Unicirc]] or the [[Shang ring]] are available.<ref name=WHO_adult_devices_2012/>

===Pain management===
The circumcision procedure causes pain, and for neonates this pain may interfere with mother-infant interaction or cause other behavioral changes,<ref name=perera_2010/> so the use of [[analgesia]] is advocated.<ref name=AAP_2012/><ref name=CPSBC_2009/> Ordinary procedural pain may be managed in [[Pharmacology|pharmacological]] and non-pharmacological ways. Pharmacological methods, such as localized or regional pain-blocking injections and topical analgesic creams, are safe and effective.<ref name=AAP_2012/><ref name=lonngvist_2010/><ref name=shockley_2011/> The [[Nerve block|ring block]] and dorsal penile nerve block (DPNB) are the most effective at reducing pain, and the ring block may be more effective than the DPNB. They are more effective than [[Lidocaine/prilocaine|EMLA]] (eutectic mixture of local anesthetics) cream, which is more effective than a [[placebo]].<ref name=lonngvist_2010/><ref name=shockley_2011/> Topical creams have been found to irritate the skin of [[low birth weight]] infants, so penile nerve block techniques are recommended in this group.<ref name=AAP_2012/>

For infants, non-pharmacological methods such as the use of a comfortable, padded chair and a [[sucrose]] or non-sucrose pacifier are more effective at reducing pain than a placebo,<ref name=shockley_2011/> but the [[American Academy of Pediatrics]] (AAP) states that such methods are insufficient alone and should be used to supplement more effective techniques.<ref name=AAP_2012/> A quicker procedure reduces duration of pain; use of the Mogen clamp was found to result in a shorter procedure time and less pain-induced stress than the use of the Gomco clamp or the Plastibell.<ref name=shockley_2011/> The available evidence does not indicate that post-procedure pain management is needed.<ref name=AAP_2012/>  For adults, [[topical anesthesia]], ring block, dorsal penile nerve block (DPNB) and [[general anesthesia]] are all options,<ref name=wolter_2008/> and the procedure requires four to six weeks of abstinence from [[masturbation]] or intercourse to allow the wound to heal.<ref name="Jhpiego-2009" />

==Effects==

===Sexually transmitted infections===

====Human immunodeficiency virus====
{{See also|Circumcision in Africa#Circumcision to prevent the spread of human immunodeficiency virus in Africa}}
{{excerpt|Circumcision and HIV|paragraphs=1-2}}

====Human papillomavirus====
[[Human papillomavirus]] (HPV) is the most commonly transmitted [[sexually transmitted infection]], affecting both men and women. While most infections are [[asymptomatic]] and are cleared by the [[immune system]], some types of the virus cause [[genital wart]]s, and other types, if untreated, cause various forms of cancer, including [[cervical cancer]], and [[penile cancer]]. Genital warts and cervical cancer are the two most common problems resulting from HPV.<ref name=CDC_HPV/>

Circumcision is associated with a reduced [[prevalence]] of [[Carcinogenesis|oncogenic]] types of HPV infection, meaning that a randomly selected circumcised man is less likely to be found infected with cancer-causing types of HPV than an uncircumcised man.<ref name=hpv_prevalence_ref_bundle/><ref name=zhu>{{cite journal | vauthors = Zhu YP, Jia ZW, Dai B, Ye DW, Kong YY, Chang K, Wang Y | title = Relationship between circumcision and human papillomavirus infection: a systematic review and meta-analysis | journal = Asian Journal of Andrology | volume = 19 | issue = 1 | pages = 125–131 | date = 8 March 2016 | pmid = 26975489 | pmc = 5227661 | doi = 10.4103/1008-682X.175092 | doi-access = free }}</ref> It also decreases the likelihood of multiple infections.<ref name=rehmeyer_2011/> {{As of|2012}} there was no strong evidence that it reduces the rate of new HPV infection,<ref name=larke_HPV_2011/><ref name=rehmeyer_2011/><ref name=albero_2012/> but the procedure is associated with increased [[Clearance (medicine)|clearance]] of the virus by the body,<ref name=larke_HPV_2011/><ref name=rehmeyer_2011/> which can account for the finding of reduced prevalence.<ref name=rehmeyer_2011/>

Although genital warts are caused by a type of HPV, there is no [[Statistical significance|statistically significant relationship]] between being circumcised and the presence of genital warts.<ref name=larke_HPV_2011/><ref name=zhu/><ref name=albero_2012/>

====Other infections====
Studies evaluating the effect of circumcision on the rates of other sexually transmitted infections have, generally, found it to be protective. A 2006 meta-analysis found that circumcision was associated with lower rates of [[syphilis]], [[chancroid]], and possibly genital [[herpes]].<ref name=weiss_2006_syphilis>{{cite journal | vauthors = Weiss HA, Thomas SL, Munabi SK, Hayes RJ | title = Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis | journal = Sexually Transmitted Infections | volume = 82 | issue = 2 | pages = 101–9; discussion 110 | date = April 2006 | pmid = 16581731 | pmc = 2653870 | doi = 10.1136/sti.2005.017442 }}</ref> A 2010 review found that circumcision reduced the incidence of [[herpes simplex virus|HSV]]-2 (herpes simplex virus, type 2) infections by 28%.<ref name=wetmore_2010>{{cite journal | vauthors = Wetmore CM, Manhart LE, Wasserheit JN | title = Randomized controlled trials of interventions to prevent sexually transmitted infections: learning from the past to plan for the future | journal = Epidemiologic Reviews | volume = 32 | issue = 1 | pages = 121–136 | date = April 2010 | pmid = 20519264 | pmc = 2912604 | doi = 10.1093/epirev/mxq010 }}</ref> The researchers found mixed results for protection against [[trichomonas vaginalis]] and [[chlamydia trachomatis]], and no evidence of protection against [[gonorrhea]] or syphilis.<ref name=wetmore_2010/> It may also possibly protect against syphilis in MSM.<ref name=templeton_2010>{{cite journal | vauthors = Templeton DJ, Millett GA, Grulich AE | title = Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men | journal = Current Opinion in Infectious Diseases | volume = 23 | issue = 1 | pages = 45–52 | date = February 2010 | pmid = 19935420 | doi = 10.1097/QCO.0b013e328334e54d | s2cid = 43878584 }}</ref>

===Phimosis, balanitis and balanoposthitis===
Phimosis is the inability to retract the foreskin over the glans penis.<ref name="hayashi_2011">{{cite journal | vauthors = Hayashi Y, Kojima Y, Mizuno K, Kohri K | title = Prepuce: phimosis, paraphimosis, and circumcision | journal = TheScientificWorldJournal | volume = 11 | pages = 289–301 | date = February 2011 | pmid = 21298220 | pmc = 5719994 | doi = 10.1100/tsw.2011.31 | doi-access = free }}</ref> At birth, the foreskin cannot be retracted due to [[Adhesion (medicine)|adhesions]] between the foreskin and glans, and this is considered normal (physiological phimosis).<ref name="hayashi_2011"/> Over time the foreskin naturally separates from the glans, and a majority of boys are able to retract the foreskin by age three.<ref name="hayashi_2011"/> Less than one percent are still having problems at age 18.<ref name="hayashi_2011"/> If the inability to do so becomes problematic (pathological phimosis) circumcision is a treatment option.<ref name=lissauer_2012/><ref name=becker_2011/> 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.<ref name=Moreno2014/> [[Steroid]] creams are also a reasonable option and may prevent the need for surgery including in those with mild BXO.<ref name=Moreno2014>{{cite journal | vauthors = Moreno G, Corbalán J, Peñaloza B, Pantoja T | title = Topical corticosteroids for treating phimosis in boys | journal = The Cochrane Database of Systematic Reviews | volume = 9 | issue = 9 | pages = CD008973 | date = September 2014 | pmid = 25180668 | doi = 10.1002/14651858.CD008973.pub2 | pmc = 10765470 }}</ref><ref>{{cite journal | vauthors = Celis S, Reed F, Murphy F, Adams S, Gillick J, Abdelhafeez AH, Lopez PJ | title = Balanitis xerotica obliterans in children and adolescents: a literature review and clinical series | journal = Journal of Pediatric Urology | volume = 10 | issue = 1 | pages = 34–39 | date = February 2014 | pmid = 24295833 | doi = 10.1016/j.jpurol.2013.09.027 | doi-access = free }}</ref> The procedure may also be used to prevent the development of phimosis.<ref name=hay_2012/> Phimosis is also a complication that can result from circumcision.<ref name="Complications of circumcision">{{cite journal | vauthors = Krill AJ, Palmer LS, Palmer JS | title = Complications of circumcision | journal = TheScientificWorldJournal | volume = 11 | pages = 2458–2468 | date = 2011 | pmid = 22235177 | pmc = 3253617 | doi = 10.1100/2011/373829 | doi-access = free }}</ref>

An inflammation of the glans penis and foreskin is called balanoposthitis, and the condition affecting the glans alone is called [[balanitis]].<ref name=leber_2006/><ref name=osipov_2006/> Most cases of these conditions occur in uncircumcised males,<ref name=aridogan_2011/> affecting 4{{endash}}11% of that group.<ref name=hayashi_2011/> The moist, warm space underneath the foreskin is thought to facilitate the growth of pathogens, particularly when hygiene is poor. Yeasts, especially ''[[Candida albicans]]'', are the most common penile infection and are rarely identified in samples taken from circumcised males.<ref name=aridogan_2011/> Both conditions are usually treated with topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams.<ref name=leber_2006/><ref name=osipov_2006/> Circumcision is a treatment option for refractory or recurrent balanoposthitis, but in the twenty-first century the availability of the other treatments has made it less necessary.<ref name=leber_2006/><ref name=osipov_2006/>

===Urinary tract infections===
A UTI affects parts of the [[urinary system]] including the [[urethra]], [[Urinary bladder|bladder]], and [[kidney]]s. There is about a one percent risk of UTIs in boys under two years of age, and the majority of incidents occur in the first year of life. There is good but not [[Randomized controlled trial|ideal evidence]] that circumcision of babies reduces the incidence of UTIs in boys under two years of age, and there is fair evidence that the reduction in incidence is by a factor of 3{{endash}}10 times (100 circumcisions prevents one UTI).<ref name=AAP_2012/><ref name="MorrisWiswell2013">{{cite journal | vauthors = Morris BJ, Wiswell TE | title = Circumcision and lifetime risk of urinary tract infection: a systematic review and meta-analysis | journal = The Journal of Urology | volume = 189 | issue = 6 | pages = 2118–2124 | date = June 2013 | pmid = 23201382 | doi = 10.1016/j.juro.2012.11.114 }}</ref>{{COI source|sure=yes|date=March 2023}}<ref name=jagannath_2012/> Circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects,<ref name=AAP_2012/> and may be used to treat recurrent UTIs.<ref name=lissauer_2012/>

There is a plausible biological explanation for the reduction in UTI risk after circumcision. The orifice through which urine passes at the tip of the penis (the [[urinary meatus]]) hosts more urinary system disease-causing bacteria in uncircumcised boys than in circumcised boys, especially in those under six months of age. As these bacteria are a risk factor for UTIs, circumcision may reduce the risk of UTIs through a decrease in the bacterial population.<ref name=AAP_2012/><ref name=jagannath_2012/>

===Cancers===
Not being circumcised is the primary [[risk factor]] for [[penile cancer]].<ref name=tpc>{{cite book |vauthors=Ottenhof SR, Bleeker MC, Heideman, DA, Snijders PJ, Meijer CJ, Horenblas S |chapter=Etiology of Penile Cancer |year=2016 |veditors=Muneer A, Horenblas S|title=Textbook of Penile Cancer |publisher=Springer |doi=10.1007/978-3-319-33220-8_2 |edition=2nd |pages=11–15 |isbn=9783319332208}}</ref><ref>{{cite web |publisher=[[American Cancer Society]] |url=https://www.cancer.org/cancer/penile-cancer/causes-risks-prevention/risk-factors.html |title=Risk Factors for Penile Cancer |date=25 June 2018 |access-date=25 January 2023 |archive-date=25 July 2022 |archive-url=https://web.archive.org/web/20220725193031/https://www.cancer.org/cancer/penile-cancer/causes-risks-prevention/risk-factors.html |url-status=live }}</ref> Pre-adolescent circumcision has a strong protective effect against penile cancer in later life.<ref name="pc" /> Penile cancer is a rare disease in the [[developed world]] but much more prevalent in the [[developing world]].<ref name="pc" /> The penile tissue removed during circumcision is a potential origin for penile cancer.<ref>{{cite journal |vauthors=Hakenberg OW, Compérat EM, Minhas S, Necchi A, Protzel C, Watkin N |title=EAU guidelines on penile cancer: 2014 update |journal=Eur Urol |volume=67 |issue=1 |pages=142–150 |date=January 2015 |pmid=25457021 |doi=10.1016/j.eururo.2014.10.017 |type=Practice guideline}}</ref> Risk-benefit considerations around the use of circumcision as a cancer-preventative measure are a source of debate.<ref name="tpc" />

Penile cancer development can be detected in the carcinoma ''in situ'' (CIS) cancerous precursor stage and at the more advanced invasive squamous cell carcinoma stage.<ref name="AAP_2012" />  There is an association between adult circumcision and an increased risk of invasive penile cancer; this is believed to be from men being circumcised as a treatment for penile cancer or a condition that is a precursor to cancer rather than a consequence of circumcision itself.<ref name="larke_penile_cancer_2011" /> Penile cancer has been observed to be nearly eliminated in populations of males circumcised neonatally.<ref name="hayashi_2011" />

Important risk factors for penile cancer include phimosis and HPV infection, both of which are mitigated by circumcision.<ref name=larke_penile_cancer_2011/> The mitigating effect circumcision has on the risk factor introduced by the possibility of phimosis is secondary, in that the removal of the foreskin eliminates the possibility of phimosis. This can be inferred from study results that show uncircumcised men with no history of phimosis are equally likely to have penile cancer as circumcised men.<ref name=AAP_2012/><ref name=larke_penile_cancer_2011/> Circumcision is also associated with a reduced prevalence of cancer-causing types of HPV in men<ref name=rehmeyer_2011/> and a reduced risk of cervical cancer (which is caused by a type of HPV) in female partners of men.<ref name=hay_2012/>

There is some evidence that circumcision is associated with reduced risk of [[prostate cancer]].<ref name=prost>{{cite journal |vauthors=Morris BJ, Matthews JG, Pabalan N, Moreton S, Krieger JN |title=Male circumcision and prostate cancer: a meta-analysis revisited |journal=Can J Urol |volume=28 |issue=4 |pages=10768–10776 |date=August 2021 |pmid=34378513 |doi= |type=Meta-analysis}}</ref>

=== Women's health ===
A 2017 systematic review found consistent evidence that male circumcision prior to heterosexual contact was associated with a decreased risk of cervical cancer, [[Cervical intraepithelial neoplasia|cervical dysplasia]], HSV-2, chlamydia, and syphilis among women. The evidence was less consistent in regards to the potential association of circumcision with women's risk of HPV and HIV.<ref>{{cite journal | vauthors = Grund JM, Bryant TS, Jackson I, Curran K, Bock N, Toledo C, Taliano J, Zhou S, Del Campo JM, Yang L, Kivumbi A, Li P, Pals S, Davis SM | display-authors = 6 | title = Association between male circumcision and women's biomedical health outcomes: a systematic review | journal = The Lancet. Global Health | volume = 5 | issue = 11 | pages = e1113–e1122 | date = November 2017 | pmid = 29025633 | pmc = 5728090 | doi = 10.1016/S2214-109X(17)30369-8 }}</ref>

===Sexual effects===
The accumulated data show circumcision does not have an adverse physiological effect on sexual pleasure, function, desire, or fertility.<ref name=bless>{{Cite journal |last1=Bañuelos Marco |first1=Beatriz |last2=García Heil |first2=Jessica Leigh |date=March 2021 |title=Circumcision in childhood and male sexual function: a blessing or a curse? |journal=International Journal of Impotence Research |language=en |volume=33 |issue=2 |pages=139–148 |doi=10.1038/s41443-020-00354-y |pmid=32994555 |pmc=7985026 |issn=1476-5489}}</ref><ref name="sexual_function">The American Academy of Pediatrics Task Force on Circumcision "Technical Report" (2012) addresses sexual function, sensitivity and satisfaction without qualification by age of circumcision. Sadeghi-Nejad ''et al.'' "Sexually transmitted diseases and sexual function" (2010) addresses adult circumcision and sexual function. Doyle ''et al.'' "The Impact of Male Circumcision on HIV Transmission" (2010) addresses adult circumcision and sexual function. Perera ''et al.'' "Safety and efficacy of nontherapeutic male circumcision: a systematic review" (2010) addresses adult circumcision and sexual function and satisfaction.

*{{cite journal |vauthors=Dave S, Afshar K, Braga LH, Anderson P |date=February 2018 |title=Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version) |journal=Canadian Urological Association Journal |volume=12 |issue=2 |pages=E76–E99 |doi=10.5489/cuaj.5033 |pmc=5937400 |pmid=29381458 |quote=There is lack of any convincing evidence that neonatal circumcision will impact sexual function or cause a perceptible change in penile sensation in adulthood.}}
*{{cite journal | vauthors = Shabanzadeh DM, Düring S, Frimodt-Møller C | title = Male circumcision does not result in inferior perceived male sexual function - a systematic review | journal = Danish Medical Journal | volume = 63 | issue = 7 | date = July 2016 | pmid = 27399981 | type = Systematic review }}
*{{cite journal |vauthors=Friedman B, Khoury J, Petersiel N, Yahalomi T, Paul M, Neuberger A |date=September 2016 |title=Pros and cons of circumcision: an evidence-based overview |journal=Clinical Microbiology and Infection |volume=22 |issue=9 |pages=768–774 |doi=10.1016/j.cmi.2016.07.030 |pmid=27497811 |doi-access=free}}
*{{Cite web |last=Staff |title=Statement on Newborn Male Circumcision |url=https://www.acog.org/en/womens-health/faqs/newborn-male-circumcision |access-date=March 21, 2023 |website=[[American College of Obstetricians and Gynecologists]] |language=en |quote=Some parents also may worry that circumcision harms a man's sexual function, sensitivity, or satisfaction. However, current evidence shows that it does not. |archive-date=21 March 2023 |archive-url=https://web.archive.org/web/20230321004554/https://www.acog.org/en/womens-health/faqs/newborn-male-circumcision |url-status=live }}
*{{Cite journal |last1=Shezi |first1=Mirriam Hlelisani |last2=Tlou |first2=Boikhutso |last3=Naidoo |first3=Saloshni |date=February 16, 2023 |title=Knowledge, attitudes and acceptance of voluntary medical male circumcision among males attending high school in Shiselweni region, Eswatini: a cross sectional study|quote=It was interesting to note that the young males in this study had misconceptions about sexual pleasure post male circumcision...|journal=[[BMC Public Health]] |volume=23 |issue=1 |pages=349 |doi=10.1186/s12889-023-15228-3 |issn=1471-2458 |pmc=9933013 |pmid=36797696 |doi-access=free }}
*{{Cite journal |last1=Todd Sorokan |first1=S |last2=Finlay |first2=Jane |last3=Jefferies |first3=Ann |date=September 8, 2015 |title=2015 Policy Statement on Newborn Male Circumcision |journal=[[Canadian Paediatric Society]] |volume=20 |issue=6 |pages=311–320 |doi=10.1093/pch/20.6.311 |pmid=26435672 |pmc=4578472 |language=en |quote=...medical studies do not support circumcision as having a negative impact on sexual function or satisfaction in males or their partners.}}
*{{cite web |last1=World Health Organization |last2=UNAIDS |last3=Jhpiego |date=December 2009 |title=Manual for Male Circumcision Under Local Anaesthesia |url=https://www.who.int/hiv/pub/malecircumcision/who_mc_local_anaesthesia.pdf |archive-url=https://web.archive.org/web/20120115175057/http://www.who.int/hiv/pub/malecircumcision/who_mc_local_anaesthesia.pdf |archive-date=January 15, 2012 |publisher= |quote=...there are many myths about male circumcision that circulate. For example, some people think that circumcision can cause impotence (failure of erection) or reduce sexual pleasure. Others think that circumcision will cure impotence. Let me assure you that none of these is true. |author1-link=World Health Organization |author2-link=UNAIDS |author3-link=Jhpiego }} [https://www.scribd.com/document/186396682/Who-Mc-Local-Anaesthesia Alt URL] {{Webarchive|url=https://web.archive.org/web/20230330035156/https://www.scribd.com/document/186396682/Who-Mc-Local-Anaesthesia |date=30 March 2023 }}</ref> There is some evidence that circumcision has no effect on [[Dyspareunia|pain with intercourse]], [[premature ejaculation]], time until ejaculation, [[erectile dysfunction]] or difficulties with [[orgasm]].<ref name=Tian2013>{{cite journal | vauthors = Tian Y, Liu W, Wang JZ, Wazir R, Yue X, Wang KJ | title = Effects of circumcision on male sexual functions: a systematic review and meta-analysis | journal = Asian Journal of Andrology | volume = 15 | issue = 5 | pages = 662–666 | date = September 2013 | pmid = 23749001 | pmc = 3881635 | doi = 10.1038/aja.2013.47 | type = Systematic review }}</ref>

According to a 2014 review, the effect of circumcision on sexual partners' experiences is unclear as this has not been well studied.<ref name="bossio_2014" />  According to a policy statement from the [[Canadian Paediatric Society]] that was reaffirmed in 2021,<ref>{{Cite web |last=Society |first=Canadian Paediatric |title=Newborn male circumcision {{!}} Canadian Paediatric Society |url=https://cps.ca/en/documents/position/circumcision |access-date=2023-04-10 |website=cps.ca |language=en |archive-date=11 April 2023 |archive-url=https://web.archive.org/web/20230411220045/https://cps.ca/en/documents/position/circumcision |url-status=live }}</ref> "medical studies do not support circumcision as having an impact on sexual function or satisfaction for partners of circumcised individuals".<ref name="sexual_function" />

There are popular misconceptions that circumcision benefits or adversely impacts the sexual pleasure of the circumcised person.<ref name="sexual_function" />

==Adverse effects==
Neonatal circumcision is generally a safe, low-risk procedure when done by an experienced practitioner.<ref>{{cite journal |vauthors=Friedman B, Khoury J, Petersiel N, Yahalomi T, Paul M, Neuberger A |date=September 2016 |title=Pros and cons of circumcision: an evidence-based overview |journal=Clinical Microbiology and Infection |volume=22 |issue=9 |pages=768–774 |doi=10.1016/j.cmi.2016.07.030 |pmid=27497811 |doi-access=free}}</ref><ref name=AUA_2007/><ref name="KrillPalmer2011"/>

The most common acute [[Complication (medicine)|complications]] are bleeding, infection and the removal of either too much or too little foreskin.<ref name="AAP_2012" /><ref name="AAFP_2013" /> These complications occur in approximately 0.13% of procedures, with bleeding being the most common acute complication in the United States.<ref name="AAFP_2013" /><!-- Quote = Acute complications can include bleeding (0.8-1.8/1,000), infection (6/10,000), and injury to the penis (4/10,000). --> Minor complications are reported to occur in three percent of procedures.<ref name="AUA_2007" /> Severe complications are rare.<ref name="Complications of circumcision" /> A specific complication rate is difficult to determine due to scant data on complications and inconsistencies in their classification.<ref name="AAP_2012" /> Complication rates are greater when the procedure is performed by an inexperienced operator, in unsterile conditions, or when the child is at an older age.<ref name="weiss_2010_complications" /> Significant acute complications happen rarely,<ref name="AAP_2012" /><ref name="weiss_2010_complications" /> occurring in about 1 in 500 newborn procedures in the United States.<ref name="AAP_2012" /> Severe to catastrophic complications, including death, are so rare that they are reported only as individual case reports.<ref name="AAP_2012" /><ref name="KrillPalmer2011" /> Where a Plastibell device is used, the most common complication is the retention of the device occurring in around 3.5% of procedures.<ref name="Selekman-2020" /> Other possible complications include [[buried penis]], [[chordee]], phimosis, [[skin bridge]]s, urethral fistulas, and [[meatal stenosis]].<ref name="KrillPalmer2011" /> These complications may be partly avoided with proper technique, and are often treatable without requiring surgical revision.<ref name="KrillPalmer2011">{{cite journal | vauthors = Krill AJ, Palmer LS, Palmer JS | title = Complications of circumcision | journal = TheScientificWorldJournal | volume = 11 | pages = 2458–2468 | year = 2011 | pmid = 22235177 | pmc = 3253617 | doi = 10.1100/2011/373829 | doi-access = free }}</ref> The most common long-term complication is meatal stenosis, this is almost exclusively seen in circumcised children, it is thought to be caused by ammonia producing bacteria coming into contact with the meatus in circumcised infants.<ref name="Selekman-2020" /> It can be treated by [[meatotomy]].<ref name="Selekman-2020" />

Effective pain management should be used during the procedure.<ref name="AAP_2012" /> Inadequate pain relief may carry the risks of heightened pain response for newborns.<ref name=perera_2010/> Newborns that experience pain due to being circumcised have different responses to vaccines given afterwards, with higher pain scores observed.<ref>{{cite journal | vauthors = Sorokan ST, Finlay JC, Jefferies AL | title = Newborn male circumcision | journal = Paediatrics & Child Health | volume = 20 | issue = 6 | pages = 311–320 | date = 8 September 2015 | pmid = 26435672 | pmc = 4578472 | doi = 10.1093/pch/20.6.311 | url = http://www.cps.ca/documents/position/circumcision | url-status = live | archive-url = https://web.archive.org/web/20160118224324/http://www.cps.ca/documents/position/circumcision | archive-date = 18 January 2016 }}</ref> For adult men who have been circumcised, there is a risk that the [[circumcision scar]] may be tender.<ref name="crit">{{cite journal |vauthors=Morris BJ, Moreton S, Krieger JN |date=November 2019 |title=Critical evaluation of arguments opposing male circumcision: A systematic review |journal=Journal of Evidence-Based Medicine |type=Systematic review |volume=12 |issue=4 |pages=263–290 |doi=10.1111/jebm.12361 |pmc=6899915 |pmid=31496128}}</ref>{{COI source|sure=yes|date=March 2023}}

It is unclear what the psychological outcomes of circumcision are. Studies have shown positive, neutral, or negative effects. There is debate in the literature over whether the pain of circumcision has lasting psychological impact, with only weak underlying data available.<ref name="crit" />{{COI source|sure=yes|date=March 2023}} There is no good evidence that circumcision affects cognitive abilities.<ref name="nhs">{{cite web |date=22 February 2016 |title=Circumcision in men |url=https://www.nhs.uk/conditions/circumcision-in-men/ |publisher=National Health Service |access-date=30 October 2018 |archive-date=29 June 2020 |archive-url=https://web.archive.org/web/20200629155854/https://www.nhs.uk/conditions/circumcision-in-men/ |url-status=live }}</ref>

==Prevalence==
{{excerpt|Prevalence of circumcision|paragraphs=1-2}}

==History==
{{Main|History of circumcision}}
{{Undue weight section|date=November 2023}}

[[File:Mangbetu Beschneidungsmesser Museum Rietberg RAC 15.jpg|thumb|upright|right|Circumcision knife from the Congo; wood, iron; late 19th/early 20th century]]
Circumcision is the oldest known surgical procedure.<ref name=":0">{{cite book |author1-last=Cox |author1-first=Guy |title=Surgical Guide to Circumcision |author2-last=Morris |author2-first=Brian J. |publisher=Springer Science & Business Media |year=2012 |isbn=9781447128588 |editor1-last=Bolnick |editor1-first=David A. |chapter=Why Circumcision? From Prehistory to the Twenty-First Century |editor2-last=Koyle |editor2-first=Martin |editor3-last=Yosha |editor3-first=Assaf}}|pp.243&#x2013;<nowiki>244}}</nowiki></ref> Depictions of circumcised penises are found in [[Paleolithic art]],<ref>{{Cite journal |last1=Angulo |first1=Javier C. |last2=García-Díez |first2=Marcos |date=2009-07-01 |title=Male Genital Representation in Paleolithic Art: Erection and Circumcision Before History |url=https://www.sciencedirect.com/science/article/pii/S0090429509000831 |journal=Urology |volume=74 |issue=1 |pages=10–14 |doi=10.1016/j.urology.2009.01.010 |pmid=19395004 |hdl=10400.26/23819 |issn=0090-4295|hdl-access=free }}</ref> predating the earliest signs of [[Trepanning|trepanation]].<ref name=":0" /><ref>{{Cite journal |last=Faria |first=Miguel A. |date=2015-05-07 |title=Neolithic trepanation decoded- A unifying hypothesis: Has the mystery as to why primitive surgeons performed cranial surgery been solved? |journal=Surgical Neurology International |volume=6 |pages=72 |doi=10.4103/2152-7806.156634 |doi-access=free |issn=2229-5097 |pmc=4427816 |pmid=25984386}}</ref>

The history of the migration and evolution of circumcision is known mainly from the cultures of two regions. In the lands south and east of the Mediterranean, starting with Sudan and Ethiopia, the procedure was practiced by the [[ancient Egypt]]ians and the [[Semitic people|Semites]], and then by the Jews and Muslims, with whom the practice travelled to and was adopted by the [[Bantu peoples|Bantu Africans]]. In Oceania, circumcision is practiced by the [[Aboriginal Australians|Australian Aboriginals]] and [[Polynesians]].<ref name="gollaher_2001_ch1" /> There is also evidence that circumcision was practiced among the [[Aztec]] and [[Maya civilization|Mayan]] civilizations in the Americas,<ref name="WHO_2007_GTDPSA" /> but little is known about that history.<ref name="Doy2005" /><ref name="alanis_2004" />

It has been speculated that circumcision originated as a substitute for [[castration]] of defeated enemies or as a [[Sacrifice|religious sacrifice]].<ref name="alanis_2004" /> In many traditions, it acts as a [[rite of passage]] marking a boy's entrance into [[adult]]hood.<ref name="alanis_2004" />

===Middle East, Africa and Europe===
{{Further|Circumcision in Africa}}

At [[Rock engravings of Oued Djerat|Oued Djerat]], in [[Algeria]], engraved rock art with masked bowmen, which feature male circumcision and may be a scene involving ritual, have been dated to earlier than 6000 BP amid the [[Bubaline Period]];<ref name="Campbell">{{cite journal |last1=Campbell |first1=Alec |last2=Coulson |first2=David |title=Big Hippo Site, Oued Afar, Algeria |journal=Sahara |date=2010 |volume=21 |pages=85, 90–91 |url=https://media.africanrockart.org.s3.amazonaws.com/wp-content/uploads/2018/12/26145300/NG_Ancient-art-of-the-Sahara-June-1999.pdf |issn=1120-5679 |s2cid=191103812 |access-date=27 August 2022 |archive-date=26 October 2022 |archive-url=https://web.archive.org/web/20221026015942/https://media.africanrockart.org.s3.amazonaws.com/wp-content/uploads/2018/12/26145300/NG_Ancient-art-of-the-Sahara-June-1999.pdf |url-status=dead }}</ref> more specifically, while possibly dating much earlier than 10,000 BP, rock art walls from the Bubaline Period have been dated between 9200 BP and 5500 BP.<ref name="Soukopova">{{cite journal |last1=Soukopova |first1=Jitka |title=Central Saharan rock art: Considering the kettles and cupules |journal=Journal of Arid Environments |date=August 2017 |volume=143 |page=12 |doi=10.1016/j.jaridenv.2016.12.011 |bibcode=2017JArEn.143...10S |s2cid=132225521 |url=https://www.academia.edu/33092285 |access-date=27 August 2022 |archive-date=7 November 2021 |archive-url=https://web.archive.org/web/20211107084913/https://www.academia.edu/33092285 |url-status=live }}</ref> The cultural practice of circumcision may have spread from the Central [[Sahara]], toward the south in [[Sub-Saharan Africa]] and toward the east in the region of the [[Nile]].<ref name="Campbell" /> Based on [[petroglyph|engraved]] evidence found on walls and evidence from [[Mummy#Egyptian mummies|mummies]], circumcision has been dated to at least as early as 6000 BCE in [[ancient Egypt]].<ref name="Al-Salem">{{cite book |last1=Al-Salem |first1=Ahmed H. |title=An Illustrated Guide to Pediatric Urology |date=November 8, 2016 |publisher=Springer Cham |isbn=978-3-319-44182-5 |doi=10.1007/978-3-319-44182-5_22 |s2cid=79015190 |page=480 |chapter-url=https://link.springer.com/chapter/10.1007/978-3-319-44182-5_22 |chapter=Male Circumcision |access-date=27 August 2022 |archive-date=23 August 2022 |archive-url=https://web.archive.org/web/20220823235108/https://link.springer.com/chapter/10.1007/978-3-319-44182-5_22 |url-status=live }}</ref> Some [[Ancient Egyptian funerary practices#History|ancient Egyptian mummies]], which have been dated as early as 4000 BCE, show evidence of circumcision.<ref name="Gollaher">{{cite book |last1=Gollaher |first1=David |title=Circumcision: A History Of The World's Most Controversial Surgery |date=2000 |publisher=Basic Books |isbn=0-465-02653-2 |s2cid=68860890 |pages=2–3 |chapter-url=https://booksdo.com/wp-content/uploads/XPreview/Surgery/2/circumcision-a-history-of-the-world%27s-most-controversial-surgery-david-gollaher-0465026532-9780465026531-270.pdf |chapter=The Jewish Tradition |access-date=27 August 2022 |archive-date=23 August 2022 |archive-url=https://web.archive.org/web/20220823235109/https://booksdo.com/wp-content/uploads/XPreview/Surgery/2/circumcision-a-history-of-the-world%27s-most-controversial-surgery-david-gollaher-0465026532-9780465026531-270.pdf |url-status=live }}</ref><ref name="Dobanovački">{{cite journal |last1=Dobanovački |first1=Dušanka |display-authors=etal |title=Surgery Before Common Era (B.C.E.*) |journal=Archive of Oncology |date=2012 |volume=20 |issue=1–2 |page=29 |doi=10.2298/AOO1202028D |s2cid=53008076 |url=http://www.doiserbia.nb.rs/img/doi/0354-7310/2012/0354-73101202028D.pdf |access-date=27 August 2022 |archive-date=12 February 2023 |archive-url=https://web.archive.org/web/20230212202036/http://www.doiserbia.nb.rs/img/doi/0354-7310/2012/0354-73101202028D.pdf |url-status=live }}</ref>

Evidence suggests that circumcision was practiced in the Middle East by the fourth millennium BCE, when the [[Sumer]]ians and the Semites moved into the area that is modern-day Iraq from the North and West.<ref name=Doy2005/>  The earliest historical record of circumcision comes from Egypt, in the form of an image of the circumcision of an adult carved into the tomb of Ankh-Mahor at [[Saqqara]], dating to about 2400{{endash}}2300 BCE. Circumcision was possibly done by the Egyptians for hygienic reasons, but also was part of their obsession with purity and was associated with spiritual and intellectual development.  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.  It may have been a mark of distinction for the elite:  the Egyptian ''[[Book of the Dead]]'' describes the sun god [[Ra]] as having circumcised himself.<ref name=alanis_2004/><ref name=gollaher_2001_ch1/>
[[File:Artemision-penis.jpg|thumb|left|upright|Detail of the [[Artemision Bronze]]; the Greeks abhorred circumcision, making life difficult for circumcised Jews living among the Greeks.]]

Circumcision is prominent in the [[Hebrew Bible]].<ref>{{cite book | vauthors = McNutt PM |title=Reconstructing the Society of Ancient Israel |url=https://archive.org/details/reconstructingso0000mcnu |url-access=registration |page=[https://archive.org/details/reconstructingso0000mcnu/page/41 41] |quote=Abraham patriarchal known history. |year=1999 |publisher=Westminster John Knox Press |isbn=978-0-664-22265-9 }}</ref> In addition to proposing that circumcision was adopted by the Israelites purely as a religious mandate, scholars have suggested that Judaism's patriarchs and their followers adopted circumcision to make penile hygiene easier in hot, sandy climates; as a rite of passage into adulthood; or as a form of blood sacrifice.<ref name="Doy2005" /><ref name="gollaher_2001_ch1" /><ref name="encyc_judaica_2006" />

Historical campaigns of [[Ethnocide|ethnic, cultural, and religious persecution]] frequently included bans on circumcision as a means of [[Forced conversion|forceful assimilation, conversion, and ethnocide]].<ref name="Antisemitism">For sources, see:

* {{Cite book |last=Livingston |first=Michael |title=Dreamworld or Dystopia: The Nordic Model and Its Influence in the 21st Century |publisher=[[Cambridge University Press]] |year=2021 |isbn=9781108757263 |pages=87 |quote=In Jewish history, the banning of circumcision (brit mila) has historically been a first step toward more extreme and violent forms of persecution. |author-link=Michael Livingston}}
* {{Cite book |last=Livingston |first=Michael |title=Dreamworld or Dystopia: The Nordic Model and Its Influence in the 21st Century |publisher=[[Cambridge University Press]] |year=2021 |isbn=9781108757263 |pages=87 |quote=In Jewish history, the banning of circumcision (brit mila) has historically been a first step toward more extreme and violent forms of persecution. |author-link=Michael Livingston}}
* {{Cite book |last=Wilson |first=Robin |title=The Contested Place of Religion in Family Law |publisher=[[Cambridge University Press]] |year=2018 |isbn=9781108417600 |pages=174 |quote=Jews have a long history of suffering punishment at the hands of government authorities for engaging in circumcision. Muslims have also experienced suppression of their identities through suppression of this religious practice.}}
* {{cite journal |last=Miller |first=Geoffrey P. |date=Spring 2002 |title=Circumcision: Cultural-Legal Analysis |journal=Virginia Journal of Social Policy & the Law |volume=9 |pages=497–585 |doi=10.2139/ssrn.201057 |ssrn=201057 <!-- | format      = PDF (free download) -- can't list format or access-date without url--> |quote=Ritual circumcision of boys is a durable tradition. Jews of ancient times refused to abandon the practice despite enormous pressure to do so. In 167 BCE the Seleucid emperor Antiochus IV, as part of a campaign to Hellenise the Jews, condemned to death every Hebrew who allowed a son to be circumcised. The Jews responded with the Maccabean revolt, a campaign of [[guerrilla warfare]] which resulted in major victories for the rebels and, eventually, a peace treaty which restored Jewish ritual prerogatives.}}
* {{Cite book |last=Silverman |first=Eric |title=From Abraham to America: A History of Jewish Circumcision |publisher=[[Rowman & Littlefield]] |year=2006 |isbn=9780742516694 |pages=161–162 |chapter=Circumcision, Anti-Semitism, and Christ's Foreskin |quote=Ancient [Greek and Roman] authors praised Jewish wisdom, courage, temperance, and justice. Still, they always denounced circumcision. The anonymous authors of Historiae Augustae, writing in the late fourth century, ttributed a Jewish revolt against Rome in 132-135, called the Bar Kokhba rebellion, to a ban on circumcision enacted by the emperor Hadrian... The prohibition was part of a broad campaign to "civilize" ethnic groups...}}
* {{Cite book |last=Rosner |first=Fred |title=Encyclopedia of Jewish Medical Ethics |publisher=[[Feldheim Publishers]] |year=2003 |isbn=9781583305928 |pages=196 |quote=Several eras in subsequent Jewish history were associated with forced conversions and with prohibitions against ritual circumcision... Jews endangered their lives during such times and exerted strenuous efforts to nullify such edicts. When they succeeded, they celebrated by declaring a holiday. Throughout most of history, Jews never doubted their obligation to observe circumcision... [those who attempted to reverse it or failed to perform the ritual were called] voiders of the covenant of Abraham our father, and they have no portion in the World to Come.}}</ref> [[Alexander the Great]] conquered the Middle East in the fourth century BCE, and in the following centuries ancient Greek cultures and values came to the Middle East. The Greeks abhorred circumcision, making life for circumcised Jews living among the Greeks and later the Romans very difficult.<ref name="Antisemitism" />  [[Circumcision and law|Restrictions on the Jewish practice]] by European governments have occurred several times in world history, including the [[Seleucid Empire]] under [[Antiochus IV Epiphanes|Antiochus IV]] and the [[Roman Empire]] under [[Hadrian]], where it was used as a means of [[Forced conversion|forceful assimilation and conversion]].<ref name="Antisemitism" /> Antiochus IV's restriction on Jewish circumcision was a major factor in the [[Maccabean Revolt]].<ref name="Antisemitism" /> [[Hadrian]]'s prohibition has also been considered by some to have been a contributing cause of the [[Bar Kokhba revolt]].<ref name="Antisemitism" /> According to Silverman (2006), these restrictions were part of a "broad campaign" by the Romans to "civilize" the Jewish people, viewing the practice as replusive and analogous to [[castration]].<ref name="Antisemitism" /> His successor, [[Antoninus Pius]], altered the edict to permit {{transliteration|he|Brit Milah}}.<ref name="Antisemitism" /> During this period in history, Jewish circumcision called for the removal of only a part of the prepuce, and [[Hellenization|Hellenized]] Jews often attempted to look uncircumcised by stretching the extant parts of their foreskins. This was considered by the Jewish leaders to be a serious problem, and during the second century CE they changed the requirements of Jewish circumcision to call for the complete removal of the foreskin,<ref>{{cite encyclopedia|vauthors=Hirsch EG, Kohler K, Jacobs J, Friedenwald A, Broydé I|date=1906|title=Circumcision|url=http://www.jewishencyclopedia.com/articles/4391-circumcision|encyclopedia=[[Jewish Encyclopedia]]|quote=In order to prevent the obliteration of the 'seal of the covenant' on the flesh, as circumcision was henceforth called, the Rabbis, probably after the [[war of Bar Kokba]] (see Yeb. l.c.; Gen. R. xlvi.), instituted the 'peri'ah' (the laying bare of the glans), without which circumcision was declared to be of no value (Shab. xxx. 6).|access-date=8 March 2018|archive-date=4 August 2011|archive-url=https://web.archive.org/web/20110804221009/http://www.jewishencyclopedia.com/view.jsp?artid=514&letter=C&search=circumcision|url-status=live}}</ref> emphasizing the Jewish view of circumcision as intended to be not just the fulfillment of a Biblical commandment but also an essential and permanent mark of membership in a people.<ref name="gollaher_2001_ch1" /><ref name="encyc_judaica_2006" />

[[File:Ludovico Mazzolino - Circumcision - WGA14715.jpg|thumb|upright|The Circumcision of Jesus Christ, by [[Ludovico Mazzolino]]|left]]A narrative in the Christian [[Gospel of Luke]] makes a brief mention of the [[circumcision of Jesus]], but physical circumcision is not part of the received teachings of Jesus.  Circumcision has [[Circumcision controversy in early Christianity|played an important role]] in [[History of Christianity|Christian history]] and [[Christian theology|theology]]. [[Paul the Apostle]] reinterpreted circumcision as a spiritual concept, arguing literal circumcision to be unnecessary for Gentile converts to Christianity. The teaching that circumcision was unnecessary for membership in a divine covenant was instrumental to the separation of Christianity from Judaism.<ref name="Jacobs-2012">{{Cite book |last=Jacobs |first=Andrew |title=Christ Circumcised: A Study in Early Christian History and Difference |publisher=[[University of Pennsylvania Press]] |year=2012 |isbn=9780812206517 |location=United States |pages=}}</ref><ref name="Bolnick-2012">{{Cite book |last1=Bolnick |first1=David |title=Surgical Guide to Circumcision |last2=Koyle |first2=Martin |last3=Yosha |first3=Assaf |publisher=[[Springer Science+Business Media|Springer]] |year=2012 |isbn=9781447128588 |location=United Kingdom |pages=290–298 |chapter=Circumcision in the Early Christian Church: The Controversy That Shaped a Continent |quote=In summary, circumcision has played a surprisingly important role in Western history. The circumcision debate forged a Gentile identity to the early Christian church which allowed it to survive the Jewish Diaspora and become the dominant religion of Western Europe. Circumcision continued to have a major cultural presence throughout Christendom even after the practice had all but vanished.... the circumcision of Jesus... celebrated as a religious holiday... [has been] examined by many of the greatest scholars and artists of the Western tradition.}}</ref> While the circumcision of Jesus is celebrated as [[Feast of the Circumcision of Christ|a feast day]] in the [[Liturgical year|liturgical calendar]] of many [[Christian denomination]]s.<ref name="Bolnick-2012"/>

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.  The practice of circumcision spread across the Middle East, North Africa, and Southern Europe with Islam.<ref name="gollaher_2001_ch2" />

[[Genghis Khan]] and the following Yuan Emperors in China forbade Islamic practices such as [[halal]] butchering and circumcision.<ref name="Leslie-1998">{{cite web|url=http://www.islamicpopulation.com/asia/China/China_integration%20of%20religious%20minority.pdf |title=The Integration of Religious Minorities in China: The Case of Chinese Muslims |author=Donald Daniel Leslie |year=1998 |page=12 |publisher=The Fifty-ninth George Ernest Morrison Lecture in Ethnology |access-date=30 November 2010 |url-status=dead |archive-url=https://web.archive.org/web/20101217112014/http://islamicpopulation.com/asia/China/China_integration%20of%20religious%20minority.pdf |archive-date=17 December 2010 }}</ref><ref name="Elverskog-2010">{{cite book|url=https://archive.org/details/buddhismislamons0000elve|url-access=registration|title=Buddhism and Islam on the Silk Road|first=Johan|last=Elverskog|year=2010|publisher=University of Pennsylvania Press|edition=illustrated|pages=[https://archive.org/details/buddhismislamons0000elve/page/228 228]|isbn=978-0-8122-4237-9|access-date=28 June 2010}}</ref>

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 [[reconquista|reconquest]] of Spain. In the second half of the first millennium CE, inhabitants from the Northeast of Africa moved south and encountered groups from Arabia, the Middle East, and West Africa. These people moved south and formed what is known today as the Bantu. Bantu tribes were observed to be upholding what was described as Jewish law, including circumcision, in the 16th century. Circumcision and elements of Jewish dietary restrictions are still found among Bantu tribes.<ref name=Doy2005/>

===Indigenous peoples of the Americas and Oceania===
Circumcision is practiced by some groups amongst [[Australian Aboriginal]] peoples, [[Polynesians]], and [[Indigenous peoples of the Americas|Native Americans]].<ref name=WHO_2007_GTDPSA/><ref name="Doy2005"/>

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.  Often seashells were used to remove the foreskin, and the bleeding was stopped with [[eucalyptus]] smoke.<ref name=Doy2005/><ref name=gollaher_2001_ch3/>

[[Christopher Columbus]] reported circumcision being practiced by Native Americans.<ref name=alanis_2004/> It probably started among South American tribes as a blood sacrifice or ritual to test bravery and endurance, and later evolved into a rite of initiation.<ref name=Doy2005/>

=== Prophylactic circumcision ===

==== Anglophonic adoption (1855–1918) ====
[[File:Jonathan Hutchinson.jpg|thumb|The first medical professional to recommend circumcision as a ''prophylaxis'' against disease was the [[British people|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 [[Anglosphere|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.<ref name="Al-Salem-2016">{{Cite book |last=Al-Salem |first=Ahmed |title=An Illustrated Guide to Pediatric Urology |publisher=[[Springer Publishing]] |year=2016 |isbn=9783319441825 |pages=481}}</ref>]]
Circumcision began to be advocated as a means of ''prophylaxis'' in 1855, primarily as a means of preventing the transmission of sexually transmitted infections. At this time, [[British people|British]] physician [[Jonathan Hutchinson]] published his findings that, among his venereal disease patients, Jews had a lower prevalence of [[syphilis]].<ref name="darby_2005" /><ref name="Hutchinson1855">{{cite journal |last1=Hutchinson |first1=Jonathan |title=On the influence of circumcision in preventing syphilis |journal=Medical Times and Gazette |date=1855 |volume=32 |pages=542–543}}</ref> Hutchinson suggested that circumcision lowers the risk of contracting syphilis.<ref name="Hutchinson1855"/> Pursuing a successful career as a general practitioner, Hutchinson went on to advocate circumcision for health reasons for the next fifty years,<ref name="darby_2005" /> eventually earned a [[knighthood]] for his contributions to medicine. His viewpoint that circumcision was prophylactic against disease was adopted by other medical professionals.<ref name="matthew_2004" />

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. He thought the procedure ameliorated such problems based on the then prominent "reflex neurosis" theory of disease, thinking that a tight foreskin inflamed the nerves and caused systemic problems.<ref name="Chubak-2013">{{Cite journal |last=Chubak |first=Barbara |date=2013-04-01 |title=1101 the orthopedic origin of popular male circumcision in america |url= |journal=Journal of Urology |volume=189 |issue=4S |pages=e451 |doi=10.1016/j.juro.2013.02.693 |quote=Male circumcision was first popularized in late 19th-century America by Lewis Sayre, a renowned orthopedic surgeon, public-health activist, and creator of the Journal of the American Medical Association. On the basis of a few orthopedic case reports, Sayre used his influence to promote male circumcision as systemic therapy, rather than a local anatomic alteration. This redefinition was consistent with the contemporary reflex neurosis theory of disease, as well as the historic humoral-mechanical understanding of the human body.}}</ref> 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]].<ref name="Gollaher 2001 106">{{harvnb|Gollaher|2001|p=106}}</ref> Sayre published works on the subject and promoted it in speeches.<ref name="Chubak-2013" /> 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]]. Its popularity spread with publications such as Peter Charles Remondino's ''History of Circumcision''.<ref name="gollaher_2001_ch4" /><ref name="darby_2003" /><ref>{{Cite journal|last1=Laumann|first1=E. O.|last2=Masi|first2=C. M.|last3=Zuckerman|first3=E. W.|date=2 April 1997|title=Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice|url=https://pubmed.ncbi.nlm.nih.gov/9091693|journal=JAMA|volume=277|issue=13|pages=1052–1057|doi=10.1001/jama.1997.03540370042034|issn=0098-7484|pmid=9091693|access-date=19 December 2021|archive-date=19 December 2021|archive-url=https://web.archive.org/web/20211219170126/https://pubmed.ncbi.nlm.nih.gov/9091693/|url-status=live}}</ref> By the late 19th century, circumcision had become common throughout the [[English-speaking world|Anglophonic world]]—Australia, Canada, the United States, and the United Kingdom—as well as the [[Union of South Africa]]. In the United Kingdom and United States, it was universally recommended.<ref name="Al-Salem-2016" /><ref name="gollaher_2001_ch4" />

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.<ref name="Gollaher 2001 106"/>

==== Interwar Period and World War II (1918–1945) ====
During the [[interwar period]], medical organizations and doctors in [[Continental Europe|mainland Europe]] experimented with the idea of routine circumcision for prophylactic reasons as well, alongside developments in the Anglophonic world. In France, the medical profession went so far as to recommend universal routine circumcision. However, prevalence in France and mainland Europe remained low.<ref name="Bolnick_2012_ch1" /> There is a lack of consensus in the academic literature on why this occurred.<ref name="Bolnick_2012_ch1" />

''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. While many of these Anglophonic polities would not be considered tolerant by modern standards: the United Kingdom had [[Benjamin Disraeli]]—a Jew—as [[Prime Minister of the United Kingdom|Prime Minister]]; [[American Jews|Jews in the United States]] were prominent and generally well-respected; while in Australia "the racial issues of the time [[White Australia policy|involved primarily Aborigines and Chinese immigration]], and Jews were essentially below the radar". They argue that once "a substantial proportion of the male population [was] circumcised, the idea that it [was] a Jewish practice [became] no longer relevant. In Britain this was aided by the fact that circumcision was well known to be as much a practice of the nobility as a Jewish religious rite, so that the racial-religious nexus was broken." These factors were absent in [[continental Europe]].<ref name="Bolnick_2012_ch1" />

Rates in the Anglophonic world began to sharply diverge after 1945.<ref name="alanis_2004" /> [[File:Benjamin McLane Spock (1976) 02.jpg|thumb|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.<ref name="Paige 2021 263">{{Cite book |last1=Paige |first1=Jeffery |title=The Politics of Reproductive Ritual |last2=Paige |first2=Karen |publisher=[[University of California Press]] |year=2021 |isbn=978-0-520-30674-5 |pages=263 |chapter=Summary and Implications for Complex Societies}}</ref> ]]

==== Mid-20th century (1945–1985) ====
After the end of [[World War II]], Britain implemented a [[National Health Service]]. [[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.<ref>{{cite journal | vauthors = Gairdner D | title = The fate of the foreskin, a study of circumcision | journal = British Medical Journal | volume = 2 | issue = 4642 | pages = 1433–7, illust | date = December 1949 | pmid = 15408299 | pmc = 2051968 | doi = 10.1136/bmj.2.4642.1433 }}</ref>

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. In the 1970s, national medical associations in Australia and Canada issued recommendations against routine infant circumcision, leading to drops in the rates of both of those countries. The United States made similar statements in the 1970s but stopped short of recommending against it.<ref name="alanis_2004" />

==== Modernity (since 1985) ====
An association between circumcision and reduced heterosexual HIV infection rates was first suggested in 1986.<ref name="alanis_2004" />

Experimental evidence was needed to establish a causal relationship, so three [[randomized controlled trial]]s were commissioned to exclude other [[Confounding|confounding factors]].<ref name="siegfried_Cochrane_2009" /> Trials took place in South Africa, Kenya and Uganda.<ref name="siegfried_Cochrane_2009" /> All three trials were stopped early by their monitoring boards because those in the circumcised group had a substantially lower rate of HIV contraction than the control group, so it was considered unethical to withhold the procedure, in light of strong evidence of prophylactic efficacy.<ref name="siegfried_Cochrane_2009" /><ref>{{Cite journal |last1=Hankins |first1=Catherine |last2=Forsythe |first2=Steven |last3=Njeuhmeli |first3=Emmanuel |date=November 29, 2011 |title=Voluntary Medical Male Circumcision: An Introduction to the Cost, Impact, and Challenges of Accelerated Scaling Up |journal=[[PLOS Medicine]] |volume=8 |issue=11 |pages=e1001127 |doi=10.1371/journal.pmed.1001127 |pmc=3226452 |pmid=22140362 |doi-access=free}}</ref> WHO assessed these as "gold standard" studies and found "strong and consistent" evidence from later studies that confirmed the results of the studies.<ref name="WHO-PrevHIV" /> A scientific consensus subsequently developed that circumcision reduces heterosexual HIV infection rates in high-risk populations;<ref name="Merson-2017" /><ref name="Chikutsa-2015" /><ref name="Bell-2016">{{Cite book |last=Bell |first=Kirsten |title=Health and Other Unassailable Values: Reconfigurations of Health, Evidence and Ethics |publisher=Taylor & Francis |year=2016 |isbn=9781317482031 |pages=106 |quote=...defending the casual relation between male circumcision and reduced HIV transmission has become essentially hegemonic in the academic literature.}}</ref> the WHO, along with other major medical organizations, have since promoted circumcision of high-risk populations as part of the program to reduce the spread of HIV.<ref name="WHO-PrevHIV" /> The ''Male Circumcision Clearinghouse'' website was created in 2009 by WHO, UNAIDS, FHI and AVAC to provide evidence-based guidance, information, and resources to support the delivery of safe male circumcision services in countries that choose to scale up the procedure as one component of comprehensive HIV prevention services.<ref name="NYTimes_2009" /><ref name="AVAC_2015" />

==Society and culture==
[[File: Circumcision central Asia2.jpg|thumb|right| A circumcision being performed in Central Asia, {{circa|1865–1872}}]]

The word [[wikt:circumcision|circumcision]] is from Latin {{Lang|la|circumcidere}}, meaning "to cut around".<ref name="WHO_2007_GTDPSA" />

===Cultures and religions {{Anchor|Cultures and religions}}===
{{See also|Cultural views on circumcision|Religious male circumcision}}

{{Undue weight section|date=November 2023}}

Many societies hold [[Cultural views on circumcision|cultural, ethical, or social views on the practice]], with perspectives ranging widely. In some cultures, males are generally required to be circumcised shortly after birth, during childhood or around puberty as part of a rite of passage. Circumcision is commonly practiced in the Jewish and Islamic and [[Druze]] faiths and in [[Coptic Orthodox Church of Alexandria|Coptic Christianity]] and the [[Ethiopian Orthodox Tewahedo Church|Ethiopian Orthodox Church]] and the [[Eritrean Orthodox Tewahedo Church]].<ref name="Bolnick_2012_ch1" /><ref name="glass_1999">{{cite journal |vauthors=Glass JM |date=January 1999 |title=Religious circumcision: a Jewish view |journal=BJU International |volume=83 |issue=Suppl 1 |pages=17–21 |doi=10.1046/j.1464-410x.1999.0830s1017.x |pmid=10349410 |s2cid=2888024}}</ref><ref name="Columbia_encyc_2011_circ">{{cite encyclopedia |year=2011 |title=Circumcision |encyclopedia=Columbia Encyclopedia |publisher=Columbia University Press |url=http://www.infoplease.com/encyclopedia/science/circumcision.html |archive-url=https://web.archive.org/web/20150924051012/http://www.infoplease.com/encyclopedia/science/circumcision.html |archive-date=24 September 2015 |url-status=live}}</ref><ref name="clark_2011">{{cite book |author=Clark M |url=https://books.google.com/books?id=zPXu561ZpvgC&pg=PA178 |title=Islam For Dummies |date=10 March 2011 |publisher=John Wiley & Sons |isbn=978-1-118-05396-6 |page=170 |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=zPXu561ZpvgC&pg=PA178 |archive-date=18 January 2016 |url-status=live}}</ref><ref name="alsabbagh_1996" /><ref name="encyc_religion_2005" /><ref name="riggs_2006" /> In contrast, some religions, such as [[Mandaeism]] and [[Hinduism]] and [[Sikhism]], strongly prohibit the practice of routine circumcision.<ref name="Drower" />{{sfn|Clarence-Smith|2008|pp=14–22}}<ref name="Cherry-2013" />

====Judaism====
{{Main|Brit milah}}Circumcision is near-universal among Jews.<ref name="Cohen-Almagor-2020">{{Cite journal |last=Cohen-Almagor |first=Raphael |date=9 November 2020 |title=Should liberal government regulate male circumcision performed in the name of Jewish tradition? |journal=SN Social Sciences |language=en |volume=1 |issue=1 |pages=8 |doi=10.1007/s43545-020-00011-7 |issn=2662-9283 |quote=Protagonists and critics of male circumcision agree on some things and disagree on many others... They also do not underestimate the importance of male circumcision for the relevant communities.... Even the most critical voices of male circumcision do not suggest putting a blanket ban on the practice as they understand that such a ban, very much like the 1920–1933 prohibition laws in the United States, would not be effective... Protagonists and critics of male circumcision debate whether the practice is morally acceptable... They assign different weights to harm as well as to medical risks and to non-medical benefits. The different weights to risks and benefits conform to their underlying views about the practices... Protagonists and critics disagree about the significance of medical reasons for circumcision... |s2cid=228911544|doi-access=free }}</ref> The ''[[mitzvah]]'' of circumcision on the eighth day of life is considered among the [[613 commandments|most important commandments in Judaism]]. 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 [[Jewish eschatology|world to come]].<ref name="Mark-2003a" /><ref name="Hamilton-1990" /><ref name="Antisemitism" />

[[File:Covenant of Abraham.JPG|thumb|Preparing for a Jewish ritual circumcision]]
The basis for its observance is found in the [[Torah]] of the Hebrew Bible, in [[Lech-Lecha|Genesis chapter 17]], in which a covenant of circumcision is made with Abraham and his descendants. Jewish circumcision is part of the {{transliteration|he|[[brit milah]]}} ritual, to be performed by a specialist ritual circumciser, a {{transliteration|he|[[mohel]]}}, on the eighth day of a newborn son's life, with certain exceptions for poor health. Jewish law requires that the circumcision leaves the glans bare when the penis is flaccid.  Converts to Conservative and Orthodox Judaism must also be circumcised; those who are already circumcised undergo a symbolic circumcision ritual. Circumcision is not required by Judaism for one to be considered Jewish, but mainstream Judaism foresees serious negative spiritual consequences if it is neglected.<ref name="glass_1999" /><ref name="Bolnick_2012_ch23" /> Circumcision is not considered a [[Moral universalism|universal moral law]] within Judaism. Rather, the commandment to circumcise is seen as only applying to Jewish people. Those who are Gentiles are believed to have a portion in the "World to Come" as long as they follow the tenets of the [[Seven Laws of Noah]].<ref>{{Cite journal |last=Oliver |first=Isaac W. |date=2013-05-14 |title=Forming Jewish Identity by Formulating Legislation for Gentiles |url=http://dx.doi.org/10.30965/21967954-00401005 |journal=Journal of Ancient Judaism |volume=4 |issue=1 |pages=105–132 |doi=10.30965/21967954-00401005 |issn=1869-3296 |access-date=22 December 2022 |archive-date=14 September 2023 |archive-url=https://web.archive.org/web/20230914230852/https://brill.com/view/journals/jaj/4/1/article-p105_5.xml |url-status=live }}</ref> There are also certain exceptions for Jews with poor health.<ref>{{Cite book |last1=Levine |first1=Amy-Jill |title=The Jewish Annotated New Testament |last2=Zvi Brettler |first2=Marc |publisher=[[Oxford University Press]] |year=2017 |pages=673 |quote=With rare exceptions (e.g. matters of health), Judaism requires circumcision for all male children on their eighth day of birth. |author-link=Amy-Jill Levine |author-link2=Marc Zvi Brettler}}</ref>

According to traditional Jewish law, in the absence of an adult free Jewish male expert, a woman, a slave, or a child who has the required skills is also authorized to perform the circumcision, provided that they are Jewish.<ref>Talmud Avodah Zarah 26b; Menachot 42a; Maimonides' Mishneh Torah, Milah, ii. 1; [[Shulkhan Arukh]], Yoreh De'ah, l.c.</ref> However, most streams of non-Orthodox Judaism allow female {{transliteration|he|mohels}}, called {{transliteration|he|mohalot}} ({{lang-he|מוֹהֲלוֹת}}, the plural of {{lang|he|מוֹהֶלֶת}} {{transliteration|he|mohelet}}, feminine of {{transliteration|he|mohel}}), without restriction. In 1984 Deborah Cohen became the first certified Reform {{transliteration|he|mohelet}}; she was certified by the Berit Mila program of Reform Judaism.<ref>{{Cite web|date=2013-10-07|title=Berit Mila Program of Reform Judaism|url=http://beritmila.org/|access-date=2022-07-20|archive-url=https://web.archive.org/web/20131007073323/http://beritmila.org/ |archive-date=7 October 2013 }}</ref> An increasing number of Jews in the United States have chosen not to circumcise their sons.<ref>{{cite news |url= https://www.reuters.com/article/domesticNews/idUSN22970720071003?pageNumber=1 |title= Jewish "intactivists" in U.S. stop circumcising |access-date= 3 November 2007 | vauthors = Chernikoff H |date= 3 October 2007 |newspaper= Reuters |url-status= live |archive-url= https://web.archive.org/web/20081227025338/http://www.reuters.com/article/domesticNews/idUSN22970720071003?pageNumber=1 |archive-date= 27 December 2008 }}</ref>

All major rabbinical organizations make the recommendation that male infants should be circumcised. The issue of converts remains controversial in Reform and Reconstructionist Judaism;<ref>{{cite web| url = http://www.reformjudaism.org/learning/torah-study/lech-lcha/brit-milah-jewish-answer-modernity| title = B'rit Milah: A Jewish Answer to Modernity| access-date = 11 March 2017| vauthors = Glickman M | date = 12 November 2005| publisher = [[Reform Judaism]]| url-status = live| archive-url = https://web.archive.org/web/20170312052827/http://www.reformjudaism.org/learning/torah-study/lech-lcha/brit-milah-jewish-answer-modernity| archive-date = 12 March 2017}}</ref><ref>{{cite web|url=http://www4.jrf.org/showdt&rid=322&pid=15 |title=Bo: Defining Boundaries |access-date=3 November 2007 | vauthors = Cohen H |date=20 May 2002 |publisher=Jewish Reconstructionist Federation |url-status=dead |archive-url=https://web.archive.org/web/20071009173021/http://www4.jrf.org/showdt%26rid%3D322%26pid%3D15 |archive-date=9 October 2007 }}</ref> circumcision of converts is not mandatory in either.<ref>{{cite web|url=http://www.jewishcalgary.org/page.html?ArticleID=63645 |title=The Conversion Process |access-date=3 November 2007 | vauthors = Epstein L |year=2007 |publisher=Calgary Jewish Community Council |url-status=dead |archive-url=https://web.archive.org/web/20081227065531/http://www.jewishcalgary.org/page.html?ArticleID=63645 |archive-date=27 December 2008 }}</ref>

====Islam====
{{Main|Khitan (circumcision)}}
[[Image:Jongetjes in prinsenkledij voor besnijdenisfeest.JPG|thumb|right | Children in Turkey wearing traditional circumcision costumes]]
[[File:ASC Leiden - W.E.A. van Beek Collection - Dogon markets 39 - Eleven boys in white clothing with bonnets at Tireli market, just after circumcision, Mali 1990.jpg|thumb|Boys in white clothing with bonnets at [[Tireli, Mali|Tireli]] market, just after circumcision, Mali, 1990]]
Despite its common practice in Muslim-majority nations, circumcision is considered to be ''[[sunnah]]'' (tradition) and not required for a life directed by Allah.<ref>{{cite encyclopedia |author1-last=Šakūrzāda |author1-first=Ebrāhīm |author2-last=Omidsalar |author2-first=Mahmoud |date=October 2011 |title=Circumcision |url=http://www.iranicaonline.org/articles/circumcision |url-status=live |volume=V/6 |pages=596–600 |encyclopedia=[[Encyclopædia Iranica]] |publisher=[[Columbia University]] |location=[[New York City|New York]] |doi=10.1163/2330-4804_EIRO_COM_7731 |doi-access=free |issn=2330-4804 |archive-url=https://web.archive.org/web/20200119024047/http://www.iranicaonline.org/articles/circumcision |archive-date=19 January 2020 |access-date=7 February 2020}}</ref> According to [[History of religion|historians of religion]] and scholars of [[Religious studies]], the Islamic tradition of circumcision was derived from the [[Religion in pre-Islamic Arabia|Pagan practices and rituals]] of [[pre-Islamic Arabia]].<ref>{{cite journal |author-last=Aldeeb Abu-Sahlieh |author-first=Sami A. |author-link=Sami Aldeeb |date=1994 |title=To Mutilate in the Name of Jehovah or Allah: Legitimization of Male and Female Circumcision |journal=Medicine and Law |volume=13 |issue=7–8 |pages=575–622 |publisher=[[World Association for Medical Law]] |pmid=7731348}}; {{cite journal |author-last=Aldeeb Abu-Sahlieh |author-first=Sami A. |date=1995 |url=https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1036&context=twls |title=Islamic Law and the Issue of Male and Female Circumcision |journal=Third World Legal Studies |volume=13 |pages=73–101 |publisher=[[Valparaiso University School of Law]] |access-date=13 February 2020 |archive-url=https://web.archive.org/web/20191112162823/https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1036&context=twls |archive-date=12 November 2019 |url-status=live }}</ref> Although there is some debate within Islam over whether it is a religious requirement or mere recommendation, circumcision (called ''khitan'') is practiced nearly universally by Muslim males. Islam bases its practice of circumcision on the Genesis 17 narrative, the same Biblical chapter referred to by Jews. The procedure is not explicitly mentioned in the Quran, however, it is a tradition established by Islam's prophet [[Muhammad]] directly (following Abraham), and so its practice is considered a ''[[sunnah]]'' (prophet's tradition) and is very important in Islam. For Muslims, circumcision is also a matter of cleanliness, purification and control over one's baser self (''[[nafs]]'').<ref name=clark_2011/><ref name=alsabbagh_1996/><ref name=Bolnick_2012_ch24/>

There is no agreement across the many Islamic communities about the age at which circumcision should be performed. It may be done from soon after birth up to about age 15; most often it is performed at around six to seven years of age. The timing can correspond with the boy's completion of his recitation of the whole Quran, with a coming-of-age event such as taking on the responsibility of daily prayer or betrothal. Circumcision may be celebrated with an associated family or community event. Circumcision is recommended for, but is not required of, converts to Islam.<ref name=clark_2011/><ref name=alsabbagh_1996/><ref name=Bolnick_2012_ch24/>

====Christianity====
{{Main|Religious male circumcision#In Christianity}}
Traditionally, circumcision has not been practiced by Christians for religious reasons, with the practice being viewed as succeeded by [[Baptism]], with the [[New Testament]] chapter [[Council of Jerusalem|Acts 15]] recording that Christianity did not require circumcision from new converts.<ref>{{Cite book |last=Mark |first=Elizabeth |title=The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite |publisher=[[Brandeis University Press]] |year=2003 |isbn=9781584653073 |pages=xxiii}}</ref> Christian denominations generally hold a neutral position on circumcision for prophylactic, cultural, and social reasons, while strongly opposing it for religious reasons. This includes the [[Catholic Church]], which explicitly banned the practice of religious circumcision in the [[Council of Florence]],<ref name = "CoF">{{cite book| author = Pope Eugenius IV| author-link = Pope Eugene IV| editor-first = Norman P.| editor-last = Tanner| title = Decrees of the ecumenical councils| orig-date = 1442| access-date = 25 April 2007| series = 2 volumes| year = 1990| publisher = [[Georgetown University Press]]| location = [[Washington, D.C.]]| isbn = 978-0-87840-490-2| language = el, la| chapter = Ecumenical Council of Florence (1438–1445): Session 11—4 February 1442; Bull of union with the Copts| chapter-url = http://www.ewtn.com/library/COUNCILS/FLORENCE.HTM#5| quote = it denounces all who after that time observe circumcision| lccn = 90003209| archive-date = 25 April 2009| archive-url = https://web.archive.org/web/20090425150516/http://www.ewtn.com/library/COUNCILS/FLORENCE.HTM#5| url-status = live}}</ref> and maintains a neutral position on the practice of circumcision for other reasons.<ref name=Slosar>{{cite journal | vauthors = Slosar JP, O'Brien D | title = The ethics of neonatal male circumcision: a Catholic perspective | journal = The American Journal of Bioethics | volume = 3 | issue = 2 | pages = 62–64 | year = 2003 | pmid = 12859824 | doi = 10.1162/152651603766436306 | s2cid = 38064474 }}</ref> A majority of other [[Christian denominations]] take a similar position on circumcision, prohibiting it for religious observance, but neither explicitly supporting or forbidding it for other reasons.<ref name=Slosar/> 
[[Image:Coptic Children wearing traditional circumcision costumes.jpg|thumb|right |[[Copts|Coptic]] Children wearing traditional circumcision costumes]] 
Thus, circumcision rates of Christians are predominately determined by the surrounding cultures in which they live in. In some [[Christianity in Africa|African]] and [[Eastern Christianity|Eastern Christian denominations]] circumcision is an established practice,<ref name="N. Stearns 2008 179">{{Cite book |last=N. Stearns |first=Peter |title=The Oxford Encyclopedia of the Modern World |publisher=[[Oxford University Press]] |year=2008 |isbn=9780195176322 |pages=179 |quote=Uniformly practiced by Jews, Muslims, and the members of Coptic, Ethiopian, and Eritrean Orthodox Churches, male circumcision remains prevalent in many regions of the world, particularly Africa, South and East Asia, Oceania, and Anglosphere countries.}}</ref><ref>{{cite book|title=Cultural Encyclopedia of the Body [2 volumes]|first=Victoria |last=Pitts-Taylor|year= 2008| isbn= 9781567206913| page =394|publisher=ABC-CLIO|quote=For most part, Christianity dose not require circumcision of its followers. Yet, some Orthodox and African Christian groups do require circumcision. These circumcisions take place at any point between birth and puberty.}}</ref> and generally men undergo circumcision shortly after birth as part of a [[rite of passage]].<ref name="N. Stearns 2008 179" /> Circumcision is near-universal among [[Coptic Orthodox Church of Alexandria|Coptic Christians]],<ref>{{cite book|title= American Evangelicals in Egypt: Missionary Encounters in an Age of Empire|first=Heather |last=J. Sharkey|year= 2015| isbn=9780691168104| page =30|publisher=Princeton University Press}}</ref> and they practice circumcision as a rite of passage.<ref name=WHO_2007_GTDPSA/><ref name=Columbia_encyc_2011_circ/><ref name=riggs_2006/><ref name=Bolnick_2012_ch26/> The [[Ethiopian Orthodox Tewahedo Church|Ethiopian Orthodox Church]] calls for circumcision, with near-universal prevalence among Orthodox men in Ethiopia.<ref name=WHO_2007_GTDPSA/> [[Eritrean Orthodox]] practice circumcision as a rite of passage, and they circumcise their sons "anywhere from the first week of life to the first few year".<ref>{{Cite book|last=DeMello|first=Margo|title=Encyclopedia of Body Adornment|publisher=[[ABC-Clio]]|year=2007|isbn=9780313336959|pages=66|quote=Coptic Christians, Ethiopian Orthodox, and Eritrean Orthodox churches on the other hand, do observe the ordainment, and circumcise their sons anywhere from the first week of life to the first few years.}}</ref> Some Christian churches in South Africa disapprove of the practice, while others require it of their members.<ref name=WHO_2007_GTDPSA/>

Circumcision is practiced in some predominantly [[Christianity by country|Christian countries]] and Christian communities.<ref name="Gruenbaum 2015 61">{{cite book |last=Gruenbaum |first=Ellen |title=The Female Circumcision Controversy: An Anthropological Perspective |publisher=University of Pennsylvania Press |year=2015 |isbn=9780812292510 |page=61 |quote=Christian theology generally interprets male circumcision to be an Old Testament rule that is no longer an obligation ... though in many countries (especially the United States and Sub-Saharan Africa, but not so much in Europe) it is widely practiced among Christians}}</ref><ref>{{cite book|title=Essential Case Studies in Public Health: Putting Public Health Into Practice|first=Katherine|last= Hunting|year= 2012| isbn=9781449648756| pages =23–24 |publisher=Jones & Bartlett Publishers|quote= Neonatal circumcision is the general practice among Jews, Christians, and many, but not all Muslims.}}</ref><ref name="R. Wylie 2015 101">{{cite book |last=R. Wylie |first=Kevan |title=ABC of Sexual Health |publisher=John Wiley & Sons |year=2015 |isbn=9781118665695 |page=101 |quote=Although it is mostly common and required in male newborns with Moslem or Jewish backgrounds, certain Christian-dominant countries such as the United States also practice it commonly.}}</ref> [[Christians|Christian communities]] in [[Africa]],<ref>{{cite book |last1=Creighton|first1=Sarah |last2= Liao |first2 =Lih-Mei|title=Female Genital Cosmetic Surgery: Solution to What Problem? |date=2019 |publisher=Cambridge University Press|isbn=9781108435529|page=63 |language=English |quote=Christians in Africa, for instance, often practise infant male circumcision.}}</ref><ref>{{cite web |first =Armelle |last =Nga |url =https://www.africanews.com/2019/12/30/the-ritual-of-circumcision-in-africa-the-case-of-south-africa/ |title =The Ritual of Circumcision in Africa: The Case of South Africa |date =30 December 2019 |publisher =Africanews |quote =This practice is old and widespread among African Christians with very close links to their beliefs. It can be executed traditionally or in hospital. |access-date =8 November 2022 |archive-date =6 December 2022 |archive-url =https://web.archive.org/web/20221206235611/http://www.africanews.com/2019/12/30/the-ritual-of-circumcision-in-africa-the-case-of-south-africa/ |url-status =live }}</ref> some [[Anglosphere|Anglosphere countries]], the Philippines, the Middle East,<ref>{{cite book |last1= Bakos|first1=Gergely Tibor|title=On Faith, Rationality, and the Other in the Late Middle Ages:: A Study of Nicholas of Cusa's Manuductive Approach to Islam |date=2011 |publisher=Wipf and Stock Publishers|isbn= 9781606083420|page=228 |language=English |quote=Although it is stated that circumcision is not a sacrament necessary for salvation, this rite is accepted for the Ethiopian Jacobites and other Middle Eastern Christians.}}</ref><ref>{{cite book |last1=J. Sharkey|first1=Heather |title=A History of Muslims, Christians, and Jews in the Middle East|date=2017 |publisher=Cambridge University Press|isbn=9780521769372|page=63 |language=English |quote= On the Coptic Christian practice of male circumcision in Egypt, and on its practice by other Christians in western Asia.}}</ref> South Korea and [[Oceania]] have high circumcision rates,<ref name="Associated Press">{{cite web |date=March 30, 2008 |title=Circumcision protest brought to Florence |url=https://apnews.com/article/19456997e17c4a12a24abb9d11c01dba |publisher=[[Associated Press]] |quote=However, the practice is still common among Christians in the United States, Oceania, South Korea, the Philippines, the Middle East and Africa. Some Middle Eastern Christians actually view the procedure as a rite of passage. |access-date=2 August 2022 |archive-date=26 March 2023 |archive-url=https://web.archive.org/web/20230326234939/https://apnews.com/article/19456997e17c4a12a24abb9d11c01dba |url-status=live }}</ref><ref>{{cite book|title=Religion and Violence: An Encyclopedia of Faith and Conflict from Antiquity to the Present|first=Jeffrey |last=Ian Ross|year= 2015| isbn=9781317461098| page =169|publisher=Routledge|quote=For instance, the majority of South Koreans, Americans, and Filipinos, as well as African Christians, practice circumcision.}}</ref> while Christian communities in [[Europe]] and [[South America]] have low circumcision rates, although none of these are performed out of perceived religious obligation.<ref name="N. Stearns 2008 179" /><ref name="R. Peteet 2017 97–101">{{cite book |last=R. Peteet |first=John |title=Spirituality and Religion Within the Culture of Medicine: From Evidence to Practice |publisher=Oxford University Press |year=2017 |isbn=9780190272432 |pages=97–101 |quote=male circumcision is still observed among Ethiopian and Coptic Christians, and circumcision rates are also high today in the Philippines and the US.}}</ref> Scholar Heather L. Armstrong writes that, {{as of|lc=y|2021|post=,}} about half of Christian males worldwide are circumcised, with most of them being located in Africa, Anglosphere countries, and the Philippines.<ref name="Armstrong">{{cite book |last=L. Armstrong |first=Heather |title=Encyclopedia of Sex and Sexuality: Understanding Biology, Psychology, and Culture [2 volumes] |publisher=ABC-CLIO |year=2021 |isbn=9781610698757 |pages=115–117}}</ref>

====Druze faith====
[[Image:Preparing for a ritual circumcision to a Druze child.jpg|thumb|right |Preparing for a ritual circumcision to a [[Druze]] child]]
Circumcision is widely practiced by the [[Druze]];<ref name="Ubayd-2006a">{{cite book|title=The Druze and Their Faith in Tawhid| first=Anis|last=Ubayd|year= 2006| isbn=9780815630975| page =150|publisher=Syracuse University Press|quote=Male circumcision is standard practice, by tradition, among the Druze}}</ref> Druze practice Druzism, an [[Abrahamic religions|Abrahamic]],<ref name="BritishLibrary">{{cite web |last=Abulafia |first=Anna Sapir |author-link=Anna Abulafia |date=23 September 2019 |url=https://www.bl.uk/sacred-texts/articles/the-abrahamic-religions |title=The Abrahamic religions |website=www.bl.uk |publisher=[[British Library]] |location=[[London]] |access-date=9 March 2021 |url-status=live |archive-url=https://web.archive.org/web/20200712150432/https://www.bl.uk/sacred-texts/articles/the-abrahamic-religions |archive-date=12 July 2020}}</ref><ref name="TheDruze">{{cite book|last=Obeid|first=Anis|title=The Druze & Their Faith in Tawhid|url=https://books.google.com/books?id=FejqBQAAQBAJ&pg=PT1|year=2006|publisher=Syracuse University Press|isbn=978-0-8156-5257-1|page=1}}</ref> [[monotheistic]], [[Syncretic religion|syncretic]], and [[ethnic religion]]. The procedure is practiced as a cultural tradition, and has no religious significance in the Druze faith.<ref>{{cite book|title=Israel and the Palestinian Territories: The Rough Guide| first=Daniel|last=Jacobs|year= 1998| isbn=9781858282480| page =147|publisher=Rough Guides|quote=Circumcision is not compulsory and has no religious significance.}}</ref><ref>{{cite book|title=The History of Galilee, 1538–1949: Mysticism, Modernization, and War| first=M. |last=M. Silver|year= 2022| isbn= 9781793649430| page =97|publisher=Rowman & Littlefield|quote=Muslim men are circumcised, whereas this is not a religious obligation among the Druze}}</ref> There is no special date for this act in the [[Druze faith]]: male Druze infants are usually circumcised shortly after birth,{{sfn|Dana|2003|p=56}} however some remain uncircumcised until the age of ten or older.{{sfn|Dana|2003|p=56}}

Some Druses do not circumcise their male children and refuse to observe this "common Muslim practice".<ref>{{cite book|title=The Sunni-Shi'a Divide: Islam's Internal Divisions and Their Global Consequences| first=Robert|last=Brenton Betts|year= 2013| isbn=9781612345239| page =56|publisher=Potomac Books, Inc.|quote=There are many references to the Druze refusal to observe this common Muslim practice, one of the earliest being the rediscoverer of the ruins of Petra, John Burckhardt. "The Druses do not circumcise their children}}</ref>

====Samaritanism====

Like Judaism, the religion of [[Samaritanism]] requires ritual circumcision on the eighth day of life.<ref name="Mark-2003">{{Cite book |last=Mark |first=Elizabeth |title=The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite |publisher=[[University Press of New England]] |year=2003 |isbn=9781584653073 |pages=94–95}}</ref>

====Mandaeism====
Circumcision is forbidden in [[Mandaeism]],<ref name="Drower">{{cite book|last=Drower|first=Ethel Stefana|title=The Mandaeans of Iraq and Iran|publisher=Oxford At The Clarendon Press|year=1937}}</ref><ref>{{cite book|last1=Lupieri|first1=Edmundo|title=The Mandaeans: The Last Gnostics|date=2001|publisher=Wm. B. Eerdmans Publishing|isbn=9780802833501|url=https://books.google.com/books?id=zJ73YfrZ2T4C&q=Nicolas%20Siouffi%20christian&pg=PA12|page=60|access-date=6 August 2022|archive-date=14 September 2023|archive-url=https://web.archive.org/web/20230914230849/https://books.google.com/books?id=zJ73YfrZ2T4C&q=Nicolas%20Siouffi%20christian&pg=PA12|url-status=live}}</ref> and the sign of the Jews given to [[Abraham]] by God, circumcision, is considered abhorrent by the [[Mandaeans]].<ref>{{cite book|title=Beyond ISIS: History and Future of Religious Minorities in Iraq| first=Thomas |last=Schmidinger|year= 2019| isbn=9781912997152| page =82|publisher=Transnational Press London|quote=}}</ref> According to the Mandaean doctrine a circumcised man cannot serve as a [[Mandaean priest]].<ref>{{cite book|title=Guardians of the Gate: Angelic Vice-regency in the Late Antiquity| first=Nathaniel|last= Deutsch|year= 1999| isbn=9789004109094| page =105|publisher=BRILL|quote=}}</ref>

====Yazidism====
Circumcision is not required in [[Yazidism]], but is practised by some [[Yazidis]] due to regional customs.<ref>{{cite web |last1=Parry |first1=O. H. (Oswald Hutton) |title=Six months in a Syrian monastery; being the record of a visit to the head quarters of the Syrian church in Mesopotamia, with some account of the Yazidis or devil worshippers of Mosul and El Jilwah, their sacred book |url=https://archive.org/stream/sixmonthsinasyr00parrgoog/sixmonthsinasyr00parrgoog_djvu.txt |publisher=London : H. Cox |date=1895}}</ref> The ritual is usually performed soon after birth, it takes place on the knees of the kerîf (approximately "godfather"), with whom the child will have a life-long formal relationship.<ref>{{Cite book|last=Kreyenbroek|first=Philip G.|title=Yezidism in Europe: Different Generations Speak about Their Religion|date=2009|publisher=Otto Harrassowitz Verlag|isbn=978-3-447-06060-8|language=en}}</ref>

====Sikhism====
[[Sikhism]] does not require the elective circumcision of its followers and strongly criticizes the practice.<ref name="Cherry-2013">{{Cite book|last=Cherry|first=Mark|title=Religious Perspectives on Bioethics|publisher=[[Taylor & Francis]]|year=2013|isbn=978-9026519673|pages=213}}</ref><ref>{{cite book |first1=William Owen |last1=Cole |first2=Piara Singh |last2=Sambhi |date=1995 |title=The Sikhs: Their Religious Beliefs and Practices |publisher=Sussex Academic Press |isbn=978-1-898723-13-4 |pages=155–156}}</ref>

For example, [[Kabir|Bhagat Kabir]] criticizes the practise of circumcision in the hymn of [[Guru Granth Sahib]].

====African cultures====
{{excerpt|Circumcision in Africa|paragraphs=1}}

====Australian cultures====
Some [[Australian Aboriginal|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.  It may be accompanied by body [[scarification]] and the removal of teeth, and may be followed later by [[penile subincision]].  Circumcision is one of many trials and ceremonies required before a youth is considered to have become knowledgeable enough to maintain and pass on the cultural traditions.  During these trials, the maturing youth bonds in solidarity with the men.  Circumcision is also strongly associated with a man's family, and it is part of the process required to prepare a man to take a wife and produce his own family.<ref name=encyc_religion_2005/>

====Filipino culture====
{{Main|Tuli (rite)}}

In the Philippines, circumcision is known as "tuli" and is generally viewed as a rite of passage.<ref name=Tuli2011/> An overwhelming majority of Filipino men are circumcised.<ref name="Tuli2011">{{cite web|title=Tuli a rite of passage for Filipino boys|url=http://www.gmanetwork.com/news/story/219779/news/nation/tuli-a-rite-of-passage-for-filipino-boys|access-date=6 December 2015|date=6 May 2011|url-status=live|archive-url=https://web.archive.org/web/20151208183045/http://www.gmanetwork.com/news/story/219779/news/nation/tuli-a-rite-of-passage-for-filipino-boys|archive-date=8 December 2015}}</ref>{{efn| The most commonly-done procedure is in actuality not a ''circumcision'' but a [[dorsal slit]], where no foreskin is actually removed. When the foreskin is removed, it is commonly known locally as a "German cut" in reference to the introduction of the modern surgical technique by the founder of plastic and reconstructive surgery, [[Johann Friedrich Dieffenbach]].<ref>[https://books.google.com/books?id=hpNlnylhRKsC&pg=PA435 ''Zirkumzision nach Dieffenbach.''] {{Webarchive|url=https://web.archive.org/web/20220902032825/https://books.google.com/books?id=hpNlnylhRKsC&pg=PA435 |date=2022-09-02 }} (vgl. Schumpelick u.&nbsp;a., S. 434 ff.)</ref>}} Often this occurs, in April and May, when Filipino boys are taken by their parents. The practice dates back to the arrival of [[Islam]] in 1450. Pressure to be circumcised is even in the language: one [[Tagalog profanity]] for 'uncircumcised' is ''supot'', meaning 'coward' literally. A circumcised eight or ten year-old is no longer considered a boy and is given more adult roles in the family and society.<ref>{{cite news |title='Circumcision season': Philippine rite puts boys under pressure |url=https://www.channelnewsasia.com/news/asia/-circumcision-season---philippine-rite-puts-boys-under-pressure--11640442 |access-date=20 June 2019 |work=Channel News Asia |agency=Agence France-Presse |date=19 June 2019 |archive-date=20 June 2019 |archive-url=https://web.archive.org/web/20190620140705/https://www.channelnewsasia.com/news/asia/-circumcision-season---philippine-rite-puts-boys-under-pressure--11640442 |url-status=dead }}</ref>

===Ethical and legal issues===
{{Main|Ethics of circumcision}}
{{See also|Circumcision controversies|Circumcision and law}}

==== Ethics ====
{{excerpt|Ethics of circumcision|paragraphs=2}}

==== Legal ====
Worldwide, the large majority of polities do not have specific laws concerning the circumcision of males,<ref name=WHO_2007_GTDPSA/> with religious infant circumcision being legal in every country.<ref name="Cohen-Almagor-2020" /><ref name=RACP_2010/> A few countries have passed legislation on the procedure: Germany allows routine circumcision,<ref name=DW_2012/> while non-religious routine circumcision is illegal in South Africa and Sweden.<ref name=WHO_2007_GTDPSA/><ref name=RACP_2010/> No major medical organization recommends circumcising all males, and no major medical organization recommends banning the procedure.<ref name="Bolnick_2012_ch1" /><ref name="Basaran-2023">{{Cite book |last=Basaran |first=Oyman |title=Circumcision and Medicine in Modern Turkey |publisher=[[University of Texas Press]] |year=2023 |isbn=9781477327029 |pages=156–157 |quote=Regardless of their ethical stances, scholars of both camps tend to agree that a blanket criminalization of male circumcision would be unhelpful and harmful to boys...}}</ref><ref name="Cohen-Almagor-2020" />

In the academic literature, there is general agreement among both supporters and opponents of the practice that an outright ban would be predominately ineffective and "harmful".<ref name="Bolnick_2012_ch1" /><ref name="Cohen-Almagor-2020" /><ref name="knmg.nl">{{cite web |title=Non-therapeutic circumcision of male minors – KNMG Viewpoint |url=https://www.knmg.nl/advies-richtlijnen/knmg-publicaties/publications-in-english.htm |access-date=7 March 2018 |archive-date=8 March 2018 |archive-url=https://web.archive.org/web/20180308231353/https://www.knmg.nl/advies-richtlijnen/knmg-publicaties/publications-in-english.htm |url-status=live }}</ref><ref name="Basaran-2023" /> A consensus to keep the procedure within the purview of medical professionals is found across all major medical organizations, who advise medical professionals to yield to some degree to parental preferences in their decision to agree to circumcise.<ref name="Bolnick_2012_ch1" /><ref name="Cohen-Almagor-2020" /> The Royal Dutch Medical Association, which expresses some of the strongest opposition to routine neonatal circumcision, argues that while there are valid reasons for banning it, doing so could lead parents who insist on the procedure to turn to poorly trained practitioners instead of medical professionals.<ref name="Bolnick_2012_ch1" /><ref name=RACP_2010/>

During the 2010s, several [[Right-wing populism|right-wing nationalist]] parties prominently called for the banning of circumcision.<ref>{{Cite book |last1=Bruns |first1=Alexander |title=Legal Theory and Interpretation in a Dynamic Society |last2=Bu |first2=Yuanshi |last3=Merkt |first3=Hanno |publisher=Nomos Verlagsgesellschaft |year=2021 |isbn=9783748925842 |pages=352}}</ref> Gressgård argued that politicians that supported Norway's proposed circumcision ban debated circumcision in a manner which constituted "[[ethnocentrism]]".<ref>{{Cite book |last=Gressgård |first=Randi |title=Multicultural Dialogue: Dilemmas, Paradoxes, Conflicts |publisher=[[Berghahn Books]] |year=2012 |isbn=9780857456489 |pages=7, 94}}</ref>

===Economic considerations===
The cost-effectiveness of circumcision has been studied to determine whether a policy of circumcising all newborns or a policy of promoting and providing inexpensive or free access to circumcision for all adult men who choose it would result in lower overall societal healthcare costs. As [[HIV/AIDS]] is an incurable disease that is expensive to manage, significant effort has been spent studying the cost-effectiveness of circumcision to reduce its spread in parts of Africa that have a relatively high infection rate and low circumcision prevalence.<ref name=doyle_2010/> Several analyses have concluded that circumcision programs for adult men in Africa are cost-effective and in some cases are cost-saving.<ref name=uthman_2010/><ref>{{cite journal | vauthors = Grimes CE, Henry JA, Maraka J, Mkandawire NC, Cotton M | title = Cost-effectiveness of surgery in low- and middle-income countries: a systematic review | journal = World Journal of Surgery | volume = 38 | issue = 1 | pages = 252–263 | date = January 2014 | pmid = 24101020 | doi = 10.1007/s00268-013-2243-y | s2cid = 2166354 }}</ref> In Rwanda, circumcision has been found to be cost-effective across a wide range of age groups from newborn to adult,<ref name=albero_2012/><ref name=binagwaho_2010/> with the greatest savings achieved when the procedure is performed in the newborn period due to the lower cost per procedure and greater timeframe for HIV infection protection.<ref name="kim_2010">{{cite journal |vauthors=Kim HH, Li PS, Goldstein M |date=November 2010 |title=Male circumcision: Africa and beyond? |journal=Current Opinion in Urology |volume=20 |issue=6 |pages=515–519 |doi=10.1097/MOU.0b013e32833f1b21 |pmid=20844437 |s2cid=2158164}}</ref><ref name=binagwaho_2010/> 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.<ref name=doyle_2010/> Hankins ''et al.'' (2011) estimated that a $1.5 billion investment in circumcision for adults in 13 high-priority African countries would yield $16.5 billion in savings.<ref name=hankins_2011/>

The overall cost-effectiveness of neonatal circumcision has also been studied in the United States, which has a different cost setting from Africa in areas such as public health infrastructure, availability of medications, and medical technology and the willingness to use it.<ref name=xu_2009/> A study by the CDC suggests that newborn circumcision would be societally cost-effective in the United States based on circumcision's efficacy against the transmission of HIV alone during [[coitus]], without considering any other cost benefits.<ref name=AAP_2012/><!-- Quote = "The CDC study suggests that newborn circumcision performed in the United States to prevent HIV infection is cost-effective without consideration of other health benefits." --> The American Academy of Pediatrics (2012) recommends that neonatal circumcision in the United States be covered by third-party payers such as [[Medicaid]] and insurance.<ref name=AAP_2012/> A 2014 review that considered reported benefits of circumcision such as reduced risks from HIV, HPV, and HSV-2 stated that circumcision is cost-effective in both the United States and Africa and may result in health care savings.<ref>{{cite journal | vauthors = Tobian AA, Kacker S, Quinn TC | title = Male circumcision: a globally relevant but under-utilized method for the prevention of HIV and other sexually transmitted infections | journal = Annual Review of Medicine | volume = 65 | pages = 293–306 | date = 2014 | pmid = 24111891 | pmc = 4539243 | doi = 10.1146/annurev-med-092412-090539 }}</ref> A 2014 literature review found that there are significant gaps in the current literature on male and female sexual health that need to be addressed for the literature to be applicable to North American populations.<ref name = bossio_2014/>

== References ==
{{Reflist|refs=
<!-- A -->
<ref name=AAFP_2013>{{cite web |title=Neonatal Circumcision |access-date=3 August 2015 |year=2013 |publisher=American Academy of Family Physicians |url=http://www.aafp.org/about/policies/all/neonatal-circumcision.html |url-status=live |archive-url=https://web.archive.org/web/20150721022442/http://www.aafp.org/about/policies/all/neonatal-circumcision.html |archive-date=21 July 2015 }}</ref>

<ref name=albero_2012>{{cite journal | vauthors = Albero G, Castellsagué X, Giuliano AR, Bosch FX | title = Male circumcision and genital human papillomavirus: a systematic review and meta-analysis | journal = Sexually Transmitted Diseases | volume = 39 | issue = 2 | pages = 104–113 | date = February 2012 | pmid = 22249298 | doi = 10.1097/OLQ.0b013e3182387abd | s2cid = 26859788 | doi-access = free }}</ref>

<ref name=alsabbagh_1996>{{cite book |author=al-Sabbagh, Muhammad Lutfi |title=Islamic ruling on male and female circumcision |page=[https://archive.org/details/islamicrulingonm0000alsa/page/16 16] |year=1996 |publisher=World Health Organization |isbn=978-92-9021-216-4 |url=https://archive.org/details/islamicrulingonm0000alsa/page/16 }}</ref>

<ref name=aridogan_2011>{{cite journal | vauthors = Aridogan IA, Izol V, Ilkit M | title = Superficial fungal infections of the male genitalia: a review | journal = Critical Reviews in Microbiology | volume = 37 | issue = 3 | pages = 237–244 | date = August 2011 | pmid = 21668404 | doi = 10.3109/1040841X.2011.572862 | s2cid = 31957918 }}</ref>

<ref name=AUA_2007>{{cite web|url=http://www.auanet.org/about/policy-statements/circumcision.cfm|title=Circumcision|access-date=2 November 2008|author=American Urological Association|url-status=dead|archive-url=https://web.archive.org/web/20130825011022/http://www.auanet.org/about/policy-statements/circumcision.cfm|archive-date=25 August 2013}}</ref>

<ref name=AVAC_2015>{{cite web|title=Clearinghouse on Male Circumcision for HIV Prevention Redesigned|url=http://www.avac.org/blog/clearinghouse-male-circumcision-hiv-prevention-redesigned|website=AVAC|date=May 2015|access-date=11 March 2017|url-status=live|archive-url=https://web.archive.org/web/20170312065747/http://www.avac.org/blog/clearinghouse-male-circumcision-hiv-prevention-redesigned|archive-date=12 March 2017}}</ref>

<!-- B -->
<ref name=becker_2011>{{cite journal | vauthors = Becker K | title = Lichen sclerosus in boys | journal = Deutsches Ärzteblatt International | volume = 108 | issue = 4 | pages = 53–58 | date = January 2011 | pmid = 21307992 | pmc = 3036008 | doi = 10.3238/arztebl.2011.0053 }}</ref>

<ref name=binagwaho_2010>{{cite journal | vauthors = Binagwaho A, Pegurri E, Muita J, Bertozzi S | title = Male circumcision at different ages in Rwanda: a cost-effectiveness study | journal = PLOS Medicine | volume = 7 | issue = 1 | pages = e1000211 | date = January 2010 | pmid = 20098721 | pmc = 2808207 | doi = 10.1371/journal.pmed.1000211 | veditors = Kalichman SC | doi-access = free }}</ref>

<ref name=Bolnick_2012_ch23>{{cite book | vauthors = Bolnick DA, Katz KE |year= 2012 |chapter= Jewish Ritual Circumcision| veditors = Bolnick DA, Koyle M, Yosha A |title=Surgical Guide to Circumcision |location= London |publisher=Springer |pages=265–274 |doi=10.1007/978-1-4471-2858-8_23 |isbn=978-1-4471-2857-1 }}</ref>

<ref name=Bolnick_2012_ch24>{{cite book | vauthors = El-Sheemy MS, Ziada AM |year= 2012 |chapter= Islam and Circumcision| veditors = Bolnick DA, Koyle M, Yosha A |title=Surgical Guide to Circumcision |location= London |publisher=Springer |pages=275–280 |doi=10.1007/978-1-4471-2858-8_24 |isbn=978-1-4471-2857-1 }}</ref>

<ref name=Bolnick_2012_ch26>{{cite book | vauthors = Adams G, Adams K |year= 2012 |chapter= Circumcision in the Early Christian Church: The Controversy That Shaped a Continent| veditors = Bolnick DA, Koyle M, Yosha A |title=Surgical Guide to Circumcision |location= London |publisher=Springer |pages=291–298 |doi=10.1007/978-1-4471-2858-8_26 |isbn=978-1-4471-2857-1 }}</ref>

<ref name=bossio_2014>{{cite journal | vauthors = Bossio JA, Pukall CF, Steele S | title = A review of the current state of the male circumcision literature | journal = The Journal of Sexual Medicine | volume = 11 | issue = 12 | pages = 2847–2864 | date = December 2014 | pmid = 25284631 | doi = 10.1111/jsm.12703 }}</ref>

<!-- C -->

<ref name=CDC_HPV>{{cite web |url=https://www.cdc.gov/std/HPV/STDFact-HPV.htm |title=STD facts&nbsp;– Human papillomavirus (HPV) |publisher=CDC |access-date=12 September 2012 |url-status=live |archive-url=https://web.archive.org/web/20120911095019/http://www.cdc.gov/STD/HPV/STDFact-HPV.htm |archive-date=11 September 2012 }}</ref>

<ref name=CPSBC_2009>{{cite report |title=Professional Standards and Guidelines – Circumcision (Infant Male) |work=College of Physicians and Surgeons of British Columbia |date=September 2009 }}</ref>

<!-- D -->
<ref name=darby_2003>{{cite journal| vauthors = Darby R |title=The Masturbation Taboo and the Rise of Routine Male Circumcision: A Review of the Historiography|journal=Journal of Social History|date=Spring 2003|volume=36|issue=3|pages=737–757|doi=10.1353/jsh.2003.0047|s2cid=72536074}}</ref>

<ref name=darby_2005>{{cite book| vauthors = Darby R |title=A surgical temptation: the demonization of the foreskin and the rise of circumcision in Britain|publisher=University of Chicago Press|location=Chicago|year=2005|isbn=978-0-226-13645-5|pages=262–}}</ref>

<ref name=doyle_2010>{{cite journal | vauthors = Doyle SM, Kahn JG, Hosang N, Carroll PR | title = The impact of male circumcision on HIV transmission | journal = The Journal of Urology | volume = 183 | issue = 1 | pages = 21–26 | date = January 2010 | pmid = 19913816 | doi = 10.1016/j.juro.2009.09.030 }}</ref>

<ref name=DW_2012>{{cite news | url=http://www.dw.de/circumcision-remains-legal-in-germany/a-16399336 | title=Circumcision remains legal in Germany | work=Deutsche Welle | date=12 December 2012 | access-date=11 September 2013 | url-status=live | archive-url=https://web.archive.org/web/20131026154156/http://www.dw.de/circumcision-remains-legal-in-germany/a-16399336 | archive-date=26 October 2013 }}</ref>

<!-- E -->
<ref name=encyc_religion_2005>{{cite encyclopedia |year=2005 |title=Circumcision |encyclopedia=Encyclopedia of Religion |edition=2 |publisher=Gale}}</ref>

<ref name=encyc_judaica_2006>{{cite encyclopedia |year=2006 |title=Circumcision |encyclopedia=Encyclopaedia Judaica |edition=2 |publisher=Macmillan Reference |location=USA |isbn=978-0-02-865928-2}}</ref>

<!-- F -->

<!-- G -->

<ref name=gollaher_2001_ch1>Gollaher (2001), ch. 1, ''The Jewish Tradition'', pp. 1–30</ref>

<ref name=gollaher_2001_ch2>Gollaher (2001), ch. 2, ''Christians and Muslims'', pp. 31–52</ref>

<ref name=gollaher_2001_ch3>Gollaher (2001), ch. 3, ''Symbolic Wounds'', pp. 53–72</ref>

<ref name=gollaher_2001_ch4>Gollaher (2001), ch. 4, ''From Ritual to Science'', pp. 73–108</ref>

<!-- H -->
<ref name=hankins_2011>{{cite journal | vauthors = Hankins C, Forsythe S, Njeuhmeli E | title = Voluntary medical male circumcision: an introduction to the cost, impact, and challenges of accelerated scaling up | journal = PLOS Medicine | volume = 8 | issue = 11 | pages = e1001127 | date = November 2011 | pmid = 22140362 | pmc = 3226452 | doi = 10.1371/journal.pmed.1001127 | veditors = Sansom SL | doi-access = free }}</ref>

<ref name=hpv_prevalence_ref_bundle>See:  Larke ''et al.'' "Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis" (2011), Albero ''et al.'' "Male Circumcision and Genital Human Papillomavirus: A Systematic Review and Meta-Analysis" (2012), Rehmeyer "Male Circumcision and Human Papillomavirus Studies Reviewed by Infection Stage and Virus Type" (2011).</ref>

<!-- I -->
<!-- J -->
<ref name=jagannath_2012>{{cite journal | vauthors = Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S | title = Routine neonatal circumcision for the prevention of urinary tract infections in infancy | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 5 | pages = CD009129 | date = November 2012 | pmid = 23152269 | doi = 10.1002/14651858.CD009129.pub2 | veditors = Fedorowicz Z }}</ref>

<!-- K -->
<!-- L -->

<ref name=larke_penile_cancer_2011>{{cite journal | vauthors = Larke NL, Thomas SL, dos Santos Silva I, Weiss HA | title = Male circumcision and penile cancer: a systematic review and meta-analysis | journal = Cancer Causes & Control | volume = 22 | issue = 8 | pages = 1097–1110 | date = August 2011 | pmid = 21695385 | pmc = 3139859 | doi = 10.1007/s10552-011-9785-9 }}</ref>

<ref name=leber_2006>{{cite web |url=http://www.emedicine.com/derm/topic615.htm |title=Balanitis |access-date=14 October 2008 |vauthors=Leber M, Tirumani A |date=8 June 2006 |publisher=EMedicine |url-status=live |archive-url=https://web.archive.org/web/20081007002704/http://www.emedicine.com/DERM/topic615.htm |archive-date=7 October 2008 }}</ref>

<ref name=lonngvist_2010>{{cite journal | vauthors = Lönnqvist PA | title = Regional anaesthesia and analgesia in the neonate | journal = Best Practice & Research. Clinical Anaesthesiology | volume = 24 | issue = 3 | pages = 309–321 | date = September 2010 | pmid = 21033009 | doi = 10.1016/j.bpa.2010.02.012 }}</ref>

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<ref name = "Marrazzo et al. 2014">{{cite journal | vauthors = Marrazzo JM, del Rio C, Holtgrave DR, Cohen MS, Kalichman SC, Mayer KH, Montaner JS, Wheeler DP, Grant RM, Grinsztejn B, Kumarasamy N, Shoptaw S, Walensky RP, Dabis F, Sugarman J, Benson CA | display-authors = 6 | title = HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel | journal = JAMA | volume = 312 | issue = 4 | pages = 390–409 | date = 23–30 Jul 2014 | pmid = 25038358 | pmc = 6309682 | doi = 10.1001/jama.2014.7999 }}</ref>

<ref name=matthew_2004>{{cite book| vauthors = Matthew HC |title=Oxford dictionary of national biography: in association with the British Academy: from the earliest times to the year 2000|url=https://archive.org/details/isbn_0198613644|url-access=registration|publisher=Oxford University Press|location=Oxford New York|year=2004|isbn=978-0-19-861411-1}}</ref>

<!-- N -->
<ref name=NYTimes_2009>{{cite news |title=AIDS: New Web Site Seeks to Fight Myths About Circumcision and H.I.V. | vauthors = McNeil Jr DG |author-link=Donald McNeil, Jr. |url=https://www.nytimes.com/2009/03/03/health/03glob.html |newspaper=The New York Times |date=3 March 2009 |page=D6 |access-date=1 February 2012 |url-status=live |archive-url=https://web.archive.org/web/20140108150300/http://www.nytimes.com/2009/03/03/health/03glob.html |archive-date=8 January 2014 }}</ref>

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<ref name=osipov_2006>{{cite web |url=http://www.emedicine.com/derm/topic615.htm |title=Balanoposthitis |access-date=20 November 2006 |vauthors=Osipov V, Acker S |date=November 2006 |website=Reactive and Inflammatory Dermatoses |publisher=EMedicine |url-status=live |archive-url=https://web.archive.org/web/20061211115857/http://emedicine.com/DERM/topic615.htm |archive-date=11 December 2006 }}</ref>

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<ref name=perera_2010>{{cite journal | vauthors = Perera CL, Bridgewater FH, Thavaneswaran P, Maddern GJ | title = Safety and efficacy of nontherapeutic male circumcision: a systematic review | journal = Annals of Family Medicine | volume = 8 | issue = 1 | pages = 64–72 | year = 2010 | pmid = 20065281 | pmc = 2807391 | doi = 10.1370/afm.1073 }}</ref>

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<ref name=RACP_2010>{{cite web | url=https://www.racp.edu.au/docs/default-source/advocacy-library/circumcision-of-infant-males.pdf | title=Circumcision of Infant Males | publisher=The Royal Australasian College of Physicians | date=Sep 2010 | access-date=11 September 2013 | url-status=live | archive-url=https://web.archive.org/web/20150812092333/http://www.racp.edu.au/docs/default-source/advocacy-library/circumcision-of-infant-males.pdf | archive-date=12 August 2015 }}</ref>

<ref name=riggs_2006>{{cite book |first=Thomas |last=Riggs |title=Worldmark Encyclopedia of Religious Practices: Religions and denominations |chapter=Christianity: Coptic Christianity |year=2006 |publisher=Thomson Gale |isbn=978-0-7876-6612-5 |chapter-url=https://books.google.com/books?id=uTMOAQAAMAAJ |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=uTMOAQAAMAAJ |archive-date=18 January 2016 }}</ref>

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<ref name=shockley_2011>{{cite journal | vauthors = Shockley RA, Rickett K | title = Clinical inquiries. What's the best way to control circumcision pain in newborns? | journal = The Journal of Family Practice | volume = 60 | issue = 4 | pages = 233a–233b | date = April 2011 | pmid = 21472156 }}</ref>

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<!--<ref name=templeton_2010>{{cite journal | vauthors = Templeton DJ, Millett GA, Grulich AE | title = Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men | journal = Current Opinion in Infectious Diseases | volume = 23 | issue = 1 | pages = 45–52 | date = February 2010 | pmid = 19935420 | doi = 10.1097/QCO.0b013e328334e54d | s2cid = 43878584 }}</ref>-->

<!-- U -->
<ref name=uthman_2010>{{cite journal | vauthors = Uthman OA, Popoola TA, Uthman MM, Aremu O | title = Economic evaluations of adult male circumcision for prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa: a systematic review | journal = PLOS ONE | volume = 5 | issue = 3 | pages = e9628 | date = March 2010 | pmid = 20224784 | pmc = 2835757 | doi = 10.1371/journal.pone.0009628 | veditors = Van Baal PH | doi-access = free | bibcode = 2010PLoSO...5.9628U }}</ref>

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<!--<ref name=weiss_2006_syphilis>{{cite journal | vauthors = Weiss HA, Thomas SL, Munabi SK, Hayes RJ | title = Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis | journal = Sexually Transmitted Infections | volume = 82 | issue = 2 | pages = 101–9; discussion 110 | date = April 2006 | pmid = 16581731 | pmc = 2653870 | doi = 10.1136/sti.2005.017442 }}</ref>-->

<!--<ref name=wetmore_2010>{{cite journal | vauthors = Wetmore CM, Manhart LE, Wasserheit JN | title = Randomized controlled trials of interventions to prevent sexually transmitted infections: learning from the past to plan for the future | journal = Epidemiologic Reviews | volume = 32 | issue = 1 | pages = 121–136 | date = April 2010 | pmid = 20519264 | pmc = 2912604 | doi = 10.1093/epirev/mxq010 }}</ref>-->

<ref name=WHO_adult_devices_2012>{{cite web |year=2012 |title=Use of devices for adult male circumcision in public health HIV prevention programmes: Conclusions of the Technical Advisory Group on Innovations in Male Circumcision |website=World Health Organization |url=http://whqlibdoc.who.int/hq/2012/WHO_HIV_2012.7_eng.pdf |url-status=live |archive-url=https://web.archive.org/web/20130312062922/http://whqlibdoc.who.int/hq/2012/WHO_HIV_2012.7_eng.pdf |archive-date=12 March 2013 }}</ref>

<ref name=wolter_2008>{{cite book |vauthors=Wolter C, Dmochowski R |title=Handbook of Office Urological Procedures |chapter=Circumcision |pages=88– |year=2008 |publisher=Springer |isbn=978-1-84628-523-3 |chapter-url=https://books.google.com/books?id=-ek1wPWaUKkC&pg=PA88 |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=-ek1wPWaUKkC&pg=PA88 |archive-date=18 January 2016 }}</ref>

<!-- X -->
<ref name=xu_2009>{{cite journal | vauthors = Xu X, Patel DA, Dalton VK, Pearlman MD, Johnson TR | title = Can routine neonatal circumcision help prevent human immunodeficiency virus transmission in the United States? | journal = American Journal of Men's Health | volume = 3 | issue = 1 | pages = 79–84 | date = March 2009 | pmid = 19430583 | pmc = 2678848 | doi = 10.1177/1557988308323616 }}</ref>

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}}

==Notes==
{{notelist}}
<!-- dummy edit; can be deleted. -->

== General and cited references ==
{{Refbegin}}
* {{cite book |vauthors=Bolnick DA, Koyle M, Yosha A |title=Surgical Guide to Circumcision |date=September 2012 |publisher=Springer |isbn=978-1-4471-2857-1 |url=https://books.google.com/books?id=w7zyKB9mdMwC }}
* {{cite journal |last1=Clarence-Smith |first1=William G. |date=2008 |title=Islam and Female Genital Cutting in Southeast Asia: The Weight of the Past |url=http://www.etmu.fi/fjem/pdf/FJEM_2_2008.pdf |archive-url=https://web.archive.org/web/20090306050235/http://www.etmu.fi/fjem/pdf/FJEM_2_2008.pdf |archive-date=6 March 2009 |journal=Finnish Journal of Ethnicity and Migration |volume=3 |issue=2: Special Issue: Female Genital Cutting in the Past and Today }}
* {{cite book |last=Dana |first=Nissi |year=2003 |title=The Druze in the Middle East: Their Faith, Leadership, Identity and Status| isbn=9781903900369| page =56|publisher=University of Michigan Press|quote=}}
* {{cite book |vauthors=Gollaher D |title=Circumcision: A History of the World's Most Controversial Surgery |date=February 2001 |publisher=Basic Books |isbn=978-0-465-02653-1 |url=https://books.google.com/books?id=usEzSffvPBMC |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=usEzSffvPBMC |url-status=dead |archive-date=18 January 2016 }}
{{Refend}}

== External links ==
{{Commons category}}
{{Wikinews category}}
* Videos of infant circumcision: using a [https://med.stanford.edu/newborns/professional-education/circumcision/plastibell-technique.html Plastibell], a [https://med.stanford.edu/newborns/professional-education/circumcision/gomco-clamp-technique.html Gomco clamp] and a [https://med.stanford.edu/newborns/professional-education/circumcision/mogen-clamp-technique.html Mogen clamp] (all from Stanford Medical School)
* A [https://www.youtube.com/watch?v=Zw-124t993c Xhosa circumcision] from National Geographic

{{Circumcision series}}
{{Male genital procedures}}
{{Infants and their care}}
{{Authority control}}

[[Category:Circumcision| ]]
[[Category:Cosmetic surgery]]
[[Category:Pediatric surgery]]
[[Category:Prevention of HIV/AIDS]]
[[Category:Religion and children]]
[[Category:Wikipedia medicine articles ready to translate (full)]]
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