Circumcision controversies

This article is about male circumcision. For female circumcision, see Female genital mutilation. For the female circumcision controversy in Kenya, 1929–1931, see Female circumcision controversy.

Male circumcision has often been, and remains, the subject of controversy on a number of grounds—including religious, ethical, sexual, and health.

The Ancient Greeks and Romans valued the foreskin and were opposed to circumcision – an opposition inherited by the canon and secular legal systems of the Christian West that lasted at least through to the Middle Ages, according to Hodges.^[1] Traditional Judaism and Islam have advocated male circumcision as a religious obligation.

The ethics of circumcision are sometimes controversial. From the mid 19th century, there has been advocacy in Anglophone countries on medical grounds, such as the prevention of masturbation and "reflex neurosis".^[2] Modern proponents, such as Morris, argue that circumcision reduces the risks of urinary tract infections, penile cancer, HIV, balanitis, posthitis, phimosis, and prostate cancer as well as conferring sexual benefits.^[3] In contrast, opponents of infant circumcision often question its effectiveness in preventing disease,^[4] and object to subjecting newborn boys, without their consent, to a procedure they consider to have questionable benefits, significant risks and a potentially negative impact on later sexual enjoyment.

Religious and cultural conflicts

Ancient world

Circumcision of Abraham's son Isaac. Regensburg Pentateuch, Israel Museum, Jerusalem (c. 1300)

Genesis explains circumcision as a covenant with God given to Abraham^[Gen 17:10], but many liberal scholars reject the historicity of these accounts^[5] and look elsewhere for the origin of Jewish circumcision. The most common historical explanation, dating from Herodotus, is that the custom was acquired from the Egyptians, possibly during the period of enslavement.^[6] A competing hypothesis is based on linguistic/ethnographic work begun in the 19th century,^[7] and suggests circumcision was a common tribal custom among many Semitic tribes, including Jews, Arabs and Phoenecians, before they migrated from the Arabian peninsula. Recent linguistic analysis^[8] is strengthening the case for the latter explanation, that is also more likely to convince those who consider the Bible to be a reliable historical document.^[9]

The Jewish and Islamic traditions both see circumcision as a way to distinguish a group from its neighbours.^[10] The Bible records "uncircumcised" being used as a derogatory reference for opponents^{[1Sam 17:26]} and Jewish victory in battle that culminated in mass post-mortem circumcision, to provide an account of the number of enemy casualties^{[1Sam 18:27]}. Jews were also required to circumcise all household members, including slaves^{[Gen 17:12-14]} – a practice that would later put them into collision with Roman and Christian law (see below).

Hellenistic culture found circumcision to be repulsive.^[11] In 167 BCE Judea was part of the Seleucid Empire. Its ruler, Antiochus (175–165), smarting from a defeat in a war against Ptolemaic Egypt, banned traditional Jewish religious practice, and attempted to forcibly convert the Jews to Hellenism. The Olympian Zeus was placed on the altar of the Temple, and throughout the country Jews were ordered, with the threat of execution, to sacrifice pigs to Greek gods (the normal practice in the Ancient Greek religion), desecrate the Shabbat, eat unkosher animals (especially pork), and relinquish their Jewish scriptures. Antiochus's decree also outlawed Jewish circumcision, and parents who violated his order were hanged along with their infants.1Ma 1:46-67^[2] according to Tacitus, as quoted by Hodges, Antiochus "endeavoured to abolish Jewish superstition and to introduce Greek civilization."^[1]

In the Roman Empire, circumcision was regarded as a barbaric and disgusting custom. The consul Titus Flavius Clemens was condemned to death by the Roman Senate in 95 CE for, according to the Talmud, circumcising himself and converting to Judaism. The emperor Hadrian (117-138) forbade circumcision.^[1]

Perhaps the most prominent Jewish response during these times, was rebellion. Antiochus's decree motivated the Maccabees Revolt, which ultimated in the reestablishment of an independent Jewish kingdom.

As for the anti-circumcision law passed by Hadrian, it is considered by many, to be, together with his decision to build a new temple upon the ruins of the Second Temple, which was dedicated to Jupiter, one of the main causes of the Bar Kokhba revolt (132-135). The revolt was brutally crushed. According to Cassius Dio, 580,000 Jews were killed, and 50 fortified towns and 985 villages razed.^[12][13] Cassius Dio claimed that "Many Romans, moreover, perished in this war. Therefore, Hadrian, in writing to the Senate, did not employ the opening phrase commonly affected by the emperors: 'If you and your children are in health, it is well; I and the army are in health.'"^[14] Because of the great loss of life in the war, even though Hadrian was victorious, he refused a triumph. Hadrian said regarding the war, "I forbade the Jews to mutilate themselves, and they started a war."

Hadrian policy after the rebelion reflected an attempt to root out Judaism. All Jews were forbidden to enter Jerusalem upon pain of death and the city was renamed Aelia Capitolina. Around 140, His successor Antoninus Pius (138-161) exempted Jews who circumcised their sons, though not their servants or slaves, from the decree against circumcision.^[1]

Jewish response to the decrees also took a more moderate form: circumcisions were secretly performed  – even on dead Jews –.^[2] Other Jews pursued a completely different approach, accepting the decrees, and even making efforts to restore their foreskins to better assimilate into Hellenistic society. The latter approach was common during the reign of Antiochus, and again under Roman rule. The foreskin was restored by one of two methods, that were later revived in the late twentieth century. The surgical method, described in detail by the physician Celsus (around 25BC - 50AD), involved freeing the skin covering the penis by dissection, and then pulling it forward over the glans. Celsus also described a simpler surgical technique used on men whose prepuce is naturally insufficient to cover their glans.^[15] The second approach was nonsurgical. A device called a Pondus Judaeus (Jewish burden), a special weight made of bronze, copper, or leather, was affixed to the penis, pulling its skin downward. Overtime, a new foreskin was generated, or a short prepuce was lengthened, by means of tissue expansion. Martial mentioned the instrument in Epigrammaton Libri 7:35.^[16]

The apostle Paul referred to these practices, saying: "Was a man already circumcised when he was called? He should not become uncircumcised."^[1Cor 7:18] But he also explicitly denounced circumcision of non-Jews, rejecting and condemning those who promoted the ritual to Gentile Christians, labelling such advocates of circumcision "false brothers".^[Gal 2:4] According to the same researchers, in the mid 2nd century Jewish leaders introduced a radical method of circumcision, the periah, that left the glans totally uncovered, making it almost impossible to restore the foreskin.^[16]

Under the first Christian emperor, Constantine, the two rescripts of Antoninus on circumcision were re-enacted and again in the 6th century under Justinian. These restrictions on circumcision made their way into both secular and canon law and "at least through the Middle Ages, preserved and enhanced laws banning Hebrews from circumcising non-Hebrews and banning Christians or slaves of any religious affiliation from undergoing circumcision for any reason."^[1]

Circumcision controversy in early Christianity

Main article: Circumcision controversy in early Christianity

The first Christian Church Council in Jerusalem, held in approximately 50 AD^[17] decreed that circumcision was not a requirement for Gentile converts. This became known as the "Apostolic Decree"^[18] and is one of the first acts differentiating Early Christianity from Rabbinic Judaism^[19] At roughly the same time Rabbinic Judaism made their circumcision requirement even stricter.^[20]

According to the Columbia Encyclopedia,^[21] "the decision that Christians need not practice circumcision is recorded in Acts 15;^[22] there was never, however, a prohibition of circumcision, and it is practiced by Coptic Christians."

The main focus of Christian proselytizing in the early Christian Church were the God-Fearers, gentile inhabitants of the Roman Empire who were allowed to attend Jewish synagogues as quasi-Jews without the necessity of undergoing the hated rite of circumcision. All they had to do was swear that there was "One God". Converts from this group was the primary kernel from which the early Christian Church grew. (About 10% of the inhabitants of the Roman Empire were full Jews and God-Fearers.) ^[23]

Islam

In the early 7th century, Muhammad welded together many Semitic tribes of the Arabian peninsula into the kernel of a rapidly expanding Muslim movement. The one thing that can be said with some certainty is that male and female circumcision was already well established among these tribes, and probably had been for more than a thousand years, most likely as a fertility rite. Herodotus had noticed the practice among various Semite nations in the 5th century BCE, and Josephus had specifically mentioned circumcision as a tradition among Arabs in the first century CE.^[7] After the introduction of Islam, female circumcision was prohibited, though some Muslims continued to practice it. This practice is not approved by orthodox Islam.^[24]

The practice of circumcision is sometimes characterized as a part of fitrah as mentioned in the hadith of Sahih al-Bukhari (Quotations of Prophet Muhammad)^[25][26]

Middle Ages to 19th century

Thomas Aquinas in his Summa Theologica questioned why, if under Jewish doctrine circumcision removed original sin, Jesus was circumcised – as Jesus had no original sin. Steve Jones suggests there is a theological tradition that Jesus regained his foreskin at the Ascension. "Had he failed to do so, the Saved would themselves have to be operated upon in Paradise so as not to be more perfect than their Saviour."^[27]

The Jews were expelled from England by Edward I in 1290, ostensibly over social tensions concerning usury. But the public imagination had been gripped by blood libel,^[28] since at least the 12th century: "So pervasive was the belief that Jews circumcised their victims ... that Menasseh ben Israil, the Dutch Rabbi who sought from Cromwell the readmission of the Jews in 1656, had to dwell at considerable length in his Vindiciae Judaeorum at refuting the claim."^[29]

In 15th century Spain, most Jews and Muslims were expelled and the Spanish Inquisition monitored and prosecuted converts to Christianity to ensure they were not secretly consorting with Jews or engaging in Jewish practices such as circumcision.^[30]

In 1521 Cortés defeated the Aztec empire in Mesoamerica, which was followed by a large influx of Spanish clergy, whose writings provide most of information about pre-conquest Aztec life and customs largely assembled from interviews with those who survived the invasion and subsequent epidemics, and their descendents. Diego Durán, a Dominican friar, was convinced that the Aztecs were one of the lost tribes of Israel, with a crucial piece of supporting evidence being that they had practised circumcision.^[31]

So influential was this notion that 300 years later Bancroft in his monumental Native Races^[32] began his discussion of circumcision by writing: "Whether the custom of circumcision, which has been the great prop of argument in favor of the Jewish origin of the Aztecs, really obtained among these people, has been doubted by numerous authors," concluding that it probably existed in a "certain form among some tribes" (p278). The key being "a certain form", since Bancroft makes clear in a footnote that the majority of his sources, including Clavigero, Ternaux-Compans, Carbajal Espinosa, Oviedo y Herrera, and especially Acosta, believed Durán and others "confounded the custom of drawing blood from the secret organs with circumcision", and "the incision on the prepuce and ear to have been mistaken for circumcision", adding that this blood-letting rite^[33] was "chiefly performed upon sons of great men" (p279). The case was not helped by the fact no reports of seeing a circumcised adult Aztec existed in the literature. Remondino says it is "a matter of controversy" whether the foreskin had actually been removed (p46).^[2]

In regard to the Mayans, Bancroft says that in 1858 Brasseur de Bourbourg reported finding "traces" ^[34] of circumcision in the sources, despite Cogolludo having reported that "circumcision was unknown to the Indians of Yucatan" (pp279, 679).^[32] But in 1864 Brasseur published his French translation of Diego de Landa's recently recovered 1556 ethnographic manuscript, which decisively rejected the notion of Mayan circumcision, and in a footnote he acknowledged there had probably been a "mistake", an admission that never found its way into the English-language literature^[35] although modern ethnography has long since understood the nature of these rituals.^[36] However, the Aztecs and Mayans are included by many authors from other disciplines among the list of pre-modern people who practised circumcision. Examples of such sources include UNAIDS,^[37] Kaplan,^[38] and Weiss.^[39]

Countries that do not circumcise have often held antipathy for those that do. Being circumcised was a often seen as a sign of disgrace.^[2] According to Darby, it was also seen as a serious loss of erogenous tissue: "During the Renaissance and 18th century the centrality of the foreskin to male sexual function and the pleasure of both partners was recognised by anatomists Berengario da Carpi, Gabriello Fallopio and William Harvey, in popular sex manuals like Aristotle's master-piece, and by physicians like John Hunter, who also appreciated the importance of the foreskin in providing the slack tissue needed to accommodate an erection."^[40]

In 1650, English physician John Bulwer in his study of body modification, Anthropometamorphosis: Man Transform'd, or the Artificial Changeling, wrote of the loss in sexual pleasure resulting from circumcision: "the part which hangeth over the end of the foreskin, is moved up and down in coition, that in this attrition it might gather more heat, and increase the pleasure of the other sexe; a contentation of which they [the circumcised] are defrauded by this injurious invention. For, the shortnesse of the prepuce is reckoned among the organical defects of the yard, … yet circumcision detracts somewhat from the delight of women, by lessening their titillation." The English historian Edward Gibbon, author of The History of the Decline and Fall of the Roman Empire, referred to the practice as "a painful and often dangerous rite", and a "singular mutilation" practiced only by Jews and Turks.

The first formal objection to circumcision within Judaism occurred in 1843 in Frankfurt. The Society for the Friends of Reform, a group that attacked traditional Jewish practices, said that brit milah was not a mitzvah but an outworn legacy from Israel's earlier phases, an obsolete throwback to primitive religion.^[41] With the expanding role of medicine came further opposition; certain aspects of Jewish circumcision such as periah and metzitzah (drawing the blood from the circumcision wound through sucking or a cloth) were deemed unhygienic. Later evidence that syphilis and tuberculosis – two of the most feared infectious diseases in the 19th century – were spread by mohels, caused various rabbis to advocate metzitzah to be done using a sponge or a tube.^[42] (Today, the Rabbinical Council of America, the largest group of Modern Orthodox rabbis, endorses using a glass tube)^[43]

Ephron reports that Gentiles and also some Jewish reformers in early 19th century Germany had criticized ritual circumcision as "barbaric" and that Jewish doctors responded to these criticisms with defences of the ritual or proposals for modification or reform. By the late 19th century some German Jewish doctors defended circumcision by claiming it had health advantages.^[44]

Modern debates

A protest against non-therapeutic infant circumcision in connection with the annual meeting of the American Academy of Pediatrics at the Washington Convention Center

Medical advocacy and opposition

Circumcision spread in several English-speaking nations from the late nineteenth century, with the introduction of anesthesia and antisepsis rapidly expanding surgical practice.^[6] Doctors such as Sir Jonathan Hutchinson in England wrote articles in favour of the procedure.^[45] Peter Charles Remondino, a San Diego physician, wrote a History of Circumcision from the Earliest Times to the Present: Moral and Physical Reasons for Its Performance (1891), to promote circumcision.^[46] Lewis Sayre, a prominent orthopedic surgeon at the time, was another early American advocate.^[46] However, the theories on which many early claims were made, such as the reflex theory of disease and the alleged harmful effects of masturbation, have long since been abandoned by the medical profession.^[46]

Dr. John Harvey Kellogg recommended circumcision of boys caught masturbating, writing: "A remedy for masturbation which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should be performed by a surgeon without administering anaesthetic, as the pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment." (page 295) But he was opposed to routine circumcision of infants: "It is doubtful, however, whether as much harm as good does not result from circumcision, since it has been shown by extensive observation among the Jews that very great contraction of the meatus, or external orifice of the urethra, is exceedingly common among them, being undoubtedly the result of the prolonged irritation and subsequent cicatricial contraction resulting from circumcision in infancy." (page 107)^[47]

An early British opponent of circumcision was Herbert Snow, who wrote a short book called The barbarity of circumcision as a remedy for congenital abnormality in 1890.^[48] But as late as 1936, L. E. Holt, an author of pediatric textbooks, advocated male and female circumcision as a treatment for masturbation.^[49]

The first serious questioning of the practice did not occur until late 1949 when Gairdner published The Fate of the Foreskin in the British Medical Journal; according to Wallerstein this began to affect the practice of circumcision in Britain.^[4]

According to Darby and Cox, the persistence of circumcision in the USA has led to more vigorous protest movements.^[50] A 1980 protest march at the California State Capitol was reported in an Associated Press article.^[51] The National Organization of Circumcision Information Resource Centers (NOCIRC), was formed by Marilyn Milos, R.N., in 1985.^[52] The organization's stated objective is to secure the birthright of male, female, and intersex children and babies to keep their sex organs intact. Protest rallies have been held in the USA and other areas. NOCIRC have consistently criticised the American medical community's circumcision guidelines.^[52] According to Milos and Donna Macris, "The need to defend the baby's right to a peaceful beginning was brought to light by Dr. Frederick Leboyer in his landmark work, Birth Without Violence".^[52]

This period also saw the formation of anti-circumcision organizations in Australia, Canada, the United Kingdom and South Africa. Activists began creating websites in the mid-1990s, and this process has continued. One such organization distributed questionnaires to circumcised men. The complaints included prominent scarring (33%), insufficient penile skin for comfortable erection (27%), erectile curvature from uneven skin loss (16%), and pain and bleeding upon erection/manipulation (17%). Psychological complaints included feelings of mutilation (60%), low self esteem/inferiority to intact men (50%), genital dysmorphia (55%), rage (52%), resentment/depression (59%), violation (46%), or parental betrayal (30%). Many respondents reported that their physical/emotional suffering impeded emotional intimacy with their partner(s), resulting in sexual dysfunction.^[53] Prominent men known to be unhappy about being circumcised include A E Houseman, W.H. Auden, Geoffrey Keynes and his brother John Maynard Keynes, the famous economist.^[50] In 1996 the British Medical Journal published a letter by 20 men saying that "we have been harmed by circumcision in childhood"; they argued that "it cannot be ethical for a doctor to amputate normal tissue from a normal child".^[50] Dr. Benjamin Spock (d. 1998), whose Baby and Child Care is the biggest selling American single-author book in history, originally supported circumcision but changed his mind near the end of his life.^[54]

Prominent American advocates for infant circumcision include Dr. Thomas Wiswell, who began publishing research on the relative incidence of urinary tract infections in the mid 1980s;^[55] Dr. Edgar Schoen, (b. 1925) former chair of the American Academy of Pediatrics' Task Force on Circumcision, who maintains a web site promoting circumcision^[56] and claims physical benefits in sexual performance in addition to medical arguments; and Aaron J. Fink, M.D. (d. 1990), who self-published Circumcision: A Parent's Decision for Life to promote his ideas.

In Australia, Professor Brian Morris, author of In Favour of Circumcision, asserts that circumcision confers many medical benefits including reduced risk of UTIs, penile cancer, HIV, balanitis, posthitis, phimosis, and prostate cancer and argues that circumcision has sexual benefits.^[3] Morris also claims that circumcision prevents "physical problems" such as "Bathroom splatter" and "Zipper injury".^[57] However, Morris's views have been strongly criticised by Professor Basil Donovan who argues that the protection from HIV argued by Morris is not an accurate depiction of the HIV research.^[58] David Forbes, chair of the pediatrics and child health policy and advocacy committee of the Royal Australasian College of Physicians has stated that Morris has not been asked to review the college's circumcision policy and is not a member of the college.^[59][60]

The American Academy of Pediatrics (AAP) circumcision policy has been criticised, both by those who believe that it is too negative about the practice,^[61] and those who believe that it is too positive.^[62] Hill has also criticised the Academy's circumcision information brochure for parents, arguing that the brochure is inadequate to persuade parents to avoid circumcision.^[63]

The WHO and UNAIDS recommend male circumcision as a means of reducing the rate of HIV infection,^[64] but this has also proved controversial, with doubts raised about the efficacy of mass circumcision campaigns in sub-Saharan Africa.^[65][66] Critics have themselves been the subject of criticism; Kalichman writes: "Anticircumcision groups have long existed and are increasingly vocal as MC programs for HIV prevention are promoted. Anticircumcision groups resemble other antiscience and antimedicine extremists including AIDS denialists who refute public health realities to maintain entrenched belief systems"^[67]

Another area of continuing dispute is the effect of circumcision on penile sensitivity. In April 2007, the British Journal of Urology published a study (Sorrells et al., 2007) that stated it "conclusively shows that circumcised males have a significant penile sensory deficit as compared with non-circumcised intact men" and that "the most sensitive regions in the uncircumcised penis are those removed by circumcision."^[68] But in June 2007, the BJU published a letter in response by Waskett and Morris, which concluded that "despite a poorly representative sample and a methodology prone to exaggerating the sensitivity of the prepuce, NOCIRC's claims remain unproven. When the authors' data are analysed properly, no significant differences exist. Thus the claim that circumcision adversely affects penile sensitivity is poorly supported, and this study provides no evidence for the belief that circumcision adversely affects sexual pleasure."^[69] Hugh Young, a critic of circumcision, responded to this, stating that Waskett and Morris "critique the finding of Sorrells et al. that 'circumcision ablates [removes] the most sensitive part of the penis' by excluding that part from consideration... That the foreskin itself has a sexual function was well-known for centuries before secular circumcision became widespread. What would need to be proved rigorously is that cutting a significant part of the distal penis off does not diminish sexual pleasure." ^[70] Payne et al. reported that direct measurement of penile sensation in the shaft and glans during sexual arousal failed to support the hypothesised sensory differences associated with circumcision status.^[71]

Genital integrity

A lobby against routine infant circumcision on Chicago's Pride Parade

Many opponents of circumcision see infant circumcision as unnecessary, harmful and unethical;^[72] some want the procedures prohibited.^[73] Boyle et al. suggest that "As we enter the 21st century, appropriate legal action must be taken to safeguard the physical genital integrity of male children."^[74]

Hammond asserts that every person has a right to a whole and intact body and that, where minors are concerned, "the unnecessary removal of a functioning body organ in the name of tradition, custom or any other non-disease related cause should never be acceptable to the health profession." He says that such interventions are violations of individual bodily rights and "a breach of fundamental medical ethics principles".^[53] Others also see the genital cutting of children as a human rights issue,^[75] opposing the genital modification and mutilation of children, including circumcision and female genital mutilation. Several anti-circumcision organizations also oppose the sexual-reassignment surgery of infants with ambiguous genitalia.^{[73][76][77][78]}

Current laws in many countries, and United States Federal Law as well as laws in several U.S. states, prohibit the genital modification and mutilation of female minors, with some exceptions based on medical need. Opponents of male circumcision assert that laws against genital modification and mutilation of minors should apply equally to males and females. Many anti-circumcision groups have joined the International Coalition for Genital Integrity ^[79] and endorsed its declaration,^[80] which was adopted by the First International Symposium on Circumcision, on March 3, 1989, at Anaheim, California. (There have been nine such further symposia held since, with the proceedings of several subsequently published in book form.)^[81]

However, linking male circumcision to female genital mutilation (FGM) is itself highly controversial. Organizations actually involved in combating FGM have been at considerable pains to distinguish the two, as this UNICEF document explains: "When the practice first came to be known beyond the societies in which it was traditionally carried out, it was generally referred to as "female circumcision". This term, however, draws a direct parallel with male circumcision and, as a result, creates confusion between these two distinct practices."^[82]

This stance has been largely echoed by Western medical and political authorities. The Australian Medical Association states: "The AMA rejects the euphemism "female circumcision", sometimes used to describe the various forms of female genital mutilation, because the use of this phrase trivialises the severe and often irreparable physical and psychological damage occasioned to girls and women by these practices."^[83] In the United States, the organization MGMbill.org sent a proposed bill to the US Congress and 15 state legislatures between 2004 and 2007 to extend the prohibition on genital modification and mutilation of minors to include male and intersex children.^[73] But the proposed bill has not been endorsed by any member of Congress.^[84]

Other contemporary controversies

While circumcision debates are often dominated by the concerns of Anglophone countries, very different controversies over the procedure regularly erupt in other cultural contexts. In South Asia, Pakistan has long used circumcision status as a definitive marker of Indian covert involvement in its internal affairs. But this assumption was thrown into confusion when it was discovered that large segments of its own Muslim male population, specifically from western tribal areas, were themselves uncircumcised.^[85][86]

Opposition to circumcision exists among Jews in Israel. Even though there is often pressure from family to circumcise their sons, a small but growing number of Jews are choosing to forgo the procedure.^[87] Islamic anti-circumcision groups, such as Qur'an Alone, have also emerged, arguing among other things that routine circumcision is an insult to Allah since it tries to improve on his perfect creation.^[88]

Northern Europe, which has no tradition of routine circumcision, has been struggling with the challenges of its Jewish and Muslim minorities. Finland is considering legislation to legalise male circumcision.^[89] Sweden in 2001 passed a law requiring traditional circumcisers to be certified and for the infants to be given a medically administered anaesthetic. The World Jewish Congress said that "[t]his is the first legal restriction placed on a Jewish rite in Europe since the Nazi era."^[90]

In the Xhosa areas of South Africa, the large death toll from traditional circumcision provide a constant source of friction between traditional leaders, who oppose medicalised procedures, and health authorities. In 2009 in Eastern Cape Province alone, 80 boys died and hundreds were hospitalised after attending initiation schools.^[91] The controversy looks set to spread to the Zulu, whose present-day king Goodwill Zwelithini has called for the reintroduction of customary circumcision after it was banned by Zulu king Shaka in the 19th century.^[92] Similar issues, though on a smaller scale, have arisen with traditional circumcision of Aborigines in remote areas of central Australia.^[93]

See also

• History of circumcision
• Ethics of circumcision
• Human rights
• Reproductive rights
• Ridged band
• Gliding action
• Foreskin
• Foreskin restoration
• Medical analysis of circumcision
• Penis

References

1. ^ ^{a b c d e} Hodges, F.M. (Fall 2001). "The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme". The Bulletin of the History of Medicine 75 (3): 375–405. doi:10.1353/bhm.2001.0119. PMID 11568485. http://www.cirp.org/library/history/hodges2/. 
2. ^ ^{a b c d e} Remondino, P.C (1891). History Of Circumcision. pp. 65–69. http://www.archive.org/details/HistoryOfCircumcision. 
3. ^ ^{a b} Brian Morris. "Circumcision: An Evidence-Based Appraisal". http://www.circinfo.net/. 
4. ^ ^{a b} Wallerstein, Edward (February 1985). "Circumcision: The Uniquely American Medical Enigma". Urologic Clinics of north America 12 (1): 123–132. PMID 3883617. http://www.cirp.org/library/general/wallerstein/. 
5. ^ Thompson, Thomas (2002). The Historicity of the Patriarchal Narratives: The Quest for the Historical Abraham. Valley Forge, Pa: Trinity Press International. ISBN 1-56338-389-6. http://books.google.com.au/books?id=lwrzapZYqFAC&dq. "It must be concluded that any such historicity ... about the patriarchs of Genesis is hardly possible and totally improbable. (p. 328)" 
6. ^ ^{a b} Dunsmuir WD, Gordon EM (1999). "The history of circumcision". BJU Int 83 (Suppl. 1:1-12): 1–12. doi:10.1046/j.1464-410x.1999.0830s1001.x. PMID 10349408. http://www.cirp.org/library/history/dunsmuir1/. 
7. ^ ^{a b} George Barton (1902). A sketch of Semitic origins, social and religious. Macmillan. pp. 98–100. ISBN 142861575X. OCLC 1850150. http://www.archive.org/details/cu31924029872938. 
8. ^ Kitchen, A.; Ehret, C.; Assefa, S.; Mulligan, C. (2009). "Bayesian phylogenetic analysis of Semitic languages identifies an Early Bronze Age origin of Semitic in the Near East". Proceedings. Biological sciences / the Royal Society 276 (1668): 2703–2710. doi:10.1098/rspb.2009.0408. PMC 2839953. PMID 19403539. http://rspb.royalsocietypublishing.org/content/276/1668/2703.full. 
9. ^ For an example of popular Christian apologetics, see Abraham didn't exist? Moses a myth? Archeological and historical evidence of Biblical accuracy
10. ^ See the story of Dina & Shechem in Genesis. Also the mass circumcision during the exodus from Egypt.
11. ^ Jewish Encyclopedia: Circumcision: In Apocryphal and Rabbinical Literature: "Contact with Grecian life, especially at the games of the arena [which involved nudity], made this distinction obnoxious to the Hellenists, or antinationalists; and the consequence was their attempt to appear like the Greeks by epispasm ("making themselves foreskins"; I Macc. i. 15; Josephus, "Ant." xii. 5, § 1; Assumptio Mosis, viii.; I Cor. vii. 18; , Tosef., Shab. xv. 9; Yeb. 72a, b; Yer. Peah i. 16b; Yeb. viii. 9a). All the more did the law-observing Jews defy the edict of Antiochus Epiphanes prohibiting circumcision (I Macc. i. 48, 60; ii. 46); and the Jewish women showed their loyalty to the Law, even at the risk of their lives, by themselves circumcising their sons."; Hodges, Frederick, M. (2001). "The Ideal Prepuce in Ancient Greece and Rome: Male Genital Aesthetics and Their Relation to Lipodermos, Circumcision, Foreskin Restoration, and the Kynodesme" (PDF). The Bulletin of the History of Medicine 75 (Fall 2001): 375–405. doi:10.1353/bhm.2001.0119. PMID 11568485. http://www.cirp.org/library/history/hodges2/. Retrieved 2007-07-24. 
12. ^ The 'Five Good Emperors' (roman-empire.net)
13. ^ Mosaic or mosaic?—The Genesis of the Israeli Language by Zuckermann, Gilad
14. ^ Cassius Dio, Roman History
15. ^ Rubin, Jody P. (1980-07). "Celsus's Decircumcision Operation". Urology 16 (1): 121–4. doi:10.1016/0090-4295(80)90354-4. PMID 6994325. http://www.cirp.org/library/restoration/rubin/. 
16. ^ ^{a b} "Uncircumcision: A Historical Review of Preputial Restoration". http://www.cirp.org/library/restoration/schultheiss/. 
17. ^ Acts of the Apostles, chapter 15
18. ^ Catholic Encyclopedia: Judaizers: Council of Jerusalem (A.D. 50 OR 51): "But to still the clamours of the converts from Pharisaism who demanded that the Gentile converts "must be circumcised and be commanded to observe the Law of Moses", the matter was discussed in a public meeting. ... By the decree of the Apostles the cause of Christian liberty was won against the narrow Judaizers, and the way smoothed for the conversion of the nations. The victory was emphasized by St. Paul's refusal to allow Titus to be circumcised even as a pure concession to the extremists (Galatians 2:2-5)."
19. ^ Jewish Encyclopedia: Baptism: "According to rabbinical teachings, which dominated even during the existence of the Temple (Pes. viii. 8), Baptism, next to circumcision and sacrifice, was an absolutely necessary condition to be fulfilled by a proselyte to Judaism (Yeb. 46b, 47b; Ker. 9a; 'Ab. Zarah 57a; Shab. 135a; Yer. Kid. iii. 14, 64d). Circumcision, however, was much more important, and, like baptism, was called a "seal" (Schlatter, "Die Kirche Jerusalems," 1898, p. 70). But as circumcision was discarded by Christianity, and the sacrifices had ceased, Baptism remained the sole condition for initiation into religious life. The next ceremony, adopted shortly after the others, was the imposition of hands, which, it is known, was the usage of the Jews at the ordination of a rabbi. Anointing with oil, which at first also accompanied the act of Baptism, and was analogous to the anointment of priests among the Jews, was not a necessary condition."
20. ^ "peri'ah", (Shab. xxx. 6)
21. ^ Entry on "circumcision", The Columbia Encyclopedia, Sixth Edition, 2001-05.
22. ^ Acts 15
23. ^ Cross, Colin Who Was Jesus? 1972
24. ^ Female Circumcision and Islam; Sheikh (Dr.) `Abd al-Rahmân b. Hasan al-Nafisah, editor of the Contemporary Jurisprudence Research Journal, Riyadh http://www.islamicemirate.com/index.php?option=com_content&view=article&id=310:female-circumcision-in-islam&catid=69:misconceptions-articles&Itemid=223
25. ^ Saheeh Al Bukhari Hadeeth No. 5509 http://www.sahihalbukhari.com/sps/sbk/sahihalbukhari.cfm?scn=dsphadeeth&HadeethID=5509}
26. ^ Saheeh Al Bukhari Hadeeth No. 5511 http://www.sahihalbukhari.com/sps/sbk/sahihalbukhari.cfm?scn=dsphadeeth&HadeethID=5511}
27. ^ Steve Jones (2005). Y: the descent of men, Chapter 5. Mariner Books. ISBN 0-618-13930-3. http://www.circumstitions.com/y.html. 
28. ^ recurring stories of forced circumcision of Christian boys, often followed by their ritual murder|
29. ^ James Shapiro (1998). Shakespeare and the Jews. ISBN 9780312216894. http://books.google.com/?id=BR4BxGfBqrIC&lpg=PA82&dq=england%20expulsion%20jews%20circumcision&pg=PR5#v=onepage&q=&f=false. 
30. ^ Henry Kamen (1997). The Spanish Inquisition: A Historical Revision.. Yale University Press. ISBN 0297817191. 
31. ^ The History of the Indies of New Spain, Chapter 1 concerns the Jewish origins of the Aztecs, a very common idea at the time. Gods and Rite, Chapter 3 deals with the associated idea of circumcision
32. ^ ^{a b} Bancroft, Hubert Howe (1882). The Native Races, Volume 2, Civilized Nations. http://collections.lib.ttu.edu/cdm4/item_viewer.php?CISOROOT=/hfwc&CISOPTR=2&CISOBOX=1&REC=7. 
33. ^ It is now thought this ubiquitous Mesoamerican ritual dates back to the Olmecs. See Olmec Bloodletting: An Iconographic Study
34. ^ In fact the term used is "restes déformés des rites antiques" or "deformed remnants of ancient rites" p35 Histoire des nations civilisées du Mexique et de l'Amérique Centrale (1857-9)
35. ^ Landa, Diego de (1864). Relation des choses de Yucatan de Diego de Landa. p. 162. ISBN 1145379303. http://books.google.com/?id=exorAAAAYAAJ&dq=inauthor:Diego+inauthor:de+inauthor:Landa#v=onepage&q=&f=false. 
36. ^ Joralemon, D. (1974). "Ritual Blood-Sacrifice among the Ancient Maya: Part I". In Merle Green Robertson. Primera Mesa Redonda de Palenque. pp. 59–76. http://www.mesoweb.com/pari/publications/RT02/Joralemon1974.pdf. 
37. ^ "Circumcision: Global Trends and Determinants of Prevalence, Safety and Acceptability". http://www.malecircumcision.org/media/documents/MC_Global_Trends_Determinants.pdf. 
38. ^ Kaplan GW (March 1977). "Circumcision--an overview". Curr Probl Pediatr 7 (5): 1–33. PMID 321186. 
39. ^ Weiss, Charles (1966). "Motives for male circumcision among preliterate and literate peoples". The Journal of Sex Research 2 (2): 69–88. doi:10.1080/00224496609550503. 
40. ^ Robert Darby (2003). "Medical history and medical practice: persistent myths about the foreskin". Medical Journal of Australia 178 (4): 178–9. PMID 12580747. http://www.mja.com.au/public/issues/178_04_170203/dar10676_fm.html. 
41. ^ Gollaher, p. 27.
42. ^ Gollaher, p. 29.
43. ^ Metzitza Be'Peh - Halachic Clarification Regarding Metzitza Be'Peh, RCA Clarifies Halachic Background to Statement of March 1, 2005
44. ^ John M. Ephron (2001). Medicine and the German Jews. Yale University Press. pp. 222–233. 
45. ^ "Mr Hutchinson on circumcision". historyofcircumcision.net. http://www.historyofcircumcision.net/index.php?option=com_content&task=view&id=38&Itemid=0. Retrieved 2010-01-03. 
46. ^ ^{a b c} Gollaher DL (1994). Journal of Social History 28 (1): 5–36. http://www.cirp.org/library/history/gollaher/. 
47. ^ John Harvey Kellogg (1888). Plain Facts for Young and Old. F. Segner & Co.. ISBN 0585232644. http://etext.lib.virginia.edu/etcbin/toccer-new2?id=KelPlai.sgm&images=images/modeng&data=/texts/english/modeng/parsed&tag=public&part=11&division=div1. 
48. ^ Robert Darby. "The barbarity of circumcision, 1890. Herbert Snow's attempt to turn the tide". historyofcircumcision.net. http://www.historyofcircumcision.net/index.php?option=content&task=view&id=45#dow. Retrieved 2009-06-05. "Snow's book may be viewed here." 
49. ^ Paige KE (May 1978). "The Ritual of Circumcision". Human Nature: 40–48. http://www.noharmm.org/paige.htm. 
50. ^ ^{a b c} Robert, Darby; Laurence Cox (2009). "Objections of a Sentimental Character:The Subjective Dimensions of Foreskin loss". In Chantal Zabus. Fearful Symmetries: Essays and Testimonies Around Excision and Circumcision. Editions Rodopi B.V.. p. 150. ISBN 9789042025721. 
51. ^ Associated Press in San Francisco Examiner with UPI Photograph (29 September 1980). "Protest Against Circumcision". p. B4. 
52. ^ ^{a b c} Milos, Marilyn; MacRis, D (1992-03). "Circumcision: A Medical or a Human Rights Issue?". Journal of Nurse-Midwifery 37 (2:Suppl.): 87S–96S. doi:10.1016/0091-2182(92)90012-R. PMID 1573462. http://www.cirp.org/library/ethics/milos-macris/. Retrieved 2008-10-08. 
53. ^ ^{a b} Hammond, T. (January 1999). "A preliminary poll of men circumcised in infancy or childhood" (PDF). BJU International 83 (Supplement 1): 85–92. doi:10.1046/j.1464-410x.1999.0830s1085.x. PMID 10349419. http://www3.interscience.wiley.com/cgi-bin/fulltext/119091408/PDFSTART. 
54. ^ B. Spock, Circumcision - It's Not Necessary Redbook, April 1989
55. ^ Neonatal circumcision revisited Fetus and Newborn Committee, Canadian Paediatric Society
56. ^ Edgar Schoen. "Circumcision: A lifetime of medical benefits". http://www.medicirc.org/. 
57. ^ http://www.circinfo.net/physical_problems.html
58. ^ Basil Donovan. "Book Review". http://historyofcircumcision.org/index.php?option=com_content&task=view&id=64&Itemid=0. 
59. ^ David Forbes (2009-09-12). "No evidence to support routine circumcision". The Sydney Morning Herald. http://www.smh.com.au/national/letters/no-evidence-to-support-routine-circumcision-20090911-fkna.html. 
60. ^ Louise Hall (2009-09-11). "Doctors circumspect on circumcision". The Sydney Morning Herald. http://www.smh.com.au/national/doctors-circumspect-on-circumcision-20090910-fjep.html. 
61. ^ Schoen EJ, Wiswell TE, Moses S (2000). "New policy on circumcision--cause for concern". Pediatrics 105 (3 Pt 1): 620–3. doi:10.1542/peds.105.3.620. PMID 10699119. 
62. ^ Van Howe, R. (13 December 2007). "This Commentary was rejected by Pediatrics". Pediatrics. http://pediatrics.aappublications.org/cgi/eletters/119/5/1006#23937. Retrieved 2009-06-05. 
63. ^ Hill, G. (August 2002). "Informed Consent for Circumcision". Southern Medical Journal 95 (8): 946. PMID 12190244. http://www.cirp.org/library/ethics/hill2/. Retrieved 2009-06-05. 
64. ^ "...experts attending the consultation recommended that male circumcision now be recognized as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men", UNAIDS website
65. ^ G. Dowsett, M. Couch. "Male Circumcision and HIV Prevention: Is There Really Enough of the Right Kind of Evidence?". Reproductive Health Matters. http://www.cirp.org/library/disease/HIV/dowsett2007. 
66. ^ A. Myers, J. Myers. "Male circumcision: The new hope?". South Africa Medical Journal. http://www.historyofcircumcision.net/index.php?option=content&task=view&id=77. 
67. ^ Kalichman SC (2010). "Neonatal circumcision for HIV prevention: Cost, culture, and behavioral considerations". PLoS Med. 7 (1): e1000219. doi:10.1371/journal.pmed.1000219. PMC 2808206. PMID 20098515. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2808206. 
68. ^ Sorrells ML, Snyder JL, Reiss MD, et al. (April 2007). "Fine-touch pressure thresholds in the adult penis". BJU International 99 (4): 864–9. doi:10.1111/j.1464-410X.2006.06685.x. PMID 17378847. http://www.doctorsopposingcircumcision.org/pdf/sorrells_2007.pdf. 
69. ^ Fine-touch pressure thresholds in the adult penis: Response
70. ^ Fine-touch pressure thresholds in the adult penis: Young replies
71. ^ Payne, Kimberley; Lea Thaler, Tuuli Kukkonen, Serge Carrier, Yitzchak Binik (April 2007). "Sensation and Sexual Arousal in Circumcised and Uncircumcised Men". Journal of Sexual Medicine 4 (3): 667–674. doi:10.1111/j.1743-6109.2007.00471.x. PMID 17419812. http://www3.interscience.wiley.com/journal/118496134/abstract. Retrieved 2008-09-07. 
72. ^ Doctorsopposingcircumcision.org: Medical ethics and the circumcision of children
73. ^ ^{a b c} U.S. MGM Bill
74. ^ Boyle GJ, Svoboda JS, Price CP, Turner JN. Circumcision of Healthy Boys: Criminal Assault? J Law Med 2000; 7: 301
75. ^ Doctors Opposing Circumcision Genital Integrity Policy Statement
76. ^ Students for Genital Integrity: fighting for the rights of all sexes
77. ^ ICGI - Genital Integrity
78. ^ National Organization of Circumcision Information Resource Centers
79. ^ Member organizations of the International Coalition for Genital Integrity
80. ^ Declaration of the International Coalition for Genital Integrity
81. ^ Nocirc.org: International Symposia on Circumcision, Sexual Mutilations, and Genital Integrity
82. ^ Changing a harmful social convention, UNICEF
83. ^ Female Genital Mutilation, Australian Medical Association, 1994.
84. ^ MGMBill.org: US MGM Bill Status
85. ^ Circumcision no longer acid test to identify Indian spies
86. ^ A case of unchecked terrorists
87. ^ Krieger, Hilary (21 November 2002). "A cut above the rest". Jerusalem Post. http://www.cirp.org/news/jerusalempost11-21-02/. Retrieved 2008-09-26. 
88. ^ Circumcision: Does the Qur'an approve it?
89. ^ Finland Considers Legalising Male Circumcision
90. ^ Jews protest Swedish circumcision restriction
91. ^ Summer circumcision season deaths reach 23
92. ^ Thousands face agony or death after Zulu king's circumcision decree
93. ^ Ceremonial circumcisions botched in NT

External links

Opposition to circumcision

• The Circumcision Information and Resource Pages
• Intact America
• National Organization of Circumcision Information Resource Centers (NOCIRC)
• MGMbill.org
• Doctors Opposing Circumcision

Criticism of opposition to circumcision

• "Anti-Circumcision Lobby Groups"
• "Myths, Lies and Half-Truths About Male Circumcision

Circumcision advocates

• The Benefits of Male Circumcision by Dr David Hawker, General Practitioner, UK
• Medical Benefits of Circumcision by Professor Brian Morris, Australia
• Circumcision: a lifetime of medical benefits by Dr. Edgar J. Schoen, USA
• Operation Abraham
• Clearinghouse on Male Circumcision for HIV Prevention

Critics of circumcision advocacy

• Myths about circumcision
• Circumcision Positions of Advocates and Critics
• Circumcision: The Step to Becoming a REAL Man