Circumcision

Disease prevention Approximately half of all circumcisions worldwide are performed for reasons of prophylactic healthcare. 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. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) 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. 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 a method of controlling the spread of HIV. The World Health Organization (WHO), UNAIDS, and American medical organizations take the position that its prophylactic health benefits outweigh the risks, while European, Australian, and New Zealand medical organizations generally hold that its medical benefits are insufficient to justify it. The American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Centers for Disease Control and Prevention have said that circumcision's potential benefits outweigh the risks. In 2010, the World Health Organization said: Pathologies Circumcision is also used to treat various pathologies. These include pathological phimosis, refractory balanoposthitis and chronic or recurrent urinary tract infections (UTIs). == Contraindications ==

Circumcision is contraindicated in certain cases. These include infants with certain genital structure abnormalities, such as a misplaced urethral opening (as in hypospadias and epispadias), curvature of the head of the penis (chordee), or ambiguous genitalia, because the foreskin may be needed for reconstructive surgery. Circumcision is contraindicated in premature infants and those who are not clinically stable and in good health. If a person 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. ==Technique==

. After the operation, the glans is exposed even when the penis is flaccid. The foreskin is the double-layered fold of tissue at the distal end of the human penis that covers the glans and the urinary meatus. For infants, healing is usually complete within one week. Removal of the foreskin For infant circumcision, devices such as the Gomco clamp, Plastibell and Mogen clamp are commonly used in the USA. Pain management The circumcision procedure causes pain, and for neonates this pain may interfere with mother-infant interaction or cause other behavioral changes, During the proliferative and remodeling phases of recovery, the body undergoes angiogenesis (the formation of new blood vessels) and lymphangiogenesis. The vascular and lymphatic networks are gradually reconstructed to establish new collateral drainage pathways across the surgical boundary. As this structural tissue remodeling matures over the weeks following the procedure, the post-operative swelling resolves and physiological fluid balance is restored to the penile skin. ==Effects==

Sexually transmitted infections Human immunodeficiency virus 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 warts, 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. It also decreases the likelihood of multiple infections. Although genital warts are caused by a type of HPV, there is no statistically significant relationship between being circumcised and the presence of genital warts. At birth, the foreskin cannot be retracted due to adhesions between the foreskin and glans, and this is considered normal (physiological phimosis). 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. Steroid creams are also a reasonable option and may prevent the need for surgery including in those with mild BXO. The procedure may also be used to prevent the development of phimosis. An inflammation of the glans penis and foreskin is called balanoposthitis, and the condition affecting the glans alone is called balanitis. Only 1% of males have phimosis by age 17. There is also 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. Women's health A 2017 systematic review found consistent evidence that male circumcision before heterosexual contact was associated with a decreased risk of cervical cancer, cervical dysplasia, HSV-2, chlamydia, and syphilis among women. The evidence was less consistent in regard to an association of circumcision with women's risk of HPV and HIV. Sexual effects The accumulated data show circumcision has no adverse physiological effect on sexual pleasure, function, desire, or fertility. There is some evidence that circumcision has no effect on pain with intercourse, premature ejaculation, intravaginal ejaculation latency time, erectile dysfunction, or difficulties with orgasm. There are popular misconceptions that circumcision benefits or adversely affects the sexual pleasure of the circumcised person. "medical studies do not support circumcision as having an impact on sexual function or satisfaction for partners of circumcised individuals". ==Adverse effects==

Neonatal circumcision is generally a safe, low-risk procedure when done by an experienced practitioner. Severe complications are rare. Significant acute complications happen rarely, 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. For adult men who have been circumcised, there is a risk that the circumcision scar may be tender. There is no good evidence that circumcision affects cognitive abilities. ==History==

The word circumcision is from Latin , meaning "to cut around". Depictions of circumcised penises are found in Paleolithic art, predating the earliest signs of trepanation. 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 Central Sahara, Sudan and Ethiopia, the procedure was practiced by the ancient Egyptians and the Semites, and then by the Jews and Muslims. In Oceania, circumcision is practiced by the Australian Aboriginals and Polynesians. 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. 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. Some ancient Egyptian mummies, which have been dated as early as 4000 BCE, show evidence of circumcision. Evidence suggests that circumcision was practiced in the Middle East by the fourth millennium BCE, when the Sumerians and the Semites moved into the area that is modern-day Iraq from the North and West. 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. 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. 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. While the circumcision of Jesus is celebrated as a feast day in the liturgical calendar of many Christian denominations. The practice of circumcision is thought to have been brought to the Bantu-speaking tribes of Africa by either the Jews after one of their many expulsions from European countries, or by Muslim Moors escaping after the 1492 reconquest of Spain. 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. In Southeast Asia, evidence suggests that indigenous forms of genital cutting predate the arrival of Islam. In the Indonesian archipelago, a traditional incision practice existed prior to Islamization; scholarly research has shown that this was progressively replaced by full circumcision following the adoption of Islam, a process accelerated in the late 19th century when Meccan jurists issued fatwas disapproving of the older local practice. In the Philippines, the traditional practice of tuli historically involved a dorsal slit rather than full circumcision, a form similar to practices among Pacific Islanders, suggesting an indigenous origin distinct from Islamic influence. The antiquity of circumcision in the region is further evidenced by the fact that Makassan traders from Sulawesi are recorded as having introduced circumcision to Aboriginal communities in Arnhem Land, Australia. With the spread of Islam across the archipelago from the 13th century onward, indigenous cutting practices were largely absorbed into or replaced by Islamic circumcision. Prophylactic circumcision Anglophonic adoption (1855–1918) physician Jonathan Hutchinson in 1855. By the late 19th century, the belief that circumcision acted as an effective prophylactic against disease was held by a majority of the core Anglosphere's medical communities and doctors, such as the prominent Lewis Sayre, president of the American Medical Association, subsequently leading to its widespread adoption. 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 physician Jonathan Hutchinson published his findings that, among his venereal disease patients, Jews had a lower prevalence of syphilis. Hutchinson suggested that circumcision lowers the risk of contracting syphilis. Pursuing a successful career as a general practitioner, Hutchinson went on to advocate circumcision for the next fifty years, 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. By the late 19th century, circumcision had become common throughout the 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. originally 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. 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. Modernity (since 1985) An association between circumcision and reduced heterosexual HIV infection rates was first suggested in 1986. WHO assessed these as "gold standard" studies and found "strong and consistent" evidence from later studies that confirmed the results of the studies. 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. 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. ==Society and culture==

Circumcision is one of the oldest surgical procedures in human history, and remains a highly emotional and controversial issue. Many societies hold a wide ranging perspectives and different cultural, ethical, or social views on circumcision. Islamic, The mitzvah of circumcision on the eighth day of life is considered among the 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 world to come. The basis for its observance is found in the Torah of the Hebrew Bible, in Genesis chapter 17, in which a covenant of circumcision is made with Abraham household and his descendants. Jewish circumcision is part of the ritual, to be performed by a trained ritual circumciser, a , on the eighth day of a newborn son's life, with certain exceptions for poor health. Jewish law requires that circumcision leaves the glans bare when the penis is flaccid. Mainstream Judaism foresees serious negative spiritual consequences if it is neglected. Though there are certain exceptions for those with poor health. The Reform and Reconstructionist movements generally do not require a circumcision as part of the conversion process. However, most streams of non-Orthodox Judaism allow female , called (, the plural of , feminine of ), without restriction. In 1984 Deborah Cohen became the first certified Reform ; she was certified by the Berit Mila program of Reform Judaism. All major rabbinical organizations recommend that male infants should be circumcised. The issue of converts remains controversial in Reform and Reconstructionist Judaism. Brit shalom (Hebrew: ברית שלום; "Covenant of Peace"), also called alternative brit to the practice of brit milah, is a naming ceremony for Jews that does not involve circumcision. The first known ceremony is said to have been celebrated around 1970 by Rabbi Sherwin Wine, the founder of the Society for Humanistic Judaism. Although increasingly many U.S. Jews have chosen not to circumcise their sons, a study by The Jewish Journal in the Greater Los Angeles area found brit shalom to be extremely rare. Islam (present-day Indonesia), colonial era. , 2013 Islamic scholars have diverse opinions on the obligatory nature of male circumcision, with some considering it mandatory (wājib), while others view it as only being recommended (sunnah). According to historians of religion and scholars of religious studies, the Islamic tradition of circumcision was derived from the Pagan practices and rituals of pre-Islamic Arabia. 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). Christianity Traditionally, circumcision has not been practiced by Christians for religious reasons. The practice was viewed as succeeded by Baptism and the New Testament chapter Acts 15 recorded that Christianity did not require circumcision from new converts. 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, and maintains a neutral position on the practice of circumcision for other reasons. 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. and generally boys undergo circumcision shortly after birth as part of a rite of passage. and they practice circumcision as a rite of passage. Some Christian churches in South Africa disapprove of the practice, while others require it of their members. Christian communities in Africa, some Anglosphere countries, the Philippines, the Middle East, South Korea and Oceania have high circumcision rates, while Christian communities in Europe and South America have low circumcision rates, although none of these are performed out of perceived religious obligation. Scholar Heather L. Armstrong writes that, about half of Christian males worldwide are circumcised, with most of them being located in Africa, Anglosphere countries, and the Philippines. Druze faith child Circumcision is widely practiced by the Druze, who practice Druzism, an Abrahamic, monotheistic, syncretic, and ethnic religion. The procedure is a cultural tradition and has no religious significance in Druzism. There is no special date for it; male infants are usually circumcised shortly after birth, Samaritanism Like Judaism, the religion of Samaritanism requires ritual circumcision on the eighth day of life. Mandaeism Circumcision is forbidden in Mandaeism, and Mandaeans consider it abhorrent. According to Mandaean doctrine, a circumcised man cannot serve as a Mandaean priest. Yazidism Circumcision is not required in Yazidism, but is practised by some Yazidis due to regional customs. 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 lifelong formal relationship. Indian religions Hinduism , male sex organ-placed on yoni, female sex organ. In Hinduism, lingam and yoni represent the masculine and the feminine creative principles respectively. In Hinduism, the Upanishads say that the nature of the higher self (Brahman), in essence, is bliss (ānanda), which the self in each being (Atman) experiences during dreamless deep sleep but remains unconscious of, consciously experiencing it during sensual activity. The Brihadaranyaka Upanishad says that in humans, genitals are the "single locus of pleasure (ānanda)". In Sanskrit literature, the penis is called Upastha ("that which stands up") and is traditionally considered a "source of great power or vitality (ojas)." In Yoga physiology, the penis corresponds with svadhishthana chakra, and channels the flow of nadis, which enable higher sensations and consciousness. Consequently, circumcision, or even an interference with a tight foreskin, is strictly forbidden in Hindu traditions. Sikhism Sikhism does not require circumcision of its followers and strongly criticizes the practice. The Guru Granth Sahib criticizes circumcision in a hymn. The holy book of Sikhs, dating to 1708, bans circumcision as an Islamic custom, saying: "If God wished me to be a Muslim, it would be cut off by itself." Buddhism Buddhism neither requires nor prohibits circumcision, and it contains no canonical injunction regarding circumcision; the Pali Vinaya, which governs monastic conduct in detail, makes no mention of the practice. The 10th of the 32 attributes of an enlightened person is possibly a reference to circumcision: "His sexual organs are concealed in a sheath and exude a pleasant odor similar to vanilla."The ceremony, known as sünnet düğünü (circumcision celebration) in Turkey, is typically one of the most important events in a boy's life, often rivaling weddings in scale and expense. Boys are usually circumcised between the ages of 2 and 14, with the timing varying by region and family preference. The celebration commonly includes the boy wearing special ceremonial attire, often resembling a prince's costume or military uniform, and parading through the community on horseback or in a decorated vehicle. Among the Uyghurs, the tradition is called xetne toyi and remains an important rite of passage. In traditional practice, the ceremony was accompanied by feasting, music, and gift-giving, serving as an important occasion for community bonding and the affirmation of cultural identity.|250x250px Filipino culture In the Philippines, circumcision is known as "tuli" and is generally viewed as a rite of passage. 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". A circumcised eight- or ten-year-old is no longer considered a boy and is given more adult roles in the family and society. Ethics Regulations Worldwide, most polities have no laws about circumcision of males, Randi Gressgård, Researcher at the Centre for Women's and Gender Research (SKOK) at the University of Bergen, argued that politicians that supported Norway's proposed circumcision ban debated circumcision in a manner which constituted "ethnocentrism". 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. In Rwanda, circumcision has been found to be cost-effective across a wide range of age groups from newborn to adult, A 2014 literature review found significant gaps in the literature on male and female sexual health that must be addressed for the literature to be applicable to North American populations. == References ==