Circumcision

Circumcision is the removal of some or all of the foreskin (prepuce). The frenulum may also be removed at the same time, in a procedure called frenectomy. The word circumcision comes from Latin circum (meaning "around") and caedere (meaning "to cut"). Female circumcision is a term applied to a variety of procedures performed on the female genitalia. Except where specified, "circumcision" in this article should be taken as "male circumcision". Some opponents of this practice use the term male genital mutilation (MGM).

An intact or uncircumcised penis has not had the foreskin removed (the precise terminology is contentious since the driving factors for circumcision are generally either religious or cultural rather than medical). In sexual terms, particularly American gay subculture, the word uncut is also often used. As a religious term, "uncircumcised" describes someone not Jewish, or, metaphorically and considerably less commonly, a non-Christian. As used in the New Testament, it can refer to non-believers of either gender, regardless of physical circumcision. See Gentile. The term 'uncircumcised' is sometimes also applied to a woman who has not undergone female genital cutting.

See images:

intact penis

intact penis with foreskin retracted

Reasons for circumcision

Circumcision is performed for religious, aesthetic, cultural, or medical reasons, or as a form of body modification.

Religious and cultural circumcision

Circumcision is a religious practice traditionally required by Judaism, usually performed in a ceremony called a Brit milah or Bris Milah (Hebrew for "Covenant of circumcision" or "Covenant of the word"). The ceremony is to be performed on the eighth day after birth of the newborn boy unless health reasons force a delay. A trained professional, called a mohel, performs the ceremony. The first circumcision was said to have been conducted by the earliest Jewish settlers in what is modern day Syria, using very thin reeds of the papyrus plant in a practice adapted from an Egyptian method of skinning sugar cane. See also: Circumcision in the Bible.

Islam stresses cleanliness and considers circumcision a form of natural hygiene. Although circumcision is not mentioned in the Qur'an, it is mentioned in some parts of the Hadith. Fiqh scholars differ in their opinion about the compulsion of circumcision in Shariah, depending on which Hadith are accepted and how they are interpreted. According to Imam Abu Hanifa, Imam Malik and a majority of others it is a recommended practice (Sunnah), while some scholars including Imam Shafi, consider it obligatory. Muslim custom on circumcision varies. Some Muslim communities perform circumcision on the eighth day of life, as the Jews do, while others perform the rite at a different time. Turkish, Balkan, and Central Asian Muslims typically circumcise boys between the ages of six and eleven and the event is viewed communally as a joyous occasion and celebrated with sweets and feasting. In contrast, Iranian Muslims are typically circumcised in the hospital at birth without much ado. In Egypt, farmers in rural areas celebrate circumcision as a joyous occasion, while in urban populations, as in many industrialized countries such as the USA, the procedure is routinely performed at a hospital. Kamyar et al describe it as an 'obligatory custom', and note that it is not necessary for the circumciser to be a Muslim.[1]

Circumcision is also customary in the Coptic Christian and Ethiopian Orthodox religious traditions. It is usually performed on the eighth day of life. This practice was condemned by the Council of Florence [2] in 1442, held by leading theologians of the Roman Catholic Church, which said in part:

Therefore it strictly orders all who glory in the name of Christian, not to practise circumcision either before or after baptism, since whether or not they place their hope in it, it cannot possibly be observed without loss of eternal salvation. [3]

Circumcision is also common in a number of African and Australian Aboriginal tribal traditions. Among some West African animist groups, such as the Dogon and Dowayo, it is taken to represent a removal of "feminine" aspects of the male, turning boys into fully masculine males. Among Nilotic peoples, such as the Nandi, circumcision is a rite of passage observed collectively by a number of boys every few years, and boys circumcised at the same time are taken to be members of a single age set. Aboriginal circumcision ceremonies, which also constitute a rite of passage, are noted for their painful nature, including subincision for some tribes.

The United States, the Philippines and South Korea are the only countries that still practice circumcision routinely on a majority of males for non-religious reasons. Routine circumcision practices in South Korea are largely the result of American cultural and military influence following the Korean War. The origin of the practice in the Philippines is uncertain according to one newspaper article [4]. However, Antonio de Morga's "History of the Philippine Islands" (1907) attributes circumcision to Islamic influence [5].

Medical circumcision

Circumcision may be necessary to treat penile cancer [6]. While less invasive treatments for phimosis (a very tight foreskin), posthitis (an inflamed foreskin) [7] and balanitis [8][9][10] exist, these are not as successful than circumcision in treating balanitis xerotica obliterans [11] [12] [13]. Circumcision may also be advised for recurrent urinary tract infections [14] and Zoon's balanitis [15].

A Kenyan study published in 1989 in The Lancet , a British medical journal, showed that intact men were many-fold more likely than circumcised men to contract HIV at the same time as acquiring another sexually transmitted disease in a high-risk setting of commercial sex (prostitution). A South African controlled clinical trial published in 2005 found that circumcision reduces the transmission of HIV (the virus that causes AIDS) by 61%[16]. The study was terminated early for ethical reasons as the effect was striking, and so that circumcision could be offered to the control group. However, The Lancet declined to publish the report. At issue, authors Auvert and Puren told Science, "is a disagreement on ethics that involves how participants learned their HIV status and the counselling they received." Some fear that if circumcision is touted as an effective way to reduce HIV infection rates, people could develop a false sense of security and be more likely to engage in sexual intercourse without latex condoms [17].

Several studies have shown that intact men are at greater risk of human papilloma virus (HPV) infection.[18] [19] [20] One study found no statistically significant difference between men with foreskins for HPV infection than those who are circumcised, but did note a significantly higher incidence of HPV lesions and urethritis [21]. Some strains of HPV are known to cause cervical cancer. Circumcised men are thought to be less likely to infect their partners. Further, many medical studies have found that being circumcised reduces a man's risk of developing penile cancer [22]. However, some of these studies compare different cultures that may have other reasons for disparate cancer rates, such as a genetic predisposition or dietary and other lifestyle and hygiene differences. Many of the studies often quoted date from a time when households were not equipped with sanitation as they are today, meaning that frequent showering and bathing, (and by inference, increased sub-preputial hygiene), were not possible, and sexual education was much more restricted.

Circumcising infants as a disease preventative measure is controversial. While some argue that circumcision is a significant public health measure, preventing dozens of different infections, others assert that there are no net benefits to the procedure, that the drawbacks outweigh the benefits or that the procedure should be discouraged or banned. The possible catastrophic complications of a poorly carried out circumcision, or of post-operative bleeding or infection, are not to be taken lightly. All surgery carries a risk. The American Academy of Pediatrics argues that parents should make an informed decision based upon the medical and other benefits and risks[23]. For a detailed discussion, see medical analysis of circumcision.

Circumcision and body modification

Circumcision may be undertaken voluntarily as a body modification. (See also foreskin restoration).

Risks of circumcision

As with all surgical procedures, circumcision has associated risks. The incidence of complications is unknown, but the American Academy of Pediatrics notes that the rate appears to be 0.2% to 0.6%, mostly consisting of minor complications.[24] More rarely, severe complications may occur.

For more information, please see medical analysis of circumcision#Possible risks of circumcision.

History of circumcision

Main article: History of male circumcision

It has been variously proposed that circumcision began as a religious sacrifice, as a rite of passage marking a boy's entrance into adulthood, as a form of sympathetic magic to ensure virility, as a means of suppressing (or enhancing) sexual pleasure, as an aid to hygiene where regular bathing was impractical, as a means of marking those of lower (or higher) social status, as a means of differentiating a circumcising group from their non-circumcising neighbors, as a means of discouraging masturbation or other socially proscribed sexual behaviors, to increase a man's attractiveness to women, as a symbolic castration, as a demonstration of one's ability to endure pain, or as a male counterpart to menstruation or the breaking of the hymen. It is possible that circumcision arose independently in different cultures for different reasons.

Circumcision in the Ancient World

The oldest documentary evidence for circumcision comes from Egypt. Tomb artwork from the Sixth Dynasty (2345 - 2181 BC) shows men with circumcised penises, and one relief from this period shows the rite being performed on a standing adult male. The Egyptian hieroglyph for "penis" depicts either a circumcised or an erect organ. The examination of Egyptian mummies has found some with foreskins and others who were circumcised.

Circumcision was common, although not universal, among ancient Semitic peoples. The Book of Jeremiah, written in the sixth century BC, lists the Egyptians, Jews, Edomites, Ammonites, and Moabites as circumcising people. Herodotus, writing in the fifth century BC, would add the Colchians, Ethiopians, Phoenicians, and Syrians to that list.

In the aftermath of Alexander the Great's conquests, Greek dislike of circumcision led to a decline in its incidence among many peoples that had previously practiced it. The writer of 1 Maccabees wrote that under the Seleucids, many Jewish men attempted to hide or reverse their circumcision so they could exercise in Greek gymnasia.

One example of pressure to circumcise in the Hellenistic world was when the Judean king John Hyrcanus conquered the Idumeans. He forced them to become circumcised and convert to Judaism, but their ancestors the Edomites had practiced circumcision in pre-Hellenistic times.

Circumcision in the Greco-Roman World

According to Hodges, ancient Greek aesthetics of the human form considered circumcision a mutilation of a previously perfectly shaped organ. Greek artwork of the period portrayed penises as covered by the foreskin (sometimes in exquisite detail), except in the portrayal of satyrs, lechers, and barbarians.[25]

This dislike of the appearance of the circumcised penis led to a decline in the incidence of circumcision among many peoples that had previously practiced it throughout Hellenistic times. In Egypt, only the priestly caste retained circumcision, and by the second century, the only circumcising groups in the Roman Empire were Jews and Proselytes, Egyptian priests, and the Nabatean Arabs. Circumcision was sufficiently rare among non-Jews that being circumcised was considered conclusive evidence of Judaism (or early Christianity and others derogatively called Judaizers) in Roman courts—Suetonius in Domitian 12.2 [26] described a court proceeding in which a ninety-year-old man was stripped naked before the court to determine whether he was evading the head tax placed on Jews and Judaizers. The first-century Alexandrian Apion denounced circumcision as a barbaric custom in his diatribe against the Jews, notwithstanding that it was still practised among the Egyptian priestly caste.

Roman satirists including Horace and Juvenal equated the exposure of the glans that results from circumcision to its exposure during erection, and they caricatured Jewish men as being lustful or lecherous, sometimes in an incestuous or homosexual sense, often implying that Jewish men had unusually large penises and were of great sexual potency.

Techniques for restoring the appeareance of a foreskin were known by the 2nd century B.C. In one such technique, a copper weight (called the Judeum pondum) was hung from the remnants of the circumcised foreskin until, in time, they became sufficiently stretched to cover the glans. The first-century writer Celsus described two surgical techniques for foreskin restoration in his medical treatise De Medicina. [27] In one of these, the skin of the penile shaft was loosened by cutting in around the base of the glans. The skin was then stretched over the glans and allowed to heal, giving the appearance of an intact penis. Jewish religious writers denounced such practices as abrogating the covenant of Abraham in 1 Maccabees and the Talmud [28]. Because of these attempts, and for other reasons, the Pharisees, ca. 100, added two more steps to the Biblical rite of circumcision:

Brit Peri'ah, which went beyond the relatively simple and Biblical trimming of excess foreskin, and stripped the mucosal lining of the foreskin back to the coronal sulcus.
Brit Mezizah, by which the trained circumciser ("mohel") fills his mouth with wine and sucks the wound made by the circumcision; the saliva acts as an anti-bacterial agent, preventing infection. This step is no longer done by mouth, except in the ultra-Orthodox Jewish community.

Circumcision was an important issue for first century Jews and Christians. Flavius Josephus in Jewish Antiquities book 20 [29], chapter 2 recorded the story of King Izates who decided to follow the Law of Moses at the advice of a Jewish merchant named Ananias. He was going to get circumcised, but his mother, Helen, who herself embraced the Jewish customs, advised against it on the grounds that the subjects wouldn't stand to be ruled by someone who followed such "strange and foreign rites". Ananias likewise advised against it, on the grounds that worship of God was superior to circumcision (Robert Eisenman in James the Brother of Jesus claims that Ananias is Paul of Tarsus who held similar views) and that God would forgive him for fear of his subjects. So Izates decided against it. However, later, "a certain other Jew that came out of Galilee, whose name was Eleazar", who was well versed in the Law, convinced him that he should, on the grounds that it was one thing to read the Law and another thing to practice it, and so he did. Once Helen and Ananias found out, they were struck by great fear of the possible consequences, but as Josephus put it, God looked after Izates. As his reign was peaceful and blessed, Helen visited the Jerusalem Temple to thank God, and since there was a terrible famine at the time, she brought lots of food and aid to the people of Jerusalem.

There was also division in Pharisaic Judaism between Hillel the Elder and Shammai on the issue of circumcision of proselytes.

The Council of Jerusalem in Acts of the Apostles 15 addressed the issue of whether circumcision was required of new converts. Both Simon Peter and James the Just spoke against requiring circumcision in Gentile converts and the Council ruled that circumcision was not necessary. However, Acts 16 and many references in the letters of Paul of Tarsus show that the practice was not immediately eliminated. Paul, who was said to be directly responsible for one man's circumcision in Acts 16:1-3 and who appeared to praise Jewish circumcision in Romans 3:2, said that circumcision didn't matter in 1 Corinthians 7:19 and then increasingly turned against the practice, accusing those who promoted circumcision of wanting to make a good showing in the flesh and boasting or glorying in the flesh in Galatians 6:11-13. In a later letter, Philippians 3:2, he is repored as warning Christians to beware the "mutilation". Circumcision was so closely associated with Jewish men that Jewish Christians were referred to as "those of the circumcision" (e.g. Colossians 3:20) [30] or conversely Christians who were circumcised were refered to as Jewish Christians or Judaizers.

The Gospel of Thomas saying 53, said to be of Jesus, states:

"His disciples said to him, "is circumcision useful or not?" He said to them, "If it were useful, their father would produce children already circumcised from their mother. Rather, the true circumcision in spirit has become profitable in every respect."" SV [31]

Parallels to Thomas 53 are found in Paul's Romans 2:29, Philemon 3:3, 1 Corinthians 7:19, Galatians 6:15, Colossians 2:11-12.

Medical circumcision in the 19th century and early 20th century

Until 1870, medical circumcisions were performed to treat conditions local to the penis: phimosis, balanitis, and penile cancer. In that year, Lewis Sayre, a prominent New York orthopedic surgeon and vice president of the newly-formed American Medical Association, examined a five-year-old boy who was unable to straighten his legs, and whose condition had so far defied treatment. Upon noting that the boy's genitals were inflamed, Sayre hypothesized that chronic irritation of the boy's foreskin had paralyzed his knees via reflex neurosis. Sayre circumcised the boy, and within a few weeks, he recovered from his paralysis. After several additional incidents in which circumcision also appeared effective in treating paralyzed joints, Sayre began to promote circumcision as a powerful orthopedic remedy.

Sayre's prominence within the medical profession allowed him to reach a wide audience. He lectured widely in the United States and the United Kingdom, and his ideas influenced physicians throughout the English-speaking world. As more practitioners tried circumcision as a treatment for otherwise intractable medical conditions, sometimes achieving positive results, the list of ailments reputed to be treatable through circumcision grew. By the 1890s, hernia, bladder infections, kidney stones, insomnia, chronic indigestion, rheumatism, epilepsy, asthma, bedwetting, Bright's disease, erectile dysfunction, syphilis, insanity, and skin cancer had all been linked to the foreskin, and many physicians advocated universal circumcision as a preventive health measure.

Specific medical arguments aside, several hypotheses have been raised in explaining the American public's acceptance of infant circumcision as preventive medicine. The success of the germ theory of disease had not only enabled physicians to combat many of the postoperative complications of surgery, but had made the wider public deeply suspicious of dirt and bodily secretions. Accordingly, the smegma that collects under the foreskin was viewed as unhealthy, and circumcision readily accepted as good penile hygiene.[32] Secondly, moral sentiment of the day regarded masturbation as not only sinful, but also physically and mentally unhealthy, stimulating the foreskin to produce the host of maladies of which it was suspected. In this climate, circumcision could be employed as a means of discouraging masturbation.[33] All About the Baby, a popular parenting book of the 1890s, recommended infant circumcision for precisely this purpose. Ironically, a 1410-man survey in the United States in 1992, Laumann found that circumcised men were more likely to report masturbating at least once a month (though the 47% rate for circumcised men and 34% rate for intact men are both low enough that it's clear that the only difference revealed was in admitting to masturbating. Any difference in actual frequency of masturbation remains unknown.) Thirdly, with the proliferation of hospitals in urban areas, childbirth, at least among the upper and middle classes, was increasingly undertaken in the care of a physician in a hospital rather than that of a midwife in the home. It has been suggested that once a critical mass of infants were being circumcised in the hospital, circumcision became a class marker of those wealthy enough to afford a hospital birth.[34]

During the same time period, circumcision was becoming easier to perform. William Halstead's 1885 discovery of hypodermic cocaine as a local anaesthetic made it easier for doctors without expertise in the use of chloroform and other general anaesthetics to perform minor surgeries. Also, several mechanically-aided circumcision techniques, forerunners of modern clamp-based circumcision methods, were first published in the medical literature of the 1890s, allowing surgeons to perform circumcisions more safely and successfully.

By the 1920s, advances in the understanding of disease had undermined much of the original medical basis for preventive circumcision. Doctors continued to promote it, however, as good penile hygiene and as a preventive for a handful of conditions local to the penis: balanitis, phimosis, and penile cancer.

Routine infant circumcision was taken up in the English-speaking parts of Canada, the United States and Australia, and to a lesser extent in New Zealand and the United Kingdom. Although it is difficult to determine historical circumcision rates, one estimate[35] of infant circumcision rates in the United States holds that 30% of newborn American boys were being circumcised in 1900, 55% in 1925, and 72% in 1950.

Circumcision since 1950

In 1949, a lack of consensus in the medical community as to whether circumcision carried with it any notable health benefit motivated the United Kingdom's newly-formed National Health Service to remove routine infant circumcision from its list of covered services. One factor in this rejection of circumcision may have been Douglas Gardiner's famous paper, 'The fate of the foreskin' which revealed that for the years 1942–1947, about 16 children per year had died because of circumcision in England and Wales.[36] Since then, circumcision has been an out-of-pocket cost to parents, and the proportion of newborns circumcised in England and Wales has fallen to less than one percent.

In Canada, individual provincial health services began delisting circumcision in the 1980s. At present, only Manitoba pays for the procedure. The infant circumcision rate in Canada has fallen from roughly half in the 1970s to its present value of 13%, albeit with strong regional variations.[37]

In South Korea, circumcision was largely unknown before the establishment of the United States trusteeship in 1945 and the spread of American influence. More than 90% of South Korean high school boys are now circumcised, but the average age of circumcision is 12 years [38].

In South Africa circumcision has roots in several belief systems and is performed much of the time to teen aged males : "...The young men in the eastern Cape belong to the Xhosa ethnic group for whom circumcision is considered part of the passage into manhood... A law was recently introduced requiring initiation schools to be licensed and only allowing circumcisions to be performed on youths aged 18 and older. But Eastern Cape provincial Health Department spokesman Sizwe Kupelo told Reuters news agency that boys as young as 11 had died. Each year thousands of young men go into the bush alone, without water, to attend initiation schools. Many do not survive the ordeal..." [39].

In the United States, it is unclear whether circumcision rates are rising or falling. A recent study found that circumcision rates had significantly increased since 1988.[40] However, statistics collected by the National Center for Health Statistics show that the overall rate of neonatal circumcision has gone down recently, and has fallen from 64% in 1979 to 60% in 2002.[41] Strong regional differences in the circumcision rates have developed during this time. While almost 80% of newborn boys are circumcised in the Midwest and South, circumcision rates have declined to only 31.4% in 2003 in the West [42]. This has been attributed in part to increasing births among Latin Americans, who usually do not circumcise [43]. As of August 2005, 16 states have abolished payment for the procedure under Medicaid; 34 states still allow circumcision to be funded with taxpayers' money (see map).

The major medical societies in Britain, Canada, Australia and New Zealand do not support routine non-therapeutic infant circumcision. Major medical organizations in the United States state that parents should decide what is in their child's best interests, declining to make a recommendation one way or another. Neonatal circumcision remains the most common pediatric operation carried out in the U.S. today.

**Table 1: International circumcision rates**
Country	Year	Neonatal circumcisions (%)
United States	1999	65.3% [44]
Canada	2003	11.5% [45]
Australia	2004	12.7% [46]
New Zealand	1995	0.35%* [47]
United Kingdom	1972	0.41% [48]
*Samoans, Tongans and Niueans in New Zealand continue to practice circumcision, but not in public hospitals, to which these data refer.

Emotional impact of circumcision and non-circumcision

Much attention has been given to the emotional impact of female genital cutting. The emotional impact of circumcision will vary from person to person and depend on cultural context and other factors. Issues about the rights of the child are often overlooked, as is the possibility that circumcision causes emotional harm to some males.

Two large-scale internet surveys have found that the percentages of circumcised and intact males dissatisfied with their status are approximately equal.[49] [50] The second survey found 12.2% of the circumcised males opposed to 10.6% of the intact males dissatisfied with their status. The only formal study in the literature, by Schlossberger et al., found that in a group of 73 boys aged 12-14 the 59 circumcised boys scored higher on satisfaction items.[51] This study was done in a culture which had circumcision as the norm.

The state of non-circumcision can usually be rectified, to the satisfaction of the dissatisfied individual, by having the operation as a consenting adult. However, the individual will have the pain and memory of the adult operation, rather than as an unremembered infant experience. The individual aggrieved at having been circumcised, very often without his consent, is unable to replace the removed prepuce, and restoration using extension of the remaining skin will not replace the missing nerve endings of the original foreskin.

Support groups

There are an increasing number of support groups for circumcised males that are dissatisfied with their circumcised state. These groups often advocate foreskin restoration. There are also support groups for men dissatisfied with being intact, and considering adult circumcision.

The issue of consent is of particular relevance to circumcision because it is often done to infants, who are unable to consent to this, or indeed any other, medical procedure. The decision, therefore, must fall to the child's caregiver(s).

Debate also focuses on what limits, if any, should be placed on a caregiver's ability to make a decision for a boy about a painful (and, some argue, mutilating) procedure with disputed immediate medical value that may be unwanted later in life. Some question the apparent inconsistency in allowing male circumcision but in prohibiting female genital cutting [52]. Some suggest that circumcision may cause emotional scarring later in life, and claim that the procedure should be left until the person is mature enough to make the choice for himself. Others think that the procedure is less traumatic when performed in infancy and do not wish to disturb the traditional right of parents to make medical decisions on behalf of their child.

Religious circumcision of minors

In some parts of the world it is customary or obligatory for minors to be circumcised for religious or cultural reasons. Many believe that this practice is protected by the principle of freedom of religion. Others disagree, arguing that no right has precedence over the rights of a child. Still others contend that freedom of religion only applies to belief, not action involving others.

Prevalence of circumcision worldwide

Estimates of the proportion of males that are circumcised worldwide vary from one sixth[53] to one third[54].

Except for Muslims and Jews, most males are not circumcised in:

India, South-East Asia, China, Europe and Latin America.

The majority of males are circumcised in the following countries, in most of which the predominant religion is Islam, which endorses circumcision:

Afghanistan, Albania, Algeria, Azerbaijan, Bahrain, Bangladesh, Benin, Bosnia and Herzegovina, Cameroon, Chad, Comoros, Djibouti, Egypt, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Indonesia, Iran, Iraq, Israel, Kazakhstan, Kenya, Kuwait, Lebanon, Libya, Madagascar, Malaysia, Maldives, Mali, Mauritania, Morocco, Niger, Nigeria, Oman, Pakistan, Qatar, Republic of the Congo, Saudi Arabia, Sierra Leone, Somalia, "Somaliland", Sudan, Syria, Tajikistan, Tunisia, Turkey, "Turkish Republic of Northern Cyprus", Turkmenistan, United Arab Emirates, Uzbekistan, and Yemen.

In other countries where circumcision predominates it is endorsed by religion (Israel) or by local custom or tradition:

Philippines, Samoa, South Africa, South Korea, Togo, Tonga, The United States and Vanuatu

United States

Statistics from different sources give a somewhat different picture of the prevalence of circumcision in the United States.

The National Center for Health Statistics stated that the overall rate of neonatal circumcision was 64.3% in 1979 and 65.3% in 1999. However, the rate for white infants was 0.3% lower in 1999 than 1979 and the circumcision rate for black infants increased by 6.5% over this time [55]. Also, strong regional differences developed. In the West, circumcision declined from 63.9% to 36.7%, but this was counterbalanced by rises in the Midwest and South. [56] The decline in the West has been partly attributed to increasing births among Latin Americans, who usually do not circumcise [57].

A recent study, which used data from the Nationwide Inpatient Sample (a sample of 5-7 million of the nation's total inpatient stays, and representing a 20% sample taken from 8 states in 1988 and 28 in 2000), stated that circumcisions rose from 48.3% in 1988 to 61.1% in 1997.[58]

Figures from the Nationwide Hospital Discharge Survey (a sample of 270,000 inpatient stays), state that circumcision rates declined from 64.7% in 1980 to 59.0% in 1990, then rose to 64.1% in 1995, and fell again to 60.1% in 2002. Overall, the West saw the most significant change, declining from 61.8% in 1980 to 32.6% in 2002 (see Table 44, page 51 of the National Hospital Discharge Survey, 2002) [59].

Sixteen states no longer pay for the procedure under Medicaid [60]. One study in the Midwest of the US found that this had no effect on the newborn circumcision rate but it did affect the demand for circumcision at a later time.[61]

External links

General information

Circumcision. In: The Catholic Encyclopedia, 1905-1914.
Circumcision. In: The Jewish Encyclopedia, 1901-1906.
A Judaism-based view of circumcision

Circumcision opposition

National Organization of Circumcision Information and Resource Centers (NOCIRC)
Circumcision Resource Center
Circumcision Information and Resource Pages by Geoffrey T. Falk and George Hill
History of Circumcision Pages by Robert Darby PhD

Circumcision promotion

Benefits of circumcision: medical, health and sexual a literature review by Professor Brian Morris
Circumcision: a lifetime of medical benefits by Dr Edgar Schoen
Circuncisión en Español Circumcision discussion (in Spanish and English)
Circlist - A source of information on circumcision.

References

Billy Ray Boyd. Circumcision Exposed: Rethinking a Medical and Cultural Tradition. Freedom, CA: The Crossing Press, 1998. (ISBN 0-89594-939-3)
Anne Briggs. Circumcision: What Every Parent Should Know. Charlottesville, VA: Birth & Parenting Publications, 1985. (ISBN 0-9615484-0-1)
Robert Darby. A surgical temptation: The demonization of the foreskin and the rise of circumcision in Britain. Chicago: University of Chicago Press, 2005. (ISBN 0-226-13645-0)
Aaron J. Fink, M.D. Circumcision: A Parent's Decision for Life. Kavanah Publishing Company, Inc., 1988. (ISBN 0-962-13470-8)
Paul M. Fleiss, M.D. and Frederick Hodges, D. Phil. What Your Doctor May Not Tell You About Circumcision. New York: Warner Books, 2002. (ISBN 0-446-67880-5)
Leonard B. Glick. Marked in Your Flesh: Circumcision from Ancient Judea to Modern America. New York: Oxford University Press, 2005. (ISBN 0-19-517674-X)
David L. Gollaher. Circumcision: A History of the World's Most Controversial Surgery. New York: Basic Books, 2000. (ISBN 0-456-04397-6)
Ronald Goldman, Ph.D. Circumcision: The Hidden Trauma. Boston: Vanguard, 1996. (ISBN 0-964-44895-3-8)
Brian J. Morris, Ph.D., D.Sc. In Favour of Circumcision. Sydney: UNSW Press, 1999. (ISBN 0-86840-537-X)
Rosemary Romberg. Circumcision: The Painful Dilemma. South Hadley, MA Bergan & Garvey, 1985. (ISBN 0-897-89073-6)
Edgar J Schoen, M.D. Ed Schoen, MD on Circumcision. Berkeley, CA: RDR Books, 2005. (ISBN 1-57143-123-3)
Edward Wallerstein. Circumcision: An American Heath Fallacy. New York: Springer, 1980 (ISBN 0-826-13240-5)
Gerald N. Weiss M.D. and Andrea W Harter. Circumcision: Frankly Speaking. Wiser Publications, 1998. (ISBN 0-966-72190-X)Template:Link FA