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Circumcision

Circumcision is the surgical removal of some or all of the prepuce or foreskin of the penis of male humans. So-called "female circumcision" is a term applied to a variety of procedures performed on female genitalia, only one of which, the removal of the clitoral hood, is comparable to male circumcision. However, only the operation on males is discussed in the remainder of this article as "circumcision". An unrelated form of surgery practiced on the penis in some cultures is subincision.

Circumcision is an essential religious practice of Judaism. The Jewish ceremony of circumcision is called a Brit milah or Bris Milah (Hebrew for "Covenant of circumcision"). According to many Muslim religious leaders, circumcision is an important element of Islam (though the Koran proscribes body mutilation). Circumcision is also required in the Coptic Christian religious tradition. Circumcision also has been or continues to be an important part of religious and cultural practices for other ethnic and religious groups, including the ancient Egyptians and many African tribes.

From a global perspective, approximately one-sixth of males are circumcised [1] (http://www.cirp.org/library/complications/williams-kapila/). The United States is the only country that still practices circumcision routinely on a majority of infants for non-religious reasons.

Historically routine neonatal circumcision has also been widely practiced in Canada, Australia, New Zealand, and the United Kingdom. It has been argued (e.g. Goldman 1997) that the practice did not transcend English-speaking nations because others considered the arguments for it fallacious. In South Korea, circumcision was largely unknown before the establishment of the United States trusteeship in 1945. More than 90% of South Korean high school boys are now circumcised, but the average age of circumcision is 12 years, which makes South Korea a unique case [2] (http://www.cirp.org/library/cultural/pang1/).

Routine circumcision has been largely abandoned in New Zealand and Britain, and is now much less common in Australia and in Canada (see table 1). In most of the rest of the world, circumcision is known only as a religious ritual, a rare therapeutic procedure and a lifestyle choice.

Table 1
International circumcision rates
CountryYearRoutine neonatal circumcisions (%)
United States199762.8% [3] (http://www.cirp.org/library/statistics/USA/)
CanadaFY 1996/9717% [4] (http://www.cirp.org/library/statistics/Canada/)
Australia1995-9610.6% [5] (http://www.cirp.org/library/statistics/Australia/)
New Zealand19950.35%* [6] (http://www.cirp.org/library/statistics/NZ/)
United Kingdom19983.8% [7] (http://bmj.com/cgi/content/full/321/7264/792)
*The Samoan and Tongan tribes in New Zealand continue to practice circumcision as a ritual, but usually not in public hospitals, which this data refers to

The decline in circumcision in the United Kingdom has been explained with the decision by the National Health Service (NHS) in 1948 not to cover the procedure because of its perceived lack of proven medical benefits.

Circumcision in the United States grew out of the fear that the practice of masturbation leads to various diseases, a view that is now almost universally rejected in the medical community. Circumcision was considered effective in reducing the incidence of masturbation and other sexual behaviors considered undesirable (see below).

In the countries where it was practiced, various medical benefits were proposed, such as the prevention of epilepsy or a reduction in penile cancer; this scientific trend was started by many of the same authors who also advertised the effectiveness of circumcision against sexual misconduct. However, most of these originally alleged benefits have been shown not to exist.

More recent studies have reported different health benefits (and other studies have challenged these results), but most doctors now judge these benefits, if any, to be too small to justify the risk of using circumcision as a routine procedure. Nevertheless, neonatal circumcision remains the most common pediatric operation carried out in the U.S. today. See medical analysis of circumcision for a detailed discussion.

Table of contents

How circumcision is performed

In adults, circumcision is generally done under general anaesthetic, and the foreskin is partly removed with a sharp-bladed instrument of some kind. The remaining foreskin is then stiched back using dissolvable stitches. The penis is then wrapped in protective bandages and a jockstrap style harness to keep it in place.

The skin that was previously underneath the foreskin is very sensitive; some people are prone to bleeding. After the circumcision, the pain is controllable and goes away quickly during the day. Normally there is no distress when the penis is flacid, but the penis becomes partialy or fully erect one or more times each night. Thus, for the first week or two after an adult circumcision, the patient experiences a significant amount of pain during the erection. Some patients stay in a hospital for 1-2 nights after the operation. During this time, and for about a month afterwards, the skin is slowly desensitized.

Medical analysis of circumcision

Origins of circumcision

The origin of circumcision is hidden in the mists of pre-history; historians currently do not have information that would allow them to definitively say where and why this practice originated. It is possible that it arose as a religious ritual, as a form of sympathetic magic, as a health control measure, as a way to control the sexuality of children and adults, or as a way to to prevent masturbation. It is possible, if not likely, that it independently developed in different cultures for different reasons.

Desmond Morris offer this possibility: "The Egyptians believed that when the snake shed its skin, and emerged shiny and new again, it was undergoing rebirth. They reasoned that if, by shedding skin, the snake could become apparently immortal, then humans should follow suit. They made the simple equation: snakeskin = foreskin, and the operation began." Others, however, strongly question whether the snakeskin metaphor was the original motivation, and suggest that it may have been an after-the-fact justification.

Dunsmuir and Gordon write that "Nineteenth century historians suggested that the ritual is an ancient form of social control. They conceive that the slitting of a man's penis to cause bleeding and pain is to remind him of the power of the Church, i.e. 'We have control over your distinction to be a man, your pleasure and your right to reproduce'. The ritual is a warning and the timing dictates who is warned; for the new-born it is the parents who accede to the Church: 'We mark your son, who belongs to us, not to you'. For the young adolescent, the warning accompanies the aggrandisement of puberty; the time when growing strength give independence, and the rebellion of youth."

However, many modern historians would disagree, seeing this as a historical anachronism. Circumcision likely evolved before the development of modern organized religions, making such a reason impossible.

Some philosophers, including the Jewish philosophers Maimonides and Philo believe that the reason circumcision was commanded was to control the male's sexual impulses. Other Jewish philosophers hold that the reason is to seal in one's flesh a symbol of the covenant between God and the Jewish people.

Circumcision opponents tend to believe that circumcision was developed, and is still used, to control a child's sexuality, that this is the core motive behind circumcision, and that any other explanation as secondary or a pretexts.

Circumcision in the Bible

According to Judaism, the practice of ritual circumcision on male children is a commandment from God that Jews are obligated to follow; Jews do not believe that non-Jews are obligated to follow this commandment. Many Christians have the same understanding of this issue (i.e. that it is a law intended for Jews, but not for Christians.)

According to the Bible, circumcision was enjoined upon the biblical patriarch Abraham and his descendants as "a token of the covenant" concluded with him by God for all generations. The penalty of non-observance was karet, excision from the people (Gen. 17:10-14, 21:4; Lev. 12:3). Non-Israelites had to undergo circumcision before they could be allowed to partake of the feast of Passover (Ex. 12:48), or marry into a Jewish family (Gen. 34:14-16).

According to the Bible, it was "a reproach" for an Israelite to be uncircumcised (Josh. 5:9.) The name arelim (uncircumcised) became an opprobrious term, denoting the Philistines and other non-Israelites (I Sam. 14:6, 31:4; II Sam. i. 20) and used synonymously with tame (unclean) for heathen (Isa. 52:1). The word 'arel' (uncircumcised) is also employed for "unclean" (Lev. 26:41, "their uncircumcised hearts"; compare Jer. 9:25; Ezek. xliv. 7, 9); it is even applied to the first three years' fruit of a tree, which is forbidden (Lev. 19:23).

However, the Israelites born in the wilderness after the exodus from Egypt reportedly did not practice circumcision. As recorded in Josh. 5:2-9, "all the people that came out" of Egypt were circumcised, but those "born in the wilderness" were not. Therefore Joshua, before the celebration of the Passover, had them circumcised at Gilgal.

Deut. 10:16 says, "Circumcise the foreskin of your heart," thus giving the rite a spiritual meaning; circumcision as a physical act being enjoined nowhere in the whole book. Jer. 9:25, 26 says that circumcised and uncircumcised will be punished alike by the Lord; for "all the nations are uncircumcised, and all the house of Israel are uncircumcised in heart."

Cirucmcision in the 19th century

It is now generally understood that circumcision in the English-speaking countries arose in a climate of sexual fear, especially concerning masturbation. To which extent this masturbation fear was causative for the practice remains controversial, as other medical benefits were also promised. In her 1978 article The Ritual of Circumcision, Karen Erickson Paige writes: "In the United States, the current medical rationale for circumcision developed after the operation was in wide practice. The original reason for the surgical removal of the foreskin, or prepuce, was to control 'masturbatory insanity' - the range of mental disorders that people believed were caused by the 'polluting' practice of 'self-abuse.'"

"Self-abuse" was a term commonly used to describe masturbation in the 19th century. According to Paige, "treatments ranged from diet, moral exhortations, hydrotherapy, and marriage, to such drastic measures as surgery, physical restraints, frights, and punishment. Some doctors recommended covering the penis with plaster of Paris, leather, or rubber; cauterization; making boys wear chastity belts or spiked rings; and in extreme cases, castration." Paige details how circumcision became popular as a masturbation remedy:

"In the 1890s, it became a popular technique to prevent, or cure, masturbatory insanity. In 1891 the president of the Royal College of Surgeons in Great Britain published On Circumcision as Preventive of Masturbation, and two years later another British doctor wrote Circumcision: Its Advantages and How to Perform It, which listed the reasons for removing the 'vestigial' prepuce. Evidently the foreskin could cause 'nocturnal incontinence,' hysteria, epilepsy, and irritation that might 'give rise to erotic stimulation and, consequently, masturbation.' Another physician, P.C. Remondino, added that 'circumcision is like a substantial and well-secured life annuity...it insures better health, greater capacity for labor, longer life, less nervousness, sickness, loss of time, and less doctor bills.' No wonder it became a popular remedy. [8] (http://www.noharmm.org/paige.htm)

At the same time circumcisions were advocated on men, clitoridectomies (removal of the clitoris) were also performed for the same reason (to treat female masturbators). The US "Orificial Surgery Society" for female "circumcision" operated until 1925, and clitoridectomy and infibulation would continue to be advocated by some through the 1930s.

One of the leading advocates of circumcision was Harvey Kellogg[?], who is well known for his pseudo-scientific views on human sexuality. He advocated the consumption of Kellogg's corn flakes to prevent masturbation, and he believed that circumcision would be an effective way to eliminate masturbation in males.

"Covering the organs with a cage has been practiced with entire success. A remedy 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 an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. The soreness which continues for several weeks interrupts the practice, and if it had not previously become too firmly fixed, it may be forgotten and not resumed. If any attempt is made to watch the child, he should be so carefully surrounded by vigilance that he cannot possibly transgress without detection. If he is only partially watched, he soon learns to elude observation, and thus the effect is only to make him cunning in his vice."

The anti-circumcision movement

Several anti-circumcision groups have developed in recent years. Most of them term routine neonatal or ritual circumcision sexual mutilation of infants, and consider circumcision to be barbaric, primitive, unnecessary and/or dangerous. Some hold that circumcision is especially problematic when performed without anaesthesia on the infant, as is common, but most oppose circumcision in all cases.

The goal of most of these groups is to end, and possibly criminalize, circumcision. Anti-circumcision groups take a varying approach toward Judaism and Islam; while some make no distinction between differently motivated types of circumcision, others ask for reform instead of criminalization. [9] (http://www.noharmm.org/anti-semitism.htm) Most Jewish and Muslim groups oppose the anti-circumcision movement, as they fear that it could criminalize a key practice of their religions.

Some of the anti-circumcision groups include: BUFF (Brothers United for Future Foreskins), UNCIRC (UNCircumcising Information and Resources Center), NOHARMM (the National Organization to Halt the Abuse and Routine Mutilation of Males), and NORM (the National Organization of Restoring Men) and its predecessor, RECAP (Recover a Penis). One of the positions held by opponents of circumcision is that a significant part of the infant's body is unnecessarily and permanently removed without the subject's consent. Some have tried to challenge the legal status of circumcision.

There exists a group of men who oppose having been unconsentingly circumcised. Some are activists who try to inform people that the procedure is medically unnecessary, while others seek to regain their foreskin through medical procedures. Some of them attempt non-medical methods such as stretching the skin covering the distal penile shaft down over the glans penis through techniques such as wearing weights on it, or taping the skin over a small cap worn over the glans. This process is known as epispasm or foreskin restoration. They report to have some success, although a great deal of patience and consistency is required to have any permanent affect. Cosmetic surgical procedures to repair the foreskin also exist; but none of these methods can repair the erotogenic nerves that are severed during circumcision.

Few Jewish individuals have joined the anti-circumcision movement. Ronald Goldman[?] has collected arguments against circumcision in his book Questioning Circumcision: A Jewish Perspective. Based on many of the above arguments, he argues that circumcision is unnecessary and dangerous, and claims that foregoing the practice would be consistent with traditional and reformist Jewish ethics, while continuing it would not. The book has been strongly condemned by the Jewish community. Some Reconstructionist and Reform rabbis, who no longer follow Jewish law, have given it favorable reviews. A small number of Jews have joined a group called Jews Against Circumcision [10] (http://www.jewsagainstcircumcision.org/). People in this group and some other Jews opposed to the Brit Milah practice an alternative ritual called Brit Shalom which does not involve circumcision [11] (http://www.circumstitions.com/Jewish-shalom). Such alternative rituals are rejected by the mainstream Jewish community.

External links

  • Circumcision Information and Resource Pages (http://www.cirp.org), collects summaries and scientific studies on the subject of circumcision. The site is written from a moderate anti-circumcision position; source documents are sometimes commented, but not otherwise edited.
  • Circlist (http://www.circlist.com/circhome), a pro-circumcision website and discussion group
  • ACT inc. (http://www.act-now.org/), "Advocating Circumcision Today", a Jewish group that refers mohels for circumcisions
  • Intactivism (http://www.circumstitions.com/), a site which is strongly opposed to circumcision and collects arguments on the subject
    • Circumcision and HIV (http://www.circumstitions.com/HIV) - criticism of studies regarding a link between circumcision and HIV transmission
  • Foreskin.org (http://www.foreskin.org/page2.htm), collects explicit images and related material regarding the intact male foreskin
  • The Case for Labectomy (http://hcsoftware.sourceforge.net/jason-rohrer/writing/nonfiction/labectomy/) by Jason Rohrer, a satirical anti-circumcision text.

References

Goldman, Ronald: Circumcision. The Hidden Trauma. Boston 1997.

Goldman, Ronald: Questioning Circumcision. A Jewish Perspective. Boston 1998.

Wallerstein, E.: Circumcision: The Uniquely American Medial Enigma, Urological Clinics of North America 12 (February 1985): 123-32.

John Harvey Kellogg Treatment for Self-Abuse and its Effects in Plain Fact for Old and Young. Burlington, Iowa: F. Segner & Co. (1888). P. 295



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