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Circumcision

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This article is about male circumcision. For the practice sometimes referred to as "female circumcision", see Female genital cutting.

Circumcision is the procedure that cuts some or all of the foreskin (prepuce) from the penis. The frenulum may also be cut away at the same time, in a procedure called a frenectomy. The word "circumcision" comes from Latin circum (meaning "around") and caedere (meaning "to cut").
Circumcision predates recorded human history, with depictions found in stone-age cave drawings and Ancient Egyptian tombs.<SUP class=reference id=_ref-0>[1]</SUP> The origins of the practice are lost in antiquity. Theories include that circumcision is a form of ritual sacrifice or offering, a health precaution, a sign of submission to a deity, a rite of passage to adulthood, a mark of defeat or slavery, or an attempt to alter esthetics or sexuality.<SUP class=reference id=_ref-Gollaher_0>[2]</SUP> Circumcision of males is a religious commandment in Judaism and Islam,<SUP class=reference id=_ref-1>[3]</SUP><SUP class=reference id=_ref-2>[4]</SUP> and is customary in some Oriental Orthodox and other Christian churches in Africa.<SUP class=reference id=_ref-Christian_0>[5]</SUP> It is also practiced by the majority of South Koreans,<SUP class=reference id=_ref-3>[6]</SUP> Americans,<SUP class=reference id=_ref-4>[7]</SUP> and Filipinos.<SUP class=reference id=_ref-5>[8]</SUP> Infant circumcision is controversial in several English-speaking countries. The American Medical Association defines “non-therapeutic” circumcision as the non-religious, non-ritualistic, not medically necessary, elective circumcision of male newborns. It states that medical associations in the US, Australia, and Canada do not recommend the routine non-therapeutic circumcision of newborns.<SUP class=reference id=_ref-CSA:I-99_0>[9]</SUP> Genital integrity supporters condemn all infant circumcision as male genital mutilation comparable to female genital cutting,<SUP class=reference id=_ref-Milos_0>[10]</SUP> while proponents of circumcision consider that infant circumcision is a worthwhile public health measure.<SUP class=reference id=_ref-Schoen_0>[11]</SUP>
Three randomised trials carried out in African areas of high HIV infection have provided evidence that a man's risk of acquiring HIV through heterosexual intercourse is halved if he is circumcised.<SUP class=reference id=_ref-Newell_0>[12]</SUP><SUP class=reference id=_ref-baileyrct_0>[13]</SUP><SUP class=reference id=_ref-grayrct_0>[14]</SUP> although some voice doubt regarding the value of male circumcision in reducing an epidemic.<SUP class=reference id=_ref-Garenne_0>[15]</SUP> The World Health Organisation recommended in 2007 that "promoting male circumcision should be recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men."<SUP class=reference id=_ref-WHO_HIV_1_0>[16]</SUP>
Circumcision may be used to treat inflammation of the glans penis<SUP class=reference id=_ref-6>[17]</SUP> and penile cancer.<SUP class=reference id=_ref-7>[18]</SUP> The use of circumcision to treat phimosis is debated in medical literature.<SUP class=reference id=_ref-dewan_0>[19]</SUP><SUP class=reference id=_ref-beauge_0>[20]</SUP>
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</TD></TR></TBODY></TABLE>The procedures of circumcision

Circumcision removes the foreskin from the penis. For infant circumcision, clamps, such as the Gomco clamp, Plastibell, and Mogen are often used.<SUP class=reference id=_ref-8>[21]</SUP> These clamps are meant to protect the glans while they cut the blood supply to the foreskin and prevent any bleeding. With the Plastibell clamp, the foreskin and the clamp come away in three to seven days. Before a Gomco clamp is used, a section of skin is crushed with a hemostat then slit with scissors. The foreskin is drawn over the bell shaped portion of the clamp and inserted through a hole in the base of the clamp. The clamp is then tightened, "crushing the foreskin between the bell and the base plate." The crushing limits the bleeding (provides the hemostasis). With the flared bottom of the bell fit tightly against the hole of the base plate, the foreskin is cut away with a scalpel from above the base plate, while the bell covers the glans to prevent it being reached by the scalpel.<SUP class=reference id=_ref-9>[22]</SUP>
With a Mogen clamp, the foreskin and the glans are separated with a blunt probe and/or curved hemostat (as with the first part of the Gomco and Plastibell procedure). The foreskin is then grabbed dorsally with a straight hemostat, and lifted up. The Mogen clamp is then slid between the glans and hemostat, following the angle of the corona to "avoid removing excess skin ventrally and to obtain a superior cosmetic result," compared with Gomco or Plastibell circumcisions. The clamp is locked shut, and a scalpel is used to cut the foreskin from the flat (upper) side of the clamp.<SUP class=reference id=_ref-Pfenninger_0>[23]</SUP><SUP class=reference id=_ref-Reynolds_0>[24]</SUP>
The frenulum is cut if frenular chordee is evident.<SUP class=reference id=_ref-10>[25]</SUP><SUP class=reference id=_ref-Shechet_0>[26]</SUP>



Cultures and religions

Some cultures circumcise their males either shortly after birth, in childhood or around puberty, when it may be part of a rite of passage. Geographically, circumcision is prevalent in Muslim countries, the United States, the Philippines and South Korea. It is less prevalent in Europe, Latin America, China and India. Among religious groups, circumcision is most prevalent among Jews and Muslims.