Circumcision

Circumcision is the removal of the foreskin from the human penis.[1][2] In the most common procedure the foreskin is extended with forceps (in pre-pubescent children its normal adhesion to the glans must also be broken with a probe), then a circumcision device may be placed, after which the foreskin is excised. Topical or locally injected anesthesia is often used to reduce pain and physiologic stress.[3] The procedure is usually an elective surgery performed on babies and children for religious or cultural reasons.[4] Medically, circumcision is a treatment option for problematic cases of phimosis and balanoposthitis that do not resolve with other treatments, and for chronic urinary tract infections (UTIs).[5][6] It is contraindicated in cases of certain genital structure abnormalities or poor general health.[1][6]

The positions of the world's major medical organizations range from a belief that elective circumcision of babies and children carries significant risks and offers no medical benefits to a belief that the procedure has a modest health benefit that outweighs small risks.[7] No major medical organization recommends circumcising all males, and no major medical organization recommends banning the procedure.[7] Ethical and legal questions regarding informed consent and human rights have been raised over the circumcision of babies and children for non-medical reasons; for these reasons, the procedure is controversial.[8][9]

Male circumcision reduces the risk of HIV infection among heterosexual men in sub-Saharan Africa.[10][11] Consequently, the World Health Organization (WHO) recommends consideration of circumcision as part of a comprehensive HIV prevention program in areas with high rates of HIV.[10] The effectiveness of using circumcision to prevent HIV in the developed world is unclear.[12] The WHO does not recommend circumcision for HIV prevention in men who have sex with men.[10] Circumcision is also associated with reduced rates of cancer-causing forms of human papillomavirus (HPV),[13][14] and UTIs.[3] It also decreases the risk of cancer of the penis via effectively curing phimosis.[3] Prevention of these conditions is not seen as a justification for routine circumcision of infants in the Western world.[5] Studies of other sexually transmitted infections also suggest that circumcision is protective, including for men who have sex with men.[15] A 2010 review found circumcisions performed by medical providers to have a typical complication rate of 1.5% for babies and 6% for older children, with few cases of severe complications.[16] Bleeding, infection, and the removal of either too much or too little foreskin are the most common acute complications. Meatal stenosis is the most common long term complication.[17] Complication rates are higher when the procedure is performed by an inexperienced operator, in unsterile conditions, or in older children.[16] Circumcision does not appear to have a negative impact on sexual function.[18][19]

An estimated one-third of males worldwide are circumcised.[4][16][20] Circumcision is most common among Muslims and Jews (among whom it is near-universal for religious reasons), and in the United States, parts of Southeast Asia, and Africa.[4][21] It is relatively rare for non-religious reasons in Europe, Latin America, parts of Southern Africa, and most of Asia.[4] The origin of circumcision is not known with certainty; the oldest documented evidence for it comes from ancient Egypt.[4][22] Various theories have been proposed as to its origin including as a religious sacrifice and as a rite of passage marking a boy's entrance into adulthood.[23] It is part of religious law in Judaism[24] and is an established practice in Islam, Coptic Christianity, and the Ethiopian Orthodox Church.[4][25][26] The word circumcision is from Latin circumcidere, meaning "to cut around".[4]