Circumcision

Male circumcision (from Latin circumcidere, meaning "to cut around") is the surgical removal of the foreskin (prepuce) from the penis. It is estimated that one-third of males worldwide are circumcised. It is most prevalent in the Muslim world (where it is near-universal), parts of Southeast Asia, Africa, the United States and Oceania; it is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia. The origin of circumcision is not known with certainty; the oldest documentary evidence for it comes from ancient Egypt. Various theories have been proposed as to how it began, including as a religious sacrifice and as a rite of passage marking a boy's entrance into adulthood. It is considered religious law in Judaism and established tradition in Islam to circumcise sons.

In modern times, for infants, the procedure is often performed using devices such as the Plastibell, or the Gomco or Mogen-style clamps. The foreskin is opened and then separated from the glans after inspection. The circumcision device (if used) is placed, and then the foreskin is removed. Topical or locally-injected anesthesia may be used to reduce pain and physiologic stress. For adults, general anesthesia is an option, and the procedure is often performed without a specialized circumcision device. A review of literature worldwide found circumcisions performed by medical providers to have a median complication rate of 1.5% for newborns and 6% for older children, with few severe complications. Bleeding, infection, and the removal of either too much or too little foreskin are the most common complications cited. Circumcision does not appear to have a negative impact on sexual function.

Circumcision may be indicated for both therapeutic and prophylactic reasons. It is a treatment option for phimosis, posthitis and other such conditions. A Cochrane meta-analysis of studies done on sexually active men in Africa found that circumcision reduces the infection rate of HIV among heterosexual men by 38%–66% over a period of 24 months, and studies have concluded it is cost-effective in sub-Saharan Africa. The World Health Organization (WHO) recommends considering it as part of a comprehensive HIV program in areas with high endemic rates of HIV. Circumcision reduces the incidence of HSV-2 infections by 28%, and is associated with reduced HPV prevalence and a reduced risk of both urinary tract infections (UTIs) and penile cancer. Studies of its protective effects against other sexually transmitted infections have been inconclusive.

Circumcision is controversial. Ethical and legal questions regarding consent and autonomy have been raised over non-therapeutic neonatal circumcision. Some medical associations take the position that the parents should determine what is in the best interest of the infant or child; others state parents are not entitled to demand medical procedures contrary to their child's best interests, or infringe on the right of the child to make an informed choice for himself when older. Summaries of the views of professional associations of physicians state that none recommend routine circumcision, and that none recommend prohibiting the practice.