A November 2008 article discussing 18 common myths about routine infant circumcision.

Circumstitions' page on reasons not to circumcise.

"I always see more problems from a circumcision than from a foreskin."
                                                        - a paediatrician, quoted on America On Line.

An article in Advocates of Youth that compares data between Europe and the United States.

In France, Germany, and the Netherlands, two things create greater, easier access to sexual health information and services for all people, including teens. They are: 1) societal openness and comfort in dealing with sexuality, including teen sexuality; and 2) pragmatic governmental policies. The result - better sexual health outcomes for French, German, and Dutch teens when compared to U.S. teens.

A comparison between Chinese foot binding of women and routine infant circumcision of boys.  The Chinese stopped foot binding in the 20th Century with good results. Routine infant circumcision has yet to enjoy that result.

Circumcision in Australia is a website presenting circumcision information. The site addresses news items, has a guide for parents, discusses the ethics of circumcision of infants, provides information on the statements of medical authorities, and discusses the failed claims to health benefits of circumcision.

The Circumcision Resource Center is a nonprofit educational organization with the purpose of informing the public and professionals about the practice of circumcision. It's mission is to raise awareness and facilitate healing.

The Female Patient feature article: Circumcision Update 2009. The article discusses benefits, risks, prevalence, and circumcision techniques. It concludes, "Neonatal circumcision has limited medical benefits as well as potential risks. Parents should be apprised of these prior to giving informed consent. Many American parents are uninformed of the risks and the limited benefits because of the universality of circumcision a generation ago."

October 2009 Article in the Examiner describing what can go wrong during a routine infant circumcision. No organization tracks circumcision complications, so very little information is available.

Dr. John Dean writes about circumcision issues for netdoctor. The December 2005 article discusses how the foreskin in children is not retractable and addresses why circumcision occurs. He discusses why circumcision is not reasonable as a disease prevention measure. He also identifies the complications of circumcision.

Cut is a documentary film by Eliyahu Ungar-Sargon which examines the subject of male circumcision from a religious, scientific and ethical perspective. Using cutting-edge research, in addition to interview footage of rabbis, philosophers, and scientists, Cut challenges the viewer to confront their biases by asking difficult questions about this long-standing practice.

Dutch journalist/filmmaker Michael Schaap's personal documentary. He learns from interviewing his own mother, circumcisers, politicians, Jews, Muslims, a restored British man, and some American intactivists.

The site explores the varied history of circumcision around the world. The distinction is made between ritual and medical circumcision.

Part of a debate published in BMJ, 2007;335:1180 (8 December), doi:10.1136/bmj.39406.520498. Geoff Hinchley argues that the practice of male infant circumcision is harmful and should be stopped.

The unpalatable truth is that logic and the rights of the child play little part in determining the acceptability of male genital mutilation in our society. The profession needs to recognise this and champion the argument on behalf of boys that was so successful for girls.

The Jewish Circumcision Resource Center is a section of the Circumcision Resource Center. The Jewish Circumcision Resource Center represents Jews around the world who question circumcision (bris or brit milah). The primary intended audience is non-traditional Jews, those Jews who generally evaluate an idea not solely based on its conformance with the Torah, but also in light of its agreement with reason and experience. They believe that Jewish practice must be consistent with what they think and feel.

Jews Against Circumcision is a group of educated and enlightened Jews who realize that the barbaric, primitive, torturous, and mutilating practice of circumcision has no place in modern Judaism.

National Organization to Halt the Abuse and Routine Mutilation of Males (NOHARMM) page describing keratinization of the mucous membranes of the circumcised penis, namely the glans and inner foreskin remnant.

A pro-intact forum in which mothers and others describe their experiences regarding circumcision. The forum is very active with many posts each day.

Mothers Against Circumcision is an older website advocating against routine infant circumcision. The last update was apparently made in 2002.

NOCIRC, the National Organization of Circumcision Information Resource Centers, provides information to expectant parents, healthcare professionals, educators, lawyers, ethicists, and concerned individuals about circumcision and genital cutting of male, female, and intersex infants and children, genital integrity, and human rights.

Paul Fleiss article in Mothering magazine. The article identifies various statements provided by doctors who wish to circumcise an infant or young boy. These statements are analyzed and reasons why circumcision is not indicated are provided.

One half of a debate published in Can Fam Physician, Vol. 53, No. 12, December 2007, pp.2097 - 2099. Deirdre Andres, MD CCFP, addresses historical reasons for circumcision, along with the small amount of health benefit relative to the risk of the surgery. See Should newborns be circumcised? Yes for the other half of the debate.

One half of a debate published in Can Fam Physician, Vol. 53, No. 12, December 2007, pp.2096 - 2098. Edgar J. Schoen relies upon the protective benefits of circumcision to support his position. See Should newborns be circumcised? No for the other half of the debate.

Gussie Fauntleroy writes The Truth About Circumcision and HIV in Mothering magazine.

Dr. David Alwin, MD, discusses the reduced risk of male infant urinary tract infections (UTI) from circumcision. The decreased incidence is inconsequential, as he shows with his illustrations and analysis.

Routine Infant Circumcision video provided as an educational resource for healthcare professionals and parents/guardians who are interested in learning more about what circumcision entails. Actual surgery on a baby done by a doctor in a hospital is shown, so viewer discretion is advised.

Mothering magazine article about the decision on circumcision.

A YouTube Video by Dan and Jenn where they describe why infant circumcision, although widely practiced, violates the bodily integrity of the infant. Babies cannot give informed consent for genital alterations. If it was any other body part that was being altered, everyone would be upset.

A radio interview with Dr. Dean Edell with accompanying images. Dr. Edell describes the harm of circumcision and how circumcising men in Africa who consent to the surgery is different than circumcising infants. Dr. Edell also notes that there are no long term studies of the efficacy of circumcision with respect to preventing HIV. The Africa trials were short term studies.

Study published in the Journal of Urology, Volume 167, Issue 5, Pages 2113-2116 (May 2002).  The study's purpose was to determine the effect of the prepuce (foreskin) on sexual intercourse. The researchers examined sexual function outcomes in men who experienced sexual intercourse in the uncircumcised and circumcised states.

The study chose as subjects men who were circumcised for medical reasons. Only 7% of the men were circumcised as elective surgery. Even with such a large proportion of the subjects being circumcised for having problems with their foreskin, 38% reported that it was worse being circumcised.

Study published in The Lancet, Volume 374, Issue 9685, Pages 229 - 237, 18 July 2009. doi:10.1016/S0140-6736(09)60998-3.  The study assessed whether circumcision in HIV-infected men would reduce transmission of the virus to female sexual partners. Circumcision of HIV-infected men did not reduce HIV transmission to female partners over 24 months; longer-term effects could not be assessed. Condom use after male circumcision is essential for HIV prevention.  The results indicate that there is a probability of 21.7% HIV infection rate for female partners of circumcised HIV infected men, compared to 13.4% HIV infection rate for female partners of HIV infected men. Women with circumcised partners had more than a 50% increase in the infection rate of women compared to women with un-circumcised partners.

Study published in the Journal of the American Medical Association (JAMA), Volume 278 No. 24, pages 2157-2162, December 24/31, 1997. The study was a randomized controlled trial to compare various anesthesia methods for infant circumicison. Enrollment in the study was stopped after it was determined that the control group (babies not receiving any anesthesia) were in great distress from their circumcision.  "The results of this study suggest that an anesthetic should be administered to newborns prior to undergoing circumcision.

A study published in BMC Urology, 2010, 10:2 doi:10.1186/1471-2490-10-2 February 2010. The results showed: "Sixteen prospective studies evaluated complications following neonatal and infant circumcision. Most studies reported no severe adverse events (SAE), but two studies reported SAE frequency of 2%. The median frequency of any complication was 1.5% (range 0-16%). Child circumcision by medical providers tended to be associated with more complications (median frequency 6%; range 2-14%) than for neonates and infants. Traditional circumcision as a rite of passage is associated with substantially greater risks, more severe complications than medical circumcision or traditional circumcision among neonates."

Study published in The Lancet, Volume 349, Issue 9052, Pages 599 - 603, 1 March 1997.

The authors found, "There was a significant linear trend on all outcome measures, showing increasing pain scores from uncircumcised infants, to those circumcised with Emla, to those circumcised with placebo." Their interpretation was, "Circumcised infants showed a stronger pain response to subsequent routine vaccination than uncircumcised infants."

Study published in The Lancet, Volume 345, Number 8945: Pages 291-292, 4 February 1995. doi:10.1016/S0140-6736(95)90278-3

The study notes, "Circumcised babies have short-term alterations in behaviour, sleep patterns, frequency of feeding, crying, fussiness, and heart rate." For the longer term, the study notes,

Male circumcision . . . causes intense pain and measurable changes in behaviour that last up to 1 day. We found that circumcision status was associated with increased infant pain response to routine vaccination at 4-6 months. Circumcised boys had significantly longer crying bouts and higher pain scores. That both outcome measures, pain index, and cry duration, were influenced by circumcision lends credibility to our observations.

Article published in Journal of the New Zealand Medical Association, September 12, 2003, Vol 116, No. 1181. Women reported that they are significantly more likely to experience vaginal dryness during sexual intercourse with circumcised men than with genitally intact men. The authors thought that the vaginal dryness becomes more apparent as women get older.

The authors concluded "Most likely, reported vaginal dryness and the related clinical designation female arousal disorder is but a normal female response to coitus with a man with an iatrogenically deficient penis." An iatrogenically deficient penis is one that has been circumcised.

An article discussion the pain response of infants. Unlike adults, infants are not capable of inhibiting pain. Instead, the "brain actually enhances the pain inputs rather than suppressing them. It's a complete reverse of what happens in an adult," says Professor Fitzgerald. The fact that the infant nervous system is, in a sense, receiving more pain than in adults intensifies the need to look for better analgesics (pain-relieving drugs) for newborn babies.

Study published in BJUI (British Journal of Urology International), Volume 99, Issue 4, Pages 864-869 (March 2007). This is the Sorrells study. The Sorrels study is remarkable because it used objective measurements to determine fine-touch sensitivity of various parts of the intact penis and the circumcumcised penis, showing that circumcision removes the most sensitive parts of the penis.

Watch a YouTube video of Dr. Sorrells discussing the study and his results.

Study published in Clinical Pediatrics, Vol. 45, No. 1, 49-54 (2006). DOI: 10.1177/000992280604500108. Dr. Howe concluded, "Meatal stenosis may be the most common complication following neonatal circumcision. The frequency of this complication and the need for surgical correction need to be disclosed as part of the informed consent for neonatal circumcision." The study found 24 of 329 (7%) circumcised boys had meatal stenosis.

Study published in Pediatric Surgery International, doi 10.1007/s00383-010-2566-9. The authors studied later complications of children who had neonatal circumcisions. Penile adhesions, skin bridges, meatal stenosis, redundant foreskin (incomplete circumcision with uncircumcised appearance), recurrent phimosis, buried penis and penile rotation were the most frequent complications treated after the original circumcision had healed.

Study published in Journal of Health Psychology, Vol. 7, No. 3, 329-343 (2002). DOI: 10.1177/135910530200700310. The abstract states, "Infant male circumcision continues despite growing questions about its medical justification. As usually performed without analgesia or anaesthetic, circumcision is observably painful. It is likely that genital cutting has physical, sexual and psychological consequences too. Some studies link involuntary male circumcision with a range of negative emotions and even post-traumatic stress disorder (PTSD). Some circumcised men have described their current feelings in the language of violation, torture, mutilation and sexual assault."

Study published in The Journal of Urology, Volume 169, Issue 6, Pages 2332-2334 (June 2003). Doctors at a clinic reviewed their experience in treating patients with a trapped penis due to phimosis following newborn circumcision. The infants were circumcised with a Gomco device. Fifteen of 521 circumcised boys (2.9%) developed phimosis after circumcision.  Three boys had recurrence of phimosis after treatment.

A study published in Urologia Internationalis, Vol. 75, No. 1, 2005 (Urol Int 2005;75:62-66) (DOI: 10.1159/000085930). The authors assessed the effect of circumcision on sexually active men and the relative impact this may have on informed consent prior to surgery. 

The male subjects were circumcised for a benign desease. Penile sensation got worse for 18% of the men who got an adult circumcision. Only 61% of the men were satisfied with their adult circumcision. Considering that circumcision was for a disease, it is significant that not more men were satisfied with the cure.

Study published in Annals of Family Medicine, 8:64-72 (2010). doi: 10.1370/afm.1073. A meta analysis of the literature from 1997 through 2008 regarding male circumcision. The study found, "There is little evidence showing clinical benefit from nontherapeutic male circumcision." The implications were stated: "Patients who request circumcision for clinical reasons should be informed of the lack of consensus surrounding the procedure, the lack of strong evidence regarding its benefits, and the potential medical and psychosocial harms of the procedure."

The study concluded:

The role of adult nontherapeutic male circumcision in preventing sexually transmitted infections, urinary tract infections, and penile cancer remains unclear. Current evidence fails to recommend widespread neonatal circumcision for these purposes.

Shirley's Wellness Cafe is an educational website that promotes holistic health for humans and their animals.

The circcumcision page describes the harm of infant circumcision. The surgical procedure of infant circumcision is described, in detail. Various authorities are quoted regarding the pain of infant circumcision.

The circumcision information page includes links to various organizations and other sources that provide information on infant circumcision.

Research article published in Archives of Disease in Childhood, Vol. 62, Issue 1, pp. 80-81, 1987. doi:10.1136/adc.62.1.80 

Abstract

Four newborn babies developed acute heart failure a few hours after circumcision at 8 days. During this procedure, a sponge soaked in epinephrine was applied to the circumcision site and left there for several hours. Treatment was with digoxin and diuretics and signs of heart failure disappeared within 24-72 hours.

Study published in the BJUI (British Journal of Urology International), Volume 99, Issue 3, Pages 619-622 (March 2007). The study showed that there was a loss of sexual pleasure and enjoyment for a significant percentage of men.

Paper published in BJUI (British Journal of Urology International), Volume 83, Suppl. 1, pages 79–84, (1999), and authored by K. O'Hara & J. O'Hara. The authors surveyed women having sexual experience with both circumcised and anatomically complete partners to determine if there were any differences in sexual enjoyment. They determined that circumcision results in a less satisfying sexual experience.

The Jerusalem Post reports on a new technique to lengthen the shaft skin for a man with a botched circumcision. Too much skin was removed during circumcision. It sounds like the man had a severe case of turkey neck and the doctors found a way of grafting skin to make that part of the outer skin longer to reduce the turkey neck. I don't know if the surgery technique would work to make a foreskin, but it may bear further investigation.

The doctors wrote up their results and published it in the Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 63, Issue 3, Pages e325-e326 (March 2010), titled: The five-flap technique for the correction of post-circumcision peno-scrotal webbing. The journal article is a pay-to-view article and the cost is $31.50 US.

Study published in Journal of Pediatric Urology, 2009 Aug 7. doi:10.1016/j.jpurol.2009.07.007. "Knowledge of normal meatal/urethral width in a growing boy is important to create a neourethra of adequate size to correct hypospadias. Thus far, normal size values have been based on the study of circumcised, awake boys. The aim of this study was to measure normal urethral width in healthy uncircumcised boys under general anesthesia to provide a tool to create a neourethra of adequate size."

The Vulnerability of Men is a thoughtful article by an intact man describing why a circumcised father would want to circumcise his son. The author, Vincent Bach, describes the typical stages a cut man goes through when first confronted with the question of whether his son should be circumcised.

Vincent believes that the driving force behind circumcision in the United States is circumcised men. Many circumcised men feel cornered because they had their penis reduced by circumcision without their consent. His sexual well-being is based on how he perceives himself, and that includes seeing himself with a circumcised penis. To allow his son to remain intact would be to admit that he has less than a full, complete sex organ.

The page was also reproduced at Circumstitions. The content has since moved.
Edited October 28, 2018

HAARETZ.com reports in a 2008 article that traditional circumcision results in an increased rate of urinary tract infections (UTIs) for male infants. "Circumcision as performed by mohels, men whose profession is performing the Jewish ritual of brit milah, leads to a high rate of urinary tract infections among babies, according to a report released recently by physicians at Schneider Children's Medical Center in Petah Tikva."

The article reports that the researchers "found urinary tract infections to be far more common among babies who had undergone circumcision by a mohel rather than a physician." One researcher said, "Without appropriate and intensive treatment, the bacteria could reach the blood, possibly even causing death." The researchers believe the infections are caused by the bandage left on the penis after circumcision.

Paper published in Medical Decision Making, Vol. 24, No. 6, 584-601 (2004). The author, Robert S. Van Howe, MD, MS, FAAP, determined that it was more costly to circumcise than to leave baby boys intact. The study concludes, "Neonatal circumcision is not good health policy, and support for it as a medical procedure cannot be justified financially or medically."

A study in the Journal of the Israel Medical Association found that a significant percentage of boys had a UTI shortly after their Bris.

Isr Med Assoc J. 2010 May;12(5):262-5 by Toker O, Schwartz S, Segal G, Godovitch N, Schlesinger Y, Raveh D. Department of Pediatrics, Shaare Zedek Medical Center, affiliated with Hadassah-Hebrew University Medical School, Jerusalem, Israel.

Abstract

BACKGROUND: Ritual circumcision in neonates may cause a urinary tract infection within 2 weeks of the procedure.

Article in the Journal of Medical Ethics, Vol. 31, Issue 8, 2005;31:463-469 doi:10.1136/jme.2004.009340. The authors conclude that "it is ethically inappropriate to subject children—male or female—to the acknowledged risks of circumcision and contend that there is no compelling legal authority for the common view that male circumcision is lawful."

Article published in The Journal of Infection in Developing Countries, Vol 2, No 05, 2008 Oct 1;2(5):328-34. The full text of the article is available as a pdf file.  The authors cannot say enough good things about male circumcision as a way to reduce HIV in Africa. The article does not address the finding that male circumcision increases the HIV rate for the male to female vector.

An article in Advocates of Youth that compares data between Europe and the United States.

In France, Germany, and the Netherlands, two things create greater, easier access to sexual health information and services for all people, including teens. They are: 1) societal openness and comfort in dealing with sexuality, including teen sexuality; and 2) pragmatic governmental policies. The result - better sexual health outcomes for French, German, and Dutch teens when compared to U.S. teens.

Study published in the Journal of Urology, Volume 167, Issue 5, Pages 2113-2116 (May 2002).  The study's purpose was to determine the effect of the prepuce (foreskin) on sexual intercourse. The researchers examined sexual function outcomes in men who experienced sexual intercourse in the uncircumcised and circumcised states.

The study chose as subjects men who were circumcised for medical reasons. Only 7% of the men were circumcised as elective surgery. Even with such a large proportion of the subjects being circumcised for having problems with their foreskin, 38% reported that it was worse being circumcised.

Study published in International Journal of Men's Health, Volume 10, Number 2 / July 2011. DOI10.3149/jmh.1002.184. In the first study of its kind,  Dan Bollinger and Robert S. Van Howe, M.D., M.S., FAAP, look at the link between circumcision and the personality trait disorder alexithymia. The study found that circumcised men are 60% more likely to suffer from alexithymia.

Alexithymia is the inability to process emotions. People suffering from alexithymia have difficulty identifying and expressing their feelings. The disorder translates into not being able to imagine what others are feeling and leading to an inability to respond to others’ needs. If acquired at an early age, the disorder might limit access to language and interfere with the socialization process that begins early in life. Moderate to high alexithymia can interfere with personal relationships and hinder therapy. Impulsive behavior is a key symptom of alexithymia, and impulsivity is a precursor to violence.

A paper published BJU International, Vol. 100, Issue 1, pp 5-6 (April 2007).  Three avid pro-circumcision advocates wrote a paper justifying male circumcision as a preventative against prostate cancer. The authors claim that lack of circumcision is a risk factor of prostate cancer.

Dr. Van Howe responded to the Morris paper in the BJU International, Vol. 100, Issue 5, pp. 1193-94 (2007). Dr. Van Howe identified faults and unsubstantiated assumptions in the original paper. He states, "The concept of using circumcision to reduce prostate cancer risk has no biological or epidemiological foundation. Even if one is willing to depart from reality and use the most extreme assumptions as put forth by Morris et al., circumcision of infants is not cost-effective."

A study published Sexually Transmitted Infections, doi:10.1136/sti.2010.042895, determined that there was no association between circumcision and HIV for men having sex with men. The researchers concluded that circumcision is unlikely to be a feasible HIV prevention strategy for gay men in the UK.

This study supports other studies that found no link between circumcision status and HIV infection rates among homosexual men.

Study published in Sexually Transmitted Diseases, 22 August 2011,doi: 10.1097/OLQ.0b013e31822e60cb.

Methods: Male university students (aged 18-20 years) were recruited from 2003 to 2009 and followed up triannually. Shaft/scrotum, glans, and urine samples were tested for 37 [alpha] human papillomavirus (HPV) genotypes.

Results: In 477 men, rates of acquiring clinically relevant HPV types (high-risk types plus types 6 and 11) did not differ significantly by circumcision status.

Conclusions:Although the likelihood of HPV acquisition did not differ by circumcision status, uncircumcised men were more likely than circumcised men to have infections detected at multiple genital sites, which may have implications for HPV transmission.

Critical Appraisal published in Canadian Family Physician, Vol. 49, 1096-97, September 2003. The author attempts to answer the question if circumcision is warranted as a preventative measure against HPV and cervical cancer. Using only 7 case-control studies, the author's results were ambiguous and and apparently tied to other factors. "If both male and female partners were at low risk of infection, the women's risk of cervical cancer was similar whether their partners were circumcised or uncircumcised."

CATIE-News: Bite-sized HIV/AIDS news bulletins published by Canadian AIDS Treatement Information Exchange. The page addresses many of the current studies and meta-analysis for HIV and the gay man. The results of the various studies and meta-analysis are consistent and show that there is little to no benefit in circumcising gay men to reduce HIV.

Researchers studying the increase and spread of HIV have concluded in several studies that increases in high-risk sex have overwhelmed any decrease in infectivity due to HAART (highly active antiretroviral therapy). This does not mean that current HIV prevention efforts have failedwithout these efforts, rates of new cases of HIV and STIs might be much higher. This environment of high-risk sex and STIs must be taken into account when considering the potential impact and rollout of new prevention interventions--such as male circumcision, microbicides or pre-exposure prophylaxis (PrEP)--in gay and bisexual men in high-income countries.

Study published in The Journal of Infectious Diseases, 2009; 200:000–000. DOI: 10.1086/648376. The authors found a correlation of reduced incidence of syphilis among men who reported predominantly insertive unprotected anal intercourse.

Study published in The Journal of Pediatrics, Volume 152, Issue 3, Pages 383-387 (March 2008). The study's objective was to determine the impact of early childhood circumcision on sexually transmitted infection (STI) acquisition to age 32 years.  "Overall, up to age 32 years, the incidence rates for all STIs were not statistically significantly different . . . for the uncircumcised and circumcised men, respectively. This was not affected by adjusting for any of the socioeconomic or sexual behavior characteristics."

Study published in the BJUI (British Journal of Urology International), Volume 101, Issue 1, Pages 65-70 (January 2008). The study determinded that for men in Uganda, there were no differences between intact men and men circumcised after 24 months.

Study published in MJA, Vol. 178, 155-58, February 2003. The study was to investigate the incidence rate of circumcision for phimosis and other medically indicated reasons in Western Australian boys. The authors found that as the national rate of routine circumcision decreased, the rate of medically indicated circumcisions increased for boys aged less than 15 years. More than half of the boys circumcised for phimosis were under the age of 5. Pathological phimosis is rare in that age group. The authors attributed the high rate of circumcision to physicians mistaking normal penile development for pathological phimosis.

Study published in Australian and New Zealand Journal of Public Health, Vol. 34 Issue 2, Pages 160 - 164 (April 2010).  The study concluded that "Circumcision appears to have minimal protective effects on sexual health in Australia." Translated into English, "Circumcised men do not have any additional protection against sexually transmitted diseases."

Study published in The Lancet, Volume 374, Issue 9685, Pages 229 - 237, 18 July 2009. doi:10.1016/S0140-6736(09)60998-3.  The study assessed whether circumcision in HIV-infected men would reduce transmission of the virus to female sexual partners. Circumcision of HIV-infected men did not reduce HIV transmission to female partners over 24 months; longer-term effects could not be assessed. Condom use after male circumcision is essential for HIV prevention.  The results indicate that there is a probability of 21.7% HIV infection rate for female partners of circumcised HIV infected men, compared to 13.4% HIV infection rate for female partners of HIV infected men. Women with circumcised partners had more than a 50% increase in the infection rate of women compared to women with un-circumcised partners.

Study published in JAMA, 1997; 277(13): 1052-1057. The objective was to assess the prevalence of circumcision across various social groups and examine the health and sexual outcomes of circumcision. The authors analyzed the National Health and Social Life Survey (NHSLS) data to determine the effects of circumcision. The results indicate, "We find no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases." 

An article by Ronald Goldman, PhD, published in Paediatrics & Chid Health, Vol. 9, No. 9, pp. 630-33 (November 2003).  The article provides a very good overview of the current social standing of male infant circumcision. The author makes the point that the current reluctance to confront the religious issue undermines the core values (e.g., the health of the patient is paramount) and ethics (e.g., first, do no harm) that drive medical decision-making.

Published in Pediatrics, Vol. 118 No. 5 November 2006, pp. 1971-1977 (doi:10.1542/peds.2006-1175). The authors conclude that their "findings suggest that uncircumcised males are at greater risk of acquiring sexually transmitted infection than circumcised males. Male circumcision may reduce the risk of sexually transmitted infection acquisition and transmission by up to one half, suggesting substantial benefits accruing from routine neonatal circumcision."

Article published in Journal of Nurse-Midwifery, Volume 37, Number 2 (Suppl.): Pages 87S-96S, March/April 1992. Marilyn Fayre Milos, RN, and Donna Macris, CNM, MSN, describe the procedure and outcomes of male infant circumcision. The authors discuss the American double standard of the acceptance of circumcision for males but not for women. They also address the many myths that have arisen about male infant circumcision and they debunk them all.

Consider further: The foreskin is normal, healthy, functioning tissue. Circumcision has inherent risks, including hemorrhage, infection, mutilation, and death. Circumcision is painful, even when an anesthetic is used. Circumcision causes both physical and psychological scars. Most importantly, every human being has an inherent, inalienable right to his own body.

Study published in The Lancet, Volume 352, Issue 9143, Pages 1813-16, 5 December 1998. doi:10.1016/S0140-6736(98)02392-7. The authors interpreted their findings to "support the notion that circumcision may protect boys from UTI, [although] the magnitude of this effect may be less than previously estimated." The study found that "195 circumcisions would be needed to prevent one hospital admission for UTI in the first year of life."

Study published in the Journal of the American Medical Association (JAMA), Volume 278 No. 24, pages 2157-2162, December 24/31, 1997. The study was a randomized controlled trial to compare various anesthesia methods for infant circumicison. Enrollment in the study was stopped after it was determined that the control group (babies not receiving any anesthesia) were in great distress from their circumcision.  "The results of this study suggest that an anesthetic should be administered to newborns prior to undergoing circumcision.

A study published in BMC Urology, 2010, 10:2 doi:10.1186/1471-2490-10-2 February 2010. The results showed: "Sixteen prospective studies evaluated complications following neonatal and infant circumcision. Most studies reported no severe adverse events (SAE), but two studies reported SAE frequency of 2%. The median frequency of any complication was 1.5% (range 0-16%). Child circumcision by medical providers tended to be associated with more complications (median frequency 6%; range 2-14%) than for neonates and infants. Traditional circumcision as a rite of passage is associated with substantially greater risks, more severe complications than medical circumcision or traditional circumcision among neonates."

Paper published in Clinical Ethics, 2009;4:181-186.  doi:10.1258/ce.2009.009029. David Shaw, Faculty of Medicine and Centre for Applied Ethics & Legal Philosophy, University of Glasgow, writes that the current General Medical Council (GMC) guidelines are flawed in stating that any doctor who does not wish to carry out a non-therapeutic circumcision (NTC) on a boy must invoke conscientious objection.

A HelpDesk Answer published in Evidence-Based Practice, March 2010. Dr. Julia Fashner updates the February 2004 Clinical Inquiry in American Family Physician, 2004; 69(4):909–910.  Dr. Fashner answers the question posed:

Yes. The use of EMLA cream does decrease pain, but it is likely that a dorsal penile nerve block (DPNB) does an even better job. Neither will completely eliminate the discomfort of the procedure [infant circumcision].

Study in Chinese Medical Journal, 2009, Vol. 122 No. 24:3017-3019 describing the dorsal penil nerve and how it affects premature ejaculation. The penis has highly variable innervation with between 1 and 7 branches of the dorsal penile nerve, In some cases branches continue the way round to the ventral aspect. The nerve topology could possibly explain the highly variable subjective outcome for circumcision. The study states, "the anatomic distribution of penile dorsal neural variation may account for the disadvantages of circumcision."

Study published in BJU International, Volume 94, Issue 4, Pages 627-629 (Aug. 25, 2004).  The authors concluded "that circumcision during antireflux surgery has no effect on the incidence of postoperative UTI."

Study published in The Lancet, Volume 349, Issue 9052, Pages 599 - 603, 1 March 1997.

The authors found, "There was a significant linear trend on all outcome measures, showing increasing pain scores from uncircumcised infants, to those circumcised with Emla, to those circumcised with placebo." Their interpretation was, "Circumcised infants showed a stronger pain response to subsequent routine vaccination than uncircumcised infants."

Study published in The Lancet, Volume 345, Number 8945: Pages 291-292, 4 February 1995. doi:10.1016/S0140-6736(95)90278-3

The study notes, "Circumcised babies have short-term alterations in behaviour, sleep patterns, frequency of feeding, crying, fussiness, and heart rate." For the longer term, the study notes,

Male circumcision . . . causes intense pain and measurable changes in behaviour that last up to 1 day. We found that circumcision status was associated with increased infant pain response to routine vaccination at 4-6 months. Circumcised boys had significantly longer crying bouts and higher pain scores. That both outcome measures, pain index, and cry duration, were influenced by circumcision lends credibility to our observations.

Study published in Urology, April 2005, 65(4):773-77. The objective was to evaluate penile sensory thresholds in neonatally circumcised and uncircumcised men. The authors evaluated 125 patients, splitting them into functional and dysfunctional groups based on a questionaire. In the dysfunctional group, circumcised men were significantly younger than the intact men (7 year mean difference). The sample size was small, and when attempting to control for age, hypertension, and diabetes, all t-test significance was lost.

Article published in Journal of the New Zealand Medical Association, September 12, 2003, Vol 116, No. 1181. Women reported that they are significantly more likely to experience vaginal dryness during sexual intercourse with circumcised men than with genitally intact men. The authors thought that the vaginal dryness becomes more apparent as women get older.

The authors concluded "Most likely, reported vaginal dryness and the related clinical designation female arousal disorder is but a normal female response to coitus with a man with an iatrogenically deficient penis." An iatrogenically deficient penis is one that has been circumcised.

Letters published in Canadian Family Physician, Vol. 49, 1591-92, December 2003, are critical of the Circumcision and cervical cancer article. 

Study in The Journal of Infectious Diseases, Volume 203, Issue1, pp. 58-65, (2011). doi: 10.1093/infdis/jiq015. The authors examined the baseline prevalence of penile, scrotal, and perineal/perianal human papillomavirus (HPV) in heterosexual men (HM).

Results. Having >3 lifetime female sexual partners had the greatest impact on HPV prevalence. . . . Neither condom usage nor circumcision was associated with HPV DNA prevalence.
 
Conclusion. Genital-HPV DNA detection is common in young, sexually active HM. We found HPV to be most prevalent in African men and least prevalent in men from the Asia-Pacific region. Increased numbers of sexual partners was an important risk factor for HPV DNA prevalence.

Study published in BJUI (British Journal of Urology International), Volume 99, Issue 4, Pages 864-869 (March 2007). This is the Sorrells study. The Sorrels study is remarkable because it used objective measurements to determine fine-touch sensitivity of various parts of the intact penis and the circumcumcised penis, showing that circumcision removes the most sensitive parts of the penis.

Watch a YouTube video of Dr. Sorrells discussing the study and his results.

Article published in Thymos: Journal of Boyhood Studies, Vol. 4, No. 1 / Spring 2010. doi 10.3149/thy.0401.71.

Author J. Steven Svoboda discusses how genital integrity advocates struggle to safeguard all children from genital cutting. Gender equity activists promote true equality of men and women. Commonalities and differences between the two movements are very illuminating. Three words relevant to genital integrity are: exceptional, muddle, and discomfort.

Paper from 16th Conference on Retroviruses and Opportunistic Infections (2009).  A pdf file of the paper is available on the website.

Study published in Clinical Pediatrics, Vol. 45, No. 1, 49-54 (2006). DOI: 10.1177/000992280604500108. Dr. Howe concluded, "Meatal stenosis may be the most common complication following neonatal circumcision. The frequency of this complication and the need for surgical correction need to be disclosed as part of the informed consent for neonatal circumcision." The study found 24 of 329 (7%) circumcised boys had meatal stenosis.

Part of a debate published in BMJ, 2007;335:1180 (8 December), doi:10.1136/bmj.39406.520498. Geoff Hinchley argues that the practice of male infant circumcision is harmful and should be stopped.

The unpalatable truth is that logic and the rights of the child play little part in determining the acceptability of male genital mutilation in our society. The profession needs to recognise this and champion the argument on behalf of boys that was so successful for girls.

A small study published in AIDS, January 21, 2010. Researchers at the Division of Infectious Diseases, Department of Medicine, Chicago, Illinois, USA, examined the foreskins removed by circumcision of 16 men. The researchers found that there was no significant differences in the thickness of the keratin layers of the inner foreskin and the outer skin. The authors concluded: "Keratin layers alone are unlikely to explain why uncircumcised men are at higher risk for HIV infection."

Study published in Pediatric Surgery International, doi 10.1007/s00383-010-2566-9. The authors studied later complications of children who had neonatal circumcisions. Penile adhesions, skin bridges, meatal stenosis, redundant foreskin (incomplete circumcision with uncircumcised appearance), recurrent phimosis, buried penis and penile rotation were the most frequent complications treated after the original circumcision had healed.

An article in The Atlantic chronicles the research of John Ioannidis. He has made it his life's work to investigate the accuracy of medical research. He has published and spoken extensively on how much medical research is biased and that that bias effects the results of studies.

Article in American Journal of Preventive Medicine, Volume 39, Issue 5 , Pages 479-482, November 2010. The authors discuss the "external validity" of the three African randomized control trials that examined circumcision as a preventive measure for HIV infection. The nutshell version of this discussion is that clinical conditions that show promise do not necessarily translate into a real world net benefit.

Study published in International Journal of Epidemiology, April 2011. doi: 10.1093/ije/dyr104

Background One-third of the world’s men are circumcised, but little is known about possible sexual consequences of male circumcision. In Denmark (∼5% circumcised), we examined associations of male circumcision with a range of sexual measures in both sexes.
  
Results . . . circumcised men reported more partners and were more likely to report frequent orgasm difficulties after adjustment for potential confounding factors, and women with circumcised spouses more often reported incomplete sexual needs fulfilment and frequent sexual function difficulties overall, notably orgasm difficulties and dyspareunia.
  
Conclusions Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment.

Article published in Archive of Pediatrics & Adolescent Medicine, Jan. 2010; Vol. 164, No.

Study published in Journal of Health Psychology, Vol. 7, No. 3, 329-343 (2002). DOI: 10.1177/135910530200700310. The abstract states, "Infant male circumcision continues despite growing questions about its medical justification. As usually performed without analgesia or anaesthetic, circumcision is observably painful. It is likely that genital cutting has physical, sexual and psychological consequences too. Some studies link involuntary male circumcision with a range of negative emotions and even post-traumatic stress disorder (PTSD). Some circumcised men have described their current feelings in the language of violation, torture, mutilation and sexual assault."

Paper published in Ethnicities, June 2010 vol. 10 no. 2 181-207. doi: 10.1177/1468796810361654. The author argues that the assumption that there is no harm and, consequently, no reason to intervene against male circumcision, is an erroneous assumption. He highlights evidence that suggests that, according to the criteria of sexual diminution, pain and coercion employed to criticize FGM, circumcision can be viewed as a harmful act of Male Genital Mutilation (MGM).

Paper published in Sexual Health, 7(4) 463–470, November 2010. doi:10.1071/SH09080. The authors developed a mathematical model to simulate HIV propagation within a MSM population. Conclusions: "The results of these calculations suggest that circumcision as a public health intervention will not produce a substantial decrease in HIV prevalence or incidence among MSM in the near future, and only modest reductions are achievable in the long-term."

Study published in Journal of Paediatrics and Child Health, Volume 44 Issue 1-2, Pages 44 - 49, 4 Sep 2007. The study documents a longitudinal study of over 1000 individuals born in Christchurch New Zealand in mid 1977. The authors concluded, "There was no evidence of an association between neonatal circumcision status and breastfeeding outcomes, or between circumcision status and health and cognitive ability outcomes associated with breastfeeding, and the findings do not support the view that neonatal circumcision disrupts breastfeeding."

The Journal of Family Practice, September 2001 · Vol. 50, No. 9

OBJECTIVE: Our objectives were to determine if a 50% dextrose solution would reduce the percentage of circumcision procedure time a neonate spent crying by 50%, compared with water, and whether it would be similar to a dorsal penile nerve block (DPNB).

STUDY DESIGN: This was a randomized placebo-controlled blinded clinical trial.

POPULATION: We included 71 patients who were recruited from the inpatient nursery of a military community hospital over a 5-month period.

Study published in The Journal of Urology, Volume 169, Issue 6, Pages 2332-2334 (June 2003). Doctors at a clinic reviewed their experience in treating patients with a trapped penis due to phimosis following newborn circumcision. The infants were circumcised with a Gomco device. Fifteen of 521 circumcised boys (2.9%) developed phimosis after circumcision.  Three boys had recurrence of phimosis after treatment.

A pdf file of the report of the trial investigating the effects of circumcision on Africans with respect to HIV infections.

A randomized controlled trial (RCT) has shown that male circumcision (MC) reduces sexual transmission of HIV from women to men by 60% (32% - 76%; 95% CI) offering an intervention of proven efficacy for reducing the sexual spread of HIV. We explore the implications of this finding for the promotion of MC as a public health intervention to control HIV in sub-Saharan Africa.

A study published in Urologia Internationalis, Vol. 75, No. 1, 2005 (Urol Int 2005;75:62-66) (DOI: 10.1159/000085930). The authors assessed the effect of circumcision on sexually active men and the relative impact this may have on informed consent prior to surgery. 

The male subjects were circumcised for a benign desease. Penile sensation got worse for 18% of the men who got an adult circumcision. Only 61% of the men were satisfied with their adult circumcision. Considering that circumcision was for a disease, it is significant that not more men were satisfied with the cure.

A study published in BMC Infectious Diseases, 2010, 10:59doi:10.1186/1471-2334-10-59. The authors determined that male circumcision was positively associated with HSV-2 infection.

Study published in International Conference on AIDS, 15th : 2004 : Bangkok, Thailand, July 11-16: abstract no. TuPeC4861. The Naval Health Research Center conducted a study of men assigned to aircraft carriers. The results showed that "lack of circumcision was not found to be a risk factor for HIV."

Conclusion: Male circumcision "is not associated with HIV or STI prevention in this U. S. military population."

A study published in The Journal of Urology, Volume 184, Issue 4, Supplement, Pages 1754-1757 (October 2010). doi:10.1016/j.juro.2010.03.077 The authors performed a needs assessment to evaluate obstetric-gynecology residency training in neonatal circumcision. They identified that many OB/GYN residents are not qualified to identify when circumcision should not be performed.

Article by Dr. Andrew E. MacNeily, FRCSC, FAAP, published in Canada Urological Association Journal: Can Urol Assoc J. 2007 November; 1(4): 395397. Dr. MacNeily addresses the common myths that male infant cicrumcision has medical benefits. Using evidence based analysis, he disputes various claims and gives sound reasons why there is no benefit sufficient to justify infant circumcision.

Unfortunately, Dr. MacNeily does not address the current evidence that refutes many previous studies and information. For example, he says that penile cancer is reduced compared with uncircumcised men, although the American Cancer Society states that other factors contribute to penile cancer.

Study published in Annals of Family Medicine, 8:64-72 (2010). doi: 10.1370/afm.1073. A meta analysis of the literature from 1997 through 2008 regarding male circumcision. The study found, "There is little evidence showing clinical benefit from nontherapeutic male circumcision." The implications were stated: "Patients who request circumcision for clinical reasons should be informed of the lack of consensus surrounding the procedure, the lack of strong evidence regarding its benefits, and the potential medical and psychosocial harms of the procedure."

The study concluded:

The role of adult nontherapeutic male circumcision in preventing sexually transmitted infections, urinary tract infections, and penile cancer remains unclear. Current evidence fails to recommend widespread neonatal circumcision for these purposes.

The study was published in Journal of Sexual Medicine, Vol. 4 Issue 3, Pages 667 - 674, May 2007. The researchers had 20 intact men and 20 circumcised men watch erotic films before they were tested for touch sensitivity. The researchers tested a spot on the glans, the penile shaft, and the forearm of each subject. The researchers found no significant difference in glans sensitivity between the subjects. Surprisingly, the intact men were less sensitive to touch on the forearm than the circumcised men.

Study published in the BJUI (British Journal of Urology International), Volume 104, Issue 11, Pages 1698-1701 (2009). The study determinded that for women in Uganda who had partners that were circumcised, 57.3% reported the same level of sexual satisfaction for before and after the circumcision, 39.8% reported more sexual satisfaction, and 2.9% reported less satisfaction.

ISRN Urology, Volume 2013 (2013), Article ID 109846, 42 pages, http://dx.doi.org/10.1155/2013/109846 Sexually Transmitted Infections and Male Circumcision: A Systematic Review and Meta-Analysis

An article by Robert S. Van Howe of the Department of Pediatrics and Human Development, Michigan State University College of Human Medicine. He performed a systematic review and meta-analyses of studies to determine the effects of male circumcision on various sexually transmitted diseases (STDs). From the Abstract:

Chlamydia, gonorrhea, genital herpes, and human papillomavirus are not significantly impacted by circumcision. Syphilis showed mixed results with studies of prevalence suggesting intact men were at great risk and studies of incidence suggesting the opposite. Intact men appear to be of greater risk for genital ulcerative disease while at lower risk for genital discharge syndrome, nonspecific urethritis, genital warts, and the overall risk of any sexually transmitted infection. In studies of general populations, there is no clear or consistent positive impact of circumcision on the risk of individual sexually transmitted infections. Consequently, the prevention of sexually transmitted infections cannot rationally be interpreted as a benefit of circumcision, and any policy of circumcision for the general population to prevent sexually transmitted infections is not supported by the evidence in the medical literature.

A study published at PLoS ONE 2(6): e543. doi:10.1371/journal.pone.0000543. "This paper provides strong evidence that when conducted properly, cross country regression data does not support the theory that male circumcision is the key to slowing the AIDS epidemic. Rather, it is the number of infected prostitutes in a country that is highly significant and robust in explaining HIV prevalence levels across countries." The article received several critical comments, including one by Halperin. The article's author John R. Talbott provides a very good rebuttal attacking the Africa trials' statistical analysis methodology.

A study published in BMC Urology 2008, 8:6 doi:10.1186/1471-2490-8-6. Children aged from 2 to 14 were diagnosed with phimoses, in addition to other ailments. The phimosis was treated with sutureless prepuceplasty with good results. A longitudinal dorsal slit is healed by second intention, that is, the wound is allowed to close naturally without sutures.

Research article published in Archives of Disease in Childhood, Vol. 62, Issue 1, pp. 80-81, 1987. doi:10.1136/adc.62.1.80 

Abstract

Four newborn babies developed acute heart failure a few hours after circumcision at 8 days. During this procedure, a sponge soaked in epinephrine was applied to the circumcision site and left there for several hours. Treatment was with digoxin and diuretics and signs of heart failure disappeared within 24-72 hours.

Study published in the BJUI (British Journal of Urology International), Volume 99, Issue 3, Pages 619-622 (March 2007). The study showed that there was a loss of sexual pleasure and enjoyment for a significant percentage of men.

Paper published in BJUI (British Journal of Urology International), Volume 83, Suppl. 1, pages 79–84, (1999), and authored by K. O'Hara & J. O'Hara. The authors surveyed women having sexual experience with both circumcised and anatomically complete partners to determine if there were any differences in sexual enjoyment. They determined that circumcision results in a less satisfying sexual experience.

Study published in PLoS ONE, 5(1): e8422. doi:10.1371/journal.pone.0008422. The authors determined that there is a difference in the microbiota between circumcised and intact men.  Circumcision was associated with a significant change in the overall microbiota  and with a significant decrease in putative anaerobic bacterial families.

Study published in Journal of Pediatric Urology, 2009 Aug 7. doi:10.1016/j.jpurol.2009.07.007. "Knowledge of normal meatal/urethral width in a growing boy is important to create a neourethra of adequate size to correct hypospadias. Thus far, normal size values have been based on the study of circumcised, awake boys. The aim of this study was to measure normal urethral width in healthy uncircumcised boys under general anesthesia to provide a tool to create a neourethra of adequate size."

Paper published in the American Journal of Perinatology, 01 February 2011, Vol. 28, Issue 2, pp. 125-28 (2011). doi: 10.1055/s-0030-1263294. The author, Dr. James F. Smith, is chairman of the Department of Obstetrics and Gynecology (OB/GYN) at the Creighton University School of Medicine, a maternal/fetal medicine specialist with Creighton Medical Associates, and a professor of OB/GYN with Creighton University School of Medicine. Dr. Smith calls on obstetricians and gynecologists to stop performing male circumcisions because the male genital surgery is outside the area of expertise of obstetricians and gynecologists.

Popular in the United States, it [male infant circumcision] has persisted in the scope of practice of obstetrics and gynecology, a field specializing in the opposite gender. To excel in women's reproductive health, we should no longer passively accept or actively maintain this procedure in our specialty. Steps are suggested to remove the residual and improper inclusion of circumcision from the scope of practice of obstetrics and gynecology.

HAARETZ.com reports in a 2008 article that traditional circumcision results in an increased rate of urinary tract infections (UTIs) for male infants. "Circumcision as performed by mohels, men whose profession is performing the Jewish ritual of brit milah, leads to a high rate of urinary tract infections among babies, according to a report released recently by physicians at Schneider Children's Medical Center in Petah Tikva."

The article reports that the researchers "found urinary tract infections to be far more common among babies who had undergone circumcision by a mohel rather than a physician." One researcher said, "Without appropriate and intensive treatment, the bacteria could reach the blood, possibly even causing death." The researchers believe the infections are caused by the bandage left on the penis after circumcision.

Child Circumcision: An Elephant in the Hospital is a video by Ryan McAllister, PhD. McAllister presents a lecture for folks on all sides of the male circumcision debate. The video presentation covers circumcision history in the English-speaking world. He replaces the loaded words and terms surrounding the subject -- such as circumcised and uncircumcised -- with more neutral terms such as "genital cutting," and "intact."  McAllister presents a fresh look at circumcision. 

Today, many Americans think of circumcision as an outdated surgical procedure that is harmful for baby boys. Even still, neonatal male circumcision remains the most common operation carried out in the US today.

Article in the Journal of Medical Ethics, Vol. 31, Issue 8, 2005;31:463-469 doi:10.1136/jme.2004.009340. The authors conclude that "it is ethically inappropriate to subject children—male or female—to the acknowledged risks of circumcision and contend that there is no compelling legal authority for the common view that male circumcision is lawful."

An article by Ronald Goldman, PhD, published in Paediatrics & Chid Health, Vol. 9, No. 9, pp. 630-33 (November 2003).  The article provides a very good overview of the current social standing of male infant circumcision. The author makes the point that the current reluctance to confront the religious issue undermines the core values (e.g., the health of the patient is paramount) and ethics (e.g., first, do no harm) that drive medical decision-making.

Paper published in Clinical Ethics, 2009;4:181-186.  doi:10.1258/ce.2009.009029. David Shaw, Faculty of Medicine and Centre for Applied Ethics & Legal Philosophy, University of Glasgow, writes that the current General Medical Council (GMC) guidelines are flawed in stating that any doctor who does not wish to carry out a non-therapeutic circumcision (NTC) on a boy must invoke conscientious objection.

Paper published in Ethnicities, June 2010 vol. 10 no. 2 181-207. doi: 10.1177/1468796810361654. The author argues that the assumption that there is no harm and, consequently, no reason to intervene against male circumcision, is an erroneous assumption. He highlights evidence that suggests that, according to the criteria of sexual diminution, pain and coercion employed to criticize FGM, circumcision can be viewed as a harmful act of Male Genital Mutilation (MGM).

Gender Across Borders, a global feminist blog, discusses the ethics of infant circumcision. The Ethics of Neonatal Circumcision considers personal autonomy. The person undergoing routine infant circumcision is an infant who has not consented to the surgery, which lacks a clear medical need.

British Medical Association page from November 2007 discussing the Law and ethics of male circumcision. The paper states that routine infant circumcision is permitted by UK law. The BMA discusses ethics without declaring if routine infant circumcision is ethical or not.

The Association for Genital Integrity is a Canadian group committed to raising public awareness of the issues surrounding infant male circumcision. The Association seeks to promote the right of every child to bodily integrity. The site includes Canadian statistics. 

ARC, Attorneys for the Rights of the Child, is an international network of attorneys and other supporters of child rights. ARC was founded by J. Steven Svoboda in 1997 and continues to strongly advocate for child rights.

The BIID site aims to inform people about a relatively unknown and misunderstood condition which leads people to need an impairment of some sort. The most often sought impairments are: amputation, paraplegia, blindness, deafness. 

The Body Integrity Identity Disorder site seeks to increase the knowledge about the disorder. BIID is a psychological condition in which a person seeks an elective amputation. "Individuals with this condition experience the persistent desire to have their body physically match the idealized image they have of themselves." The site includes links to various papers and reports.

Children's Genitals Under The Knife, Social Imperatives, Secrecy, And Shame, By Hanny Lightfoot-Klein.

The object of this book is to give voice to the multitudes of human beings who exist behind the statistics on genital surgery performed on them when they were non-consenting children, and who have long endured their suffering in silence, for reasons of suppression, desperation, or shame. I have endeavored to create an understanding of the connection between genital surgery perpetrated on infants and children too young to be capable of meaningful consent or effective protest, and of the frequently cataclysmic diminution in quality of life that they have suffered as a consequence.
 

To anyone not totally steeped in denial, or tyrannized by social custom, as most people in genitally mutilating societies certainly tend to be, whether we are talking about female genital cutting, inter-sex surgery or male foreskin ablation, it should be perfectly obvious that genital cutting of any sort is the kind of nightmarish event that makes the most cruel reality of a child's ultimate fears.

The Rape of Innocence: female genital mutilation and circumcision in the USA, By Patricia Robinett

Genital mutilation in the USA has been a well-kept secret. "The Rape of Innocence" is an autobiographical account of a white Anglo-Saxon Protestant woman who discovered she had been the victim of clitoridectomy as a child in Kansas in the 1950s. The author is a therapist who deals with trauma. In her work, she has met many other American women and men who were genitally mutilated as children and adults. Could you -- or someone you love -- have been cut too? This book may explain the U.S. epidemic of sexual dysfunction, anger, anxiety, depression -- unresolved psychological trauma from circumcision. Now that the word is out, the healing can begin.

BoysToo^®  is dedicated to equal rights to genital integrity for both boys and girls.

The International Coalition for Genital Integrity is an alliance of organizations dedicated to protecting the normal anatomy of males, females and the intersexed, and supporter of the Genital Integrity Resolution. ICGI was formed to coalesce the many activist organizations, each with a specific focus, into one, common voice.

The Intersex Society of North America (ISNA) is devoted to systemic change to end shame, secrecy, and unwanted genital surgeries for people born with an anatomy that someone decided is not standard for male or female. The site has guidelines, tips for parents, a teaching kit, and a FAQ for disorders of sex development (DSDs).

MGMbill.org offers various publications, including a Human Rights Report,  Male Genital Mutilation Policy Statement (2006),  The Truth Seeker: Crimes of Genital Mutilation, and miscellaneous flyers and fact sheets.

Nurses for the Rights of the Child is a nonprofit organization dedicated to protecting the rights of infants and children to bodily integrity. The group seeks to protect unconsenting infants and children from surgical alterations of their healthy genitals.

Students for Genital Integrity (SGI) is group committed to ending the pratice of forced genital cutting; a human rights abuse perpetuated on children by adults. This abuse is often done in order to conform the body to a particular society's concepts of aesthetics and normality.

The Ashley Montagu Resolution and Petition website advocates against the ritual mutiation of genitals of both male and female children.

Gender Across Borders, a global feminist blog, discusses the ethics of infant circumcision. The Ethics of Neonatal Circumcision considers personal autonomy. The person undergoing routine infant circumcision is an infant who has not consented to the surgery, which lacks a clear medical need.

British Medical Association page from November 2007 discussing the Law and ethics of male circumcision. The paper states that routine infant circumcision is permitted by UK law. The BMA discusses ethics without declaring if routine infant circumcision is ethical or not.

An article published in the Duke Law Journal, 47 Duke L.J. 717 (February 1999). The article discusses the attempt by a Seattle, Washington, hospital to perform a symbolic sunna (female circumcision) on the daughters of Somali immigrants. The Somalis threatened to have a traditional circumcision performed on the girls if the hospital did not do something.

A New York Times article from September 24, 2006, about Cheryl Chase. Cheryl was born with a large clitorus that was removed as a child. She became a strong advocate for intersexed people and formed Intersex Society of North America.

Video of intactivists marching in the 2009 Gay Pride Parade in San Francisco, California. An uplifting look at how the pro-intact message is being delivered.

A November 2008 article discussing 18 common myths about routine infant circumcision.

Cut is a documentary film by Eliyahu Ungar-Sargon which examines the subject of male circumcision from a religious, scientific and ethical perspective. Using cutting-edge research, in addition to interview footage of rabbis, philosophers, and scientists, Cut challenges the viewer to confront their biases by asking difficult questions about this long-standing practice.

An interview published in Anthropology Today, Volume 25, Issue 6 (p 14-17). DOI 10.1111/j.1467-8322.2009.00699.x  Fuambai S. Ahmadu is both a professional anthropologist and an initiated member of the Bondo society of Sierra Leone. She said that she is confident that she gets all the satisfaction of anyone when she makes love. "According to her [Hanny Lightfoot-Klein, the author of Prisoners of ritual] five-year research, 94% of circumcised women reported sexual satisfaction and orgasm and many said they had sex three or four times a week."

A 2007 article in AssociatedContent Health and Wellness regarding the myth of male circumcision preventing cervical cancer. The article describes the history of research on circumcision and cervical cancer. The various studies are consdered and flaws are pointed out that make the results questionable. It is significant that the American Cancer Society does not identify circumcision status as a risk factor for cervical cancer.

NotJustSkin is an educational charity that is not associated with the government or any private corporation. "Our mission is to support the physical health, emotional wellness, and quality of relationships of children, parents, and others."  People are not just skin. The site has a circumcision FAQ.

The Vulnerability of Men is a thoughtful article by an intact man describing why a circumcised father would want to circumcise his son. The author, Vincent Bach, describes the typical stages a cut man goes through when first confronted with the question of whether his son should be circumcised.

Vincent believes that the driving force behind circumcision in the United States is circumcised men. Many circumcised men feel cornered because they had their penis reduced by circumcision without their consent. His sexual well-being is based on how he perceives himself, and that includes seeing himself with a circumcised penis. To allow his son to remain intact would be to admit that he has less than a full, complete sex organ.

The page was also reproduced at Circumstitions. The content has since moved.
Edited October 28, 2018

A New York Times article from September 24, 2006, about Cheryl Chase. Cheryl was born with a large clitorus that was removed as a child. She became a strong advocate for intersexed people and formed Intersex Society of North America.

Mothering magazine article about the decision on circumcision.

Brit Shalom is a non-cutting naming ceremony that replaces Brit Milah (ritual circumcision) for newborn Jewish boys. Brit shalom can be similar to the naming ceremony traditionally used for baby girls. It may be performed by a Rabbi or other experienced lay leader.

Catholics Against Circumcision respects the bodily integrity rights of male and female children.  Children have a right to be free from unnecessary amputations (circumcision or genital mutilation) that cause pain, trauma, scarring, and loss to their perfect bodies. New Testament Scriptures teach us that the Old Testament Law that required circumcision was rescinded after the death and resurrection of Jesus Christ.

Circumcision - Does the Qur'an Approve it?

   ختان‎    -    Khitan  -  Khatna  -  Sunat  -  Musolmani  -  Tuli  -  Urkwtha  -  Tahara  -  Touhur  -  Sünnet  -  Koran  -  Quran

A webpage describing circumcision and Islam. The page describes circumcision and what is removed from the penis. The Qur'an is quoted to show that Allah created human beings perfectly. Circumcision is not needed nor is it in the Qur'an.

The page provides a very good discussion on how Male Circumcision adversely affects the mechanics of sexual intercourse and why many circumcised men do not complain.

A 3-part video of the decision regarding with Jewish tradition of brit milah, the covenent of circumcision, the infant boy. "Two couple's touching stories, one from Israel and one from the US, are interwoven as they thoughtfully ponder what they are going to do."

Children's Genitals Under The Knife, Social Imperatives, Secrecy, And Shame, By Hanny Lightfoot-Klein.

The object of this book is to give voice to the multitudes of human beings who exist behind the statistics on genital surgery performed on them when they were non-consenting children, and who have long endured their suffering in silence, for reasons of suppression, desperation, or shame. I have endeavored to create an understanding of the connection between genital surgery perpetrated on infants and children too young to be capable of meaningful consent or effective protest, and of the frequently cataclysmic diminution in quality of life that they have suffered as a consequence.
 

To anyone not totally steeped in denial, or tyrannized by social custom, as most people in genitally mutilating societies certainly tend to be, whether we are talking about female genital cutting, inter-sex surgery or male foreskin ablation, it should be perfectly obvious that genital cutting of any sort is the kind of nightmarish event that makes the most cruel reality of a child's ultimate fears.

The Rape of Innocence: female genital mutilation and circumcision in the USA, By Patricia Robinett

Genital mutilation in the USA has been a well-kept secret. "The Rape of Innocence" is an autobiographical account of a white Anglo-Saxon Protestant woman who discovered she had been the victim of clitoridectomy as a child in Kansas in the 1950s. The author is a therapist who deals with trauma. In her work, she has met many other American women and men who were genitally mutilated as children and adults. Could you -- or someone you love -- have been cut too? This book may explain the U.S. epidemic of sexual dysfunction, anger, anxiety, depression -- unresolved psychological trauma from circumcision. Now that the word is out, the healing can begin.

An interview published in Anthropology Today, Volume 25, Issue 6 (p 14-17). DOI 10.1111/j.1467-8322.2009.00699.x  Fuambai S. Ahmadu is both a professional anthropologist and an initiated member of the Bondo society of Sierra Leone. She said that she is confident that she gets all the satisfaction of anyone when she makes love. "According to her [Hanny Lightfoot-Klein, the author of Prisoners of ritual] five-year research, 94% of circumcised women reported sexual satisfaction and orgasm and many said they had sex three or four times a week."

Study published in Journal of Sexual Medicine, Vol. 4, Issue 6, pp. 1666-78 (Oct. 23, 2007). The study found that significant percentages of women still experience orgasms after genital mutilation.

Results. The group of 137 women, affected by different types of FGM/C, reported orgasm in almost 86%, always 69.23%; 58 mutilated young women reported orgasm in 91.43%, always 8.57%; after defibulation 14 out of 15 infibulated women reported orgasm; the group of 57 infibulated women investigated with the FSFI questionnaire showed significant differences between group of study and an equivalent group of control in desire, arousal, orgasm, and satisfaction with mean scores higher in the group of mutilated women. No significant differences were observed between the two groups in lubrication and pain.

Study published in American Journal of Epidemiology, Vol. 136, No. 7: 895-907 (1992). The authors found that "a history of excision and BCG vaccinations decreased the risk of HIV-2 infection." That is, women who had undergone female genital cutting had reduced risk of HIV infection.

NOTE: The Patriotic Vanguard website is off-line. The Wayback Machine has a copy of Statement by African Women Are Free to Choose (AWA-FC), Washington DC, USA. Other copies can be found on the net by searching for "Statement by African Women Are Free to Choose."

A statement by African Women Are Free to Choose (AWA-FC) published in The Patriotic Vanguard on February 20, 2009. Western culture abhors female genital mutilation (FGM) or female circumcision (FC), although the culture accepts and endorses male genital mutatilation (MGM), commonly called male circumcision. The African Women Are Free to Choose organization asks Westerners to leave their female cutting culture alone. The AWA-FC claim that female circumcision is not mutilation.

An article published in the Duke Law Journal, 47 Duke L.J. 717 (February 1999). The article discusses the attempt by a Seattle, Washington, hospital to perform a symbolic sunna (female circumcision) on the daughters of Somali immigrants. The Somalis threatened to have a traditional circumcision performed on the girls if the hospital did not do something.

An article in Advocates of Youth that compares data between Europe and the United States.

In France, Germany, and the Netherlands, two things create greater, easier access to sexual health information and services for all people, including teens. They are: 1) societal openness and comfort in dealing with sexuality, including teen sexuality; and 2) pragmatic governmental policies. The result - better sexual health outcomes for French, German, and Dutch teens when compared to U.S. teens.

A study published Sexually Transmitted Infections, doi:10.1136/sti.2010.042895, determined that there was no association between circumcision and HIV for men having sex with men. The researchers concluded that circumcision is unlikely to be a feasible HIV prevention strategy for gay men in the UK.

This study supports other studies that found no link between circumcision status and HIV infection rates among homosexual men.

CATIE-News: Bite-sized HIV/AIDS news bulletins published by Canadian AIDS Treatement Information Exchange. The page addresses many of the current studies and meta-analysis for HIV and the gay man. The results of the various studies and meta-analysis are consistent and show that there is little to no benefit in circumcising gay men to reduce HIV.

Researchers studying the increase and spread of HIV have concluded in several studies that increases in high-risk sex have overwhelmed any decrease in infectivity due to HAART (highly active antiretroviral therapy). This does not mean that current HIV prevention efforts have failedwithout these efforts, rates of new cases of HIV and STIs might be much higher. This environment of high-risk sex and STIs must be taken into account when considering the potential impact and rollout of new prevention interventions--such as male circumcision, microbicides or pre-exposure prophylaxis (PrEP)--in gay and bisexual men in high-income countries.

Study published in The Journal of Infectious Diseases, 2009; 200:000–000. DOI: 10.1086/648376. The authors found a correlation of reduced incidence of syphilis among men who reported predominantly insertive unprotected anal intercourse.

Study published in Australian and New Zealand Journal of Public Health, Vol. 34 Issue 2, Pages 160 - 164 (April 2010).  The study concluded that "Circumcision appears to have minimal protective effects on sexual health in Australia." Translated into English, "Circumcised men do not have any additional protection against sexually transmitted diseases."

Study published in The Lancet, Volume 374, Issue 9685, Pages 229 - 237, 18 July 2009. doi:10.1016/S0140-6736(09)60998-3.  The study assessed whether circumcision in HIV-infected men would reduce transmission of the virus to female sexual partners. Circumcision of HIV-infected men did not reduce HIV transmission to female partners over 24 months; longer-term effects could not be assessed. Condom use after male circumcision is essential for HIV prevention.  The results indicate that there is a probability of 21.7% HIV infection rate for female partners of circumcised HIV infected men, compared to 13.4% HIV infection rate for female partners of HIV infected men. Women with circumcised partners had more than a 50% increase in the infection rate of women compared to women with un-circumcised partners.

Study published in JAMA, 1997; 277(13): 1052-1057. The objective was to assess the prevalence of circumcision across various social groups and examine the health and sexual outcomes of circumcision. The authors analyzed the National Health and Social Life Survey (NHSLS) data to determine the effects of circumcision. The results indicate, "We find no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases." 

The Daily Nation, a Kenyan news site, reports on September 26, 2009, that recent findings show an increase in HIV infection in regions where most males are circumcised.

Published in The Journal of the Royal Society for the Promotion of Health, Vol. 125, No. 6, 259-265 (2005) (DOI: 10.1177/146642400512500607). The authors conclude, "Even if effective, mass circumcision as a preventive measure for HIV in developed countries is difficult to justify."

Paper from 16th Conference on Retroviruses and Opportunistic Infections (2009).  A pdf file of the paper is available on the website.

Note published in The Journal of Cell Biology, Vol. 177, No. 1, 5 (March 2007), doi:10.1083/jcb.1771rr5, refers to de Witte* study in Nat. Med. doi:10.1038/nm1541. Further research shows that a suspected entry route for HIV is a dead end. Langerhans cells, rather than transmitting the virus to T cells, trap HIV-1 and thus act as a barrier to infection. The foreskin of the male penis has Langerhans cells, but they are removed, along with the foreskin, during circumcision.

Article in American Journal of Preventive Medicine, Volume 39, Issue 5 , Pages 479-482, November 2010. The authors discuss the "external validity" of the three African randomized control trials that examined circumcision as a preventive measure for HIV infection. The nutshell version of this discussion is that clinical conditions that show promise do not necessarily translate into a real world net benefit.

The Male Circumcision and HIV blog presents current information on policy decisions and various actions by organizations that can affect policy.

A well-researched article by Michael Fumento describing the transmission vectors of AIDS, as backed up by statistics. The author notes that much dis-information is promulgated regarding heterosexual AIDS. Citing statistics, Fumento notes that there are few cases of heterosexual AIDS that withstand scrutiny.

Paper published in Sexual Health, 7(4) 463–470, November 2010. doi:10.1071/SH09080. The authors developed a mathematical model to simulate HIV propagation within a MSM population. Conclusions: "The results of these calculations suggest that circumcision as a public health intervention will not produce a substantial decrease in HIV prevalence or incidence among MSM in the near future, and only modest reductions are achievable in the long-term."

Study published in American Journal of Epidemiology, Vol. 136, No. 7: 895-907 (1992). The authors found that "a history of excision and BCG vaccinations decreased the risk of HIV-2 infection." That is, women who had undergone female genital cutting had reduced risk of HIV infection.

Study published in International Conference on AIDS, 15th : 2004 : Bangkok, Thailand, July 11-16: abstract no. TuPeC4861. The Naval Health Research Center conducted a study of men assigned to aircraft carriers. The results showed that "lack of circumcision was not found to be a risk factor for HIV."

Conclusion: Male circumcision "is not associated with HIV or STI prevention in this U. S. military population."

ISRN Urology, Volume 2013 (2013), Article ID 109846, 42 pages, http://dx.doi.org/10.1155/2013/109846 Sexually Transmitted Infections and Male Circumcision: A Systematic Review and Meta-Analysis

An article by Robert S. Van Howe of the Department of Pediatrics and Human Development, Michigan State University College of Human Medicine. He performed a systematic review and meta-analyses of studies to determine the effects of male circumcision on various sexually transmitted diseases (STDs). From the Abstract:

Chlamydia, gonorrhea, genital herpes, and human papillomavirus are not significantly impacted by circumcision. Syphilis showed mixed results with studies of prevalence suggesting intact men were at great risk and studies of incidence suggesting the opposite. Intact men appear to be of greater risk for genital ulcerative disease while at lower risk for genital discharge syndrome, nonspecific urethritis, genital warts, and the overall risk of any sexually transmitted infection. In studies of general populations, there is no clear or consistent positive impact of circumcision on the risk of individual sexually transmitted infections. Consequently, the prevention of sexually transmitted infections cannot rationally be interpreted as a benefit of circumcision, and any policy of circumcision for the general population to prevent sexually transmitted infections is not supported by the evidence in the medical literature.

A study published at PLoS ONE 2(6): e543. doi:10.1371/journal.pone.0000543. "This paper provides strong evidence that when conducted properly, cross country regression data does not support the theory that male circumcision is the key to slowing the AIDS epidemic. Rather, it is the number of infected prostitutes in a country that is highly significant and robust in explaining HIV prevalence levels across countries." The article received several critical comments, including one by Halperin. The article's author John R. Talbott provides a very good rebuttal attacking the Africa trials' statistical analysis methodology.

Study published in Sexually Transmitted Diseases, 22 August 2011,doi: 10.1097/OLQ.0b013e31822e60cb.

Methods: Male university students (aged 18-20 years) were recruited from 2003 to 2009 and followed up triannually. Shaft/scrotum, glans, and urine samples were tested for 37 [alpha] human papillomavirus (HPV) genotypes.

Results: In 477 men, rates of acquiring clinically relevant HPV types (high-risk types plus types 6 and 11) did not differ significantly by circumcision status.

Conclusions:Although the likelihood of HPV acquisition did not differ by circumcision status, uncircumcised men were more likely than circumcised men to have infections detected at multiple genital sites, which may have implications for HPV transmission.

ISRN Urology, Volume 2013 (2013), Article ID 109846, 42 pages, http://dx.doi.org/10.1155/2013/109846 Sexually Transmitted Infections and Male Circumcision: A Systematic Review and Meta-Analysis

An article by Robert S. Van Howe of the Department of Pediatrics and Human Development, Michigan State University College of Human Medicine. He performed a systematic review and meta-analyses of studies to determine the effects of male circumcision on various sexually transmitted diseases (STDs). From the Abstract:

Chlamydia, gonorrhea, genital herpes, and human papillomavirus are not significantly impacted by circumcision. Syphilis showed mixed results with studies of prevalence suggesting intact men were at great risk and studies of incidence suggesting the opposite. Intact men appear to be of greater risk for genital ulcerative disease while at lower risk for genital discharge syndrome, nonspecific urethritis, genital warts, and the overall risk of any sexually transmitted infection. In studies of general populations, there is no clear or consistent positive impact of circumcision on the risk of individual sexually transmitted infections. Consequently, the prevention of sexually transmitted infections cannot rationally be interpreted as a benefit of circumcision, and any policy of circumcision for the general population to prevent sexually transmitted infections is not supported by the evidence in the medical literature.

Article from Arch Dis Child (Archives of Disease in Childhood), 2006 January; 91(1): 92. The authors "dispute the claim that Schoen represents the North American view. We think that he represents only his personal view and that of a few disciples."

Circinfo is a Twitter user who incessantly posts a pro-circ stream of tweets. This May 2009 blog discusses his tweets and his tactics.