Circumcision

• Widely practiced as religious rite since ancient times.

• Earliest evidence of the practice dates from ancient Egypt.

• Commonly practiced by Jewish, Muslims, and Christians

Jewish Religious Tradition

• Initiatory rite of Judaism

• part of Abraham’s covenant with God

• Levitical Law:

every Jewish male infant had to be circumcised on the eight day after birth, under penalty of ostracism from the congregation of Israel

Islam• Khitan or Khatrah signifies spiritual purification• Collections of Hudith

circumcision is mandatory (wajib).• It is good for their cleanliness (taharah) as well as it

is a prophetic tradition• Sunnah:

it is recommended to have the circumcision done on the seventh day of the child’s birth (including day of birth) but it can be done sooner or later

Cons:

• Circumcision is an option of Fitrah not mandatory

• circumcision existed before the time of Muhammad contradicting the Sunnah of Prophet Ibrahim and Prophet Muhammad

• Koran does not mention it, hence regarded only as Islamic custom

Christianity

• Quired by the descendants of Abraham “throughout their generations” (Genesis 17)

• Luke 2:22; Leviticus 12:6-8, Completion of the Law of Purification for male children according to Law of Moses

• Mark of God’s covenant

• Luke 2:21-40, Jesus himself was circumcised on the eight day of his life and presented on the temple on the 40th day all in Jerusalem

• Rom 3, What value is there in circumcision? First of all they have been entrusted with the very words of God.

Cons

• Christianity no longer required that a male be circumcised

• When the system of Judaism ended and was nailed to the cross (Co 2:14) it was no longer required.

• No longer a distinction between Jew and Gentile (Eph 2:14-16) but we are all one in Christ (Gal 3:28)

• For religious reasons it is not necessary and even contrary to the will of God. Rom 4; 1Cor 7; Gal 5:1-4

• There is a spiritual circumcision today (Col 2:10-15) “not made with hands”.

• 1Cor 7:19, Circumcision is nothing and uncircumcision is nothing. Keeping God’s commands is what counts.

• He will accept us if we respond by obedient faith. Heb 8; Gal 3:26-29, Acts 2:36-42

CIRCUMCISION• URINARY TRACT INFECTION

No scientifically valid or methodologically sound evidence that the foreskin is responsible for UTI or kidney failure, either in children or in adults. If a casual relationship were to be proven, male UTI are relatively rare, and can be effectively prevented or treated by other conservative methods.

-Male Health and Genital Care: Previous

Circumcision Rationale and Modern Alternatives (1994)

• URINARY TRACT INFECTION

uncircumcised males were 10-20x more

likely to develop UTI than circumcised male

infants-Decreased incidence of urinary tract infections in

circumcised male infants. Pediatrics, 1985

uncircumcised males had 12 fold increased risk of UTI compared with circumcised infant males.

-Urinary tract infections and the uncircumcised state; an update. Clin Pediatr, 1993

More recent studies using cohort and case-control design also supports an association , although reduced in magnitude. A 3-7x increased risk of UTI in uncircumcised male infants compared with that in circumcised male infants

-Urinary tract infections in febrile infants younger that 8 weeks of age. Pediatrics, 1990

-Urinary tract infections and circumcision: a case control study. Am J Dis Child,

1989

-Effect of circumcision on incidence of urinary tract infection in preschool boys. J.

Pediatr, 1996

Circumcision• PHIMOSIS

Foreskin continues to develop through adolescence. A diagnosis of penile phimosis is premature and invalid until late adolescence. Ballooning of the foreskin upon urination is not an indication for circumcision, as long as there is adequate urine stream.

-Newborns: Care of the Uncircumcised

Penis Penis. American Academy of Pediatrics 1994

Circumcision• Physiological problems of the foreskin,

such as phimosis or paraphimosis, almost always respond well to conservative non-surgical treatments, making circumcision obsolete.

-Treatment of Childhood Phimosis with Topical Steroid.

Australia-New Zealand Journal of Surgery, 1994

- Treatment of Phimosis in Boys with a Potent Topical Steroid. Acta Dermato-

Venereologica, 1993

Circumcision

• Perpetuating the mistaken belief that circumcision prevents cancer is inappropriate and distracts the public from the task of avoiding the behaviors proven to contribute to penile and cervical cancer: especially cigarette smoking and unprotected sexual relations with multiple partners.

-American Cancer Society letter, 1996

Circumcision

• Circumcision provides no discernible prophylactic benefit and may in fact increase the likelihood of STD contraction. Chlamydial infection correlates strongly with the circumcised condition.

-Circumcision in the United States. Journal of the American Medical Association, 1997

CIRCUMCISION STATUS AND STD INCLUDING HUMAN

IMMUNODEFICIENCY VIRUS (HIV)

Evidence regarding the relationship of circumcision to STD in general is complex and conflicting.

-Circumcision and sexually transmitted diseases. Am J Pub

Health, 1994

Plausible biologic examination that link non-circumcision in men with risk for HIV infection, mucous surface of the uncircumcised penis allows for viral attachment to lymphoid cells at or near the surface of the mucous membrane, as well as an increased likelihood of minor abrasions resulting in increased HIV access to target tissues

CIRCUMCISION STATS AND CANCER OF THE PENIS

Several case series noted strong association between uncircumcised status and increased risk of penile cancer

-Carcinoma of the Penis: analysis of therapy in 100 consecutive cases. J. Urol, 1946

- Carcinoma of the penis. J Urol

• Role of Hygiene

Appropriate hygiene decreased significantly the incidence of phimosis, adhesions, and inflammation, but did not eliminate all problems.

Genital hygiene needs to be emphasized as a preventive health topic throughout a patent’s lifetime

-Effect of hygiene among the uncircumcised.

J. Fam Pract., 1986

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• Sexual Practice, Sensation, and Circumcision Status

No difference in extroceptive and light tactile discrimination on the ventral or dorsal surfaces of the glans penis between circumcised and uncircumcised men.

-Masters and Johnson, Human Sexual Response, 1956

• The prepuce provides a large and important platform for several nerve endings and is an important part of the sensory apparatus of the penis

- The prepuce: specialized mjucosa of the penis and its loss to circumcision. British Journal of Urology 1996.

The intact human penis has a moveable foreskin that covers and protects the glans penis from injury, discomfort, and unintended stimulation. The foreskin prevents meatal ulceration, a common injury in circumcised infants that can lead to meatal stenosis.

Complication of Circumcision. British Journal of Surgery. 1993

• The moveable foreskin offers a fuller range of sensual experience during sexual activities than the non-intact penis. The foreskin allows the penis to glide within its own mobile sheath during intercourse.

Circumcision: Male effects upon human sexuality. Human Sexuality: An Encyclopedia 1994

• The foreskin captures the male’s natural lubricating fluid and distributes it over the glans as the foreskin retracts. This lubricates the glans for easier penetration during sexual intercourse and heightens glans sensitivity. The foreskin lessens or eliminates the need for artificial sexual lubricants.

» The foreskin is necessary. Townsend letter ofr Doctors and Patients 1996.

• Complications of the Circumcision Procedure

Complication rate is between 0.2% - 0.6%. Most complications are minor.

Most frequent complication is bleeding, followed by infection.

-Complications of circumcision. Urol Clin North Am. 1983

-Neonatal circumcision; a ten year overview with comparison of Gomco clamp and the Plastibell device. Pediatrics. 1976

-The circumcision debate. Pediatrics.

• Complications of the Circumcision Procedure

recurrent phimosis, wound separation, concealed penis, meatal stenosis, chordee, inclusion cysts, and retained Plastibell devices.

-Management of foreskin provlems. Arch. Dis

Child. 1991