Male circumcision, the surgical removal of the foreskin from the penis, is a practice with roots extending back thousands of years and across numerous cultures. Anatomist and historian Grafton Elliot Smith suggests that the procedure may date back over 15,000 years, predating recorded history. Although the origins of this practice are debated, it's known that the act of circumcision has been performed across geographically and culturally distinct groups, including ancient Egyptians, Semites, Jews, Muslims, Australian Aboriginals, Polynesians, and even the Aztec and Mayan civilizations.
In modern times, circumcision continues to be practiced in many parts of the world, including Australia, Canada, Israel, South Korea, the United States, and various regions of Southeast Asia and Africa. While reasons for circumcision can be religious, cultural, or personal, there's also a growing body of evidence pointing to the health benefits associated with the procedure.
The term "circumcision" derives from the Latin "circumcidere," which means "to cut around."
Historical Context and Prevalence
Male circumcision is widely acknowledged as the world's oldest planned surgical procedure, with its history reaching far beyond the realm of written records. The renowned anatomist and hyperdiffusionist historian, Grafton Elliot Smith, suggested that the practice could be over 15,000 years old. While we have no written or archaeological proof to verify this claim, the antiquity of the practice is nevertheless undebatable.
Archaeological evidence has been vital in our understanding of the practice's origins. Depictions of circumcision are amongst the oldest surviving records of the procedure. Found on the walls of the burial grounds and temples of ancient Egypt, these inscriptions depict scenes of circumcisions dating back to around 2400 BC, although it is believed the practice was already an established ritual by this point.
Historically, circumcision was not confined to the African continent. In the Middle East, the practice was incorporated into the rites and traditions of several emerging religions. In Judaism, the bris, or ritual circumcision, was mandated by the covenant between God and Abraham, as described in the Torah. The Islamic faith adopted circumcision as a tradition, although it is not explicitly mentioned in the Quran. In Christianity, the practice varied between different sects and changed over time.
Circumcision was also prevalent among indigenous tribes in various parts of the world. In the Americas, both the Mayans and Aztecs practiced circumcision. Similarly, numerous tribes in Sub-Saharan Africa, the Pacific Islands, and Australia included circumcision as a rite of passage, marking the transition from boyhood to manhood. Often, these rituals were embedded in complex social and religious systems, reflecting beliefs about purity, courage, and manhood.
With the advent of modern medical science, the practice began to be viewed from a health perspective. In the 19th century, Western medicine started to advocate circumcision as a preventative and curative measure for a variety of conditions. This led to a rise in the practice in English-speaking countries such as the UK, the U.S., Canada, Australia, and New Zealand.
Prevalence in the United States and Canada is estimated at 81% and 35% respectively and most are performed in the neonatal period for prophylactic reasons.
In Australia, circumcision became quite common throughout the 20th century. Medical circumcision was a routine procedure for newborn boys from the 1950s through to the late 70s. The rate of newborn circumcision was estimated at 75%-80% in the 1950s, but consistently declined to near 20% by early 2000s before starting to increase slowly as of 2004 and estimated to be around 26%-30% at present. More than half (59%) of the men are circumcised in the country, with the rate highest in Queensland and lowest in Tasmania.
The history of circumcision is as diverse as the cultures that have practiced it, reflecting a range of beliefs and practices across thousands of years. Today, it remains a significant ritual in many societies and is also recognized for its health benefits. Despite changing social attitudes and medical advice, the practice continues, remaining an important cultural and personal choice for many families.
Cultures and Religions
The practice of circumcision is deeply rooted in a variety of cultural, ethical, and social contexts. It's a customary procedure in some cultures, typically performed shortly after birth, during childhood, or around puberty as a part of a rite of passage. Circumcision is prevalent in Jewish, Islamic, Druze faiths, and in some Christian denominations like Coptic Christianity, Ethiopian Orthodox Church, and the Eritrean Orthodox Tewahedo Church. Conversely, religions such as Mandaeism, Hinduism, and Sikhism strongly discourage routine circumcision.
Judaism
Circumcision, or "Brit milah," is near-universal among Jews and is considered one of the most significant commandments in Judaism. It's performed on the eighth day of a newborn son's life unless health conditions pose a risk. The procedure is rooted in the Torah of the Hebrew Bible, specifically Genesis chapter 17, where a covenant of circumcision is made with Abraham and his descendants. Converts to Conservative and Orthodox Judaism are also required to be circumcised, even if it's a symbolic ritual. Failure to undergo the rite can have severe spiritual implications according to mainstream Judaism.
Islam
In Islam, although circumcision is a widespread practice, it's considered to be sunnah (tradition) rather than a mandatory religious requirement. Derived from pre-Islamic Arabian practices, circumcision, or "khitan," is practiced nearly universally by Muslim males. Islam refers to the Genesis 17 narrative, similar to Judaism, for its practice of circumcision. The procedure is regarded as a matter of cleanliness, purification, and control over one's baser self (nafs). The age at which circumcision should be performed varies across Islamic communities, ranging from shortly after birth to about age 15.
Christianity
Unlike Judaism and Islam, circumcision isn't a religious requirement in Christianity. Christian denominations, including the Catholic Church, are generally neutral about circumcision for prophylactic, cultural, and social reasons, but strongly oppose it for religious reasons. However, circumcision rates among Christians are influenced by their surrounding cultures. It's a common practice in some African and Eastern Christian denominations as a rite of passage.
Druze Faith
Circumcision is widely practiced among the Druze, an Abrahamic, monotheistic, syncretic, and ethnic religion. The procedure is practiced as a cultural tradition without any religious significance in the Druze faith.
Other Faiths
Like Judaism, Samaritanism also requires ritual circumcision on the eighth day of life. In contrast, Mandaeism prohibits circumcision, considering it abhorrent. Circumcision is not mandatory in Yazidism but is practiced due to regional customs. Sikhism does not require circumcision and explicitly criticizes the practice.
African Cultures
In Africa, circumcision is widespread and is often part of a rite of passage into manhood. The practice varies among cultural groups, with some performing it for cultural, purification, or subjugation reasons.
Australian Cultures
Among some Australian Aborigines, circumcision serves as a test of bravery and self-control as a part of a rite of passage into manhood.
Filipino Culture
In the Philippines, circumcision, known as "tuli," is viewed as a rite of passage. The majority of Filipino men undergo circumcision, often in April and May. This tradition dates back to the arrival of Islam in 1450.
Known Benefits of Male Circumcision
- HIV Prevention: Multiple studies, including randomized controlled trials in Africa, have shown strong evidence that circumcision reduces the risk of men acquiring HIV, especially in areas with high HIV rates. The World Health Organization (WHO) and UNAIDS recommend male circumcision as an effective intervention for HIV prevention. However, it is essential to remember that it only offers partial protection and should not replace other known HIV prevention methods.
- Human Papillomavirus (HPV) Reduction: Circumcision is associated with reduced prevalence of cancer-causing types of HPV. While there's no strong evidence that it decreases the rate of new HPV infections, it is associated with increased clearance of the virus by the body, which might explain the observed reduction in prevalence.
- Protection against Other Sexually Transmitted Infections (STIs): Circumcision has been found protective against other STIs such as syphilis, chancroid, and possibly genital herpes. It has also been observed to reduce the incidence of HSV-2 (herpes simplex virus, type 2) infections by 28%.
- Prevention of Phimosis: Phimosis is a condition where the foreskin cannot be retracted over the glans penis, which can become problematic. Circumcision is a treatment option for this condition, preventing the development of pathological phimosis.
- Reduction in Balanitis and Balanoposthitis: Both of these conditions, referring to the inflammation of the glans penis and foreskin, occur predominantly in uncircumcised males. Circumcision can reduce the incidence of these infections and is a treatment option for refractory or recurrent cases.
- Decrease in Urinary Tract Infections (UTIs): Circumcision can reduce the incidence of UTIs in boys under two years of age, potentially by a factor of 3-10 times. It is most beneficial for boys who have a high risk of UTIs due to anatomical defects.
- Penile Cancer Risk Reduction: American Cancer Society lists being uncircumcised as a risk factor for penile cancer. Circumcision, particularly when performed in infancy or childhood, provides a strong protective effect against penile cancer. Penile cancer is significantly more prevalent in uncircumcised men and populations where neonatal circumcision is prevalent.
- Potential Lower Risk of Prostate Cancer: Some studies have suggested a correlation between circumcision and a lower risk of prostate cancer, although this area requires further research for conclusive evidence.
- Women's Health Benefits: Circumcision of male partners before heterosexual contact has been associated with a reduced risk in women for several conditions, including cervical cancer, cervical dysplasia, HSV-2, chlamydia, and syphilis.
It's important to note that while these benefits have been observed, circumcision is a personal decision and often influenced by cultural, religious, and individual beliefs. Any decision regarding circumcision should be informed, considering both the potential benefits and risks.
When you’re weighing up the risks and benefits of circumcision, it’s important to consider all the evidence and information. You could ask your GP or paediatrician to talk you through the risks and benefits.
Circumcision isn't performed in Australian public hospitals and not funded through Medicare unless it's to treat conditions like repeated UTIs or foreskin problems.
The RACP, the Royal Australasian College of Surgeons, the Urological Society of Australia and New Zealand, and state health departments don’t recommend circumcision for non-medical reasons.
The only major western country where circumcision is very common and recommended by the medical bodies is the United States.
