Circumcision

Of Latin circumcisio (to cross around), the circumcision consists of the ablation total or partial of the Prépuce, which leaves the nipple of the Pénis to overdraft. This practical exists since the Antiquité. It related to, in 2006, according to an estimate of WHO, 665 million men, that is to say approximately 30% of the world male population. It is carried out mainly for reasons cultural and religious but the being also with a therapeutic, hygienic and prophylactic aim can, in prevention of certain affections.

Various types

There exist at least five types of male circumcision:

1st type: it consists to cut out and withdraw a cylinder of skin and mucous corresponding to a part or the totality of the Prépuce. It is the most current form.
2nd type: it is the form of circumcision practiced by the Jews. (See the article Brit milah).
3rd type: it consists in completely skinning the skin of the penis and sometimes the Scrotum (skin of the Testicule S) and the skin of the Pubis. This shape of circumcision, called in Arabic salkh (who wants to say to skin), existed at tribes of the south of Arabia and in certain tribes of Black Africa.
4th type: it consists in splitting the urethra, creating kind an opening which resembles the female vagina. Called subincision, this type of circumcision is practiced by Aborigènes of Australia.
5th type: it consists in carrying out a dorsal incision on the foreskin, who discovers the nipple and folds back the foreskin split on the ventral face of the penis. Called super incision or supercision, it is practiced in Philippines and in Polynesia.

Physical consequences

When the penis not circoncis is with the state of flaccidity, its principal Erotogenic zone, the nipple, is not subjected to external frictions and drying. The circumcision, by removing the foreskin, puts the nipple at discovered in a permanent way. That induces the draining of this zone and involves a Kératinisation epithelium of the nipple more marquée.
During erection of the penis not circoncis, the unfolded foreskin provides a reserve of skin which compensates for the lengthening of the male sex all while enabling him to preserve a mobile sleeve. The circumcision more or less removes this reserve according to the quantity of removed skin. The consequences in term of sensitivity of this zone are prone to debate, but a recent study indicates that the circumcision does not modify the genital sensitivity to the touch or the pain. The practice to be made circoncire to increase its sexual capacities would rest only on assumptions never supported, and false according to this study. The premature ejaculation is not improved in particular by the circumcision.

The capacity to have erections, to test pleasure as well as the fruitfulness of the individual are not affected. She is not regarded by the World Health Organization (WHO) as a mutilation contrary to the excision for the woman.

It happens that the circumcision is badly made. Under these conditions, certain a number of undesirable consequences can exist: affections of the skin; bridges of skin enters the remaining skin and the crown of the nipple; long cicatrization; tight and painful erections; bleeding of the Scar of the circumcision during a prolonged relation; penis curved because of an unequal loss of skin; deformation of the nipple. WHO consequently recommends that this “small surgery” is regarded as a true operation which must thus be carried out by people having professional competences to carry it out under the lawful conditions of Hygiène. Where the health professionals were well trained and equipped, the post-operative rate of complications is from 0,2% to 2%.

Practical ritual

Historically

The practice of the circumcision goes back to the first traces left by the Man. Representations of this surgical operation were found on rupestral drawings dating from the Neolithic , like on Hiéroglyphe S of Egyptian tombs.

The circumcision is mentioned at fifth century BC by Hérodote, which evokes it in the second book of its Histoires and allots paternity of it to the Égyptiens. This paternity is confirmed by many archaeological vestiges, oldest being an engraving of the tomb of Ankhmahor (6th dynasty, between -2300 and -2200), with Saqqarah, which represents a circumcision practiced with a Silex on a man upright.

Hérodote explains the circumcision by a hygienic regulation. It was also said that it increased sexual strength and the pleasure of the male. Conversely, in the Jewish world, the philosopher Philon of Alexandria saw in the circumcision a renunciation symbolic system of the sins of the flesh and the theologist Maïmonide saw there a reduction in the desirable pleasure for moral reason. Another religious interpretation makes of this rite an edulcorated form of sacrifice: rather than to offer his whole body to the divinity who gave him the life, the man makes him present of a small portion of his flesh.

The most frequent interpretation, in civilizations where the circumcision takes place with the préadolescence, regards the circumcision as a initiatory Rite making it possible the child to become adult.

Another interpretation must be found in civilizations wanting that the operation immediately takes place after the birth. The Bible there did she simply seek a means of perpetuating a former pagan rite? More basically, the history of Abraham, Sarah and Isaac, or Ismaël for the Moslems, founds the Filiation legitimates, recognized by the company as of the birth, and independent of the biological and marital bonds, which are problematic.

The rite of the circumcision, following the example food prohibitions and vestimentary regulations could be means of marking the religious communities by open distinctive signs.

Religions and ethnic membership

Judaism

The Jewish religion practices the circumcision the eighth day of the birth, except contrary medical opinion. It is to the father that it falls to prepare the ceremony, which must proceed early the morning. The circumcision is called in Hebrew milah (cut), but the complete expression is Brith milah, Brit meaning Alliance . Indeed, this circumcision recalls the alliance promised by God to Abraham and after him, with all the people of Israel. The Old Testament makes Abraham and of its family the first circoncis; when God appears in Abraham, it thus indicates to him the terms of its alliance with the people Juif:

Then 99 years old, Abraham circoncit, imposes the operation on its first wire Ismaël which is 13 years old, like with all the men and male children of his house. He repeats then the operation on small the Isaac, 8 days old. This difference in age is that which remains between the Moslem and Jewish traditions. The circumcision at the eighth day is the identity habit most long-lived of the people Juif, well in front of the respect of the Chabbat or of food Cachère, like had included/understood it Spinoza when he wrote: “The sign of the circumcision appears to me of such a consequence that I believe it able to be with him only the principle of the conservation of the Jewish people” ( Traité théologico-policy , 1670).

When Judaea was submitted to the successors of Alexandre Large the, the circumcision was disputed by the hellenized Jews. The quarrel turned to the confrontation when the king Antiochos IV Épiphane wanted to subject the population to a forced hellenisation implying:

the éphébie (military preparation supposing the Gymnastic naked with the palestre);
the abandonment of the circumcision whose Greeks made shame with the Jews; one thus created an operation of Restauration of the foreskin; it was all the more difficult as the only disinfectant and known antidoulor were the sheet of willow which supports the Hémorragie;
adoption of the language Greek that with the detriment of the Araméen.

This attempt is one of the causes of the war of the Macchabées which led to the advent of the hellenized dynasty of the Hasmonéens. With the the United States, country where the circumcision is extremely current, including out of any religious connotation, a minority movement of Jews opposed to the circumcision ( Jews against circumcision ) recommends the abandonment of this practice.

Christianity

In the New Testament, only one of the four evangelists evokes the circumcision of the Christ. It is about Luc (II, 21): " And when were accomplished the eight days for its circumcision, it was called name of Jesus, name indicated by the angel before its conception." Like Jesus, all his first disciples were circoncis, since Jews.

The Catholic churches and orthodoxe, far from denying or to minimize the circumcision of Jesus, celebrate it on the contrary on January 1st, that is to say eight days after the December 25th, date fixed, by convention, at the fourth century for the celebration of its birth (of which the real date is unknown). The scene of the Circumcision is frequently represented in the art of the Middle Ages. The Saint Foreskin was even venerated in time that Relique, that certain churches believed to hold.

The first Christian generation was confronted with a difficult problem when converted themselves into mass of the people of nonJewish origin. After an animated debate, the not-Jews were exempted circumcision by an assembly held in Jerusalem in the middle of the first century, traditionally called " Council of Jérusalem" (Acts of the Apostles, chapter XV). However even after this date persisted of the tensions on this subject, as one sees it in the Epistles of Saint Paul, which continues to argue against the Christians " judaïsants": only the " is necessary; circumcision of the cœur" ( Roman 2,28-29, adapted Deutéronome 10,16-17 and 30,6), or: " The circumcision is nothing, and the incirconcision is nothing; what counts, it is to keep the commands of Dieu." (2 Corinthians, VII, 19), because there are no more “neither Jews, nor pagan”, but only one body in Jesus Christ.

In the centuries which followed, the Christian Jewish communities, excommunicated by the religious authorities pharisiennes with the Synode of Jamnia (towards 90), melted themselves gradually in the other Christian communities or disappeared. The Christian authorities gradually came from there to proscribe the circumcision straightforwardly, even in the Christian families of Jewish origin, because this practice was perceived as a return at a community which refuses Christianity.

However the circumcision is still practiced by the Churches coptes of Egypt and Ethiopia, owing to the fact that this practice, commune with the populations of neighborhood, was not perceived there like a disavowal of Christianity and a return to the Judaism. In the same way practice of the circumcision forever met opposition when it is inspired by cultural and prophylactic reasons.

For example in North America or at the African blacks of Christian confessions. In the same way in French Polynesia. In the same way an Asian country with catholic majority, Philippines, has a rate of circumcision rather close to 100%, it seems that this cultural practice goes back to prehispanic origins and was encouraged by American colonization (1898-1946), the latter proposing the hygienic side.

Christian iconography

It is undoubtedly in a company which does not practice it, and which knows it only by far, that the circumcision was generally represented, namely in Christendom of the Middle Ages and the traditional age.

In 1730, Juan Interián de Ayala points out in its work Pictor christianus eruditus (" the Christian Painter détrompé") that the Christian representations of the circumcision of Jesus contain sometimes errors based on a deep ignorance of the Jewish uses. Thus one often depicts the circumcision operated by a priest in the Temple, whereas it was actually a business regulated in and by the family, even by one of the two parents themselves.

However it should be observed that these painters aimed less the historical reality (which did not have interest for the Christian world) only the theological direction of this episode of the life of Jesus. Thus, when one sees the Jesus child under the knife and on the furnace bridge, like a sacrificial offering, even like a food on a table, it is that the Circumcision is regarded as a prefiguration of the Crucifixion and Eucharistie, according to a sight developed by certain Fathers of the Church. It is the first time that the blood of Christ is versed, intended to save the men, and to water their hearts.

In other cases it is clear that the painter thinks of the baptism, rite of aggregation which replaced the circumcision in the Christian sphere.

Some works where the circumcision is represented:

Rubens, retable of the high altar, church del Gesù E dei Santi Ambrogio E Andrea , Main center of Genoa
of the scenes of the life of the Virgin, Venetian of 15th with the Museum of Louvre of Paris
It Garofalo (16th century)
It Guercino (1646) with the Museum of the Art schools of Lyon
Federico Barocci (16th century)
Andrea Boscoli with the Duomo di Fermo

Islam

The Circumcision is practiced by the vast majority of the Moslems, that is to say approximately 600 million people of male sex. The Oulémas are divided into two opinions about the circumcision: obligation or strong recommendation, which proves well that Coran does not prescribe this practice nowhere. It is only mentioned in several Hadiths (called khitân ). For example, the hadith 4:575 of Abu Huraira The envoy of God said, " Abraham circoncit itself at the 80 years age using a Adze. " . Elsewhere, the prophet of Islam declares with the new converts " Remove from the long hair of pagan and are circoncis."

Through " 'Alliance offered by god to Abraham" , Abraham, known under the name of Ibrahim in Islam, would be the founder of the circumcision for divine reasons. Insofar as Ibrahim is one of the most important prophet for the Moslems, it is logical that those practice this ritual. In addition, in the Moslem tradition, the first child to have been circoncis is Ismaël, the prophet whose line would have given Arabic. That explains why the children are circoncis when they are old between 4 and 8 years. As comparison, in the Jewish tradition, the circumcision takes place very early, during the first 8 days of life of the child. Isaac, wire of Abraham, would have been circoncis at this age. However, the line of Isaac will be that of the twelve tribes of Israel. The circumcision in Islam could also reflect the survival of older rites.

In Iran, it takes place generally the very same day birth. Elsewhere, the age where the child is circoncis is very variable, even if generally seven years is regarded as the best age. The important thing is that the operation takes place before the puberty and the first signs of sexual awakenings.

Buddhism and Confucianism

The Asian countries of Buddhist tradition, confucéenne, shintoïste, etc, practically do not know the circumcision apart from the medical cases. Only the South Korea makes exception to this rule. In this country, it was unknown before 1950. It is the American influence present because of the Guerre of Korea which ensured the promotion asserting of not shown medical benefits of it, thereafter of the press campaigns praising the profit in sexual performance , undoubtedly widespread on a particularly receptive cultural compost, relayed these arguments and allowed the emergence of a mode socially developing.

Thus towards 1970, only 5% of the conscripts of the military service were circoncis whereas in 2000, it is 80% of the conscripts who were it. At the beginning carried out with all ages, the operation has tendency maintaining to become néo-native. One finds oneself thus in a situation close to that of the the United States of the Années 1960.

Religions animists

In Black Africa (West Africa, central Africa, East Africa and part of South Africa), the circumcision is extremely widespread whatever are the ethnos group and the religion. It underwent the attraction of modernity and the families of the urban areas largely prefer to practice it, as of the first months after the birth of their male children, in the medical departments equipped for this purpose. In the rural areas the circumcision is often carried out during early childhood by “circonciseurs” (tradipraticians). At some ethnos groups in South Africa and Is like those of Xhosas in African Southern republic or that of Luos in Kenya, it preserved its initiatory character. However it is less current in certain countries of Southern Africa (Zambia, Zimbabwe, Malawi, Botswana, Swaziland and Lesotho).

It is also practiced by several Polynesian people and certain Australian aboriginals.

Ethnography

The irruption of modernity in the colonized traditional companies results in particular in photography with character or ethnographic claim. In the case of the Jewish communities of North Africa, this ethnographic function doubles of an identity function, by the means of the postcard, which makes it possible the community to be represented and to be represented within an open and laic company, for which it will massively choose when comes the hour from the choice.

Nonreligious practices

At the end of the 19th century, the British and American doctors practiced surgical operations on the genitals of the male and female children to prevent the masturbation or to prevent it. The masturbation was responsible for many diseases, according to the doctors of the time. This theory occurred in England, at the time victorienne, then was spread gradually, just as the practice of the circumcision, with the Anglo-Saxon rest of the world.

Mr. John Harvey Kellogg, doctor and “inventor of the Corn flakes”, preached the circumcision without anesthesia of the little boys to fight against the male masturbation: a remedy almost always effective against the masturbation among young boys is the circumcision. The operation must be made by a surgeon without anesthesia, because the pain of short duration during this operation has a salutary effect on the spirit, especially if it is associated with the idea of punishment. As regards the females, the author discovered that the application of pure phenol on the clitoris was an excellent means of controlling the abnormal excitation.

Once the circumcision was current thing, the reasons which justified the continuation of this practice were to make wire similar to the fathers circoncis, to conform the boys to their pars from the point of view of the anatomy, to improve hygiene, to prevent a tightened, nonretractable foreskin (from the medical point of view, it is a normal process of development of the foreskin of the child), of means of prevention against the urinary infection, MST, the cancer of the penis or the urinary collar, and to reduce the risk to contract the virus of the AIDS.

The partisans of the circumcision use as argument a prevention or a cure, although those can be obtained by other respectful means of the physical integrity. When the problems relating to the foreskin arise, of the medical care and nonsurgical exist.

In England the Victoria queen had made to circoncire her children, in particular the future king Edouard VII, under the pretext which the royal family of England descended from king David, Jewish monarch. The habit remained thereafter, but the Diana princess of alive sound refused that its two boys are circoncis. A rumor says since prince William and his brother would have been it with their request in order to resemble their father, prince Charles. With a better comprehension of the external genitals of the male and since the creation of the National British Health Service in 1948, the circumcision quickly lost ground in the United Kingdom.

The United States remains, at the present time, the country having more the recourse to the circumcision for nonreligious reasons.

Medical circumcision

The doctors of the 19th century advised the operation to reduce the masturbation, which was according to them responsible for many diseases. The circumcision was thus supposed to reduce directly or indirectly the “Hystérie”, the venereal diseases, the Satyriasis, and even the Hoquet.

The current partisans affirm that affections are due to the formation of the Smegma under the foreskin, a malodorous yellowish substance secreted by sébacées glands of the foreskin. They also quote as proof the fact that the populations circoncises (in particular Jews) present few cancers pénien and cervical. The opponents with the circumcision object to these arguments by declaring that these affections are more probably due to an insufficient hygiene and many sexual partners.

Phimosis

The Phimosis is the incapacity of retraction of the foreskin behind the nipple. The Paraphimosis is the state where the foreskin is blocked behind the nipple and cannot return to its normal position to the state of flaccidity. These two cases are due to a too small ring prépucial. In these two cases, the circumcision is applied in the majority of the cases. Let us note that there exist nonsurgical alternatives to the treatment of this condition (see further).

The non-retractability of the foreskin and the adhesion of the nipple to the foreskin are conditions frequently observed in the child. The age to which the phimosis becomes problematic is subject to deposit and its evaluation is with the discretion of the doctor. Certain studies speak about a normality until the 5 years age, others estimate the limit at 10 years, others still place it at the age of the first sexual relationships. In fact, the physiological Phimosis is presented when, during erection, the child tests a pain because of the narrowness of his foreskin. Only 1% of the 14 year old boys could not retract their foreskin. Because of this variability, the use of the circumcision in these cases makes also debate. Phimosis would be incorrectly diagnosed and the unjustified circumcisions. Certain studies show that this prevalence would be increased by the practices of uncapping forced of the foreskin of the children implemented by parents or doctors.

When the phimosis of the teenager persists in the adult, there exists to correct it alternatives to the circumcision which do not require to remove the foreskin. They consist in widening its opening in order to facilitate its retraction behind the nipple, by means of the surgery (plastie of the foreskin) or of handling: progressive expansion of fabrics forming the ring prépucial when subjected to a moderate and prolonged or repeated stretching.

Prevention of the AIDS

Since March 2007, WHO recommends the circumcision like an additional strategy in the fight against the epidemic of Sida. The the World Health Organization (WHO) and ONUSIDA (common program of the United Nations on the AIDS) thus decided to launch public awareness campaigns in favor of the circumcision, an effectiveness on the prevention of the contamination by HIV having been proven.

In his report/ratio precise WHO: “1-1La circumcision must now be recognized like an effective measure of prevention of the HIV. 1.2 It is necessary to regard the promotion of the circumcision as a new important strategy of prevention of the hétérosexuelle transmission of the HIV of the woman to the man”.

However, this type of countryside can be badly interpreted, since it can wrongfully let believe that the circumcision immunizes. However the risk of contamination is not completely eliminated, but only reduced. The use of condoms still remains and always best means of protection against the AIDS at the time of a sexual relation, than the man is circoncis or not.

WHO thus points out that the circumcision does not protect completely from the infection with HIV. The men circoncis can always contract the infection with HIV and, once HIV positives, transmit the virus to their sexual partners,

According to an exposed free-south-African study on July 26th, 2005 with the third conference on the mechanisms of the infection by the virus of the AIDS, the men circoncis would have a probability up to 65% less to contract the virus of the AIDS ". These data were confirmed by two other African studies showing a reduction of about half of the contamination at the circoncis. In March 2007, the World Health Organization (WHO) and the common Program of the United Nations on VIih/AIDS (ONUSIDA) recommended consequently the use of the circumcision like method of prevention of the infection to HIV at the men heterosexuals. It is following an organized international consultation of experts from March 6th to 8th last in Montreux, in Switzerland, that this recommendation was made. The challenge which wants to take up WHO and the ONUSIDA is to help to quickly reduce the number of new infections by the HIV in the world. The circumcision thus comes to reinforce the panoply of good practices to be observed to reduce the risks of new infections. The international consultation which allowed this recommendation joined together, according to a dispatch of WHO, experts representing a large range of interested parts, in particular of the governments, members of the civil society, researchers, defenders of the human rights and militants of the health of the women, young people, institutions of financing and partners implied in the implementation of the programs. According to Dr. Kevin De Cock, director of the department of the VIH/SIDA to WHO, this novel method of reduction of the risk of infection will allow the countries which know an high rate of infection per hétérosexuelle relation and weak a Prévalence of the circumcision to make the promotion of this solution to reduce the new infections hétérosexuelle at the men.

The recommendations of WHO are founded on three clinical trials led to Kisumu in Kenya, in Uganda, in the district of Rakai (financed by the National institutes of the health of the United States) and in Orange Farm, in South Africa (financed by the French National agency of research on the AIDS). These tests showed that the circumcision reduced from approximately 60% the transmission risk hétérosexuelle of the HIV to the man. These data, continues the dispatch, confirm the conclusions of many observational studies which suggested the geographical correlation described for a long time between a weak prevalence of the HIV and high rates of circumcision in certain countries in Africa. It was stressed that the circumcision does not protect completely from the virus from the AIDS and that it should not replace the other methods of prevention but come in complement.

Several explanatory assumptions were advanced:

the foreskin is rich in dendritic cells, which would play the part of receiver of the HIV
after a contaminating sexual relation, the HIV would persist longer at the non-circoncis because the zone between the penis and the foreskin remains wet
at the circoncis, the nipple keratinized and is thickened, and could constitute a physical barrier against the virus.

Statistics of the cases of cancer

The circumcision could also have beneficial consequences as regards cancer of the penis (particularly rare cancers in all the cases). The statistics reveal that the men circoncis are touched by this type of cancer. Nevertheless, in 1998, the American Cancer Society declares that if the probability for the men circoncis of beings touched by this shape of cancer were weak it was above all because the circumcision was practiced by one of the categories of the population less at the risk.
En 2005, a specialized company undertakes a new study and reaffirms that the circoncis are touched and that the circumcision is a method of prevention effective. This study was the criticism object on behalf of other specialists, who estimate that other factors must be taken into account (population practitioner and practitioner not the circumcision would have a rate of different risk even if one puts side the circumcision).

Circumcision néonatale

In Occident, the circumcision néonatale becomes extensive in England victorienne, at the end of the 19th century. The idea that the foreskin, by lubricating the nipple, supported the masturbation, was then dreaded in the families. The circumcision thus became a means of ensuring the young boy “a better physical and mental hygiene”.

This practice of the circumcision extends very quickly to the other Anglo-Saxon countries, in particular with the the United States and the anglophone Canada. But one gives up there the very discussed idea of fight against the masturbation with the profit of hygienic and esthetic concepts. The circumcision is then presented like an medical act Prophylactique. The majority of the male population being circoncise in the United States, the partisans of the circumcision use also conformity like argument.

In the Years 1970, in the United States nearly 80% of the male new-born babies are circoncis. This figure is of 65,3% in 1999.

However 80% to 90% of the North-American adult male population are circoncise currently and more than 90% among Americans of birth. Indeed of many circumcisions carried out during the period néonatale and early childhood in private clinics are not taken into account by the statistics. The same applies to circumcisions during adolescence. More than 55% of the adult Canadians (70% of the english-speaking and 20% of the French-speaking people) are it too; in Australia 70%, New Zealand 40%, Africa 80% to 90% (with variations according to the countries). For example in Swaziland, in Zimbabwe, in Zambia less than 30%/in Burundi, Rwanda, in Uganda, in South Africa more than 50%/in Angola, a Democratic republic of Congo, in Central Africa, in Cameroun, in Sudan, in Kenya, in Tanzania, in Mozambique, in Nigeria, with Benign, in Togo, in Ivory Coast, in Ghana, in Burkina Faso, in Cape Verde, etc more than 90%/Madagascar, in Senegal, in Niger, in Morocco, in Ethiopia, in Algeria, in Egypt almost 100%), South America 5%-10% (example Chile, Argentina) with 15%-20% (example Brazil and Mexico) according to the countries, in Europe 5-10% (Spain, Poland, Portugal, Norway, Austria, Hungary) to 15-20% (France, Great Britain, Italy, Germany, Belgium, Russia) and more than 80% (Bosnia, Albania, Turkey), in Asia 5-10% in China, 13% in Thailand, 25% in India, more than 90% in Philippines and in South Korea, almost 100% in Lebanon, in Iraq, in Pakistan, in Indonesia, in Bengladesh…

However, in England, the circumcision néonatale was withdrawn from the list of the operations covered by the National Health Service lately formed vis-a-vis the absence of consensus within the medical community as for the real medical benefit of the circumcision of the young children. One of the factors having been able to lead to this rejection of the circumcision is the report/ratio of Douglas Gairdner The Fate off the foreskin (Fate of the foreskin), which revealed that between the years 1942 and 1947, approximately 16 children would die each year following a circumcision in England and in Wales, that is to say a rate of 1 per 6000 circumcisions carried out. Since, the circumcision is at the expenses of parents and the proportion of new-born babies circoncis in England and in Wales extremely dropped.

Reconstitution of the foreskin

Some associations propose to the men circoncis to create a pseudo-foreskin by stretching the skin of the penis gradually.

Geographical distribution

According to the the World Health Organization, 30 to 34% of the men of more than 15 years are circoncis all over the world.

In North America:

With the the United States, the circumcision is usually applied to the birth, with a rate of 61.1% of circumcision néonatale observed between 1997 and 2000, in strong increase compared to the 48.8% observed over the period 1988-1991, in spite of the unfavourable recommendations with the systematization of the circumcision néonatale that the American Academy off Pediatrics reiterated into 1971,1975,1983,1989 and 1999.La proportion of children circoncis to the birth or during childhood are always maintained with an elevated level nowadays (between 76% and 92%).
It is the same for the Canada particularly in the anglophone community although its incidence is limited among French-speaking people particularly to Quebec.

In continental Europe its incidence is weak except in the African Jewish communities, Moslem women and, where it is very largely practiced. Its frequency is higher in Great Britain whatever the communities. It is current in Turkey and in certain European countries of the Balkans like the Bosnia with Moslem majority.
In South America, the circumcision although still relatively not very widespread except at the Muslim communities and Jewish, spreads at the young generations taking into account the North-American sociocultural influence. It varies however considerably from one country to another. Its incidence is highest in Brazil and Mexico where it tends to becoming the standard.
With the the Middle East and the the Middle East, the circumcision is followed by the great majority of the populations for religious reasons, these countries being with Moslem majority.
In Asia, the circumcision recovers the zones where Islam is represented. The countries mainly Moslem are the Bangladesh, the Indonesia, the Malaysia and Brunei, where one can consider that the whole of the male population is circoncis. It also is very observed in nonMoslem countries, like Philippines and South Korea. Among the countries where Islam is not the majority religion but which comprises strong population of this religion, one can quote the India, where it relates to 150 million people (13,7% of the Indian population are Moslem), the China which counts more than 50 million Moslems. With the Japan and Taiwan, it becomes increasingly popular same manner as in South Korea, probably following the influences of the American culture. The circumcision is very widespread among native-born people of the Malay Archipelago, New Guinea, Australia and the Pacific Islands, whatever the communities and the religions.
In Africa, the circumcision is very frequent. It is generalized in North Africa, countries Moslem. In sub-Saharan Africa (West Africa, of the center and Is), it also is very met, whatever the ethnos groups and the religions. It is practiced also by more half of the Southern Africans, particularly by the ethnicity Xhosa and connected (ethnos group of Nelson Mandela). It is relatively weak in part of the Southern Africa.
In Australia in spite of a constant fall of the circumcisions néonatales since the Seventies, it is still practiced for the same reasons as in North America and the adult men are it mainly. Since the beginning of the years 2000 it was noted an increase of the rates of circumcision to the birth.
In the Pacific Islands and all the islands of the Polynesian triangle, the ritual circumcision is very widespread, of Tahiti to Samoa while passing by the islands Tuvalu, Tonga, Tokelau, Cook, Marquises, Niue, Wallis and Futuna. The circumcision is an ancestral habit which existed already before the arrival of the European missionaries. It still remains as a rite which guarantees the membership of the Polynesian community and in addition of the Polynesian male identity. It is practiced between 12 and 16 years generally and it is celebrated by all the family as being the passage of childhood at the adulthood. Today, it is about an operation practiced in the hospitals, in particular in the Polynesian communities installed in New Zealand, in New Caledonia, with Hawaii, in Europe and in the United States. All the Polynesians practice it, except for the Maoris of New Zealand, which gave up this ancestral rite of initiation, some generations after their arrival on this archipelago located apart from the tropical Polynésie. If the majority of the young Polynesians go from now on to the hospital to be made circoncire (generally under local anesthesia or general), there exist still practices of “artisanal” circumcision in certain families. The foreskin is cut with a razor blade or a piece of cut bamboo. The ceremony is done at dawn on a beach, generally during school vacations from December to February. A group of teenagers are made accompany by their maternal uncles and the old ones by the village. After the Master of circumcision proceeded to the operation, the young people must go immediately in sea water to look after itself. The risks of hemorrhages and infections are limited but existing. During both or three weeks which follow, this group of young men go each day in end-of-day in the sea for a therapeutic bath. The sea is supposed to look after the wound. They are often the object of jokes on behalf of the adults and the young girls who cross them in way or on the beach. Once cured and celebrated in their respective families, these teenagers receive more consideration and are allowed in the circles of the young men to be married. They can, starting from their circumcision, to have their first adventures.

Ethical questions

The problem of the assent

No surgical act is supposed capacity being practiced on a person if it does not give its enlightened Consentement. In the case of a minor, they are the parents or tutors who must give this assent, even if the doctors sometimes try to take account of the opinion of the child if it is of age to give it. However, the circumcision is generally practiced on minors (often even on infants), and some call into question the legitimacy of the parents to choose for the child an irreversible body modification in the absence of very required medical urgent.

Legal aspects

In France

In France, the circumcision is not prohibited. According to the stop of the Court of Appeal of Aix-en-Provence of April 23rd, 1990, confirmed by the stop of May 30th, 1991 of the court of criminal appeal of the Court of appeal, in the cases authorized by the law, the surgeon who practices an surgical operation in the normal exercise of his profession enjoys a legal immunity, insofar as its intervention is justified by a therapeutic interest. In a more general way, the facts are justified when they answer certain professional practices sunken in the use. The circumcision in fact part, since it is carried out according to the lawful surgical conditions. The authorization must emanate from the two parents and only one cannot achieve this act of provision.

In Sweden

Sweden, by a law coming into effect on October 1st, 2001, authorizes the circumcision with the following restrictions:

a boy of less than two months can be circoncis by nona doctor, provided that it obtained an authorization of the Department of health.
No newborn could be circoncis without an analgesia delivered by a doctor or a nurse in exercise.

This law was adopted by the Parliament with a majority of 249 votes for, 20 abstentions, and in the absence of 70 deputies. No voice protested against the project, and 10 deputies would have wished a more restrictive law.

The Jewish community of Stockholm disapproves this law considering it too restrictive.

In Finland

The court of Turku has, on requisition of the public ministry which regards the circumcision as any other mutilation, condemned a Moslem mother for the circumcision of his/her son without the assent of the father.

The United States and Canada

Movements for the genital integrity, sometimes indicated generic term “intactivist”, which appeared especially in the United States, consider that since the ablation of the foreskin induces a loss of sexual functions, it harms the wellbeing of the man and he makes the point that the circumcision generates a physical and moral suffering real at certain people. They thus estimate that the foreskin is not “a superfluous end of skin” in the male anatomy and that the circumcision constitutes a healthy and functional sexual fabric mutilation, a true violation of the right to the body integrity, when it is practiced on human beings nonadult, correctly informed and agreeing.

Associations against the circumcision sent a private bill in order to prohibit the circumcision of the minors near the Congress of the United States which did not accept the downstream of any senator. According to the opponents with the circumcision, this one would not be justifiable médicalement that if there did not exist alternative solutions, less invasive and if the life of the patient were concerned.

South Africa

Article 12 of the Children' S Act 38 off 2005

Prohibits the circumcision of the male child of less than 16 years

except when it has a religious goal
except when it is

Fait to depend the circumcision on the male child of more than 16 years of its assent on the prescribed method, on the respect of an obligation of council, and respect of the prescribed method.
Recognizes the right of any male child to refuse the circumcision, counts being held of its age, its maturity and its developmental stage.

Psychological consequences of the circumcision

It is advisable to remain careful when it is a question of evaluating the psychological consequences of the circumcision. This question touches with lived and with felt individual and could not suffer from generalizations. If it seems that the majority of the men circoncis consider their completely normal state|date= 11/5/07 , there exist also negative consequences at certain subjects. These consequences are evaluated differently according to the age to which the circumcision is carried out (it is difficult to study the cases of circumcision on infants) and has different effects according to the ages|date= 11/5/07 . It is also necessary to distinguish the traumatism which can cause the operation itself, of the discomfort that the state can involve to be circoncis.

Psychoanalytical prospects and psychological consequences of the circumcision

See also: psychoanalytical Prospects and psychological consequences for the circumcision

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