Male circumcision has often been, and remains, the subject of controversy on a number of grounds—including religious, ethical, sexual, and health related. The Ancient Greeks and Romans valued the foreskin and were opposed to circumcision – an opposition inherited by the canon and secular legal systems of the Christian West that lasted at least through to the Middle Ages. Traditional Judaism and Islam have advocated male circumcision as a religious obligation.
The ethics of circumcision are sometimes controversial. From the mid-19th century, there has been advocacy in some Anglophone countries on medical grounds, such as the prevention of masturbation and ‘reflex neurosis.’ Modern proponents argue that circumcision reduces the risks of a range of infections and diseases as well as conferring sexual benefits. In contrast, opponents, particularly of infant circumcision, often question its effectiveness in preventing disease, and object to subjecting newborn boys, without their consent, to a procedure they consider to have debatable benefits, significant risks, and a potentially negative impact on general health and later sexual enjoyment.
Genesis explains circumcision as a covenant with God given to Abraham, but liberal scholars reject the historicity of these accounts and look elsewhere for the origin of Jewish circumcision. The most common historical explanation, dating from Herodotus, is that the custom was acquired from the Egyptians, possibly during the period of enslavement. A competing hypothesis is based on linguistic/ethnographic work begun in the 19th century, and suggests circumcision was a common tribal custom among many Semitic tribes, including Jews, Arabs and Phoenecians, before they migrated from the Arabian peninsula. Recent linguistic analysis is strengthening the case for the latter explanation. The Jewish and Islamic traditions both see circumcision as a way to distinguish a group from its neighbors. The Bible records ‘uncircumcised’ being used as a derogatory reference for opponents and Jewish victory in battle that culminated in mass post-mortem circumcision, to provide an account of the number of enemy casualties. Jews were also required to circumcise all household members, including slaves – a practice that would later put them into collision with Roman and Christian law.
Hellenistic culture found circumcision to be repulsive. In 167 BCE, Judea was part of the Seleucid Empire (a Greek-Macedonian state). Its ruler, Antiochus, smarting from a defeat in a war against Ptolemaic Egypt, banned traditional Jewish religious practice, and attempted to forcibly convert the Jews to Hellenism. The Olympian Zeus was placed on the altar of the Temple, and throughout the country Jews were ordered, with the threat of execution, to sacrifice pigs to Greek gods (the normal practice in the Ancient Greek religion), desecrate the Shabbat, eat unkosher animals (especially pork), and relinquish their Jewish scriptures. Antiochus’s decree also outlawed Jewish circumcision, and parents who violated his order were hanged along with their infants. He ‘endeavoured to abolish Jewish superstition and to introduce Greek civilization.’ Perhaps the most prominent Jewish response during these times, was rebellion. Antiochus’s decree motivated the Maccabees Revolt, which resulted in the reestablishment of an independent Jewish kingdom. Hanuka is the annual remembered of the Maccabees, a Jewish rebel army that took control of Judea. In the Roman Empire, circumcision was regarded as a barbaric and disgusting custom. The consul Titus Flavius Clemens was condemned to death by the Roman Senate in 95 CE for, according to the Talmud (Jewish Commentary), circumcising himself and converting to Judaism. The emperor Hadrian (117-138) forbade circumcision.
The anti-circumcision law passed by Hadrian is considered by many, to be, together with his decision to build a new temple upon the ruins of the Second Temple, which was dedicated to Jupiter, one of the main causes of the Bar Kokhba revolt (132-135). The revolt was brutally crushed. According to Cassius Dio, 580,000 Jews were killed, and 50 fortified towns and 985 villages razed. Cassius Dio claimed that ‘Many Romans, moreover, perished in this war. Therefore, Hadrian, in writing to the Senate, did not employ the opening phrase commonly affected by the emperors: ‘If you and your children are in health, it is well; I and the army are in health.’ Because of the great loss of life in the war, even though Hadrian was victorious, he refused a triumph. Hadrian said regarding the war, ‘I forbade the Jews to mutilate themselves, and they started a war.’ Hadrian policy after the rebellion reflected an attempt to root out Judaism. All Jews were forbidden to enter Jerusalem upon pain of death and the city was renamed Aelia Capitolina. Around 140, His successor Antoninus Pius exempted Jews who circumcised their sons, though not their servants or slaves, from the decree against circumcision.
Jewish response to the decrees also took a more moderate form: circumcisions were secretly performed – even on dead Jews. Other Jews pursued a completely different approach, accepting the decrees, and even making efforts to restore their foreskins to better assimilate into Hellenistic society. The latter approach was common during the reign of Antiochus, and again under Roman rule. The foreskin was restored by one of two methods, that were later revived in the late 20th century. The surgical method, described in detail by the physician Celsus (around 25 BCE – 50 CE), involved freeing the skin covering the penis by dissection, and then pulling it forward over the glans. Celsus also described a simpler surgical technique used on men whose prepuce is naturally insufficient to cover their glans: a device called a Pondus Judaeus (Jewish burden), a special weight made of bronze, copper, or leather, was affixed to the penis, pulling its skin downward. Overtime, a new foreskin was generated, or a short prepuce was lengthened, by means of tissue expansion.
Paul referred to these practices, saying: ‘Was a man already circumcised when he was called? He should not become uncircumcised.’ But he also explicitly denounced the forcing of circumcision upon non-Jews, rejecting and condemning those who stipulated the ritual to Gentile Christians, labeling such advocates as ‘false brothers.’ According to the same researchers, in the mid-2nd century Jewish leaders introduced a radical method of circumcision, the periah, that left the glans totally uncovered, making it almost impossible to restore the foreskin. Under the first Christian emperor, Constantine, the two laws of Antoninus on circumcision were re-enacted and again in the 6th century under Justinian. These restrictions on circumcision made their way into both secular and canon law and ‘at least through the Middle Ages, preserved and enhanced laws banning Hebrews from circumcising non-Hebrews and banning Christians or slaves of any religious affiliation from undergoing circumcision for any reason.’
The first Christian Church Council in Jerusalem, held in approximately 50 CE, decreed that circumcision was not a requirement for Gentile converts. This became known as the ‘Apostolic Decree’ and is one of the first acts differentiating Early Christianity from Rabbinic Judaism. At roughly the same time Rabbinic Judaism made their circumcision requirement even stricter. The main focus of Christian proselytizing in the early Christian Church were the God-Fearers, gentile inhabitants of the Roman Empire who were allowed to attend Jewish synagogues as quasi-Jews without the necessity of undergoing the hated rite of circumcision. All they had to do was swear that there was ‘One God.’ Converts from this group was the primary kernel from which the early Christian Church grew. (About 10% of the inhabitants of the Roman Empire were full Jews and God-Fearers.)
In the early 7th century, Muhammad welded together many Semitic tribes of the Arabian peninsula into the kernel of a rapidly expanding Muslim movement. The one thing that can be said with some certainty is that male and female circumcision was already well established among these tribes, and probably had been for more than a thousand years, most likely as a fertility rite. Herodotus had noticed the practice among various Semite nations in the 5th century BCE, and Josephus had specifically mentioned circumcision as a tradition among Arabs in the 1st century CE. There are some narrations attributed to the prophet Muhammad in which he approves of female circumcision, however many scholars believe that these narrations are weak and lack authenticity.
Thomas Aquinas in his ‘Summa Theologica’ questioned why, if under Jewish doctrine circumcision removed original sin, Jesus was circumcised – as Jesus had no original sin. Steve Jones suggests there is a theological tradition that Jesus regained his foreskin at the Ascension. ‘Had he failed to do so, the Saved would themselves have to be operated upon in Paradise so as not to be more perfect than their Savior.’ The Jews were expelled from England by Edward I in 1290, ostensibly over social tensions concerning usury. But the public imagination had been gripped by blood libel (a false accusation that Jews murder children to use their blood in religious rituals), since at least the 12th century: ‘So pervasive was the belief that Jews circumcised their victims … that Menasseh ben Israil, the Dutch Rabbi who sought from Cromwell the readmission of the Jews in 1656, had to dwell at considerable length in his Vindiciae Judaeorum at refuting the claim.’
In 15th century Spain, most Jews and Muslims were expelled and the Spanish Inquisition monitored and prosecuted converts to Christianity to ensure they were not secretly consorting with Jews or engaging in Jewish practices such as circumcision. In 1521, Cortés defeated the Aztec empire in Mesoamerica, which was followed by a large influx of Spanish clergy, whose writings provide most of information about pre-conquest Aztec life and customs largely assembled from interviews with those who survived the invasion and subsequent epidemics, and their descendents. Diego Durán, a Dominican friar, was convinced that the Aztecs were one of the lost tribes of Israel, with a crucial piece of supporting evidence being that they had practiced circumcision. So influential was this notion that 300 years later Bancroft in his monumental ‘Native Races’ began his discussion of circumcision by writing: ‘Whether the custom of circumcision, which has been the great prop of argument in favor of the Jewish origin of the Aztecs, really obtained among these people, has been doubted by numerous authors,’ concluding that it probably existed in a ‘certain form among some tribes.’ The key being ‘a certain form,’ since Bancroft makes clear in a footnote that the majority of his sources, believed Durán and others ‘confounded the custom of drawing blood from the secret organs with circumcision,’ and ‘the incision on the prepuce and ear to have been mistaken for circumcision,’ adding that this blood-letting rite was ‘chiefly performed upon sons of great men.’ The case was not helped by the fact no reports of seeing a circumcised adult Aztec existed in the literature. Remondino says it is ‘a matter of controversy’ whether the foreskin had actually been removed.
Countries that do not circumcise have often held antipathy for those that do. Being circumcised was an often seen as a sign of disgrace. According to Darby, it was also seen as a serious loss of erogenous tissue: ‘During the Renaissance and 18th century the centrality of the foreskin to male sexual function and the pleasure of both partners was recognized by anatomists Berengario da Carpi, Gabriello Fallopio and William Harvey, in popular sex manuals like Aristotle’s master-piece, and by physicians like John Hunter, who also appreciated the importance of the foreskin in providing the slack tissue needed to accommodate an erection.’ In 1650, English physician John Bulwer in his study of body modification, ‘Anthropometamorphosis: Man Transform’d, or the Artificial Changeling,’ wrote of the loss in sexual pleasure resulting from circumcision: ‘the part which hangeth over the end of the foreskin, is moved up and down in coition, that in this attrition it might gather more heat, and increase the pleasure of the other sexe; a contentation of which they [the circumcised] are defrauded by this injurious invention. For, the shortnesse of the prepuce is reckoned among the organical defects of the yard, … yet circumcision detracts somewhat from the delight of women, by lessening their titillation.’ The English historian Edward Gibbon, author of The History of the Decline and Fall of the Roman Empire, referred to the practice as ‘a painful and often dangerous rite,’ and a ‘singular mutilation’ practiced only by Jews and Turks.
The first formal objection to circumcision within Judaism occurred in 1843 in Frankfurt. The Society for the Friends of Reform, a group that attacked traditional Jewish practices, said that brit milah was not a mitzvah but an outworn legacy from Israel’s earlier phases, an obsolete throwback to primitive religion. With the expanding role of medicine came further opposition; certain aspects of Jewish circumcision such as periah and metzitzah (drawing the blood from the circumcision wound through sucking or a cloth) were deemed unhygienic. Later evidence that syphilis and tuberculosis – two of the most feared infectious diseases in the 19th century – were spread by mohels, caused various rabbis to advocate metzitzah to be done using a sponge or a tube.
Circumcision spread in several English-speaking nations from the late 19th century, with the introduction of anesthesia and antisepsis rapidly expanding surgical practice. Doctors such as Sir Jonathan Hutchinson in England wrote articles in favor of the procedure. Peter Charles Remondino, a San Diego physician, wrote a ‘History of Circumcision from the Earliest Times to the Present: Moral and Physical Reasons for Its Performance’ (1891), to promote circumcision. Lewis Sayre, a prominent orthopedic surgeon at the time, was another early American advocate. However, the theories on which many early claims were made, such as the reflex theory of disease and the alleged harmful effects of masturbation, have long since been abandoned by the medical profession. Dr. John Harvey Kellogg recommended circumcision of boys caught masturbating, writing: ‘A remedy for masturbation which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should be performed by a surgeon without administering anaesthetic, as the pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment.’ But he was opposed to routine circumcision of infants: ‘It is doubtful, however, whether as much harm as good does not result from circumcision, since it has been shown by extensive observation among the Jews that very great contraction of the meatus, or external orifice of the urethra, is exceedingly common among them, being undoubtedly the result of the prolonged irritation and subsequent cicatricial contraction resulting from circumcision in infancy.’
An early British opponent of circumcision was Herbert Snow, who wrote a short book called ‘The barbarity of circumcision as a remedy for congenital abnormality’ in 1890. But as late as 1936, L. E. Holt, an author of pediatric textbooks, advocated male and female circumcision as a treatment for masturbation. The first serious questioning of the practice did not occur until late 1949 when Gairdner published ‘The Fate of the Foreskin’ in the ‘British Medical Journal’; according to Wallerstein this began to affect the practice of circumcision in Britain. According to Darby and Cox, the persistence of circumcision in the US has led to more vigorous protest movements. A 1980 protest march at the California State Capitol was reported in an Associated Press article. The National Organization of Circumcision Information Resource Centers (NOCIRC), was formed by Marilyn Milos, R.N., in 1985. The organization’s stated objective is to secure the birthright of male, female, and intersex children and babies to keep their sex organs ‘intact.’ Protest rallies have been held in the US and other areas. NOCIRC have consistently criticized the American medical community’s circumcision guidelines. According to Milos and Donna Macris, ‘The need to defend the baby’s right to a peaceful beginning was brought to light by Dr. Frederick Leboyer in his landmark work, ‘Birth Without Violence.”
This period also saw the formation of anti-circumcision organizations in Australia, Canada, the United Kingdom and South Africa. Activists began creating websites in the mid-1990s, and this process has continued. One such organization distributed questionnaires to circumcised men. The complaints included prominent scarring (33%), insufficient penile skin for comfortable erection (27%), erectile curvature from uneven skin loss (16%), and pain and bleeding upon erection/manipulation (17%). Psychological complaints included feelings of mutilation (60%), low self esteem/inferiority to ‘intact’ men (50%), genital dysmorphia (55%), rage (52%), resentment/depression (59%), violation (46%), or parental betrayal (30%). Many respondents reported that their physical/emotional suffering impeded emotional intimacy with their partner(s), resulting in sexual dysfunction. Prominent men known to be unhappy about being circumcised include A E Houseman, W.H. Auden, Geoffrey Keynes and his brother John Maynard Keynes, the famous economist. In 1996 the ‘British Medical Journal’ published a letter by 20 men saying that ‘we have been harmed by circumcision in childhood’; they argued that ‘it cannot be ethical for a doctor to amputate normal tissue from a normal child.’ Dr. Benjamin Spock (died 1998), whose ‘Baby and Child Care’ is the biggest selling American single-author book in history, originally supported circumcision but changed his mind near the end of his life.
Prominent American advocates for infant circumcision include Dr. Thomas Wiswell, who began publishing research on the relative incidence of urinary tract infections in the mid 1980s; Dr. Edgar Schoen, (b. 1925) former chair of the American Academy of Pediatrics’ Task Force on Circumcision, who maintains a web site promoting circumcision and claims physical benefits in sexual performance in addition to medical arguments; and Aaron J. Fink, M.D. (died 1990), who self-published ‘Circumcision: A Parent’s Decision for Life’ to promote his ideas. In Australia, Professor Brian Morris, author of ‘In Favor of Circumcision,’ asserts that circumcision confers many medical benefits including reduced risk of UTIs, penile cancer, HIV, balanitis, posthitis, phimosis, and prostate cancer and argues that circumcision has sexual benefits. Morris also claims that circumcision prevents ‘physical problems’ such as ‘Bathroom splatter’ and ‘Zipper injury.’ However, Morris’s views have been strongly criticized by Professor Basil Donovan who argues that the protection from HIV argued by Morris is not an accurate depiction of the HIV research. David Forbes, chair of the pediatrics and child health policy and advocacy committee of the Royal Australasian College of Physicians has stated that Morris has not been asked to review the college’s circumcision policy and is not a member of the college.
The American Academy of Pediatrics (AAP) circumcision policy has been criticized both by those who believe that it is too negative about the practice, and those who believe that it is too positive. Hill has also criticized the Academy’s circumcision information brochure for parents, arguing that the brochure is inadequate to persuade parents to avoid circumcision. The WHO and UNAIDS recommend male circumcision as a means of reducing the rate of HIV infection, but this has also proved controversial, with doubts raised about the efficacy of mass circumcision campaigns in sub-Saharan Africa. Critics have themselves been the subject of criticism; Kalichman writes: ‘Anticircumcision groups have long existed and are increasingly vocal as MC programs for HIV prevention are promoted. Anticircumcision groups resemble other antiscience and antimedicine extremists including AIDS denialists who refute public health realities to maintain entrenched belief systems’
Another area of continuing dispute is the effect of circumcision on penile sensitivity. In 2007, the ‘British Journal of Urology’ published a study that stated it ‘conclusively shows that circumcised males have a significant penile sensory deficit as compared with non-circumcised intact men’ and that ‘the most sensitive regions in the uncircumcised penis are those removed by circumcision.’ Later that year, the BJU published a letter in response by Waskett and Morris, which concluded that ‘despite a poorly representative sample and a methodology prone to exaggerating the sensitivity of the prepuce, NOCIRC’s claims remain unproven. When the authors’ data are analysed properly, no significant differences exist. Thus the claim that circumcision adversely affects penile sensitivity is poorly supported, and this study provides no evidence for the belief that circumcision adversely affects sexual pleasure.’ Hugh Young responded to this, stating that Waskett and Morris ‘critique the finding of Sorrells et al. that ‘circumcision ablates [removes] the most sensitive part of the penis’ by excluding that part from consideration… That the foreskin itself has a sexual function was well-known for centuries before secular circumcision became widespread. What would need to be proved rigorously is that cutting a significant part of the distal penis off does not diminish sexual pleasure.’ Payne et al. reported that direct measurement of penile sensation in the shaft and glans during sexual arousal failed to support the hypothesized sensory differences associated with circumcision status.
Current laws in many countries, and United States Federal Law as well as laws in several U.S. states, prohibit the genital modification and mutilation of female minors, with some exceptions based on medical need. Opponents of male circumcision assert that laws against genital modification and mutilation of minors should apply equally to males and females. Many anti-circumcision groups have joined the International Coalition for Genital Integrity and endorsed its declaration, which was adopted by the First International Symposium on Circumcision, in 1989, at Anaheim, California. (There have been nine such further symposia held since, with the proceedings of several subsequently published in book form.) ‘Intact America,’ founded in 2008, lobbies organizations such as the American Academy of Pediatrics, American Civil Liberties Union, and Centers for Disease Control to alter policy and change attitudes toward male infant circumcision.
However, linking male circumcision to female genital mutilation (FGM) is itself highly controversial.Organizations actually involved in combating FGM have been at considerable pains to distinguish the two, as a UNICEF document explains: ‘When the practice first came to be known beyond the societies in which it was traditionally carried out, it was generally referred to as ‘female circumcision.’ This term, however, draws a direct parallel with male circumcision and, as a result, creates confusion between these two distinct practices.’ This stance has been largely echoed by Western medical and political authorities. The Australian Medical Association states: ‘The AMA rejects the euphemism ‘female circumcision,’ sometimes used to describe the various forms of female genital mutilation, because the use of this phrase trivializes the severe and often irreparable physical and psychological damage occasioned to girls and women by these practices.’ In the United States, the organization MGMbill.org sent a proposed bill to the US Congress and 15 state legislatures between 2004 and 2007 to extend the prohibition on genital modification and mutilation of minors to include male and intersex children. The proposed bill has not been endorsed by any member of Congress.
While circumcision debates are often dominated by the concerns of Anglophone countries, very different controversies over the procedure regularly erupt in other cultural contexts. In South Asia, Pakistan has long used circumcision status as a definitive marker of Indian covert involvement in its internal affairs. But this assumption was thrown into confusion when it was discovered that large segments of its own Muslim male population, specifically from western tribal areas, were themselves uncircumcised. Opposition to circumcision exists among Jews in Israel. Even though there is often pressure from family to circumcise their sons, a small but growing number of Jews are choosing to forgo the procedure. Islamic anti-circumcision groups, such as Qur’an Alone (the principle that by universal agreement of Islamic scholars puts one out of fold of Islam), have also emerged, arguing among other things that routine circumcision is an insult to Allah since it tries to improve on his perfect creation.
Northern Europe, which has no tradition of routine circumcision, has been struggling with the challenges of its Jewish and Muslim minorities. Finland is considering legislation to legalize male circumcision. Sweden in 2001 passed a law requiring traditional circumcisers to be certified and for the infants to be given a medically administered anaesthetic. The World Jewish Congress said that ‘[t]his is the first legal restriction placed on a Jewish rite in Europe since the Nazi era.’ In 2012, a court in Cologne, Germany ruled that circumcision was ‘inflicting bodily harm on boys too young to consent,’ deciding that the practice contravenes the ‘interests of the child to decide later in life on his religious beliefs.’ The decision of the court in the city of Cologne, that a child’s right to physical integrity trumps religious and parental rights, is non-binding and does not apply to the whole country. The ruling was condemned by Jewish and Muslim groups in Europe. Doctors in Germany have begun to advocate that doctors be present during traditional circumcisions and for the infants to be given a medically administered anaesthetic. A group of German lawmakers passed a resolution asking Angela Merkel’s government to clarify the ruling to allow Jews and Muslims to continue to practice their religion. Yona Metzger, Israel’s chief Ashkenazi rabbi, visited Germany and met with reporters, voicing his opposition to the ruling.
In the Xhosa areas of South Africa, the large death toll from traditional circumcision provide a constant source of friction between traditional leaders, who oppose medicalized procedures, and health authorities. In 2009 in Eastern Cape Province alone, 80 boys died and hundreds were hospitalized after attending initiation schools. The controversy looks set to spread to the Zulu, whose present-day king Goodwill Zwelithini has called for the reintroduction of customary circumcision after it was banned by Zulu king Shaka in the 19th century. Similar issues, though on a smaller scale, have arisen with traditional circumcision of Aborigines in remote areas of central Australia.
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