Traditional Circumcision
by Rabbi Boruch Mozes
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Circumcision

Note: The following information is contained in the Wikipedia website. This is not an exact copy of all the information found on the Wikipedia website, nor do we take responsibility for updating this information. For the complete and current information contained in the Wikipedia website, please go onto the Wikipedia website.

From Wikipedia, the free encyclopedia

Circumcision is a surgical procedure that removes some or all of the foreskin (prepuce) from the penis. [1] The word "circumcision" comes from Latin circum (meaning "around") and caedere (meaning "to cut").

Since March 2007 the World Health Organization and UNAIDS recommend male circumcision to fight HIV. [2] According to WHO, 30 per cent of men worldwide have had the procedure, mostly in countries where it is common for religious or health reasons.

Circumcision procedures

Circumcision removes the foreskin from the penis. For infant circumcision, clamps, such as the Gomco clamp, Plastibell, and Mogen are often used. [20] Clamps are designed to cut the blood supply to the foreskin, stop any bleeding and protect the glans. Before using a clamp, the foreskin and the glans are separated with a blunt probe and/or curved hemostat.

  • With the Plastibell, the foreskin and the clamp come away in three to seven days.
  • With a Gomco clamp, a section of skin is first crushed with a hemostat then slit with scissors. The foreskin is drawn over the bell shaped portion of the clamp and inserted through a hole in the base of the clamp and the clamp is tightened, "crushing the foreskin between the bell and the base plate." The crushing limits bleeding (provides hemostasis). While the flared bottom of the bell fits tightly against the hole of the base plate, the foreskin is then cut away with a scalpel from above the base plate. The bell prevents the glans being reached by the scalpel. [21]
  • With a Mogen clamp, the foreskin is grabbed dorsally with a straight hemostat, and lifted up. The Mogen clamp is then slid between the glans and hemostat, following the angle of the corona to "avoid removing excess skin ventrally and to obtain a superior cosmetic result," than with Gomco or Plastibell circumcisions. The clamp is locked shut, and a scalpel is used to cut the foreskin from the flat (upper) side of the clamp. [22][23]

The frenulum is cut if frenular chordee is evident. [24][25]

Judaism

Circumcision is a fundamental rite of Judaism. It is a positive commandment obligatory under Jewish law for Jewish males, and is only postponed or abrogated in the case of threat to the life or health of the child. [27] It is usually performed in a ceremony called a Brit milah (or Bris milah, colloquially simply bris) (Hebrew for "Covenant of circumcision"). A mohel performs the ceremony on the eighth day after birth unless health reasons force a delay. According to the Torah (Genesis, chapter 17 verses 9-14), God commanded Abraham to circumcise himself, his offspring and his slaves as a sign of an everlasting covenant. According to Jewish law, failure to follow the commandment carries the penalty of karet, or being cut off from the community by God. Brit milah is considered to be so important that should the eighth day fall on the Sabbath, actions that would normally be forbidden because of the sanctity of the day are permitted in order to fulfill the requirement to circumcise. The expressly ritual element of circumcision in Judaism, as distinguished from its non-ritual requirement in Islam, is shown by the requirement that a child who either is born aposthetic (without a foreskin) or who has been circumcised without the ritual must nevertheless undergo a Brit milah in which a drop of blood (hatafat-dam , הטפת דם ) is drawn from the penis at the point where the foreskin would have been or was attached. [28]


 Legality

Traditionally, circumcision has been presumed to be legal when performed by a trained operator.

Pain and pain relief during circumcision

According to the American Academy of Pediatrics' 1999 Circumcision Policy Statement, “There is considerable evidence that newborns who are circumcised without analgesia experience pain and psychologic stress.” [68] In the statement, the Academy recommends the use of pain relief for circumcision. [68] One of the supporting studies, Taddio 1997, found a correlation between circumcision and intensity of pain response during vaccination months later. They acknowledge that there may be other factors besides circumcision that account for different levels of pain response, but felt that such differences were not present in their study. [78]

Stang, 1998, found 45% of physicians used anaesthesia - most commonly a dorsal penile nerve block - for infant circumcisions. Obstetricians used anaesthesia significantly less often (25%) than family practitioners (56%) or pediatricians (71%). [79]

J.M. Glass, 1999, stated that Jewish ritual circumcision is so quick that "most mohelim do not routinely use any anaesthesia as they feel there is probably no need in the neonate. However, there is no Talmudic objection and should the parents wish for local anaesthetic cream to be applied there is no reason why this cannot be done." Tannenbaum and Shechet, 2000, stated that an “authentic, traditional bris performed by a mohel does not use clamps, so there is no pain associated with crushing tissue.” [25] They also asserted that due to the speed of the procedure and rarity of complication, it is “more humane not to subject the infant to a local anesthetic.” [25]

HIV

Observational studies in the 1980's identified a strong association of circumcision status and reduced risk of HIV infection, as well as of sexually transmitted genital ulcer disease, although behavioural factors may have been a part of that association. [105] Population based studies suggested that circumcision may protect against HIV but likewise social or religious factors may have skewed results. In March 2005, the Cochrane review found the medical evidence at that point "insufficient" to consider implementing circumcision "as a public-health intervention" but the positive results of observational studies suggested that circumcision was "worth evaluating in randomised controlled trials.” [106]

Three randomised control trials published since 2005 confirm that adult male circumcision results in a 50-60% reduction in risk of HIV transmission (from female to male) during heterosexual intercourse. [107] The results of the first trial were published in November 2005. It found a 60% reduction in the rate of new HIV infection (from 2.1 per 100 to 0.85 per 100 in the intervention group. The authors said, “Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa .” [63] Two further trials conducted in Uganda and Kenya were stopped early on December 13, 2006 on grounds that circumcision was so effective that it would be unethical to continue the experiment and not offer circumcision in the uncircumcised men who were acting as controls. The results showed that circumcised males in Uganda were, depending upon the analysis, 51%-60% less likely to be infected. [15] In Kenya, circumcised males were 53%-60% less likely to be infected. [14] A paper published in the journal PLoS Medicine in July, 2006, calculated that if all men in sub-Saharan Africa were circumcised over the next 10 years, two million new infections could potentially be avoided. [108]

On March 28, 2007 , the World Health Organisation and UNAIDS issued joint recommendations about male circumcision and HIV/AIDS. [114] These are:

  • Male circumcision should now be recognized as an efficacious intervention for HIV prevention.
  • Promoting male circumcision should be recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men. [2]

Langerhans cells and HIV transmission

Langerhans cells are part of the human immune system. Three studies identified high concentrations of Langerhans and other "HIV target" cells in the foreski [119][120] and Szabo and Short suggested that the Langerhans cells in the foreskin may provide an entry point for viral infection. [121] McCoombe, Cameron, and Short also found that the keratin is thinnest on the foreskin and frenulum. Fleiss, Hodges and Van Howe had previously stated a belief that the prepuce has an immunological function. [123] While their specific hypothesis was criticised on technical grounds. [124] a study published in 2007 by de Witte and others said that Langerlin, excreted by Langerhans cells, is a natural barrier to HIV-1 transmission by Langerhans cells. [125]

Infectious and chronic conditions

Studies have found that boys with foreskins tend to have higher rates of various infections and inflammations of the penis than those who are circumcised. [132][133][134] The reasons are unclear, but several hypotheses have been suggested:

  • The foreskin may harbor bacteria and become infected if it is not cleaned properly. [135]
  • The foreskin may become inflamed if it is cleaned too often with soap. [136]
  • The forcible retraction of the foreskin in boys can lead to infections. [98]

The usual treatment for balanoposthitis is to use topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams. [137]

Balanitis

Balanitis, an inflammation of the glans penis, has a variety of causes. [138] Some of these, such as anaerobic infection, occur more frequently in uncircumcised men. [139] There are less invasive treatments than circumcision that have been shown to be effective in treating most mild cases of balanitis. [138] Birley, et al, found that in 90% of their cases of chronic or recurring balanitis "use of emollient creams and restriction of soap washing alone controlled symptoms satisfactorily". They also state that circumcision “might be of benefit in a patient whose balanitis relapses despite these measures, and remains the principal treatment for specific conditions such as lichen sclerosus and plasma cell balanitis.” [136] The, less invasive procedures are not as successful in treating balanitis xerotica obliterans, or BXO [141][142] which is much less common but harder to treat. [143]

Lichen sclerosus et atrophicus (LSA) produces a whitish-yellowish patch on the skin, and is not believed to be always harmful or painful, and may sometimes disappear without intervention. Some consider balanitis xerotica obliterans to be a form of LSA that happens to be on the foreskin, where it may cause pathological phimosis. Circumcision is believed to reliably reduce the threat of BXO.

Penile cancer

Most cases of penile cancer occur in men over the age of 70. [145] Boczko and Freed (1979) stated that since Wolbarst's 1932 review, "there have been only eight documented cases of penile carcinoma in an individual circumcised in infancy." They described the ninth reported case, concluding that "performing it in infancy continues to be the most effective prophylactic measure against penile carcinoma." [146] The AMA remarked that in six case series published from 1932 and 1986, "all penile cancers occurred in uncircumcised individuals." [62] Maden et al (1993) reported that the risk of penile cancer was 3.2 times greater in men who were never circumcised and 3 times greater among those who were circumcised after the neonatal period. [147] An editorial by Holly and Palefsky complimented the study for noting other risk factors for penile cancer, and also for providing corroborating evidence as to the association between a lack of neonatal circumcision and the development of penile cancer. However, they criticised include the study for combining data from invasive and in situ cancers. They concluded that as Maden reported that 20% of the men with penile cancer were circumcised at birth, the recommendation of circumcision for medical indications remained somewhat controversial and the risks and benefits must be weighed. [148] The American Academy of Pediatrics made similar criticism, also noting the possibly inaccurate use of self-report to determine circumcision status. [68] Schoen et al studied the association between neonatal circumcision and invasive penile cancer in 2000, and found that the relative risk for uncircumcised men was 22 times that of circumcised men. [149]

The American Academy of Pediatrics (1999) stated that studies suggest that neonatal circumcision confers some protection from penile cancer, but circumcision at a later age does not seem to confer the same level of protection. Further, penile cancer is a rare disease and the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, remains low. [68] Similarly, the American Medical Association states that although neonatal circumcision seems to lower the risk of contracting penile cancer, because it is rare and occurs later in life, the use of circumcision as a preventive practice is not justified. [62]

Kochen and McCurdy performed a life table analysis on penile cancer rates. They assumed that penile cancer occurred only in uncircumcised males and that the rates from older groups applied to the 1971 birth cohort. [155] They estimated a rate of 1 in 600, or 0.167% in uncircumcised males, with a median age of occurrence of 67 years. They stated, “Since the uncircumcised male is uniquely susceptible, virtually all of these cancers are preventable by neo-natal circumcision. The number of lifetime incident cancers that could be prevented annually by circumcision can be estimated with birth statistics available for 1971. In that year, there were 1,822,910 recorded live male births. If none had been neonatally circumcised, our analysis predicts that one in 600, or more than 3,000 would have penile cancer in their lifetimes.” [155]

The Medical College of Georgia is now studying the impact of the new vaccine against "HPV types 16 and 18, the two most common causes of cervical and penile cancer" [7]

HPV

Several studies have shown that uncircumcised men are at greater risk of human papilloma virus (HPV) infection. [156][157] Some genital HPV strains some can cause genital warts, cervical or penile cancer [8]. One study found no statistically significant difference in HPV infection between circumcised and uncircumcised men, but did note a significantly higher incidence of urethritis in the uncircumcised. [158]

Phimosis and paraphimosis

It is normal for an infant's foreskin to be attached to the glans. Dawson and Whitfield, say "True phimosis is rare but may cause appreciable problems in either childhood or adolescence."[9] Rickwood defined the term 'phimosis' as "scarring of the tip of the prepuce". [159] The AAP state that the true frequency of problems such as phimosis is unknown. [68] Fergusson et al found phimosis in 16% of non-circumcised boys, [132] while Herzog and Alvarez found it in 2.6%.[10] Rickwood and Walker raised concern that phimosis is frequently misdiagnosed by physicians confusing it with the developmentally non-retractable foreskin. [160] Several researchers have described less invasive treatments for phimosis than circumcision, and recommend that they be tried first. [18][19]

Several studies have identified phimosis as a risk factor for penile cancer. A letter to the British Medical Journal stated it would be irresponsible to expose a patient to risk for longer than necessary. [161]

Paraphimosis is an acute condition when a tight foreskin is stuck behind the glans and cannot be returned to its original position, curbing the blood flow to the glans. In children, it is sometimes caused by a caregiver trying to forcibly retract the infant foreskin. [103]

Urinary tract infections

Twelve studies have indicated that neonatal circumcision reduces the rate of Urinary tract infections in male infants by a factor of about 10. [162] The March 1999 AAP statement notes that premature boys are usually not circumcised because of their fragile health status. [68] Studies have found that 1 in 10 premature infants will have a urinary tract infection during the first month of life. [11] Some UTI studies have been criticised for not taking this and other factors into account. A Swedish study found that the cumulative incidence of UTIs in boys under 2 years of age was 2.2%. [163] The AMA cites evidence that the incidence of UTI’s is “small (0.4%–1%)” in uncircumcised infants, and “depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI…One model of decision analysis concluded that the incidence of UTI would have to be substantially higher in uncircumcised males to justify circumcision as a preventive measure against this condition.” [62]

The Canadian Paediatric Society questions whether increased UTI and balanitis rates in uncircumcised male infants may be caused by forced premature retraction. [98] Lerman and Liao, state that apart from its effects on UTI infection rates, "Most of the other medical benefits of circumcision probably can be realized without circumcision as long as access to clean water and proper penile hygiene are achieved." [164]

Policies of various national medical associations

United States

The American Academy of Family Physicians (2007) recommends that physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering circumcision for newborn boys. [165]

The American Academy of Pediatrics (1999) found both potential benefits and risks in infant circumcision. It felt that there was insufficient data to recommend routine neonatal circumcision, and recommended that parental decisions on circumcision should be made with as much accurate and unbiased information as possible, taking medical, cultural, ethnic, traditional, and religious factors into account. The AAP also recommended using analgesia as a safe and effective method for reducing pain associated with circumcision, and that circumcision on newborns only be performed on infants who are stable and healthy. [166]

The American Medical Association supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics. [62]

The American Urological Association (2007) recommends "that circumcision should be presented as an option for health benefits."

References

Some referenced articles are available on-line only in the Circumcision Information and Resource Page’s (CIRP) library or in The Circumcision Reference Library (CIRCS). CIRP articles are chosen from an anti-circumcision point of view, and text in support of this position is often highlighted on-screen using HTML. CIRCS articles are chosen from a pro-circumcision point of view. If documents are not freely available on-line elsewhere, links to articles in one or other of these two websites may be provided.

1. Surgery:

2. "Circumcision, surgical removal of all or part of the foreskin of the human male...", "Circumcision", Microsoft Encarta, 2007.

3. "Male circumcision is an elective surgery to remove the foreskin..." Circumcision , British Columbia Health Guide, June 2, 2006. Retrieved July 18, 2007.

4. "Circumcision is surgery..." Pain and Your Infant: Medical Procedures, Circumcision and Teething , University of Michigan Health System, February 2007. Retrieved July 18, 2007.

5. " Circumcision is cutting away part of the foreskin... When this surgery is performed..." Newborn Care , Danbury Hospital website. Retrieved July 18, 2007.

6. (March 28, 2007). " New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications " (PDF). World Health Organization. Retrieved on 2007-08-13.

7. Wrana, P. (1939). "Historical review: Circumcision". Archives of Pediatrics56: 385–392.   as quoted in: Zoske, Joseph (Winter 1998). " Male Circumcision: A Gender Perspective ". Journal of Men’s Studies6 (2): 189–208. Retrieved on 2006-06-14.  

8. Gollaher, David L. (February 2000). Circumcision: a history of the world’s most controversial surgery . New York, NY: Basic Books, 53–72. ISBN 978-0-465-04397-2 LCCN 99-40015 .  

9. Circumcision . American-Israeli Cooperative Enterprise. Retrieved on 2006-10-03.

10. Beidelman, T. (1987). " CIRCUMCISION ". The Encyclopedia of religionVolume 3. Ed. Mircea Eliade. New York, NY: Macmillan Publishers. 511–514. LCCN 86-5432 ISBN 978-0-02-909480-8 . Retrieved on 2006-10-03.  

11. Customary in some Coptic and other churches:

14. Xu, F, L Markowitz, M Sternberg, and S Aral (2006). " Prevalence of circumcision in men in the United States: data from the National Health and Nutrition Examination Survey (NHANES), 1999-2002 ". XVI International AIDS Conference. Retrieved on 2006-09-21.

15. Lee, R.B. (2005). " Circumcision practice in the Philippines: community based study " (PDF). Sexually Transmitted Infections81 (1): 91. DOI: 10.1136/sti.2004.009993 . PMID 15681733 . Retrieved on 2006-10-03.  

16. Ku, J.H.; M.E. Kim, N.K. Lee, and Y.H. Park (2003). " Circumcision practice patterns in South Korea: community based survey " (PDF). Sexually Transmitted Infections79 (1): 65–67. DOI: 10.1136/sti.79.1.65 . PMID 12576619 . Retrieved on 2006-10-03.  

17. Milos, Marilyn Fayre; Donna Macris (March-April 1992). " Circumcision: A medical or a human rights issue? ". Journal of Nurse-Midwifery37 (2 S1): S87–S96. DOI: 10.1016/0091-2182(92)90012-R . PMID 1573462 . Retrieved on 2007-04-06.  

18. Schoen, Edgar J (1997). " Benefits of newborn circumcision: is Europe ignoring medical evidence? " ((free registration required)). Archives of Disease in Childhood77 (3): 258-260. PMID 9370910 . Retrieved on 2007-04-06.  

19. Newell, Marie-Lousie; Till Bärnighausen (February 24, 2007). " Male circumcision to cut HIV risk in the general population " (PDF). The Lancet369 (9562): 617–619. DOI: DOI:10.1016/S0140-6736(07)60288-8 . PMID 17321292 . Retrieved on 2007-04-01.  

20. Bailey, Robert C; Stephen Moses, Corette B Parker, Kawango Agot, Ian Maclean, John N Krieger, Carolyn F M Williams, Richard T Campbell, Jeckoniah O Ndinya-Achola (February 24, 2007). " Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial " (PDF). The Lancet369 (9562): 643–656. DOI: DOI:10.1016/S0140-6736(07)60312-2 . PMID 17321310 . Retrieved on 2007-04-01.  

21. Gray, Ronald H; Godfrey Kigozi, David Serwadda, Frederick Makumbi, Stephen Watya, Fred Nalugoda, Noah Kiwanuka, Lawrence H Moulton, Mohammad A Chaudhary, Michael Z Chen, Nelson K Sewankambo, Fred Wabwire-Mangen, Melanie C Bacon, Carolyn F M Williams, Pius Opendi, Steven J Reynolds, Oliver Laeyendecker, Thomas C Quinn, Maria J Wawer (February 24, 2007). " Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial " (PDF). The Lancet369 (9562): 657–666. DOI: DOI:10.1016/S0140-6736(07)60313-4 . PMID 17321311 . Retrieved on 2007-04-01.  

22. Holman, John R.; Keith A. Stuessi (March 15, 1999). " Adult Circumcision ". American Family Physician59 (6): 1514–1518. ISSN 0002-838X PMID 10193593 . Retrieved on 2006-06-30.  

23. Rempelakos A; et al (Jan-Mar 2004). "Carcinoma of the penis: experience from 360 cases". J BUON9 (1): 51-5. “"The surgical treatment which was performed included: circumcision 32 patients"”  

24. Dewan, P.A.; Tieu H.C., and Chieng B.S. (August 1996). "Phimosis: Is circumcision necessary?". Journal of Paediatrics and Child Health32 (4): 285–289. PMID 8844530 .  

25. Beaugé, Michel (September/October 1997). " The causes of adolescent phimosis ". British Journal of Sexual Medicine26. Retrieved on 2006-06-14.  

26. Holman, John R.; Evelyn L. Lewis, Robert L. Ringler (August 1995). " Neonatal circumcision techniques - includes patient information sheet ". American Family Physician52 (2): 511–520. ISSN 0002-838X PMID 7625325 . Retrieved on 2006-06-29.  

27. Peleg, David; Ann Steiner (September 15, 1998). " The Gomco Circumcision: Common Problems and Solutions ". American Family Physician58 (4): 891–898. ISSN 0002-838X PMID 9767725 . Retrieved on 2006-06-29.  

28. Pfenninger, John L.; Grant C. Fowler [1994] (July 21, 2003). Procedures for primary care , 2nd, Mosby. ISBN 978-0-323-00506-7 LCCN 2003-56227 .  

29. Reynolds, RD (July 1996). "Use of the Mogen clamp for neonatal circumcision" (Abstract). American Family Physician54 (1): 177–182. PMID 8677833 . Retrieved on 2006-07-18.  

30. Griffin A, Kroovand R (1990). "Frenular chordee: implications and treatment". Urology35 (2): 133-4. PMID 2305537 .  

31. Shechet, Jacob; Barton Tanenbaum (2000). " Circumcision---The Debates Goes On " (PDF). Pediatrics105 (3): 682–683. DOI: doi:10.1542/peds.105.3.681 . PMID 10733391 . Retrieved on 2007-04-06.  

32. Hodges, Frederick, M. (2001). " Religious circumcision: a Jewish view " (PDF). The Bulletin of the History of Medicine75 (Fall 2001): 375–405. Retrieved on 2007-07-24.  

33. Glass, J.M. (January 1999). " Religious circumcision: a Jewish view " (PDF). BJU International83 (Supplement 1): 17–21. DOI: doi:10.1046/j.1464-410x.1999.0830s1017.x . PMID 10766529 . Retrieved on 2006-10-18.  

34. Shulchan Aruch, Yoreh De'ah, 263:4

37. Talmud Bavli Tractate Shabbos 133b: Rav Pappa said, “A mohel who does not perform metzitzah endangers the baby and is dismissed.”

49. Hamdullah Aydın, M.D. and Zeynep Gülçat, Ph.D., "Turkey," in The International Encyclopedia of Sexuality, http://www2.hu-berlin.de/sexology/IES/turkey.html#5 retrieved 8 July 2007.

50. Iftikhar Ahmad Jan, "Circumcision in babies and children with Plastibell technique: An easy procedure with minimal complications - Experience of 316 cases," Pak J Med Sci 2004, 20(3) 175-180.

54. Who Are the Druze? . SEMP Biot #176. Suburban Emergency Management Project (February 17, 2005). Retrieved on 2007-01-30.

55. Guidelines for health Care Providers Interacting with Patients of the Sikh Religion and their Families . Metropolitan Chicago Healthcare Council (November 2000). Retrieved on 2007-05-01.

56. Rebollido, Rommel G.. " Passage to manhood ", General Santos, Sun Star Publishing, Inc., March 21, 2005. Retrieved on 2006-07-01.  

58. Ajuwon et al., "Indigenous surgical practices in rural southwestern Nigeria: Implications for disease," Health Educ. Res..1995; 10: 379-384 Health Educ. Res..1995; 10: 379-384 Retrieved 3 October 2006

59. "PNG circumcision campaign hopes to halt HIV," (htm). ABC Radio Australia citing the Papua New Guinea Post-Courier (2007-02-08, 14:21:13,).

60. Aaron David Samuel Corn (2001). " Ngukurr Crying: Male Youth in a Remote Indigenous Community " (PDF). Working Paper Series No. 2. University of Wollongong. Retrieved on 2006-10-18.

61. Migration and Trade . Green Turtle Dreaming. Retrieved on 2006-10-18. “In exchange for turtles and trepang the Makassans introduced tobacco, the practice of circumcision and knowledge to build sea-going canoes.”

62. Jones, IH (June 1969). "Subincision among Australian western desert Aborigines". British Journal of Medical Psychology42 (2): 183–190. ISSN 0007-1129 PMID 5783777 .  

63. RECENT GUEST SPEAKER . Australian AIDS Fund Incorporated (2006). Retrieved on 2006-07-01.

65. Circumcision amongst the Dogon . The Non-European Components of European Patrimony (NECEP) Database (2006). Retrieved on 2006-09-03.

66. Agberia, John Tokpabere (2006). " Aesthetics and Rituals of the Opha Ceremony among the Urhobo People " (PDF). Journal of Asian and African Studies41 (3): 249-260. DOI: 10.1177/0021909606063880 . Retrieved on 2006-10-18.  

68. Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision . 1999 AMA Interim Meeting: Summaries and Recommendations of Council on Scientific Affairs Reports 17. American Medical Association (December 1999). Retrieved on 2006-06-13.

69. Auvert, Bertran; Dirk Taljaard, Emmanuel Lagarde, Joëlle Sobngwi-Tambekou, Rémi Sitta, Adrian Puren (November 2005). " Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial " (PDF). PLoS Medicine2 (11): 1112–1122. DOI: 10.1371/journal.pmed.0020298 . PMID 16231970 . Retrieved on 2006-07-09.  

71. Van Howe, R.S.; J.S. Svoboda, J.G. Dwyer, and C.P. Price (January 1999). " Involuntary circumcision: the legal issues " (PDF). BJU International83 (Supp1): 63–73. DOI: 10.1046/j.1464-410x.1999.0830s1063.x . PMID 10349416 . Retrieved on 2007-02-12.  

72. Lightfoot-Klein, Hanny (2003). Similarities in Attitudes and Misconceptions toward Infant Male Circumcision in North America and Ritual Female Genital Mutilation in Africa. . The FGC Education and Networking Project. Retrieved on 2006-07-01.

73. Benatar, David; Benatar, Michael (2003). " How not to argue about circumcision ". American Journal of Bioethics 3 (2): W1-W9.  

74. American Academy of Pediatrics Task Force on Circumcision (March 1, 1999). " Circumcision Policy Statement " (PDF). Pediatrics103 (3): 686–693. DOI: 10.1542/peds.103.3.686 . ISSN 0031-4005 PMID 10049981 . Retrieved on 2006-07-01.  

75. Fetus and Newborn Committee (March 1996). " Neonatal circumcision revisited ". Canadian Medical Association Journal154 (6): 769–780. Retrieved on 2006-07-02.   “We undertook this literature review to consider whether the CPS should change its position on routine neonatal circumcision from that stated in 1982. The review led us to conclude the following. There is evidence that circumcision results in an approximately 12-fold reduction in the incidence of UTI during infancy. The overall incidence of UTI in male infants appears to be 1% to 2%. The incidence rate of the complications of circumcision reported in published articles varies, but it is generally in the order of 0.2% to 2%. Most complications are minor, but occasionally serious complications occur. There is a need for good epidemiological data on the incidence of the surgical complications of circumcision, of the later complications of circumcision and of problems associated with lack of circumcision. Evaluation of alternative methods of preventing UTI in infancy is required. More information on the effect of simple hygienic interventions is needed. Information is required on the incidence of circumcision that is truly needed in later childhood. There is evidence that circumcision results in a reduction in the incidence of penile cancer and of HIV transmission. However, there is inadequate information to recommend circumcision as a public health measure to prevent these diseases. When circumcision is performed, appropriate attention needs to be paid to pain relief. The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns. There is therefore no indication that the position taken by the CPS in 1982 should be changed. When parents are making a decision about circumcision, they should be advised of the present state of medical knowledge about its benefits and harms. Their decision may ultimately be based on personal, religious or cultural factors.

76. Medical Ethics Committee (June 2006). The law and ethics of male circumcision - guidance for doctors . British Medical Association. Retrieved on 2006-07-01. “ Circumcision for medical purposes
Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate. Male circumcision in cases where there is a clear clinical need is not normally controversial. Nevertheless, normal anatomical and physiological characteristics of the infant foreskin have in the past been misinterpreted as being abnormal. The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision. Doctors should be aware of this and reassure parents accordingly.

Non-therapeutic circumcision
Male circumcision that is performed for any reason other than physical clinical need is termed non-therapeutic (or sometimes “ritual”) circumcision. Some people ask for non-therapeutic circumcision for religious reasons, some to incorporate a child into a community, and some want their sons to be like their fathers. Circumcision is a defining feature of some faiths.

There is a spectrum of views within the BMA’s membership about whether non-therapeutic male circumcision is a beneficial, neutral or harmful procedure or whether it is superfluous, and whether it should ever be done on a child who is not capable of deciding for himself. The medical harms or benefits have not been unequivocally proven except to the extent that there are clear risks of harm if the procedure is done inexpertly. The Association has no policy on these issues. Indeed, it would be difficult to formulate a policy in the absence of unambiguously clear and consistent medical data on the implications of the intervention. As a general rule, however, the BMA believes that parents should be entitled to make choices about how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices. ”

77. Policy Statement On Circumcision (PDF). Royal Australasian College of Physicians (September 2004). Retrieved on 2007-02-28. “ The Paediatrics and Child Health Division, The Royal Australasian College of Physicians (RACP) has prepared this statement on routine circumcision of infants and boys to assist parents who are considering having this procedure undertaken on their male children and for doctors who are asked to advise on or undertake it. After extensive review of the literature the RACP reaffirms that there is no medical indication for routine neonatal circumcision. Circumcision of males has been undertaken for religious and cultural reasons for many thousands of years. It remains an important ritual in some religious and cultural groups.…In recent years there has been evidence of possible health benefits from routine male circumcision. The most important conditions where some benefit may result from circumcision are urinary tract infections, HIV and later cancer of the penis.…The complication rate of neonatal circumcision is reported to be around 1% to 5% and includes local infection, bleeding and damage to the penis. Serious complications such as bleeding, septicaemia and meningitis may occasionally cause death. The possibility that routine circumcision may contravene human rights has been raised because circumcision is performed on a minor and is without proven medical benefit. Whether these legal concerns are valid will be known only if the matter is determined in a court of law. If the operation is to be performed, the medical attendant should ensure this is done by a competent operator, using appropriate anaesthesia and in a safe child-friendly environment. In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents. Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate. ”

78. Medical Ethics Committee (June 2006). The law and ethics of male circumcision - guidance for doctors . British Medical Association. Retrieved on 2006-07-01.

79. Goldman, R. (January 1999). " The psychological impact of circumcision " (PDF). BJU International83 (S1): 93–102. DOI: 10.1046/j.1464-410x.1999.0830s1093.x . Retrieved on 2006-07-02.  

81. Sweden restricts circumcisions . BBC Europe (October 1, 2001). Retrieved on 2006-10-18. “Swedish Jews and Muslims object to the new law, saying it violates their religious rights.”

82. Reuters (June 7, 2001). Jews protest Swedish circumcision restriction . Canadian Children's Rights Council. Retrieved on 2006-10-18. “A WJC spokesman said, ‘This is the first legal restriction placed on a Jewish rite in Europe since the Nazi era. This new legislation is totally unacceptable to the Swedish Jewish community.’”

83. Bureau of Democracy, Human Rights, and Labor (September 15, 2006). Sweden . International Religious Freedom Report 2006. US Department of State. Retrieved on 2007-07-04.

84. Taddio, Anna; Joel Katz, A Lane Ilersich, Gideon Koren (March 1997). " Effect of neonatal circumcision on pain response during subsequent routine vaccination " (PDF — free registration required). The Lancet349 (9052): 599–603. DOI: 10.1016/S0140-6736(96)10316-0 . Retrieved on 2007-08-08.  

85. Stang, Howard J.; Leonard W. Snellman (June 1998). " Circumcision Practice Patterns in the United States " (PDF). Pediatrics101 (6): e5–. DOI: 10.1542/peds.101.6.e5 . ISSN 1098-4275 . Retrieved on 2006-06-29.  

86. Glass, J.M. (January 1999). " Religious circumcision: a Jewish view " (PDF). BJU International83 (Supplement 1): 17–21. DOI: doi:10.1046/j.1464-410x.1999.0830s1017.x . PMID 10766529 . Retrieved on 2007-04-25.  

87. Brady-Fryer, B; Wiebe N, Lander JA (July 2004). " Pain relief for neonatal circumcision ". The Cochrane Database of Systematic Reviews (3): Art. No.: CD004217. DOI: 10.1002/14651858.CD004217.pub2 . PMID 15495086 . Retrieved on 2006-06-29.  

88. Razmus I, Dalton M, Wilson D. "Pain management for newborn circumcision". Pediatr Nurs30 (5): 414-7, 427. PMID 15587537 .  

89. Ng, WT; et al (2001). "The use of topical lidocaine/prilocaine cream prior to childhood circumcision under local anesthesia". Ambul Surg9 (1): 9-12. PMID 11179706 .  

90. Circumcision: Position Paper on Neonatal Circumcision . American Academy of Family Physicians (2007). Retrieved on 2007-01-30.

91. Boyle, Gregory J; Svoboda, J Steven; Goldman, Ronald; Fernandez, Ephrem (2002). Male circumcision: pain, trauma, and psychosexual sequelae . Bond University Faculty of Humanities and Social Sciences.

92. Schoen, Edgar J.; Christopher J. Colby, Trinh T. To (March 2006). " Cost Analysis of Neonatal Circumcision in a Large Health Maintenance Organization " (Abstract). The Journal of Urology175 (3): 1111–1115. DOI: 10.1016/S0022-5347(05)00399-X . PMID 16469634 . Retrieved on 2006-07-01.  

93. Alanis, Mark C.; Richard S. Lucidi (May 2004). " Neonatal Circumcision: A Review of the World’s Oldest and Most Controversial Operation" (Abstract). Obstetrical & Gynecological Survey59 (5): 379-395. PMID 15097799 . Retrieved on 2006-09-27.  

94. Van Howe, Robert S. (November 2004). " A Cost-Utility Analysis of Neonatal Circumcision " (Abstract). Medical Decision Making24 (6): 584–601. DOI: 10.1177/0272989X04271039 . PMID 15534340 . Retrieved on 2006-07-01.  

95. Ganiats, TG; Humphrey JB, Taras HL, Kaplan RM. (Oct–Dec 1991). "Routine neonatal circumcision: a cost-utility analysis". Medical Decision Making11 (4): 282–293. PMID 1766331 . Retrieved on 2006-07-01.  

96. Lawler, FH; Bisonni RS, Holtgrave DR. (Nov–Dec 1991). "Circumcision: a decision analysis of its medical value.". Family Medicine23 (8): 587–593. PMID 1794670 . Retrieved on 2006-07-01.  

97. Christakis, Dmitry A.; Eric Harvey, Danielle M. Zerr, Chris Feudtner, Jeffrey A. Wright, and Frederick A. Connell (January 2000). " A Trade-off Analysis of Routine Newborn Circumcision " (PDF). Pediatrics105 (1): 246–249. DOI: 10.1542/peds.105.1.S2.246 . PMID 10617731 . Retrieved on 2006-07-01.  

98. Ahmed A,, A; Mbibi NH, Dawam D, Kalayi GD (March 1999). "Complications of traditional male circumcision". Annals of Tropical Paediatrics19 (1): 113–117. PMID 10605531 ISSN 0272-4936 . Retrieved on 2006-07-01.  

99. Kaplan, George W., M.D. (August 1983). " Complications of Circumcision " (HTML). UROLOGIC CLINICS OF NORTH AMERICA10 (3): 543–549. Retrieved on 2006-09-29.  

100. Naimer, Sody A.; Roni Peleg, Yevgeni Meidvidovski, Alex Zvulunov, Arnon Dov Cohen, and Daniel Vardy (November 2002). " Office Management of Penile Skin Bridges with Electrocautery " (PDF). Journal of the American Board of Family Practice15 (6): 485–488. PMID 10605531 . Retrieved on 2006-07-01.  

101. Gee, W.F.; J.S. Ansell (December 1976). " Neonatal circumcision: a ten-year overview: with comparison of the Gomco clamp and the Plastibell device " (Abstract). Pediatrics58 (6): 824–827. PMID 995507 . Retrieved on 2006-07-11.  

103. Williams, N; L. Kapila (October 1993). " Complications of circumcision " (Abstract). British Journal of Surgery80 (10): 1231–1236. DOI: 10.1002/bjs.1800801005 . PMID 8242285 . Retrieved on 2006-07-11.  

104.

105. Yegane, Rooh-Allah; Abdol-Reza Kheirollahi, Nour-Allah Salehi, Mohammad Bashashati, Jamal-Aldin Khoshdel, and Mina Ahmadi (May 2006). " Late complications of circumcision in Iran " (Abstract). Pediatric Surgery International22 (5): 442–445. DOI: 10.1007/s00383-006-1672-1 . PMID 16649052 . Retrieved on 2006-07-02.  

106. Angel, Carlos A. (June 12, 2006). http://www.emedicine.com/PED/topic2356.htm . eMedicine. WebMD. Retrieved on 2006-07-02.

107. Complications Of Circumcision . Paediatric Policy - Circumcision. The Royal Australasian College of Physicians (October 2004). Retrieved on 2006-07-11.

108. Paediatric Death Review Committee: Office of the Chief Coroner of Ontario (April 2007). Coroner's Corner Circumcision: A minor procedure? . Paediatric Child Health Vol 12 No 4, April 2007 pages 311-312. Pulsus Group Inc.. Retrieved on 2007-06-17.

110.

111. www.ncbi.nlm.nih.gov

112. Siegfried, N; M Muller, J Deeks, J Volmink, M Egger, N Low, S Walker, and P Williamson (March 2005). " HIV and male circumcision—a systematic review with assessment of the quality of studies " (PDF — free registration required). The Lancet Infectious Diseases5 (3): 165–173. DOI: 10.1016/S1473-3099(05)01309-5 . PMID 15766651 . Retrieved on 2007-07-09.  

113. WHO and UNAIDS Secretariat welcome corroborating findings of trials assessing impact of male circumcision on HIV risk . World Health Organization (February 23, 2007). Retrieved on 2007-02-23.

114. Williams, Brian G.; James O. Lloyd-Smith, Eleanor Gouws, Catherine Hankins, Wayne M. Getz, John Hargrove, Isabelle de Zoysa, Christopher Dye, Bertran Auvert (July 2006). " The Potential Impact of Male Circumcision on HIV in Sub-Saharan Africa " (PDF). PLoS Medicine3 (7): e262. DOI: 10.1371/journal.pmed.0030262 . PMID 16822094 . Retrieved on 2006-07-13.  

115. WHO and UNAIDS Secretariat welcome corroborating findings of trials assessing impact of male circumcision on HIV risk . World Health Organization (February 23, 2007). Retrieved on 2007-02-23.

116. Male circumcision reduces the risk of becoming infected with HIV, but does not provide complete protection . World Health Organization (December 13, 2006). Retrieved on 2006-07-20.

117. Circumcision 'reduces HIV risk' . BBC News (October 25, 2005).

118. Virginia Differding (March 12, 2007). Women may be at heightened risk of HIV infection immediately after male partner is circumcised . Aidsmap News. Retrieved on 2007-03-14.

119. Brewer, Devon (February 2007). " Male and Female Circumcision Associated with Prevalent HIV Infection in Virgins and Adolescents in Kenya, Lesotho, and Tanzania ". Annals of Epidemiology17 (3): pp.217-226. Retrieved on 2007-03-04. “ (Kenyan females: 3.2% vs. 1.4%, odds ratio [OR] = 2.38; Kenyan males: 1.8% vs. 0%, OR undefined; Lesothoan males: 6.1% vs. 1.9%, OR 3.36; Tanzanian males: 2.9% vs. 1.0%, OR 2.99; weighted mean phi correlation = 0.07, 95% confidence interval, 0.03 to 0.11). ”  

120. WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention . World Health Organisation (March 2007).

121. Garenne, Michel (January 2006). " Male Circumcision and HIV Control in Africa ". PLoS Medicine3 (1): e78. DOI: doi:10.1371/journal.pmed.0030078 . PMID 16435906 . Retrieved on 2007-04-01.  

123. Butler, D; Odling-Smee, L (June 2007). " Circumcision for HIV needs follow-up ". Nature : 1040-1041.  

124. Hussain LA, LA; T. Lehner (July 1995). "Comparative investigation of Langerhans' cells and potential receptors for HIV in oral, genitourinary and rectal epithelia" (Abstract). Immunology85 (3): 475–484. PMID 7558138 . Retrieved on 2006-07-09.  

125. Patterson, Bruce K.; Alan Landay, Joan N. Siegel, Zareefa Flener, Dennis Pessis, Antonio Chaviano, and Robert C. Bailey (2002). " Susceptibility to Human Immunodeficiency Virus-1 Infection of Human Foreskin and Cervical Tissue Grown in Explant Culture " (PDF). American Journal of Pathology161 (3): 867–873. PMID 12213715 . Retrieved on 2006-07-09.  

126. Donoval, BA; AL Landay, S Moses, K Agot, JO Ndinya-Achola, EA Nyagaya, I MacLean, and RC Bailey (March 2006). " HIV-1 target cells in foreskins of African men with varying histories of sexually transmitted infections " (Abstract). American Journal of Clinical Pathology125 (3): 386–391. DOI: 10.1309/JVHQ-VDJD-YKM5-8EPH . PMID 16613341 . Retrieved on 2006-07-09.  

127. Szabo, Robert; Roger V. Short (June 2000). " How does male circumcision protect against HIV infection? " (PDF). BMJ320 (7249): 1592–1594. DOI: 10.1136/bmj.320.7249.1592 . PMID 10845974 . Retrieved on 2006-07-09.  

128. McCoombe SG, Cameron PU, Short RV (July 7, 2002). " The distribution of HIV-1 target cells and keratin in the human penis. " (Abstract). International AIDS Society. Retrieved on 2006-07-09.

129. Fleiss, PM; FM Hodges, RS Van Howe (October 1998). " Immunological functions of the human prepuce " (PDF). Sexually Transmitted Infections74 (5): 364–367. PMID 10195034 . Retrieved on 2006-07-09.  

130. Waskett, Jake H. (June 20, 2005). Apocrine glands in inner prepuce doubtful . Electronic letters. BMJ Publishing Group Ltd. Retrieved on 2006-07-09.

131. de Witte, L. (March 4, 2007). Langerin is a natural barrier to HIV-1 transmission by Langerhans cells . Abstract. www.Pubmed.gov. Retrieved on 2007-03-19.

132. Although the Academy's 1975 statement asserted that "A program of education leading to continuing good personal hygiene would offer all the advantages of circumcision without the attendant surgical risk," the 1999 statement cites a study which found that "appropriate hygiene decreased significantly the incidence of phimosis, adhesions, and inflammation, but did not eliminate all problems."

133. Care Of The Foreskin . Paediatric Policy - Circumcision. The Royal Australasian College of Physicians (October 2004). Retrieved on 2006-07-13.

134. Birley (October 1993). " Clinical Features and management of recurrent balanitis; association with atopy and genital washing ". Genitourinary Medicine69 (5): 400–403. DOI: 10.1136/jme.2002.001313 . PMID 15173354 . Retrieved on 2007-07-04.  

135. Sonnex, C; Croucher, PE; Dockerty WG (Dec 1997). "Balanoposthitis associated with the presence of subpreputial "smegma stones"". Genitourin Med73 (6): 567.  

136. Hutson, J.M. (June 2004). " Circumcision: a surgeon’s perspective " (PDF). Journal of Medical Ethics30 (3): 238–240. DOI: 10.1136/jme.2002.001313 . PMID 15173354 . Retrieved on 2006-07-09.  

137. Darby, Robert (July 2005). " The riddle of the sands: circumcision, history, and myth " (PDF). The New Zealand Medical Journal118 (1218): 76–82. ISSN 11758716 PMID 16027753 . Retrieved on 2006-07-09.  

138. Fergusson, DM; JM Lawton and FT Shannon (April 1988). " Neonatal circumcision and penile problems: an 8-year longitudinal study ". Pediatrics81 (4): 537–541. PMID 3353186 . Retrieved on 2007-07-18.  

139. Fakjian, N; S Hunter, GW Cole and J Miller (August 1990). "An argument for circumcision. Prevention of balanitis in the adult". Arch Dermatol126 (8): 1046–7. PMID 2383029 .  

140. Herzog, LW; SR Alvarez (March 1986). "The frequency of foreskin problems in uncircumcised children". Am J Dis Child140 (3): 254–6. PMID 3946358 .  

141. O’Farrel, Nigel; Maria Quigley and Paul Fox (August 2005). " Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study " (Abstract). International Journal of STD & AIDS16 (8): 556–588(4). DOI: 10.1258/0956462054679151 . PMID 16105191 . Retrieved on 2006-08-20.   Editor’s note: I cannot confirm that the article substantiates the claim as I cannot access the full article.

142. Birley, HD; MM Walker, GA Luzzi, R Bell, D Taylor-Robinson, M Byrne, and AM Renton (October 1993). " Clinical Features and management of recurrent balanitis; association with atopy and genital washing ". Genitourinary Medicine69 (5): 400–403. PMID 8244363 . Retrieved on 2006-08-20.  

143. Osipov, Vladimir O.; Scott M. Acker (November 14, 2006). Balanoposthitis . Reactive and Inflammatory Dermatoses. EMedicine. Retrieved on 2006-11-20.

144. Au, T.S.; K.H. Yeung (2003). " Balanitis, Bacterial Vaginosis and Other Genital Conditions ", in Pedro Sá Cabral, Luís Leite, and José Pinto (eds.): HANDBOOK OF DERMATOLOGY & VENEREOLOGY , 2nd ed., Lisbon, Portugal: Department of Dermatology—Hospital Pulido Valente. ISBN 978-962-334-030-4 . Retrieved on 2006-09-04.  

145. Edwards, Sarah (June 1996). " Balanitis and balanoposthitis: a review ". Genitourinary Medicine72 (3): 155–159. PMID 8707315 . Retrieved on 2006-09-04.  

146. Vincent, Michelle Valerie; Ewan MacKinnon (April 2005). " The response of clinical balanitis xerotica obliterans to the application of topical steroid-based creams " (Abstract). Journal of Pediatric Surgery40 (4): 709–712. DOI: 10.1016/j.jpedsurg.2004.12.001 . PMID 15852285 . Retrieved on 2006-09-21.  

147. Wright, J.E. (May 1994). " The treatment of childhood phimosis with topical steroid ". The Australian and New Zealand journal of surgery64 (5): 327–328. PMID 8179528 . Retrieved on 2006-09-21.  

148. Webster, T.M.; M.P. Leonard (April 2002). " Topical steroid therapy for phimosis " (Abstract). The Canadian journal of urology9 (2): 1492–1495. PMID 12010594 . Retrieved on 2006-09-21.  

149. Scheinfeld, Noah S.; George C. Keough, Daniel Lehman (January 11, 2006). http://www.emedicine.com/derm/topic46.htm . Diseases Of The Dermis. EMedicine. Retrieved on 2006-09-21.

150. Mattioli, G.; P. Repetto, C. Carlini, C. Granata, C. Gambini, and V. Jasonni (May 2002). " Lichen sclerosus et atrophicus in children with phimosis and hypospadias " (Abstract). Pediatric Surgery International18 (4): 273–275. DOI: 10.1007/s003830100699 . PMID 12021978 . Retrieved on 2006-09-21.  

151. Cancer of the penis (penile cancer) . Questions and Answers: Penis cancer questions. Cancer Research UK (January 14, 2004). Retrieved on 2006-09-26. “Penile cancer is more common in older men. Most cases are in men over 70. It is rare in men under 40.”

152. Boczko, S; Freed, S (1979). "Penile carcinoma in circumcised males". N Y State J Med79 (12): 1903-4.   [1]

153. Maden, C; et al (Jan 1993). "History of circumcision, medical conditions, and sexual activity and risk of penile cancer". J Natl Cancer Inst85 (1): 19-24. PMID 8380060 .  

154. Holly, EA; Palefsky, JM (Jan 1993). " Factors related to risk of penile cancer: new evidence from a study in the Pacific Northwest ". J Natl Cancer Inst85 (1): 2-4.  

155. Schoen, EJ; Oehrli, M; Colby, C; Machin, G (Mar 2000). " The highly protective effect of newborn circumcision against invasive penile cancer ". Pediatrics105 (3): e36.  

156. http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_ penile_cancer_35.asp

157. http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_ penile_cancer_35.asp

158. http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_ penile_cancer_35.asp

159. What Are the Risk Factors for Penile Cancer? . Cancer Reference Information. American Cancer Society (May 31, 2006). Retrieved on 2006-10-01.

160. Can Penile Cancer Be Prevented? . Cancer Reference Information. American Cancer Society (May 31, 2006). Retrieved on 2006-10-01.

161. Kochen, Mosze; Stephen McCurdy (May 1980). " Circumcision and the risk of cancer of the penis. A life-table analysis ". American Journal of Diseases of Children134 (5): 484–486. DOI: 10.1001/archpedi.134.5.484 . PMID 7377156 . Retrieved on 2006-09-26.  

162. Castellsagué, Xavier; et al. (April 11, 2002). " Male circumcision, penile human papillomavirus infection, and cervical cancer " (PDF — free registration required). The New England Journal of Medicine346 (15): 1105–1112. DOI: 10.1056/NEJMoa011688 . PMID 11948269 . Retrieved on 2006-07-09.  

163. Lajous, Martín; Nancy Mueller, Aurelio Cruz-Valdéz, Luis Victor Aguilar, Silvia Franceschi, Mauricio Hernández-Ávila, and Eduardo Lazcano-Ponce (2005 July). " Determinants of Prevalence, Acquisition, and Persistence of Human Papillomavirus in Healthy Mexican Military Men " (PDF). Cancer Epidemiology Biomarkers and Prevention14 (7): 1710–1716. DOI: 10.1158/1055-9965.EPI-04-0926 . PMID 16030106 . Retrieved on 2006-07-09.  

164. Aynaud, O.; D. Piron, G. Bijaoui, and JM Casanova (1999 July). " Developmental factors of urethral human papillomavirus lesions: correlation with circumcision " (PDF). BJU International84 (1): 57–60. DOI: 10.1046/j.1464-410x.1999.00104.x . PMID 10444125 . Retrieved on 2006-07-09.  

165. Rickwood, AM.; V. Hemalatha, G. Batcup, and L. Spitz (April 1980). " Phimosis in boys ". British Journal of Urology52 (2): 147–150. PMID 7191744 . Retrieved on 2006-10-10.  

166. Rickwood, AM.; Jenny Walker (September 1989). " Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence? ". Annals of the Royal College of Surgeons of England71 (5): 275–277. PMID 2802472 . Retrieved on 2006-10-10.  

167. Robin J Willcourt, "Re: Circumcision is a last resort - to be avoided, whenever possible" - letters to the editor, British Medical Journal http://bmj.bmjjournals.com/cgi/eletters/321/7264/792#110919

168. Singh-Grewal, D.; J. Macdessi, and J. Craig (August 1, 2005). " Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies " (PDF). Archives of Disease in Childhood90 (8): 853-858. DOI: 10.1136/adc.2004.049353 . PMID 15890696 . Retrieved on 2006-09-21.  

169. Jakobsson 1999, et al. Minimum incidence and diagnostic rate of first urinary tract infection. Pediatrics. 1999 August;104 (2 Pt 1):222–6. ( full text )

170. Lerman SE, Liao JC. Neonatal circumcision. Pediatr Clin North Am. 2001 December;48(6):1539-57. PMID 11732129

171. Circumcision: Position Paper on Neonatal Circumcision . American Academy of Family Physicians (2007). Retrieved on 2007-01-30. “ Considerable controversy surrounds neonatal circumcision. Putative indications for neonatal circumcision have included preventing UTIs and their sequelae, preventing the contraction of STDs including HIV, and preventing penile cancer as well as other reasons for adult circumcision. Circumcision is not without risks. Bleeding, infection, and failure to remove enough foreskin occur in less than 1% of circumcisions. Evidence-based complications from circumcision include pain, bruising, and meatitis. More serious complications have also occurred. Although numerous studies have been conducted to evaluate these postulates, only a few used the quality of methodology necessary to consider the results as high level evidence.

The evidence indicates that neonatal circumcision prevents UTIs in the first year of life with an absolute risk reduction of about 1% and prevents the development of penile cancer with an absolute risk reduction of less than 0.2%. The evidence suggests that circumcision reduces the rate of acquiring an STD, but careful sexual practices and hygiene may be as effective. Circumcision appears to decrease the transmission of HIV in underdeveloped areas where the virus is highly prevalent. No study has systematically evaluated the utility of routine neonatal circumcision for preventing all medically-indicated circumcisions in later life. Evidence regarding the association between cervical cancer and a woman’s partner being circumcised or uncircumcised, and evidence regarding the effect of circumcision on sexual functioning is inconclusive. If the decision is made to circumcise, anesthesia should be used.

The American Academy of Family Physicians recommends physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering this procedure for their newborn son. ”

172. Task Force on Circumcision (March 1, 1999). " Circumcision Policy Statement " (PDF). Pediatrics103 (3): 686–693. DOI: 10.1542/peds.103.3.686 . ISSN 0031-4005 PMID 10049981 . Retrieved on 2006-07-01.   “Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided. If circumcision is performed in the newborn period, it should only be done on infants who are stable and healthy.”

173. Circumcision: Information for parents . Caring for kids. Canadian Paediatric Society (November 2004). Retrieved on 2006-10-24. “ Circumcision is a “non-therapeutic” procedure, which means it is not medically necessary. Parents who decide to circumcise their newborns often do so for religious, social or cultural reasons. To help make the decision about circumcision, parents should have information about risks and benefits. It is helpful to speak with your baby’s doctor. After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions. ”

174. Ronald Immerman and Wade Mackey (1997). " A Biocultural Analysis of Circumcision ". Social Biology44: 265-275.  

175. (1855) "On the influence of circumcision in preventing syphilis". Medical Times and GazetteNS Vol II: 542–3.  

176. Epstein E (1874). "Have the Jews any Immunity from Certain Diseases?". Medical and Surgical Reporter (Philadelphia)XXX: 40–41.  

177. Weiss, HA; Thomas, SL; Munabi SK; Hayes RJ (Apr 2006). " Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis ". Sex Transm Infect82 (2): 101-9. PMID 16581731 .  

178. Waldeck, S.E. (2003). " Using Male Circumcision to Understand Social Norms as Multipliers ". UNIVERSITY OF CINCINNATI LAW REVIEW72 (2): 455-526.  

179. Pang, MG; Kim DS (2002). " Extraordinarily high rates of male circumcision in South Korea: history and underlying causes ". BJU Int89 (1): 48-54.  

180. Adler, R; et al (2001). " Circumcision: we have heard from the experts; now let's hear from the parents ". Pediatrics107 (2): E20.  

181. Williams N, Kapila L. Complications of circumcision. Brit J Surg. 1993;80:1231-6. ( full text )

182. Crawford DA. Circumcision: a consideration of some of the controversy. J Child Health Care. 2002 December;6(4):259-70. PMID 12503896

183. {{cite journal | last = StanWisniewski | first = Z. | year = 2004 | title = Circumcision in Western Australia | journal = ANZ Journal of Surgery | volume = 74 | issue = 5 | pages = 387-388 | doi = 10.1111 | url = http://pt.wkhealth.com/pt/re/aunz/fulltext.00130494-200405000-00028.htm | accessdate = 2007-03-31

184. (2006) " Demand for male circumcision rises in a bid to prevent HIV ". Bulletin of the World Health Organization84 (7): 505-588. “As a result, there are already indications of increasing demand for male circumcision in traditionally non-circumcising societies in southern Africa.”  

185. Skatssoon, Judy (July 2004). Circumcision rates rise for some . Sydney Morning Herald (reprint: CIRP.org).

187. J.H. Ku1, M.E. Kim, N.K. Lee and Y.H. Park, "Circumcision practice patterns in South Korea: community based survey" (Sex Transm Inf 2003;79:65-67 http://sti.bmjjournals.com/cgi/content/full/79/1/65 retrieved 1 October 2006

188. Dave, SS; et al (2003). "[ http://sti.bmj.com/cgi/content/full/79/6/499 Male circumcision in Britain: findings from a national probability sample survey]". Sex Transm Infect79 (6): 499-500.  

189. Nelson, CP.; R. Dunn, J. Wan, JT. Wei (March 2005). " The increasing incidence of newborn circumcision: data from the nationwide inpatient sample " (Abstract). Journal of Urology173 (3): 978–981. DOI: 10.1097/01.ju.0000145758.80937.7d . ISSN 0022-5347 PMID 15711354 . Retrieved on 2006-09-21.  

190. Kozak, LJ; KA Lees, and CJ DeFrances (2006). " National Hospital Discharge Survey: 2003 annual summary with detailed diagnosis and procedure data. " (PDF). Vital Health Statistics13 (160). Retrieved on 2007-01-30.  

191. Trends in circumcisions among newborns . Health E-Stats. National Center for Health Statistics (January 11, 2007). Retrieved on 2007-01-30. “ However, the most notable change occurred in the West where newborn circumcisions dropped from 62 percent in 1980 to 37 percent in 1999. This latest available figure for the West represents over a two-fold difference when compared with circumcision estimates for the Midwest. This dramatic decline, in part, reflects the increased birth rate among Hispanics who have been shown in several other studies to be less likely to receive circumcisions than other white and black infants. ”

192. Xu, F, L Markowitz, M Sternberg, and S Aral (2006). " Prevalence of circumcision in men in the United States: data from the National Health and Nutrition Examination Survey (NHANES), 1999-2002 ". XVI International AIDS Conference. Retrieved on 2006-09-21.

193. Schoen, Edgar J. (July 2006). " Ignoring evidence of circumcision benefits ". Pediatrics118 (1): 385–387. ISSN 0031-4005 PMID 16818586 . Retrieved on 2006-09-21.  

194. Betsy A., Lehman. " The Age-old Question of Circumcision " (CIRP (CIRP has modified text display)), The Boston Globe, June 22, 1987, pp. 41 & 43. Retrieved on 2007-04-06.  

195. Quayle, SS.; DE. Coplen, PF. Austin (October 2003). "The effect of health care coverage on circumcision rates among newborns". Journal of Urology170 (4 Pt 2): 1533–1536. ISSN 0022-5347 PMID 14501653 . Retrieved on 2006-09-21.  



"I have had the occasion of working with Rabbi Boruch Mozes on urological surgery. Rabbi Mozes has impressed me with his professionalism and judgment."
Dr. Howard M. Snyder-a world renowned urological surgeon. Children’s Hospital Of Philadelphia
I am happy to confidently recommend Rabbi Boruch Mozes as an experienced and highly skilled mohel. Many families have been extremely satisfied with his services as a mohel. I wish him continued success.
Dr. Batya Wagner Pediatrician NY

As both a parent and a medical professional, I was extremely impressed with the Bris that Rabbi Boruch Mozes performed on my son. I have in the past and will continue to recommend him to all as an outstanding mohel.
Dr. Isaac Braverman Pediatrician NJ

When our third son was born on a Shabbos and the mohel that we had used for our previous two sons was going to Israel, I was concerned. Rabbi Mozes made the several hour trip to our community and spent Shabbos away from his family so that the bris could be performed on the proper day. He was highly qualified and his manner was reassuring. I would recommend Rabbi Mozes to any family desiring an experienced and skilled mohel for the circumcision of their son.
Dr. Daniel Eisenberg Radiologist PA

Dr.Daniel Eisenberg Radiologist PA

Bris in University Surgery Center - 2013

"…my personal experience with Rabbi Boruch Mozes allows me to highly recommend him to you for the performance of circumcision (Brit Milah). Please feel free to contact me ... if I may be of further assistance in recommending this excellent mohel to you in the future."
MICHAEL H. FLEISHER, M.D., FAAP, FACS
Pediatric Urologist New Jersey

Michael H. Fleisher, M.D., FAAP, FACS

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