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Circumcision,
Medical ,Cultural , and Ethical Aspects
Sameh Shehata
Alexandria , Egypt
EPSA PRESIDENT
WOFAPS VICE PRESIDENT
AAPS Fukuoka 2016
Circumcision
• Cercum: around
• Caedere: cut
• Oldest
• Most commonly performed
• Most controversial
AAPS Fukuoka 2016
Circumcision
• Brit Milah - Hebrews
• Circoncision - French
• Katsurei - Japanese
• Hallae - Korean
• Tuli - Filipino
• Cua paw phe - Chinese
AAPS Fukuoka 2016
Circumcision
• Where did it begin .
• Religion and faith.
• Medical indications .
• Opponents /proponents .
• Medical societies .
AAPS Fukuoka 2016
Where and when ?
• 10,000 (?) BC: Aboriginal tribes introduce
circumcision of boys as puberty rite
• 6000 (?) BC: Circumcision was practiced as
puberty rite by tribes in north-eastern African
and Arabian peninsula
AAPS Fukuoka 2016
History of Circumcision
• Egypt
– Depicted in tombs (2300
B.C.)
– Mummies were
circumcised
– First depicted operation
• Captured warriors were
often mutilated AAPS Fukuoka 2016
Sakkara 2400 BC
AAPS Fukuoka 2016
What is common?
• Egypt,
• Saudi Arabia,
• Mexico,
• Kalahari
• central Australia
AAPS Fukuoka 2016
Desert
Hot
Humid
Sand
AAPS Fukuoka 2016
US Army report
General John Patton
• World War II 150,000 soldiers were
hospitalized for foreskin problems due to
inadequate hygiene
• “Time and money could have been saved had
prophylactic circumcision been performed before
the men were shipped overseas”
AAPS Fukuoka 2016
On the other side
Foreskin was beneficial in
savannah-wandering or
cave-dwelling ancestors
AAPS Fukuoka 2016
RELIGIOUS CIRCUMCISION
The Covenant
AAPS Fukuoka 2016
The covenant : Torah
the old testament
A covenant is made between God and Abraham
that God would make Abraham a rich and
powerful man and the father of a great
nation, and in return, Abraham's people
would adhere to a certain way of life
AAPS Fukuoka 2016
Judaism
Religious Circumcision: Jewish View
– A Mitzvah
(commandment)
– In the Talmud: whole
glans uncovered when
penis is flaccid
– Performed by a Mohel
• Metzitzah performed
AAPS Fukuoka 2016
Greco-Roman
311 AC
AAPS Fukuoka 2016
Reversal of circumcision
•Epispasm :
• Different techniques.
– Stretching
– Weights
– Surgery
AAPS Fukuoka 2016
Christianity
• The Early Church ( the Council of Jerusalem) decided that
circumcision is not required for Gentile Christians.
• The Council of Florence in the 15th century] prohibited
it.
AAPS Fukuoka 2016
Luther and Calvin.
• the spiritual circumcision of the heart
• the physical circumcision of the foreskin.
AAPS Fukuoka 2016
Christian philosophy
Jesus Christ
born as a Jew,
circumcised
on the 8th day
AAPS Fukuoka 2016
AAPS Fukuoka 2016
Jesus David
Religious Circumcision: Muslim
View
• Word for circumcision is
an ancient Arabic word
• “Sunnah” : Prophet’s
tradition
• “Tahara” : Procedure for
cleanliness
AAPS Fukuoka 2016
Circumcision =Tahara
•to cleanse and/or purify
•circumcised males more pure or clean
AAPS Fukuoka 2016
possible philosophy behind
religious circumcision
•covenant between god and man .
•human sacrifice .
•reduce excessive desire .
AAPS Fukuoka 2016
INDICATIONS
AAPS Fukuoka 2016
• cure of “impotence, sterility, priapism,
masturbation, venereal disease, epilepsy,
bed-wetting, night terrors, paralysis and
homosexuality
• Immunity against tuberculosis, cancer,
syphilis, polio, idiocy, forgetfulness
AAPS Fukuoka 2016
19th century
AAPS Fukuoka 2016
MEDICAL INDICATIONS
Evidence Based
AAPS Fukuoka 2016
AAPS Fukuoka 2016
20th Century
• In 1932, Wolbarst
• penile cancer virtually never
occurred in circumcised men
AAPS Fukuoka 2016
Medical indications
• The Lancet 1999 editorial
• mass circumcision in Africa to prevent
spread of HIV-AIDS
• WHO 2002 Male foreskin increases risk
of cervical cancer in women which lead to
demand for universal male circumcision
• UTI is significantly lower in circumcised
boys (2008)
AAPS Fukuoka 2016
MEDICAL SOCIETIES
Changing attitudes
AAPS Fukuoka 2016
AAPS Fukuoka 2016
USA Rates of Circumcision
AAPS Fukuoka 2016
Circumcision map
AAPS Fukuoka 2016
Reasons for Circumcision
•Necessity (hygiene)
•Religious (sacrifice/reduce desire)
•Indicator of status(elite/slaves)
•Medical (false/true)
AAPS Fukuoka 2016
Enigma
•Devine /human
•Pain /pleasure
•Fact /fiction
•Proponents /opponents
AAPS Fukuoka 2016
More evidence
• Function of prepuce .
• Benefits .
• Disadvantages .
AAPS Fukuoka 2016
AAPS Fukuoka 2016

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