Circumcision: The history, health benefits, pros and cons - explainer

Circumcision is one of the oldest surgical procedures in the world and holds an important place in Judaism as the brit mila. Here's everything you should know.

A man prepares the items needed for a circumcision. (photo credit: REUTERS)
A man prepares the items needed for a circumcision.
(photo credit: REUTERS)

An ancient but still common surgical procedure, circumcision refers to the removal of the foreskin from the penis. It is still practiced in religions and nations worldwide, with the World Health Organization estimating that between 76-92% of people in the US are circumcised. 

In Judaism, circumcision is known as brit mila and is performed on male babies eight days after birth. The ceremony is an important ritual symbolizing the Jewish people's covenant with God and has been one of the religion's most defining laws and characteristics for thousands of years, differentiating it from other peoples around the world.

Similarly, circumcision is also practiced by Muslims although at the age of 13, rather than at eight days old.

But why exactly do people get circumcised? What happens when you do? Does it hurt? And what happens if it goes wrong?

Here is everything you need to know about circumcision.

A ‘MOHEL’ holds a scalpel as he performs a circumcision (credit: RONEN ZVULUN/REUTERS)
A ‘MOHEL’ holds a scalpel as he performs a circumcision (credit: RONEN ZVULUN/REUTERS)
What is circumcision? When did circumcision start?

Circumcision is one of the world's oldest surgical procedures, and while it is thought to have originated at least tens of thousands of years ago, no one is quite clear why exactly it began.

A number of theories have been put forth, but ultimately the question is still debated. By far, the most famous case of circumcision is in Judaism. Jewish circumcision is an ancient ritual dating back to the biblical times.

However, it wasn't just limited to Jews. There is considerable archeological evidence that circumcision was common to some extent in Egypt, and may have been practiced in other cultures.

But what is also widely agreed upon by both biblical accounts and contemporary evidence is that the Greeks loathed circumcision, with Greek art emphasizing the purity of the human form and the inclusion of foreskins on males. As the Greeks spread their influence in the ancient world, circumcision became less common.

By the time of the Roman Empire, only a select few groups, specifically Jews, still practiced circumcision. 

Christianity also initially adopted the practice of circumcision, but this declined as Christianity continued to develop and circumcision was seen as unnecessary.

However, the practice became more normalized and today, circumcision is widespread, even among Christian countries, specifically the US and the Philippines.

It is clear from these various discoveries that circumcision dates back quite far into the past, but there is no definitive link to a specific community being the originator of the practice.

Are most men circumcised?

Not exactly. Circumcision rates depend on the area, and by far most of the males circumcised in the world are Muslim, whereas the numbers are far lower in Europe and China. However, it is thought that the number of circumcised males will increase in the coming years.

However, other places in the West have urged against it, especially advocating against religious circumcision. In recent years, there is a massive debate about circumcision, some even going so far as to claim it is genital mutilation.

What is female circumcision?

The practice of female genital mutilation (FGM) is completely different, though their ancient roots may be the same.

Exactly how this practice is done varies, but it typically involves the removal of certain external female genitalia, meaning parts of the female genitalia outside the vagina itself. Usually, this means removing the clitoral hood and clitoral gland as well as closing the vulva and removing the labia.

Unlike male circumcision, which has some noted benefits (see below), there are no known benefits to FGM, and there are several adverse health effects that could occur.

As for why this happens, the practice varies, though it is essentially rooted in ideas of modesty, purity, repressing women's sexuality and promoting gender equality. The practice is widely condemned internationally but is still practiced in a few places like Africa, the Middle East and Indonesia.

Relatives look at a baby after his brit milah in Jerusalem September 24, 2012.  (credit: REUTERS)
Relatives look at a baby after his brit milah in Jerusalem September 24, 2012. (credit: REUTERS)
How does circumcision work? Does a circumcision hurt?

Circumcision itself is simply the removal of the foreskin and is a surgical technique honed by millennia of practice. 

This can be a total removal, like in Judaism, or a partial removal like in parts of Africa, or simply the removal of the frenulum rather than the foreskin, as is done in some places.

For adults and older babies, the circumcision is usually done without any specialized tools, though this is not always the case, and simply involves applying anesthesia and snipping the foreskin off, followed by stopping the bleeding.

Circumcision is very painful without the use of anesthesia, but this isn't much of an issue in the modern day. 

In terms of healing, adults would need about a week to heal the superficial wound, but up to six months to fully heal. Babies, however, can usually completely heal within a week.

The Jewish circumcision, however, is a bit more complex and ritualistic. Here, the circumcision must be done when the baby is eight days old, barring postponements for health issues or premature births

The circumcision, or brit mila, is a public ceremony usually done at a synagogue. The procedure itself is performed by a mohel, who has been trained to perform the circumcision safely and in line with halacha. 

After the circumcision itself, another Jewish practice sees the mohel place his mouth on the open wound to suck the blood. This practice, known as metzitza b'peh, is ancient and well-established in Jewish law going back millennia, and is explicitly outlined as being an essential step to fulfill the mitzva. The reason for this is that it is meant to essentially clean the wound and prevent infection or disease.

However, not only are there more effective ways at preventing infection, like antiseptics, but there is a large body of evidence indicating that the practice is actually harmful and unsanitary. 

Some Jews still do this practice today, but it remains an issue of contention among Jewish streams and has largely been abandoned among many of them.

Why is circumcision important?

In Judaism, the importance of circumcision is widely agreed to be the spiritual significance reflecting the covenant between God and the Jewish people.

However, there are other aspects to this, specifically the perceived reduction of sexual pleasure and lust as well as for perceived health benefits.

But regardless, circumcision has become an essential part of Judaism and is practiced by nearly all streams for millennia.

But among non-Jews, specifically Christians and secular people, the reason for circumcision is quite different.

After being repressed for thousands of years among non-Jews in the West, circumcision began to spike in popularity in the late 19th century in the English-speaking world.

This primarily was due to two reasons: Circumcision was thought to be healthier and it was thought to lessen sexual desire, specifically that it would lead to less masturbation.

At the time, masturbation was seen in the West in a very negative light, so circumcision gained popularity as a preventative measure of sorts. 

So... does circumcision reduce pleasure?

Though there are numerous misconceptions about this, circumcision has not been shown to have much of an impact on sexual pleasure or sexual function in any way, nor has it been shown to have much of an impact on masturbation.

Are there benefits to circumcision?

While beliefs about circumcision impacting sexual pleasure and desire may be a myth, the beliefs that it could have health benefits may hold some water.

While further research still needs to be done, some scientists believe that circumcision can reduce risk of urinary tract infections (UTIs) in males as well as prostate cancer. In addition, a considerable amount of evidence indicates that circumcision significantly reduces the risk of developing penile cancer. 

Other benefits of circumcision is the possible ability to provide protection against some sexually transmitted diseases, such as genital herpes and maybe even chlamydia and syphilis. 

But perhaps most significant is the growing body of evidence that circumcision can reduce the risk of contracting HIV. This evidence is so strong that the World Health Organization (WHO) has even recognized its effectiveness. However, this is only a reduction of risk, not elimination.

Further, it seems circumcision doesn't actually protect men from contracting HIV, but preventing women who have sex with circumcised men from contracting it. 

Overall, condoms are still a much safer option overall as this is only partially effective.