What is most interesting about the argument of the circumcision promoters - that all boys should be circumcised soon after birth - is that most of the health benefits they proclaim do not kick in until adulthood or old age. If the "advantages" of circumcision were as overwhelming as the advocates assert, you would think that babies and boys could be left alone and that most rational adults would choose to have the operation done in their late teens or early twenties. Oddly enough, when they get to that age most men prefer to keep their foreskins. In fact, even if it were valid, the "health" case for routine or preventive circumcision never amounted to a convincing argument for circumcising infants or boys. At its best, it was no more than an argument for circumcision in adulthood. Even if all the claims were true, the most you would expect is that a few ultra-nervous adults would elect it for themselves, not that the operation would be inflicted on thousands of babies who had never even inquired.
On this page we review the arguments of the circumcision promoters, suggest some reasons for the revival of the old "health" arguments for circumcision since the mid-1990s, and ask why the advocates insist that children must be circumcised even before they are aware of their bodies.
Between the mid-eighteenth and the late nineteenth century, but only in English-speaking countries, the status of the male foreskin fell disastrously. It was transformed from "the best of your property", as a popular rhyme of the period put it, and an adornment which brought pleasure to its owner and his partners, to "a useless bit of flesh", an enemy of man, and a "harbour for filth", as Dr Remondino and other scissors-happy doctors of the late Victorian period asserted. It is hard to think of any body part whose standing fell so far and so rapidly, nor one which came to be treated with such savage hostility; even today in countries with a history of routine circumcision doctors seem to regard the foreskin as guilty until proven innocent. Yet, as the Canadian pathologists Chris Cold and John Taylor point out, the prepuce has been a prominent feature of the external genitals of all primate species for 65 million years, and the species in which it has developed most luxuriantly is precisely the one which has been most successful in the struggle for existence; despite this, since the nineteenth century it has been "the most vilified normal anatomical structure of the human body" (1).
But aside from calling the foreskin nasty names, have the supporters of involuntary circumcision really made much of a case for their favourite surgery? Strictly speaking, it is not the opponents of routine male circumcision who need to make a case against the procedure, but its supporters who must prove its necessity: they need to explain why a natural part of the human body, and one common to all primates, is so dangerous that it must be amputated before a baby can talk, crawl or do anything much except scream. What has naturally evolved must be presumed to be beneficial or harmless unless there is overwhelming evidence to the contrary. Here we will consider what sort of a case the anti-foreskin lobby has been able to put up.
The penis consists of several major parts, but one useful way of looking at it is to divide it into an erectile portion (the part that gets stiff) and a non-erectile portion (the part that does not). The foreskin is the non-erectile portion. A more conventional definition would be to describe it as the soft, sensitive double-fold of tissue which covers the lower half of the penis shaft, extends in a sleeve over the head (glans) and usually ends in a tapering nozzle or spout. The outer layer is tender skin, the inner layer a sensitive mucous membrane. There is no agreed anatomical definition about where the foreskin ends and the skin of the penis shaft begins, and hence no exact surgical definition of what circumcision is meant to remove. As a consequence, the amount of tissue cut off by the operation is highly variable (some doctors take more, some less), but a typical circumcision carried out in a western hospital will remove about 50 per cent of the surface tissue of the penis.
The foreskin is not just a flap of skin, but a complex web of mucous membrane, muscle fibres, blood vessels and nerves: in fact, it supports one of the densest concentrations of nerves in the whole body. The underside of the penis (just beneath the glans) is called the fraenum, and this carries ridged bands which are densely packed with fine-touch nerve receptors and a very rich blood supply. The main nerve supplying the penis goes down to the end and then doubles back, allowing the foreskin to slide backwards and forwards, and showing that this is exactly what it evolved to be able to do. To operate at its best, the penis is meant to be covered with a mobile sheath of responsive flesh.
Circumcision is the surgical amputation of this tissue. By routine male circumcision we mean the removal of the foreskin from the penis of normal male babies or boys, on the decision of adults (usually parents or guardians), without the boy's consent, and in the absence of any genuine medical indication, and particularly in the absence of the sort of critical injury, malformation or disease that would be required for the legal amputation of any other part of the body without the subject's consent. In the past the procedure was referred to as Routine Neonatal Circumcision or Routine Infant Circumcision, abbreviated here as RNC.
Strictly speaking, RNC is no longer practised in Australia, since most doctors are opposed to the practice and only do it in response to parental insistence. Each case today is thus an individual decision, not a matter of mere routine. In the heydey of circumcision in the 1950s, doctors pressured parents to agree to have their baby boys circumcised and would automatically do it unless they strenuously objected; sometimes they did it without even parental consent. The essential elements of routine (medically unnecessary) circumcision as practised today are (1) decision by adults; (2) absence of medical indication or need; (3) lack of consent on the part of the boy.
Circumcision was a Victorian medical fad which should have gone out with neck-to-knee bathing costumes, phrenology and the idea that children should be seen and not heard. Instead, a small band of medical researchers and moral fanatics keep coming up with new reasons for doing it. First there was the claim that it would stop masturbation and the imaginary disease of spermatorrhoea. Then it was suggested that it would protect men from syphilis. Then doctors forgot that all baby boys have a tight and non-retractable foreskin (phimosis) and declared that the natural condition of the infant penis was a pathological abnormality requiring urgent surgical correction. After that it was asserted that circumcision would give immunity to cancer of the penis in men and of the cervix in women. Some doctors seriously believed that circumcision would cure various forms of muscular paralysis, brass poisoning and whooping cough; others claimed it would prevent tuberculosis, polio, epilepsy and wet dreams. Then there was a lot of vague talk about hygiene, as though boys and men were too stupid to wash themselves, and ridiculous references to embarrassment in locker rooms.
At no time did more than a handful of adult men choose to have themselves circumcised; it was always something to done to babies and boys without their agreement or permission.
In the 1990s the myth about syphilis was revived in a new form: that uncircumcised men have a higher risk of catching HIV-AIDS (and that therefore all boys should be circumcised soon after birth). Most recently there has been an attempt to resuscitate the old claim (dating from the 1930s, refuted by studies in the 1960s and 70s) that male circumcision will reduce the incidence of cervical cancer in their female partners. One by one these claims for the harmfulness of the foreskin and the benefits of its amputation have been proven false or misguided, but new reasons keep being invented.
Australia inherited circumcision from Britain in the nineteenth century, and by the early 1900s as many as 25 per cent of male infants were already having part of their penis cut off, either soon after birth or in early childhood. Although Britain itself dropped RNC in the late 1940s (and New Zealand in the 1950s), Australia followed United States practice, and the figure rose steadily to a peak of about 90 per cent in 1955, before falling back again: down to 50 per cent by 1975, and only 10 per cent by 1995.
Circumcision incidence in Australia
|Year||Newborn circumcision rate (%)||Living males who have been circumcised (%)|
It can be seen from the table that the biggest jump in the rate of RNC occurred in the decade 1910-1920, giving Australia the distinction of being the first modern nation to circumcise half its male babies. This was a period of acute fear of venereal disease, particularly syphilis; the erroneous belief that circumcision would provide protection against syphilis was probably an important reason why more parents were having their boys cut at this time. The year 2000 was a landmark as the first time since 1945 when the total number of uncut males in Australia outnumbered the circumcised. Interestingly, though, despite the hight rate of RNC, the total number of cut males has never exceeded 61 per cent - less than two thirds.
The rate of routine circumcision declined steadily in the 1980s and 90s and looked set to fall below 5 per cent nationally, but there has been a slight rise in the frequency of the procedure since 1999, possibly as a response to recent scares over STDs (especially HIV-AIDS), urinary tract infections (UTIs) and most recently HPV (human papillomavirus -- the wart virus implicated in cancer of the penis and cervix). Long-time advocates of RNC have been doing their best to exploit popular fears of these diseases in order to put pressure on the medical profession to revive the procedure as a public health measure, despite powerful criticism of their claims in the medical literature and increasing warnings that the procedure is unethical and potentially illegal (as the Queensland Law Reform Commission warned in 1993).
Although Australia largely abandoned RNC in the 1980s, and did so with very little fuss, the issue has suddenly become topical and controversial. A few die-hard circumcision enthusiasts and medical researchers, mainly from the USA and other cultures where routine male circumcision is the rule, are making strident claims for the protective effect of circumcision against a number of diseases which defy normal control strategies, and particularly the one for which there is still no cure and of which everybody is afraid: AIDS. They attempt to exploit this fear by demanding widespread (indeed, universal) circumcision of male infants as a public health measure, on the feeble and misleading analogy that it is just like immunisation, and thus the sort of harmless and effective medical intervention which should be made compulsory. The main objective of this propaganda is to halt the decline of RNC in the USA and to revive it in Australia, Canada and Britain.
The evidence strongly suggests that the push for mass male circumcision as the answer to AIDS is driven more by culture than by science – or rather, by science in the service of culture. If the genital mucosa is the Trojan horse for HIV and its reduction by various forms of pre-emptive excision decreases a person’s risk of becoming infected, it follows that the genital mucosa of the female (on the clitoral hood and labia, for example) might be as vulnerable as the male foreskin, and thus that certain forms of female circumcision might protect women in the same way as posthectomy is thought to protect men. There is in fact evidence that female circumcision does reduce the risk of HIV infection in women (Stallings and Karugendo 2005), and at least one other study suggests that female circumcision can also indirectly protect women from HIV infection (Yount and Abraham 2007). But so strong is the revulsion from any form of female genital surgery among the Western researchers and agencies that control AIDS policy that it is not considered proper even to ask the question, let alone conduct research into the possibility. Like the obstetricians who shouted Baker Brown down, modern health policy makers prefer female genitals intact, no matter what health advantages might accrue from surgical intervention. If the male genitals were regarded with the same respect as the female, MGC would be held in the same abhorrence as FGC, and experiments involving foreskin removal would be unthinkable.
The sudden resurgence of demands for routine circumcision of boys as a health precaution in some developed countries (notably the United States and Australia) has a similarly cultural explanation. Paradoxically, it can be traced back to developments in the 1980s that sought to improve the legal mechanisms for child protection and reduce all forms of child abuse. These were expressed most dramatically in the United Nations Convention on the Rights of the Child (1989), Article 24 (3) of which required parties to take “all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children. This looked promising, but a startling procedural fact that Svoboda (2004) unearthed shows that it did not take long for “children” to mean “girls only.” As late as 25 June 1997, one document pertaining to the UN’s work on traditional practices referred to the responsible official, known as a special rapporteur, as “Special Rapporteur on traditional practices affecting the health of women and children” (United Nations Commission on Human Rights 1997a). But by the time the pertinent meeting was nearing its conclusion and had issued its report on the session, the special rapporteur’s mandate had been changed to cover “traditional practices affecting the health of women and the girl child” (United Nations Commission on Human Rights 1997b). There had never been any substantive discussion of this highly significant change, which excluded all male children at the stroke of a pen, nor was the change of title ever alluded to in any known UN document.
Other pertinent child protection developments include the rise of a vocal intact rights (anti-circumcision) movement in the only Western country where routine MGC remained common (the United States); a hesitant but visible tendency for secular and reforming Jews to question the necessity for the rite; and, in places where MGC was unusual and abhorred (such as Scandinavia), measures to regulate ritual circumcision as performed by ethnic and religious minorities. Given that the wording of the UN Convention on the Rights of the Child protected all children without discrimination, it is curious but symptomatic of assumptions about gender and sexuality that many governments passed legislation to make all forms of FGC unlawful, but none prohibited any form of MGC. Although some jurisdictions (such as the Australian States of South Australia and Queensland) looked seriously into the question of whether circumcision of boys should also be restricted, no current government has moved far in this direction. Sweden has placed mild restrictions on the practice, and the South Africa’s Children’s Act 2007 makes the circumcision of male children under age 16 unlawful except for religious or medical reasons – which are, of course, the two principal categories of justification for the practice. As Smith (1998) had found, however, the Convention on the Rights of the Child clearly referred to genital mutilation of children, without discrimination on the basis of gender, and there could be no valid or effective response, in terms of human rights or medical ethics, to the argument that circumcision of minor was a violation of accepted principles of human rights and medical ethics.
Since all the arguments deployed against FGC applied just as strongly to MGC (McDonald 2004, Bouclin 2005, Narulla 2007), the persistence of the practice was an anomaly that demanded attention. But the Convention left a loophole in its reference to “practices prejudicial to health”, that is, harmful practices: if MGC could be shown to be not harmful or, even better, beneficial in some way, then Article 24 would not apply to MGC, and those who wanted to continue the practice, whether for traditional or medical reasons, could continue doing so with a clear conscience and little fear of restriction. It was the imperative to save MGC from the human rights experts, lawyers and ethicists that has inspired the resurgence of research and advocacy, not only into the benefits of the procedure (old ones dusted up, new ones found), but a whole new research agenda, defying common sense and the consensus of the ages, aimed at proving that deleting the most densely innervated parts of the penis makes no difference to sexual experience (Morris 1999, 2006). This research flies in the face of reason, common sense and plenty of other research.
To defend a customary practice with the discoveries or rhetoric of science is not a new strategy. Back in Roman times the Jewish philosopher Philo sought to discourage his co-religionists from abandoning male circumcision (as some were doing, in the interests of integration) with several arguments, prominent among which was the claim that it conferred immunity against a kind of carbuncle on the penis that he called anthrax (Darby 2003:57). In mid-nineteenth century Germany, a strong movement among reforming Jews sought to drop male circumcision along with many other oppressive observances; their campaign was defeated by the conservative rabbis, who cited new medical evidence from Britain and the United States that male circumcision was an effective defence against syphilis, masturbation and other problems, and thus an example of modern science, not an ancient superstition at all (Efron 2001:189; Glick 2005: chs. 5 and 6).
But it was in the United States just before World War I that the strategy had its finest flowering. Confronted with evidence that ritual circumcision was infecting babies with serious diseases (including diphtheria, tuberculosis and syphilis), and with a consequent campaign by paediatricians to ban or at least regulate the procedure (Holt 1913), the physician Abraham Wolbarst had the genius to perceive that the surest way to preserve male circumcision as a religious rite within the Jewish community was to generalize it throughout the whole of society as a necessary health precaution. Accordingly, he did not try to justify it on the culturally relativist ground of ethnic particularity, but on the modern, scientific ground that it was a valid measure of preventive health that should be imposed on every male. Far from spreading syphilis, Wolbarst asserted (and produced statistics showing) that male circumcision conferred high resistance, if not immunity, to syphilis, as well as curing or preventing a great many other problems, including herpes, cancer, and masturbation. He understood that a modern society that respected science needed modern arguments in defence of ancient customs (Wolbarst 1914; Darby 2003).
Strictly speaking, it is not the opponents of routine male circumcision who need to make a case against the procedure, but its supporters who must prove its necessity: they need to explain why a natural part of the human body, and one common to all primates, is so dangerous that it must be amputated before a baby can talk, crawl or do anything much except scream. But since the operation has become entrenched in the medical culture of English-speaking countries over the past 120 years, it has come to be seen as reasonable, customary or even normal. As the sorcerer's apprentice found to his cost, starting a practice ("seemed a good idea at the time …") is often much easier than stopping it.
Advocates of RNC particularly have to
demonstrate (1) that the benefits of the operation significantly outweigh the injury inflicted, the risks of the procedure and the physical and psychological disadvantages of losing the foreskin; and (2) that the operation must be done before the child is able to give legal consent;
explain how a part of the body which has evolved over millions of years could be pathogenic (disease-producing) and must be removed to ensure a normal level of health.
No such proof has even been attempted, let alone achieved.
Advocates of RNC have never been able to explain why all primates (monkeys, chimps etc) have foreskins, or how humans became the most successful mammal on the planet while carrying this supposedly pathogenic burden. For 99 per cent of the million or so years during which modern humans have prospered, males have lived and died with their foreskins intact, and in that time our species managed to colonise just about every corner of the earth. Perhaps the foreskin was a factor in that triumph. There is good evidence that the human foreskin became longer, more luxuriant and more richly networked with sensory nerves than those of our near relatives, suggesting that it must have conferred a selective advantage: the more foreskin you had, the more offspring you left behind, and the more your extra-foreskin genes spread through the population. (Ref. 1) This could not have happened if the foreskin had been as troublesome as its enemies claim: what has naturally evolved must be presumed to be beneficial or harmless unless there is overwhelming evidence to the contrary. (Ref. 2)
It is this proof that circumcision advocates are obliged to provide, and which they have been struggling unsuccessfully to manufacture since the 1850s (when Jonathan Hutchinson announced that his statistics showed that circumcised men were all but immune to syphilis). The world is still waiting for them to make a convincing case. Although there have been mountains of reports and studies (more than anybody could read in a lifetime), the issue is still, at the most, inconclusive - so inconclusive, in fact, that the most rational and only ethical policy is to leave the choice up to the individual.
This has not prevented scaremongering professors and self-interested GPs (who make a lot of money from performing circumcision operations) from flooding the media and Google advertising with claims for the "pros" of circumcision. (Dr Russell's website also claims to discuss the cons, but you will look in vain for a list of those.) But the worst that even these crusaders can come up is a murky statement that that RNC "may reduce the risk of STDs (syphilis, gonorrhoea, herpes and candida) and carcinoma of the cervix in female partners", as well as phimosis, paraphimosis, HIV-AIDS, neonatal UTIs and carcinoma of the penis. (Ref. 3) This is not good enough: "may" is not much different from "may not".
Australia's other prominent circumcision promoter, Professor Brian Morris, cites several studies which purport to show a higher incidence of gonorrhoea and syphilis among uncut males and reaches the dithering conclusions that (1) "based on the bulk of evidence it would seem that at least some STDs could be more common in uncircumcised males under some circumstances"; but that (2) "there may be little difference in most STDs between those with and those without a foreskin". (Ref. 4) That's really helpful.
Can these guys be serious? They want to circumcise all boys at birth because retention of the foreskin "may" increase the risk of their getting a few diseases they most likely would not get anyway; most of which are curable; and which, even if they did get them, do not strike until many years later. Except for infantile UTIs (which are usually cured easily by antibiotics), there is plenty of time for a boy to reach maturity and make his own assessment of the risks and choose the best means, for him, of managing them. To make a convincing case for RNC Russell, Morris and Co must do much better than they have done so far: we need proof that that if the foreskin is not cut off urgently the child will get seriously ill or die before he is old enough to make his own health decisions. Nothing like this has ever been achieved by the circumcision lobby, or even seriously attempted. Statistics are not available, but it is quite likely that more boys under the age of eighteen die as a result of circumcision, or its complications, than from any of the diseases circumcision is supposed to protect them against. Certainly this is true in South Africa, where several hundred boys each year die as a result of tribal circumcision.
As to why boys must be circumcised in infancy, Morris is quite explicit: if the decision was left to them to make when they reached the age of consent they would make the wrong decision. (Ref. 5)
Both Dr Russell and Professor Morris are frequently seen in the media urging parents to have their boys circumcised, and much of their routine is just a long list of nasty diseases, designed to terrify people into seeking urgent medical aid. How different it is from the rantings of a Victorian quack is a matter of personal judgement. In 1891 Dr Peter Charles Remondino wrote:
The prepuce seems to exercise a malign influence in the most distant and apparently unconnected manner; where, like some of the evil genii or sprites in the Arabian tales, it can reach from afar the object of its malignity, striking him down unawares in the most unaccountable manner; making him a victim to all manner of ills, sufferings and tribulations; unfitting him for marriage or the cares of business; making him miserable and an object of continual scolding and punishment in childhood, through its worriments and nocturnal enuresis; later on, beginning to affect him with all kinds of physical distortions and ailments, nocturnal pollutions, and other conditions calculated to weaken him physically, mentally, and morally; to land him, perchance, in jail or even in a lunatic asylum." (Ref. 6)
Presumably Professor Morris, who has repeatedly stated that the Victorians were "right" about circumcsion, also agrees with the following statement from Dr Remondino:
"Circumcision is like a substantial and well-secured life annuity; every year of life you draw the benefit, and it has not any drawbacks … Parents cannot make a better paying investment for their little boys, as it insures them better health, greater capacity for labor, longer life less nervousness, sickness, loss of time, and less doctor-bills, as well as increases their chances for an euthanasian death." (Ref. 7)
Drs Russell and Morris are radicals and extremists: most Australian doctors are opposed to RNC or undecided on the issue, and the Royal Australasian College of Physicians has recently issued yet another statement against the practice. The truth is that RNC has never been supported by more than a small fraction of the world's medical establishment and remains a controversial and unproven therapy. Back in the 1890s an early opponent of RNC noted this confusion and uncertainty, not only over the risks and touted benefits of the operation but when and how to do it, how much tissue to excise, how to stop bleeding etc, and asked: "Where doctors differ, who shall decide?" (Ref. 8)
There can be only one answer to that question: the owner of the organ in question.
1. J.R.Taylor, A.P. Lockwood and A.J.Taylor, "The prepuce: specialized mucosa of the penis and its loss to circumcision", British Journal of Urology, Vol. 77,1996, pp. 291-295; C.J. Cold and J.R. Taylor, "The prepuce", BJU International, Vol. 83, Supplement 1 (January) 1999, pp. 34-44; C.J. Cold and K.A. McGrath, "Anatomy and histology of the penile and clitoral prepuce in primates: Evolutionary perspective of specialised sensory tissue in the external genitalia", in George C. Denniston, Frederick Hodges and Marilyn Milos (eds), Male and female circumcision: Medical, legal and ethical considerations in pediatric practice (New York and London, Kluwer Academic/Plenum Publishers, 1999), pp. 19-30
2. The argument holds even if you believe in the creationist account of human origins. If God created men with a foreskin it must be presumed that He intended them to have one.
3. Terry Russell, "Debate: Male circumcision remains a valid procedure - Yes", Australian Doctor, 24 May 1996, p. 54
4. Brian Morris, In favour of circumcision (Sydney 1999), pp. 38 and 39. See the scathing review by Basil Donovan in Venereology, Vol. 12 (1999), pp. 68-9. Professor Donovan describes Morris as "a man on a mission to rid the world of the male foreskin" and some of his claims as "so dangerous" that the publishers ought to withdraw the book.
5. Morris, In favour of circumcision, p. 61-2. Morris writes: "It would take a very mature and well-informed adolescent male to make this decision for himself, and to undertake the process of ensuring that it was done. Most males in the late teens and early twenties, not to mention many men of any age, are reluctant to confront such issues, even if they hold private convictions and preferences about their penis. Moreover, despite having problems with this part of their anatomy, many will suffer in silence rather than seek medical advice or treatment." Or in plain English, men prefer to hang on to their foreskins because they like them.
Incidentally, contrary to Morris's assertion, there is not a shred of scientific evidence that circumcision must be done in infancy for maximum benefits against later disease. If that were true there would have been no point circumcising those adult men in the African circumcision-HIV experiments. It is equally untrue that circumcision is less risky and less harmful the earlier it is done; on the contrary, there is plenty of evidence that the earlier it is done the more risky and harmful it is. All responsible medical authorities recommend that it not be done at less than 6 months of age, and researchers in Saudi Arabia (where circumcision is common as an Islamic custom) have actually found circumcision to be significantly more dangerous if done soon after birth.
6. P.C. Remondino, History of circumcision from the earliest times to the present: Moral and physical reasons for its performance (Philadelphia and London 1891), pp. 54-5
7. Remondino, p. 186
8. Herbert Snow, The barbarity of circumcision as a remedy for congenital phimosis (London 1890), p. 32 Full text of Snow's book available here.
Bouclin, Suzanne (2005) An Examination of Legal and Ethical Issues Surrounding Male Circumcision: The Canadian Context. International Journal of Men’s Health 4 (3): 205-222
Darby, Robert (2003) Where doctors differ: The Debate on Circumcision as a Protection Against Syphilis, 1855-1914. Social History of Medicine 16:57-78
Efron, John (2001) Medicine and the German Jews. New Haven: Yale University Press
Glick, Leonard (2005) Marked in Your Flesh: Circumcision from Ancient Judea to Modern America. New York: Oxford University Press.
Holt, L. Emmett (1913) Tuberculosis Acquired through Ritual Circumcision. Journal of the American Medical Association 61(2):99-102
McDonald, Elisabeth (2004) Circumcision and the Criminal Law: The Challenge for a Multicultural State. New Zealand Universities Law Review 21: 233-267
Narulla, Ranipal (2007) Circumscribing Circumcision: Traversing the Moral and Legal Ground Around a Hidden Human Rights Violation. Australian Journal of Human Rights 12: 89-118
Smith, Jacqueline (1998) Male Circumcision and the Rights of the Child. In Mielle Bulterman, Aart Hendriks and Jacqueline Smith (eds.). To Baehr in Our Minds: Essays in Human Rights from the Heart of the Netherlands. Utrecht: Netherlands Institute of Human Rights (SIM Special No. 21): 465-498.
Stallings, R. Y., and E. Karugendo (2005) Female Circumcision and HIV Infection in Tanzania: For Better or for Worse?. Abstract of paper given at Third International AIDS Society
Svoboda, J. Steven (2004) Educating the United Nations about Male Circumcision. in Flesh and Blood: Perspectives on the Problem of Circumcision in Contemporary Society. G. C. Denniston, M. F. Milos, and F. M. Hodges, eds. New York: Kluwer Academic/Plenum Publishers.
United Nations Commission on Human Rights, Sub-Commission on Prevention of Discrimination and Protection of Minorities
(1997a) Forty-ninth session, provisional agenda item 5(a). The implementation of the human rights of women—traditional practices affecting the health of women and children--Follow-up report of the Special Rapporteur on traditional practices affecting the health of women and children, Mrs. Halima Embarek Warzazi. UN Doc. No. E/CN.4/Sub.2/1997/10 (25 June 1997).
(1997b) Forty-ninth session. Report of the Sub-Commission on Prevention of Discrimination and Protection of Minorities on its forty-ninth session. UN Doc. No. E/CN.4/1998/2, E/CN.4/Sub.2/1997/50 (29 August 1997).
Wolbarst, Abraham (1914) Universal Circumcision as a Sanitary Measure. Journal of the American Medical Association 62:92-97
Yount, Kathryn M. and Abraham, B.K. (2007) Female Genital Cutting and HIV/AIDS Among Kenyan Women. Studies in Family Planning 38(2): 73-88.
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