Circumcision - AskIslamPedia - Online Islamic Encyclopedia Circumcision - AskIslamPedia - Online Islamic Encyclopedia Navigation [+] [-] | Add AskIslampedia Search to your site CIRCUMCISION Circumcision or posthetomy, is the operative removal of all or part of the prepuce of the penis. By extension to the female the term is also used for clitoridectomy. [1] Medical definition Surgery that removes the foreskin (the loose tissue) covering the glans of the penis. Circumcision may be performed for religious, cultural reasons or health reasons. Newborn circumcision diminishes the risk for cancer of the penis and lowers the risk for cancer of the cervix in sexual partners. It also decreases the risk of urinary tract infections and lowers the risk of sexually transmitted diseases, especially HIV. The Latin "circum-" means around (or about). Circumcision is, literally, a cutting around. Circumcision dates back to prehistoric times. It is one of the oldest surgical operations known to have been performed by ancient people. [2] Islamic circumcision is defined as cutting the foreskin covering the male organ only.

[3] Qur’an “Ibraaheem was circumcised when he was eighty years old,” and Allah سبحانه و تعالى says (interpretation of the meaning): “… it is the religion of your father Ibraaheem…” Qur’an.Surah Al-Hajj 22:78 Hadith The Prophet Muhammad ﷺ said: “Five things are part of the fitrah: circumcision, removing the pubic hair, trimming the moustache, cutting the nails, and plucking the armpit hair.” Sahih Al-Bukhari 5891, Sahih Muslim 257. Circumcision is a Sunnah (action following the example of the Prophet ﷺ ) for men, and an honoring act for women. Musnad Ahmad Vol 5 pg 75 [4] [5] The Health and Religious benefits of Circumcision The Muslim obeys the command of Allah سبحانه و تعالى .

This is the meaning of Islam, which is submission to Allah سبحانه و تعالىand obedience to His command, whether the wisdom behind it is clear to him or not, because the One Who is issuing the command – Allah سبحانه و تعالى, may He be exalted – is the Creator, the All-Knowing, the All-Aware, who created mankind and knows what is good for them and what is not good for them. Circumcision is one of the rulings of sharee’ah which the Muslim carries out willingly, in submission to and out of love for Allah سبحانه و تعالى, and seeking reward with Him. He is certain that Allah سبحانه و تعالىdoes not command anything unless there is a wisdom behind it and it is good for His slaves, whether people know that or not. Since your question referred to the health benefits of circumcision, we will, after looking at the shar’i (religious) benefits, will answer your question about the health benefits, in order to increase the believers in faith in the ruling, and so that non-Muslims may see one aspect of the greatness of this sharee’ah (Islamic law) which came to bring benefits and ward off harm. Dr.

Muhammad ‘Ali al-Baar (a member of the Royal College of Surgeons in the UK and a consultant to the Islamic Medicine department of the King Fahd Centre for Medical Research in the King Abdul Aziz University in Jeddah) says in his book al-Khitaan (Circumcision): “Circumcision of newborn boys (i.e., within the first month of life) brings numerous health benefits, including: 1 – Protection against local infection in the penis, which may result from the presence of the foreskin, causing tightening of the foreskin, which may lead to retention of urine or infections of the glans (tip) of the penis – which require circumcision in order to treat these problems. In chronic cases, the child may be exposed to numerous diseases in the future, the most serious of which is cancer of the penis. 2 – Infections of the urethra. Many studies have proven that uncircumcised boys are more exposed to infection of the urethra. In some studies the rate was 39 times more among uncircumcised boys. In other studies the rate was ten times more.

Other studies showed that 95% of children who suffered from infections of the urethra were uncircumcised, whereas the rate among circumcised children did not exceed 5%. In children, infection of the urethra is serious in some cases. In the study by Wisewell on 88 children who suffered infections of the urethra, in 36 % of them, the same bacteria was found in the blood also. Three of them contracted meningitis, and two suffered renal failure. Two others died as a result of the spread of the micro-organisms throughout the body. 3 – Protection against cancer of the penis: the studies agree that cancer of the penis is almost non-existent among circumcised men, whereas the rate among uncircumcised men is not insignificant. In the US the rate of penile cancer among circumcised men is zero, whilst among uncircumcised men it is 2.2 in every 100,000 of the uncircumcised population. As most of the inhabitants of the US are circumcised, the cases of this cancer there are between 750 and 1000 per year.

If the population were not circumcised, the number of cases would reach 3000. In countries where boys are not circumcised, such as China, Uganda and Puerto Rico, penile cancer represents between 12-22 % of all cancers found in men; this is a very high percentage. 4 – Sexually transmitted diseases (STDs). Researchers found that the STDs which are transmitted via sexual contact (usually because of fornication/adultery and homosexuality) spread more among those who are not circumcised, especially herpes, soft chancres, syphilis, candida, gonorrhea and genital warts. There are numerous modern studies which confirm that circumcision reduces the possibility of contracting AIDS when compared to their uncircumcised counterparts. But that does not rule out the possibility of a circumcised man contracting AIDS as the result of sexual contact with a person who has AIDS. Circumcision is not a protection against it, and there is no real way of protecting oneself against the many sexually transmitted diseases apart from avoiding fornication/adultery, promiscuity, homosexuality and other repugnant practices.

(From this we can see the wisdom of Islamic sharee’ah in forbidding fornication/adultery and homosexuality). 5 – Protection of wives against cervical cancer. Researchers have noted that the wives of circumcised men have less risk of getting cervical cancer than the wives of uncircumcised men. From al-Khitaan, p. 76, by Dr. Muhammad al-Baar. Professor Wisewell, published in the American Family Doctor Magazine, issue no. 41, 1991 CE. [6] [7] Circumcision Benefits The American Academy of Pediatrics (AAP) says the benefits of circumcision outweigh the risks. Circumcision might have various health benefits, including: Easier hygiene. Circumcision makes it simpler to wash the penis. Washing beneath the foreskin of an uncircumcised penis is generally easy, however. Decreased risk of urinary tract infections. The overall risk of urinary tract infections in males is low, but these infections are more common in uncircumcised males. Severe infections early in life can lead to kidney problems later on. Decreased risk of sexually transmitted infections.

Circumcised men might have a lower risk of certain sexually transmitted infections, including HIV. Still, safe sexual practices remain essential. Prevention of penile problems. Occasionally, the foreskin on an uncircumcised penis can be difficult or impossible to retract (phimosis). This can lead to inflammation of the foreskin or head of the penis. Decreased risk of penile cancer. Although cancer of the penis is rare, it's less common in circumcised men. In addition, cervical cancer is less common in the female sexual partners of circumcised men. Better sexual function on average. [8] [9] Posthectomy | definition of Posthectomy by Medical dictionary Posthectomy | definition of Posthectomy by Medical dictionary The surgical removal of the foreskin of the penis or prepuce. Purpose In the United States, circumcision in infant boys is performed for social, medical, or cultural/religious reasons.

Once a routine operation urged by pediatricians and obstetricians for newborns in the middle of the twentieth century, circumcision has become an elective option that parents make for their sons on an A typical circumcision procedure involves the following steps: Figure A: The surgeon makes an incision around the foreskin. Figure B: The foreskin is then freed from the skin covering the penile shaft. Figure C: The surgeon cuts the foreskin to the initial incision, lifting the foreskin from the mucous membrane. Figure D: The surgeon sutures the top edge of the skin that covers the penile shaft and the mucous membrane. (Illustration by Electronic Illustrators Group.) individual basis. Families who practice Judaism or Islam may select to have their sons circumcised as a religious practice. Others choose circumcision for medical benefits. Female circumcision (also known as female genital mutilation ) is usually performed for cultural and social reasons by family members and others who are not members of the medical profession, with no anesthesia. Not only is the prepuce removed but often the vaginal opening is sewn to make it smaller. This practice is supposed to ensure the virginity of a bride on her wedding day.

It also prevents the woman from achieving sexual pleasure during coitus. This practice is not universally approved by the medical profession and is considered by some as a human rights violation. Though the incidence of male circumcision has decreased from 90% in 1979 to 60% in 1996, it is still the most common surgical operation in the United States. Circumcision rates are much lower for the rest of the industrialized world. In Britain, it is only done for religious practices or to correct a specific medical condition of the penis. Some of the medical reasons parents choose circumcision are to protect against infections of the urinary tract and the foreskin, prevent cancer , lower the risk of getting sexually transmitted diseases , and prevent phimosis (a tightening of the foreskin that may close the opening of the penis). Though studies indicate that uncircumcised boys under the age of five are 20 times more likely than circumcised boys to have urinary tract infections (UTIs), the rate of incidence of UTIs is quite low. There are also indications that circumcised men are less likely to suffer from penile cancer , inflammation of the penis, or have many sexually transmitted diseases.

Here again, the rate of incidence is low. Good hygiene usually prevents most infections of the penis. Phimosis and penile cancer are very rare, even in men who have not been circumcised. Education and good safe sex practices can prevent sexually transmitted diseases in ways that a surgical procedure cannot because these are diseases acquired through risky behaviors. With these factors in mind, the American Academy of Pediatrics has issued a policy statement that states though there is existing scientific evidence that indicates the medical benefits of circumcision, the benefits are not strong enough to recommended circumcision as a routine practice. Precautions Circumcision should not be performed on infants with certain deformities of the penis that may require a portion of the foreskin for repair. The most common A. uncircumcised penis. B. circumcised penis. (Illustration by Argosy Inc.) condition for surgery using the foreskin is hypospadias, a congenital deformity of the penis where the urinary tract opening is not at the tip of the glans. Also, infants with a large hydrocoele or hernia may suffer important complications through circumcision.

Premature infants and infants with serious infections are also poor candidates to be circumcised, as are infants with hemophilia , other bleeding disorders, or whose mothers had taken anticoagulant drugs. In older boys or men, circumcision is a minor procedure. Therefore, it can be performed in virtually anyone without a serious illness or unusual deformity. Description The foreskin of the penis protects the sensitivity of the glans and shields it from irritation by urine, feces, and foreign materials. It also protects the urinary opening against infection and incidental injury. In circumcision of infants, the foreskin is pulled tightly into a specially designed clamp, and the foreskin pulls away from the broadened tip of the penis. Pressure from the clamp stops bleeding from blood vessels that supplied the foreskin. In older boys or adults, an incision is made around the base of the foreskin, the foreskin is pulled back, and then it is cut away from the tip of the penis. Stitches are usually used to close the skin edges. Preparation Despite a long-standing belief that infants do not experience serious pain from circumcision, most authorities now believe that some form of local anesthesia is necessary.

The physician injects local anesthesia at the base of the penis or under the skin around the penis (subcutaneous ring block). Both anesthetics block key nerves. EMLA cream, a topical formula of several anesthetics can also be used. Aftercare After circumcision, the wound should be washed daily. An antibiotic ointment or petroleum jelly may be applied to the site. If there is an incision, a wound dressing will be present and should be changed each time the diaper is changed. Sometimes a plastic ring is used instead of a bandage. The ring will usually fall off in five to eight days. The penis will heal in seven to 10 days. Infants who undergo circumcision may be fussy for some hours afterward, so parents should be prepared for crying, feeding problems, and sleep problems. Generally these go away within a day. In older boys, the penis may be painful, but this will go away gradually. A topical anesthetic ointment or spray may be used to relieve this temporary discomfort. There may also be a "bruise" on the penis, which typically goes away with no particular attention. Risks Complications following newborn circumcision appear in one out of every 500 procedures.

Most complications are minor. Bleeding occurs in half of the complications and is usually easy to control. Infections are rare and present with fever and signs of inflammation. Key terms Foreskin — A covering fold of skin over the tip of the penis. Glans — The cone-shaped tip of the penis. Hernia — Bulging of abdominal structures through an abnormal opening in the muscular wall. Hydrocele — Collection of fluid in the scrotum. Hypospadias — A congenital deformity of the penis where the urinary tract opening is not at the tip of the glans. Phimosis — A tightening of the foreskin that may close the opening of the penis. Prepuce — A fold like the foreskin that covers the clitoris; another name for foreskin. There may be injuries to the penis itself, and these may be difficult to repair. In 2000, there were reports that the surgical clamps used in circumcision were at fault in over 100 injuries reported between July 1996 and January 2000. In nearly all cases, the clamps were assumed to be in working order but had been repaired with replacement parts that were not of the manufacturer's specifications.

Physicians were urged to inspect the clamps before use and ensure that their dimensions fit their infant patients. Resources Gollaher, David L. Circumcision: A History of the World's Most Controversial Surgery. Basic Books, 2000. Periodicals Imperio, Winnie Anne. "Circumcision Appears Safe, But Not Hugely Beneficial." OB GYN News 35, no. 7 (April 1, 2000): 9. Schmitt, B. D. "The Circumcision Decision: Pros and Cons." Clinical Reference Systems 2000: 1579. Other What is the meaning of circumcision, what is the slang definition of circumcision, circumcision is slang for circumcision means: Removal of the foreskin of the penis. What is the slang meaning/definition of circumcision ? circumcision means: Removal of the foreskin of the penis. Slang definition of circumcision circumcision means: Removal of the foreskin of the penis. More meanings / definitions of circumcision or words, sentences containing circumcision?

Posthetomy (n.): Circumcision.: Example: Circumciser (n.): One who performs circumcision.: Example: Uncircumcision (n.): The absence or want of circumcision.: Example: Circumcision (n.): The Jews, as a circumcised people.: Example: Circumcision (n.): The act of cutting off the prepuce or foreskin of males, or the internal labia of females.: Example: Circumcision (n.): Rejection of the sins of the flesh; spiritual purification, and acceptance of the Christian faith.: Example: Like to add another meaning or definition of circumcision? Words, slangs, sentences and phrases similar to circumcision Meaning of circumcision circumcision means: Removal of the foreskin of the penis.

Meaning of Posthetomy Circumcision - definition, etymology and usage, examples and related words Circumcision WordNet 3.6 n circumcision the act of circumcising; surgical removal of the foreskin of males n circumcision the act of circumcising performed on males eight days after birth as a Jewish and Muslim religious rite n Circumcision (Roman Catholic Church and Anglican Church) feast day celebrating the circumcision of Jesus; celebrated on January 1st *** Webster's Revised Unabridged Dictionary Circumcision (Script) Rejection of the sins of the flesh; spiritual purification, and acceptance of the Christian faith. Circumcision The act of cutting off the prepuce or foreskin of males, or the internal labia of females. Circumcision (Script) The Jews, as a circumcised people. *** Century Dictionary and Cyclopedia n circumcision The act of circumcising, or cutting off the foreskin or prepuce of males, or the performance of an analogous operation on females, as a religious rite, or in accordance with a custom founded on belief in the prophylactic value of the operation.

The circumcision of males is recorded in the Old Testament as divinely enjoined on Abraham and his descendants, and is required by the Mosaic law. It is still practised among the Jews, the Christians of Abyssinia, the Mohammedans, and a number of semi-barbarous tribes. n circumcision As metaphorically used in Scripture, spiritual purification. n circumcision Eccles., in the Roman Catholic, Greek, and Anglican churches, a festival observed on the octave of Christmas day (that is, the first day of January), in honor of the circumcision of Christ. n circumcision Those spiritually purified and elevated. *** Circumcision the act of circumcising *** L. circumcidĕre, circumcisum—cædĕre, to cut. Usage In some countries, females are also circumcised by removal of the nymphae. "Plain Facts for Old and Young" by John Harvey Kellogg Next morning the circumcised lads were bathed in the sea and painted red instead of white.

"The Belief in Immortality and the Worship of the Dead, Volume I (of 3)" by Sir James George Frazer So that he was not circumcised as a Jew, but, as the Bible says, to have a seal of the righteousness which he had by faith. "Bertha and Her Baptism" by Nehemiah Adams M. SALOMON GOLDSCHMIDT, Circumcision. "The Venetian Painters of the Renaissance" by Bernhard Berenson If anye be called vncircumcised / let hym not be circumcised. "A Treatise of the Cohabitation Of the Faithful with the Unfaithful" by Peter Martyr Circumcise, then, my lips, within and without, from all rashness and all untruthfulness. "On Prayer and The Contemplative Life" by St. Thomas Aquinas THE NEW-YEAR'S GIFT: OR, CIRCUMCISION'S SONG. "The Hesperides & Noble Numbers: Vol. 1 and 2" by Robert Herrick Circumcision was a binding condition; and its practise therefore became a national characteristic.

"Jesus the Christ" by James Edward Talmage The Circumcision, differently composed. "Rembrandt and His Works" by John Burnet The Arabs practiced circumcision long before the advent of Mohammed, who was himself circumcised. "History of Circumcision from the Earliest Times to the Present" by Peter Charles Remondino Lopez de Gomara says, that some of them, and not all, are circumcised. "Diary in America, Series Two" by Frederick Marryat (AKA Captain Marryat) After escaping this danger, Captain Cook looked in vain for the long-sought Cape Circumcision. "Notable Voyagers" by W.H.G. Kingston and Henry Frith Like the Israelites, they practised circumcision. "Myths & Legends of our New Possessions & Protectorate" by Charles M. Skinner In quite a considerable percentage of all males, circumcision is an absolute necessity. "The Eugenic Marriage, Vol 2 (of 4)" by W. Grant Hague Even the Young Turks did not insist on all Macedonians being circumcised. "Eugenics and Other Evils" by G. K.

Chesterton It was the promises of that covenant, of which circumcision was a sign, that Christ came to confirm. "The Ordinance of Covenanting" by John Cunningham Some of the Bantu tribes practise circumcision, the Nilotic tribes do not. "Encyclopaedia Britannica, 11th Edition, Volume 15, Slice 6" by Various So in the end they circumcised him and made him Turk. "Fifty-two Stories of the British Navy, from Damme to Trafalgar." by Alfred H. Miles Circumcision, already familiar from Exod. "Encyclopaedia Britannica, 11th Edition, Volume 15, Slice 5" by Various These Moors do circumcise their children, and give them their names, as we do when we baptize. "The Strange Adventures of Andrew Battell" by Andrew Battell *** Posthectomy - definition of Posthectomy by The Free Dictionary Posthectomy - definition of Posthectomy by The Free Dictionary 1. The act of circumcising. 2. A religious ceremony in which a boy or man is circumcised. 3.

Circumcision Christianity A feast observed on January 1 celebrating the circumcision of Jesus. Used with the. circumcision a. surgical removal of the foreskin of males b. surgical incision into the skin covering the clitoris in females c. removal of the clitoris 2. (Judaism) the act of circumcision, performed as a religious rite by Jews and Muslims 3. (Islam) the act of circumcision, performed as a religious rite by Jews and Muslims 4. (Roman Catholic Church) RC Church the festival celebrated on Jan 1 in commemoration of the circumcision of Jesus cir•cum•ci•sion 2. (cap.) a church festival in honor of the circumcision of Jesus, observed on Jan. 1. [1125–75; Middle English < Late Latin] circumcision Surgery to remove the penis foreskin, often for religious reasons. ThesaurusAntonymsRelated WordsSynonymsLegend: Noun 1.

Circumcision - (Roman Catholic Church and Anglican Church) feast day celebrating the circumcision of Jesus; celebrated on January 1st Church of Rome , Roman Catholic Church , Roman Church , Western Church , Roman Catholic - the Christian Church based in the Vatican and presided over by a pope and an episcopal hierarchy Anglican Church , Anglican Communion , Church of England - the national church of England (and all other churches in other countries that share its beliefs); has its see in Canterbury and the sovereign as its temporal head feast day , fete day - a day designated for feasting 2. circumcision - the act of circumcising performed on males eight days after birth as a Jewish and Muslim religious rite religious rite , rite - an established ceremony prescribed by a religion; "the rite of baptism" Berit , Berith , Bris , Briss , Brith - the Jewish rite of circumcision performed on a male child on the eighth day of his life 3.

cutting off , abscission - the act of cutting something off Translations [ˌsɜːrkəmˈsɪʒən] n [boy, man] → circoncision f; [girl] → excision f circumcision n → Beschneidung f; the Circumcision (Eccl) → der Tag der Beschneidung des Herrn circumcision circumcise (ˈsəːkəmsaiz) verb 1. to remove the foreskin (of a man).

besny يُطَهِّرُ الصَّبي، يَنْزَعُ القُلْفَـه обрязвам circuncidar obřezat beschneiden omskære κάνω περιτομή circuncidar ümber lõikama ختنه کردن ympärileikata circoncire לַמוֹל खतना करना obrezati körülmetél menyunat (laki-laki) umskera circoncidere 割礼を施す (남자의) 표피를 자르다 apipjaustyti apgraizīt mengkhatankan besnijden omskjære obrzezać سنت كول، ختنه كول circuncizar a circumcide совершать обрезание obrezať obrezati obrezati omskära ขลิบหนังหุ้มปลายองคชาติ sünnet etmek 割除(男人的)包皮 здійснити обрізання بچ

ے (مرد) کا ختنہ کرنا cắt đầu bao quy đầu 割除...的包皮 2.

to remove a part of the clitoris (of a woman).

reiniging يَخْتِنُ الفَتاه обрязвам circuncidar obřezat beschneiden omskære κάνω κλειτοριδεκτομή realizar una ablación de clítoris ümber lõikama برداشتن بخشی از کلیتوریس ympärileikata circoncire לַמוֹל खतना करना, मुसलमानी करना obrezati körülmetél menyunat (perempuan) infibulare 女子の）陰核を切除する (여자의) 음핵 표피를 자르다 apipjaustyti veikt klitora operāciju menyunatkan vrouwenbesnijdenis omskjære obrzezać د یوه زره کلیتوس اوچتول совершать круговое сечение urobiť obriezku klitorisu obrezati klitoris obrezati omskära ขลิบคลิทอริส kad

ının bızırını kesmek 割陰唇 здійснити обрізання عورت کا ختنہ کرنا cắt âm vật 割阴唇 ˌcircumˈcision (-ˈsiʒən) noun besnydenis تَطْهير، خِتان обрязване circuncisão obřízka, obřezání die Beschneidung omskærelse περιτομή circunsición ümberlõikus ختنه ympärileikkaus circoncision מילה खतना obrezivanje körülmetélés sunat umskurður circoncisione 割礼 (음핵의) 표피 절단, 할례 apipjaustymas apgraizīšana pengkhatanan besnijdenis omskjæring obrzezanie سنت circuncisão circumcizie обрезание obriezka obrezovanje obrezivanje omskärelse การขลิบ sünnet 割禮，環割術

 обрізання ختنہ sự cắt bao quy đầu; cắt âm vật 割礼，包皮环割术 cir·cum·ci·sion Langerhans cells in the foreskin and HIV transmission: contrary findings, one conclusion Langerhans cells, along with other classes of dendritic cells, are universally found in all skin,.

There is minimal variation between parts of the body in their content of Langerhans cells. They are found in all genital tissue including the glans, foreskin, shaft, scrotum, clitoris, clitoral hood, labia, and vagina. While Szabo and Short argue that the foreskin has MORE Langerhans cells than ordinary skin, Gerald Weiss argues that it has FEWER Langerhans cells. Predictibly, both conclude from this contradictory data that circumcision will protect men against HIV and AIDS. How does male circumcision protect against HIV infection? Robert Szabo Roger V Short , professor b. a Faculty of Medicine, Monash University, Wellington Road, Melbourne 3168, Australia, b Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, 132 Grattan Street, Melbourne 3053, Australia Correspondence to: R V Short ... Summary points ...

The inner surface of the foreskin contains Langerhans' cells with HIV receptors; these cells are likely to be the primary point of viral entry into the penis of an uncircumcised man Male circumcision should be seriously considered as an additional means of preventing HIV in all countries with a high prevalence of infection Methods To compile the information for this review a Medline search was done using the terms circumcision, HIV, Langerhans' cells, penis, foreskin, and prepuce, and extensive email correspondence with other researchers was also undertaken. Histological observations were carried out on samples of penile tissue obtained from 13 perfusion fixed cadavers of men aged 60-96 years, seven of whom had been circumcised. The pathogenesis of sexually acquired HIV infection Between 75% and 85% of cases of HIV infection worldwide have probably occurred during sexual activity. 7 Most cases of primary HIV infection are thought to involve HIV binding initially to the CD4 and CCR5 receptors found on antigen presenting cells - which include macrophages, Langerhans' cells, and dendritic cells - in the genital and rectal mucosa.

...The most widely accepted model for the sexual transmission of HIV is based on infection of the genital tract of rhesus macaques with simian immunodeficiency virus. 8 9 After female macaques are inoculated intravaginally with simian immunodeficiency virus, the virus targets the Langerhans' cells located in the vaginal mucosa. Once infected, these cells fuse with adjacent CD4 lymphocytes and migrate to deeper tissues. Within two days of infection, the virus can be detected in the internal iliac lymph nodes and shortly thereafter in systemic lymph nodes. This ultimately leads to a fatal infection. Similarly, infection in male macaques occurs when simian immunodeficiency virus is inoculated into the penile urethra or onto the foreskin; the same sequence of cellular events involving the infection of Langerhans' cells is then likely to occur. 9 Infected Langerhans' cells have also been detected in the penile mucosa of male rhesus macaques that have chronic simian immunodeficiency virus infection. 9 In humans, histological studies have identified antigen presenting cells in the mucosa of the inner foreskin and urethra.

10 Therefore it seems likely that antigen presenting cells at these mucosal sites are the primary target for HIV in men. ...[Detail of infection mechanism omitted] How HIV enters the penis ... ... A keratinised, stratified squamous epithelium covers the penile shaft and outer surface of the foreskin. This provides a protective barrier against HIV infection. In contrast, the inner mucosal surface of the foreskin is not keratinised 15 and is rich in Langerhans' cells, 10 making it particularly susceptible to the virus. This is particularly important because during heterosexual intercourse the foreskin is pulled back down the shaft of the penis, and the whole inner surface of the foreskin is exposed to vaginal secretions, providing a large area where HIV transmission could take place. ... Conclusions Of the estimated 50 million people infected with HIV worldwide, about half are men, most of whom have become infected through their penises. The inner surface of the foreskin, which is rich in HIV receptors, and the frenulum, a common site for trauma and other sexually transmitted infections, must be regarded as the most probable sites for viral entry in primary HIV infection in men.

Although condoms must remain the first choice for preventing the sexual transmission of HIV, they are often not used consistently or correctly, they may break during use, and there may be strong cultural and aesthetic objections to using them. Cultural and religious attitudes towards male circumcision are even more deeply held, but in the light of the evidence presented here circumcising males seems highly desirable, especially in countries with a high prevalence of HIV infection. Although neonatal circumcision is easy to perform, and has a low incidence of complications, 16 it would be 15-20 years before a programme of circumcision had any effect on HIV transmission rates. Circumcision at puberty, as practised by many Muslim communities, would be the most immediately effective intervention for reducing HIV transmission since it would be done before young men are likely to become sexually active. It may also be time to re-think the definition of "safe sex." ... ... Acknowledgments We thank Professor John Mills for helpful comments on an early draft of the manuscript and Professor Daine Alcorn and the staff of the Department of Anatomy, University of Melbourne, for supplying and processing the specimens from human cadavers.

Contributors: RS reviewed all the relevant literature, carried out the histological examination of the specimens, and wrote the first draft of the manuscript. RVS initiated the study and participated in redrafting of the paper. Both authors will act as guarantors. Morris B. In favour of circumcision. Sydney: University of New South Wales Press, 1999. [Damned by the critics. The level of Morris's scholarship may be seen on this site.] (Accepted 11 May 2000) Israel Journal of Medical Sciences, Vol 29 No 1, January 1993 The Distribution and Density of Langerhans Cells in the Human Prepuce: Site of a Diminished Immune Response? by Gerald N. Weiss, Melinda Sanders and Kent. C. Westbrook The possible role of the human prepuce in sexually transmitted disease and neoplasia led us to evaluate one component of the body's epithelial immune system, the intraepithelial Langerhans cell.

The study was prompted by a report stating that Langerhans cells harbor the human immunodeficiency virus, type 1 (HIV-1) [1] , and a subsequent African controlled case study indicating that uncircumcised men were more likely to be seropositive for HIV-1 than the circumcised [2] . The Langerhans cell is an epithelial component of the immune system... The epidermal Langerhans cells (ELC) play a role in the recognition and processing of antigens in order to present them to either lymphocytes and/or macrophages. They may represent the first contact of viral antigens with the cellular immune system of the skin and squamous mucosa as found in the human prepuce. It has been shown experimentally in the mouse that skin deficient in ELC (induced by ultraviolet exposure) is unable to mount hypersensitivity reactions to 2,4-dinitro-1-fluorobenzene [3] . Those authors speculate that the ELC form a "network" that renders cutaneously applied antigens immunogenic. The absence of such a network renders the host unresponsive.

We undertook a study of the count of ELC in the neonatal prepuce that could act as a baseline for comparing the cell population in the circumcised and uncircumcised male. MATERIALS AND METHODS Unfixed foreskins were obtained from all neonates undergoing circumcision at the University Hospital of Arkansas between 7 November 1988 and 6 January 1989. [Details of staining and processing of samples omitted.] RESULTS The prepuce can be divided morphologically into an outer and inner surface. The inner surface is characterized by the absence of keratinization and skin appendages, thickening of the epithelium, special sebaceous glands (Tyson's) at its junction with the corona, a relative decrease in melanocytes, and is recognized as a squamous mucosal surface. The transition between outer and inner surfaces was sharply demarcated in 22 cases. The sections stained with OKT6 also showed an abrupt transition. The outer surface of the prepuce exhibited a relative abundance of ELC. The inner surface showed virtually no such cells. The external surface exhibited a mean ELC count of 174 +/- 15 cells/sq.

mm and the internal surface exhibited a mean cell count of 8.0 +/- 2.4 cells/sq. mm (P <0.001). Fig. 1 graphically illustrates the data from these findings. DISCUSSION Our study shows a scarcity of ELC on the inner aspect of the neonatal prepuce. The outer surface exhibited cell counts comparable to those seen in a study of human skin [4] . A search of the literature failed to reveal a comparative study of ELC at the outer and inner surfaces of the human prepuce. This lack of ELC at the inner surface may result in a squamous mucosa with reduced immunological responsiveness to cutaneous antigens. Considering the role of prophylaxis in disease, this investigation favors the re-emphasis of the medical value of neonatal circumcision. The American Academy of Pediatrics Task Force on Circumcision [5] , and Wiswell [6] , a prominent neonatologist formerly opposed to circumcision, have recently revised their thinking on this issue. [The AAP does not recommend neonatal circumcision.] Wiswell now speaks of the many potential advantages to the neonate and reports that circumcision prevents urinary tract infections, penile cancer, sexually transmitted diseases and perhaps AIDS.

[Wiswell spent years desperately looking for a reason to support circumcision.] He also notes that "To date, no studies have supported the assertion that good hygiene averts the potential complications of the uncircumcised state." Careful removal of the prepuce by trained practitioners can be done with no mortality and a complication rate not exceeding 0.1% [7] . ["Can" covers a multitude of sins.] A mundane consideration is that it is economically more feasible to circumcise early in life. ["Economically more feasible?" Or more profitable, because the babies never refuse?] The discovery of the scarcity of ELC at the neonatal inner prepuce may be indicative of this site's vulnerability to infection and neoplasia [8] . Although the role of circumcision remains controversial, our study when coupled with recent scientific and epidemiological data suggests a pressing need for neonatal posthetomy [circumcision] as a prophylactic surgical procedure. REFERENCES 1. Kolanta G. Where is the AIDS virus harbored? Science 1986;232:1197. 2. Sirnonsen JN, Cameron DW, Galinya MN, et al.

Human immunodeficiency virus infection among men with sexually transmitted diseases. N Engl J Med 1988;319:274-278. 3. Streilein JW, Toews GT, Gilliam JN, et al. Tolerance or hypersensitivity to 2,4-dintro-l fluorobenzene: the role of Langerhans cell density within epidermis. J Invest Dermatol 1980;74:319-321. 4. Berman B, Chen VL, France DS, et al. Anatomic mapping of epidermal Langerhans cell densities in adults. Br J Dermatol 1983;109:553-558. 5. American Academy of Pediatrics Task Force on Circumcision. Report of the Task Force on Circumcision. Pediatrics 1989;84:388-391. 6. Wiswell T. Routine neonatal circumcision: a reappraisal. Am Fam Physician 1990,41:859-863. 7. Shulman J, Ben-Hur N, Newman Z.

Surgical complications of circumcision. Am J Dis Child 1978;107:149-154. 8. Bonilla-Musoles F, Castells A, Simon C, et al. Importance of Langerhans cells in the immune origin of carcinoma of the uterine cervix. Eur J Gynaecol Oncol 1987;VIII(1): 44-60. POST PRESENTATION COMMENTS It is an epidemiological fact that cancer of the penis and infection of the foreskin area are more common in the uncircumcised than the circumcised. [The first is not a fact. The second? Well, d'uh.] For over a century, the medical literature has been replete with these findings related to neoplasia, STD and circumcision. Recognition of preputial cellular deficiency of Langerhans cells at the mucosal surface allows for a better understanding of cellular immune reactions at this site. This knowledge of penile vulnerability in the neonate reinforces the need for early posthetomy [circumcision] as a prophylactic measure. ... Gerald N. Weiss, M.D.

Diplomate American Board of Surgery Fellow American College of Surgeons Fellow International College of Surgeons

Question: In males, posthetomy is the removal of what?
Answer: Foreskin