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<small>{{Suntingan terakhir}}</small>
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{{About|sunat pria|sunat wanita|Mutilasi genital perempuan}}
{{Interventions infobox
| Name = Sunat
| Image = Circumcision central Asia2.jpg
| Caption = Sebuah penyunatan yang diselenggarakan di [[Asia Tengah]], {{sekitar|1865{{endash}}1872}}
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| OtherCodes =
| MedlinePlus = 002998
| eMedicine = 1015820
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{{Seks dan hukum}}
'''Sunat''' atau '''sirkumsisi''' (berasal dari bahasa Latin ''circumcidere'', yang berarti “untuk memotong berputar”)<ref name=WHO_2007_GTDPSA/> adalah tindakan memotong atau menghilangkan sebagian atau seluruh kulit penutup depan ([[kulup]]) dari [[penis manusia|penis]]. <ref name=lissauer_2012/><ref name=rudolph_2011/><ref name=sawyer_2011/> Dalam prosedurnya, kulup dibuka dan dipisahkan dari [[kepala penis]] setelah pemeriksaan. [[Penjepit sunat]] (jika digunakan) akan dipasang, dan kemudian kulup akan dilepaskan. [[Anestesi]] lokal atau topikal yang telah diinjeksi dapat digunakan untuk mengurangi rasa sakit dan [[stres (fisiologi)|stres fisiologis]].<ref name=AAP_2012/> Untuk dewasa, [[anestesi umum]] adalah suatu pilihan, dan prosedur dilakukan tanpa alat yang khusus. Sunat lebih sering [[bedah elektif|dipilih]] untuk alasan religius maupun pilihan sendiri,<ref name=WHO_2007_GTDPSA/> tetapi juga dapat diindikasikan untuk [[terapi]] dan [[Pengobatan pencegahan#Profilaksis| profilaksis]]. Sunat juga merupakan salat satu pilihan pengobatan untuk [[fimosis]], refraktori [[ balanopostitis]] dan [[infeksi saluran kemih]] kronis ;<ref name=lissauer_2012/> <ref name=hay_2012/> itu merupakan kontraindikasi pada kasus kelainan struktur genital tertentu atau kesehatan umum yang buruk .<ref name=rudolph_2011/> <ref name=hay_2012/>
The positions of the world's major [[health association|medical organizations]] range from considering neonatal circumcision as having no benefit and significant risks to having a modest health benefit that outweighs small risks. No major medical organization recommends either universal circumcision for all infant males (aside from the recommendations of the [[World Health Organization]] for parts of Africa), or banning the procedure.<ref name=Bolnick_2012_ch1/> Ethical and legal questions regarding [[informed consent]] and [[autonomy]] have been raised over non-therapeutic neonatal circumcision.<ref name=caga-anan_2011/><ref name=pinto_2012/>
A 2009 [[Cochrane Collaboration|Cochrane]] [[meta-analysis]] of studies done on sexually active men in Africa found that circumcision reduces the infection rate of [[HIV]] among heterosexual men by 38{{endash}}66% over a period of 24 months.<ref name=siegfried_Cochrane_2009/> The WHO recommends considering circumcision as part of a comprehensive HIV program in areas with high [[endemism|endemic]] rates of HIV, such as sub-Saharan Africa,<ref name=uthman_2010/><ref name=WHO_HIV_2007/> where studies have concluded it is cost-effective against HIV.<ref name=uthman_2010/> Circumcision reduces the incidence of [[herpes simplex virus|HSV]]-2 infections by 28%,<ref name=wetmore_2010/> and is associated with reduced [[carcinogenesis|oncogenic]] [[human papillomavirus|HPV]] prevalence<ref name=hpv_prevalence/> and a reduced risk of both UTIs and [[carcinoma of the penis|penile cancer]],<ref name=AAP_2012/> but routine circumcision is not justified for the prevention of those conditions.<ref name=lissauer_2012/><ref name=ACS_2012/> Studies of its potential protective effects against other [[sexually transmitted disease|sexually transmitted infections]] have been inconclusive. A 2010 review of literature worldwide found circumcisions performed by medical providers to have a median [[complication (medicine)|complication]] rate of 1.5% for newborns and 6% for older children, with few instances of severe complications.<ref name=weiss_2010_complications/> [[Bleeding]], [[infection]] and the removal of either too much or too little foreskin are the most common complications cited.<ref name=weiss_2010_complications/><ref name = "AAFP_2007"/> Circumcision does not appear to have a negative impact on sexual function.<ref name=sexual_function/>
About one-third of males worldwide are circumcised.<ref name=WHO_2007_GTDPSA/><ref name=weiss_2010_complications/> The procedure is most prevalent in the [[Muslim world]] and [[Israel]] (where it is near-universal), the United States and parts of [[Southeast Asia]] and Africa; it is relatively rare in Europe, Latin America, parts of [[Southern Africa]] and most of Asia.<ref name=WHO_2007_GTDPSA/> The origin of circumcision is not known with certainty; the oldest documentary evidence for it comes from [[ancient Egypt]].<ref name=WHO_2007_GTDPSA/> Various theories have been proposed as to its origin, including as a religious [[sacrifice]] and as a [[rite of passage]] marking a boy's entrance into adulthood.<ref name=alanis_2004/> It is part of [[halakha|religious law]] in [[Judaism]]<ref name=glass_1999/> and is an established practice in [[Islam]], [[Coptic Orthodox Church of Alexandria|Coptic Christianity]] and the [[Ethiopian Orthodox Tewahedo Church|Ethiopian Orthodox Church]].<ref name=WHO_2007_GTDPSA/><ref name=Columbia_encyc_2011_circ/><ref name=clark_2011/>
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==Indikasi dan kontraindikasi==
===Routine or elective===
Neonatal circumcision is often [[elective surgery|elected]] for nonmedical reasons, such as for religious beliefs or for personal preferences possibly driven by societal norms.<ref name=hay_2012/> Outside the parts of Africa with high prevalence of HIV/AIDS, the positions of the world's major medical organizations on nontherapeutic neonatal circumcision range from considering it as having a modest net health benefit that outweighs small risks to viewing it as having no benefit with significant risks for harm.<!-- ref name=Bolnick_2012_ch1 --> No major medical organization recommends nontherapeutic neonatal circumcision, and no major medical organization calls for banning it either.<!-- ref name=Bolnick_2012_ch1 --> The Royal Dutch Medical Association, which expresses the strongest opposition to routine neonatal circumcision, does not call for the practice to be made illegal out of their concern that parents who insist on the procedure would turn to poorly trained practitioners instead of medical professionals.<!-- ref name=Bolnick_2012_ch1 --> This argument to keep the procedure within the purview of medical professionals is found across all major medical organizations.<!-- ref name=Bolnick_2012_ch1 --> In addition, the organizations advise medical professionals to yield to some degree to parents' preferences, commonly based in cultural or religious views, in the decision to agree to circumcise.<ref name=Bolnick_2012_ch1/>
Owing to the HIV/AIDS epidemic there, sub-Saharan Africa is a special case. The finding that circumcision significantly reduces female-to-male HIV transmission has prompted medical organizations serving the affected communities to promote circumcision as an additional method of controlling the spread of HIV.<ref name=Bolnick_2012_ch1/> The World Health Organization (WHO) and UNAIDS (2007) recommend circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV.<ref name=WHO_HIV_2007/>
===Medical indications===
Circumcision may be medically indicated in children for pathological [[phimosis]], refractory [[balanoposthitis]] and chronic, recurrent [[urinary tract infection]]s (UTIs) in males who are chronically susceptible to them.<ref name=lissauer_2012/><ref name=hay_2012/> The [[World Health Organization]] promotes circumcision as a preventive measure for sexually active men in populations at high risk for [[HIV]].<ref name=WHO_HIV_2007/>
===Contraindications===
Circumcision is [[contraindication|contraindicated]] in infants with certain [[sex organ|genital]] structure abnormalities, such as a misplaced [[external urethral orifice (male)|urethral opening]] (as in [[hypospadias]] and [[epispadias]]), curvature of the head of the penis ([[chordee]]), or [[ambiguous genitalia]], because the foreskin may be needed for reconstructive surgery. Circumcision is contraindicated in [[preterm birth|premature]] infants and those who are not clinically stable and in good health.<ref name=rudolph_2011/><ref name=hay_2012/><ref name=WHO_Manual_2009/> If an individual, child or adult, is known to have or has a family history of serious bleeding disorders ([[hemophilia]]), it is recommended that the blood be checked for normal [[coagulation]] properties before the procedure is attempted.<ref name=hay_2012/><ref name=WHO_Manual_2009/>
==Teknik==
{{main|Prosedur bedah sunat}}
[[File:Circumcision illustration.jpg|thumb|right|Sunat dengan hemostats dan gunting]]
[[File:Adult circumcision before and after.jpg|thumb|Sebelum (kiri) dan sesudah (kanan) dari sunat dewasa, undertaken to treat [[fimosis]]. The glans is exposed even when the penis is flaccid.]]
The [[foreskin]] extends out from the base of the [[glans penis|glans]] and covers the glans when the penis is flaccid. Proposed theories for the purpose of the foreskin are that it serves to protect the penis as the fetus develops in the mother's womb, that it helps to preserve moisture in the glans, or that it improves sexual pleasure. The foreskin may also be a pathway of infection for certain diseases. Circumcision removes the foreskin at its attachment to the base of the glans.<ref name=WHO_2007_GTDPSA/>
===Removal of the foreskin===
For infant circumcision, [[circumcision clamp|devices]] such as the [[Gomco clamp]], [[Plastibell]] and [[Mogen clamp]] are commonly used in the USA.<ref name=AAP_2012/> These follow the same basic procedure. First, the amount of foreskin to be removed is estimated. The practitioner opens the foreskin via the preputial [[body orifice|orifice]] to reveal the glans underneath and ensures it is normal before bluntly separating the inner lining of the foreskin ([[preputial mucosa|preputial epithelium]]) from its attachment to the glans. The practitioner then places the circumcision device (this sometimes requires a [[dorsal slit]]), which remains until blood flow has stopped. Finally, the foreskin is [[amputation|amputated]].<ref name=AAP_2012/> For adults, circumcision is often performed without clamps,<ref name=Bolnick_2012_ch14/> and non-surgical alternatives such as the elastic ring controlled radial compression device are available.<ref name=WHO_adult_devices_2012/>
===Pain management===
The circumcision procedure causes pain, and for neonates this pain may interfere with mother-infant interaction or cause other behavioral changes,<ref name=perera_2010/> so the use of [[analgesia]] is advocated.<ref name=AAP_2012/><ref name=CPSBC_2009/> Ordinary procedural pain may be managed in [[pharmacology|pharmacological]] and non-pharmacological ways. Pharmacological methods, such as localized or regional pain-blocking injections and topical analgesic creams, are safe and effective.<ref name=AAP_2012/><ref name=lonngvist_2010/><ref name=shockley_2011/> The [[nerve block|ring block]] and dorsal penile nerve block (DPNB) are the most effective at reducing pain, and the ring block may be more effective than the DPNB. They are more effective than [[lidocaine/prilocaine|EMLA]] (eutectic mixture of local anesthetics) cream, which is more effective than a [[placebo]].<ref name=lonngvist_2010/><ref name=shockley_2011/> Topical creams have been found to irritate the skin of [[low birth weight]] infants, so penile nerve block techniques are recommended in this group.<ref name=AAP_2012/>
For infants, non-pharmacological methods such as the use of a comfortable, padded chair and a [[sucrose]] or non-sucrose pacifier are more effective at reducing pain than a placebo,<ref name=shockley_2011/> but the [[American Academy of Pediatrics]] (AAP) states that such methods are insufficient alone and should be used to supplement more effective techniques.<ref name=AAP_2012/> A quicker procedure reduces duration of pain; use of the Mogen clamp was found to result in a shorter procedure time and less pain-induced stress than the use of the Gomco clamp or the Plastibell.<ref name=shockley_2011/> The available evidence does not indicate that post-procedure pain management is needed.<ref name=AAP_2012/> For adults, [[general anesthesia]] is an option,<ref name=wolter_2008/> and the procedure requires four to six weeks of abstinence from [[masturbation]] or intercourse to allow the wound to heal.<ref name=WHO_Manual_2009/>
==Efek==
===Penyakit menular seksual===
====HIV====
{{Main|Sunat dan HIV}}
There is strong evidence that circumcision reduces the risk of HIV infection in heterosexual men in high-risk populations.<ref name=siegfried_Cochrane_2009/><ref name=krieger_2011/> Evidence among heterosexual men in sub-Saharan Africa shows a decreased risk of between 38 percent and 66 percent over two years,<ref name=siegfried_Cochrane_2009/> and in this population studies rate it cost effective.<ref name=uthman_2010/> Whether it is of benefit in [[developed country|developed countries]] is undetermined.<ref name=kim_2010/>
There are plausible explanations based on human biology for how circumcision can decrease the likelihood of female-to-male HIV transmission. The [[epidermis (skin)|superficial skin layers]] of the penis contain [[Langerhans cell]]s, which are targeted by HIV; removing the foreskin reduces the number of these cells. When an uncircumcised penis is erect during intercourse, any small tears on the inner surface of the foreskin come into direct contact with the vaginal walls, providing a pathway for transmission. When an uncircumcised penis is [[tumescence|flaccid]], the pocket between the inside of the foreskin and the head of the penis provides an environment conducive to pathogen survival; circumcision eliminates this pocket. Some experimental evidence has been provided to support these theories.<ref name=weiss_2010_HIV/>
The WHO and the [[Joint United Nations Programme on HIV/AIDS]] (UNAIDS) state that male circumcision is an efficacious intervention for HIV prevention, but should be carried out by well trained medical professionals and under conditions of [[informed consent]].<ref name=WHO_2007_GTDPSA/><ref name=WHO_HIV_2007/><ref name=WHO_CandR_2007/> The WHO has judged circumcision to be a cost-effective public health intervention against the spread of HIV in Africa, although not necessarily more cost-effective than [[condom]]s.<ref name=WHO_2007_GTDPSA/> The [[Centers for Disease Control and Prevention]] (CDC) has calculated that newborn circumcision is cost-effective against HIV in the US.<ref name=sansom_2010/> The joint WHO/UNAIDS recommendation also notes that circumcision only provides partial protection from HIV and should not replace known methods of HIV prevention.<ref name=WHO_HIV_2007/>
The available evidence does not indicate that circumcision provides HIV protection for heterosexual women.<ref name=AAP_2012/><ref name=dinh_2010/> Data is lacking regarding the effect circumcision may have on the transmission rate of men who engage in [[anal sex]] with a female partner.<ref name=WHO_CandR_2007/><ref name=CDC_2008/> It is undetermined whether circumcision benefits [[men who have sex with men]].<ref name=templeton_2010/><ref name=wiysonge_2011/>
====Human papillomavirus====
[[Human papillomavirus]] (HPV) is the most commonly transmitted [[sexually transmitted disease]], affecting both men and women. While most infections are asymptomatic and are cleared by the [[immune system]], some types of the virus cause [[genital wart]]s, and other types, if untreated, cause various forms of [[cancer]], including [[cervical cancer]] and [[carcinoma of the penis|penile cancer]]. Genital warts and cervical cancer are the two most common problems resulting from HPV.<ref name=CDC_HPV/>
Circumcision is associated with a reduced [[prevalence]] of [[carcinogenesis|oncogenic]] types of HPV infection, meaning that a randomly selected circumcised man is less likely to be found infected with cancer-causing types of HPV than an uncircumcised man.<ref name=hpv_prevalence/> It also decreases the likelihood of multiple infections.<ref name=rehmeyer_2011/> No strong evidence indicates that it reduces the rate of new HPV infection,<ref name=rehmeyer_2011/><ref name=larke_HPV_2011/><ref name=albero_2012/> but the procedure is associated with increased [[clearance (medicine)|clearance]] of the virus by the body,<ref name=rehmeyer_2011/><ref name=larke_HPV_2011/> which can account for the finding of reduced prevalence.<ref name=rehmeyer_2011/>
Although genital warts are caused by a type of HPV, there is no statistically significant relationship between being circumcised and the presence of genital warts.<ref name=larke_HPV_2011/><ref name=albero_2012/>
====Other infections====
Studies evaluating the effect of circumcision on the incidence of other sexually transmitted infections have reached conflicting conclusions. A 2006 meta-analysis found that circumcision was associated with lower rates of [[syphilis]], [[chancroid]] and possibly genital [[herpes]].<ref name=weiss_2006_syphilis/> A 2010 review of clinical trial data found that circumcision reduced the incidence of [[herpes simplex virus|HSV]]-2 (herpes simplex virus, type 2) infections by 28%. The researchers found mixed results for protection against [[trichomonas vaginalis]] and [[chlamydia trachomatis]] and no evidence of protection against [[gonorrhea]] or syphilis.<ref name=wetmore_2010/> Among men who have sex with men, reviews have found poor evidence for protection against sexually transmitted infections other than HIV,<ref name=templeton_2010/><ref name=millett_2008/> with the possible exception of syphilis.<ref name=templeton_2010/>
===Phimosis, balanitis and balanoposthitis===
[[Phimosis]] is the inability to retract the foreskin over the glans penis. At birth, the foreskin cannot be retracted due to [[adhesion (medicine)|adhesions]] between the foreskin and glans, and this is considered normal (physiological phimosis). Over time, the foreskin naturally separates from the glans, and a majority of boys are able to retract the foreskin by age four. If the inability to do so becomes problematic (pathological phimosis), which is commonly due to the skin disease [[balanitis xerotica obliterans]] (BXO), circumcision is the preferred treatment option.<ref name=lissauer_2012/><ref name=becker_2011/> The procedure may also be used [[preventive medicine#Prophylaxis|prophylactically]] to prevent the development of phimosis.<ref name=hay_2012/>
An inflammation of the glans penis and foreskin is called balanoposthitis; that affecting the glans alone is called balanitis.<ref name=leber_2006/><ref name=osipov_2006/> Most cases of these conditions occur in uncircumcised males,<ref name=aridogan_2011/> affecting 4{{endash}}11% of that group.<ref name=hayashi_2011/> The moist, warm space underneath the foreskin is thought to facilitate the growth of pathogens, particularly when hygiene is poor. Yeasts, especially ''[[Candida albicans]]'', are the most common penile infection and are rarely identified in samples taken from circumcised males.<ref name=aridogan_2011/> Both conditions are usually treated with topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams.<ref name=leber_2006/><ref name=osipov_2006/> Circumcision is a treatment option for refractory or recurrent balanoposthitis, but in recent years the availability of these other treatments have made it less necessary.<ref name=leber_2006/><ref name=osipov_2006/>
===Urinary tract infections===
A UTI affects parts of the [[urinary system]] including the urethra, bladder, and kidneys. There is about a 1% risk of UTIs in boys under two years of age, and the majority of incidents occur in the first year of life. There is good but not ideal evidence that circumcision reduces the incidence of UTIs in boys under two years of age, and there is fair evidence that the reduction in incidence is by a factor of 3{{endash}}10 times,<ref name=AAP_2012/><ref name=jagannath_2012/> but prevention of UTIs does not justify routine use of the procedure.<ref name=lissauer_2012/> Circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects,<ref name=AAP_2012/><ref name=jagannath_2012/> and may be used to treat recurrent UTIs.<ref name=lissauer_2012/>
There is a plausible biological explanation for the reduction in UTI risk after circumcision. The orifice through which urine passes at the tip of the penis (the [[urinary meatus]]) hosts more urinary system disease-causing bacteria in uncircumcised boys than in circumcised boys, especially in those under six months of age. As these bacteria are a risk factor for UTIs, circumcision may reduce the risk of UTIs through a decrease in the bacteria population.<ref name=AAP_2012/><ref name=jagannath_2011/>
===Cancers===
Circumcision has a protective effect against the risks of penile cancer in men, and cervical cancer in the female sexual partners of heterosexual men. Penile cancer is rare, with about 1 new case per 100,000 people per year in developed countries, and higher incidence rates per 100,000 in sub-Saharan Africa (for example, 1.6 in Zimbabwe, 2.7 in Uganda and 3.2 in Swaziland).<ref name=larke_penile_cancer_2011/> Penile cancer development can be detected in the carcinoma ''in situ'' (CIS) cancerous precursor stage and at the more advanced invasive squamous cell carcinoma stage.<ref name=AAP_2012/> Childhood or adolescent circumcision is associated with a reduced risk of invasive squamous cell carcinoma in particular.<ref name=AAP_2012/><ref name=larke_penile_cancer_2011/> There is an association between adult circumcision and an increased risk of invasive penile cancer; this is believed to be from men being circumcised as a treatment for penile cancer or a condition that is a precursor to cancer rather than a consequence of circumcision itself.<ref name=larke_penile_cancer_2011/> Penile cancer has been observed to be nearly eliminated in populations of males circumcised neonatally.<ref name=hayashi_2011/>
Important risk factors for penile cancer include phimosis and HPV infection, both of which are mitigated by circumcision.<ref name=larke_penile_cancer_2011/> The mitigating effect circumcision has on the risk factor introduced by the possibility of phimosis is secondary, in that the removal of the foreskin eliminates the possibility of phimosis. This can be inferred from study results that show uncircumcised men with no history of phimosis are equally likely to have penile cancer as circumcised men.<ref name=AAP_2012/><ref name=larke_penile_cancer_2011/> Circumcision is also associated with a reduced prevalence of cancer-causing types of HPV in men<ref name=rehmeyer_2011/> and a reduced risk of cervical cancer (which is caused by a type of HPV) in female partners of men.<ref name=hay_2012/> Because penile cancer is rare (and may get more rare with increasing HPV vaccination rates), and circumcision has risks, the practice is not considered to be valuable solely as a prophylactic measure against penile cancer in the United States.<ref name=AAP_2012/><ref name=ACS_2012/><ref name=hayashi_2011/>
==Adverse effects==
Neonatal circumcision is generally safe when done by an experienced practitioner.<ref name=AUA_2007/> The most common acute [[complication (medicine)|complications]] are bleeding, infection and the removal of either too much or too little foreskin.<ref name=AAP_2012/><ref name=AAFP_2007/> These complications occur in less than 1% of procedures, and constitute the vast majority of all acute circumcision complications in the United States.<ref name=AAFP_2007/> Minor complications are reported to occur in 3% of procedures.<ref name=AUA_2007/> A specific complication rate is difficult to determine due to scant data on complications and inconsistencies in their classification.<ref name=AAP_2012/> Complication rates are greater when the procedure is performed by an inexperienced operator, in unsterile conditions, or when the child is at an older age.<ref name=weiss_2010_complications/> Significant acute complications happen rarely,<ref name=AAP_2012/><ref name=weiss_2010_complications/> occurring in about 1 in 500 newborn procedures in the United States.<ref name=AAP_2012/> Severe to catastrophic complications are sufficiently rare that they are reported only as individual case reports.<ref name=AAP_2012/> The death rate due to circumcision is estimated at 1 in every 500,000 neonatal procedures conducted within the United States.<ref name=AAFP_2007/> Other possible complications include [[buried penis|concealed penis]], [[skin bridge]]s, urethral fistulas, and [[meatal stenosis]].<ref name="KrillPalmer2011"/> These complications may be avoided with proper technique, and are most often treatable without requiring a hospital visit.<ref name="KrillPalmer2011">{{cite journal|last1=Krill|first1=Aaron J.|last2=Palmer|first2=Lane S.|last3=Palmer|first3=Jeffrey S.|title=Complications of Circumcision|journal=The Scientific World JOURNAL|volume=11|year=2011|pages=2458–2468|issn=1537-744X|doi=10.1100/2011/373829|url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253617/}}</ref>
Circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction.<ref name=sexual_function/><ref name="pmid22373281">{{cite journal |author=Morris BJ, Waskett JH, Banerjee J, Wamai RG, Tobian AA, Gray RH, Bailis SA, Bailey RC, Klausner JD, Willcourt RJ, Halperin DT, Wiswell TE, Mindel A |title=A 'snip' in time: what is the best age to circumcise? |journal=BMC Pediatr |volume=12 |issue= |pages=20 |year=2012 |pmid=22373281 |pmc=3359221 |doi=10.1186/1471-2431-12-20 |url=|quote=Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded.}}</ref> The [[Royal Dutch Medical Association]]'s 2010 Viewpoint mentions that "complications in the area of sexuality" have been reported.<ref name=KNMG_2010/> Additionally, the procedure may carry the risks of heightened pain response for newborns and dissatisfaction with the result.<ref name=perera_2010/>
==Prevalensi==
{{Main|Prevalensi sunat}}
[[File:Global Map of Male Circumcision Prevalence at Country Level.png|thumb|300px|Prevalensi sunat menurut negara]]
Sunat mungkin merupakan prosedur yang paling umum di dunia.<ref name=doyle_2005/> Sekitar satu pertiga pria di dunia telah disunat, most often for reasons other than medical indication paling sering untuk alasan lain selain indikasi medis.<ref name=WHO_2007_GTDPSA/><ref name=weiss_2010_complications/> Sunat umumnya dilakukan dari bayi hingga awal umur 20-an.<ref name=WHO_2007_GTDPSA/> [[Organisasi Kesehatan Dunia]] memperkirakan pada tahun 2007 bahwa 664.500.000 pria berusia 15 tahun ke atas disunat (30% prevalensi global) , hampir 70% di antaranya [[Muslim]].<ref name=WHO_2007_GTDPSA/> Sunat paling banyak ditemukan di [[dunia Muslim]], Israel , Korea Selatan, Amerika Serikat dan sebagian dari [[Asia Tenggara]] dan Afrika . Sunat relatif jarang terjadi di Eropa, Amerika Latin , sebagian dari [[Afrika Selatan]] dan [[Oseania]] dan sebagian besar Asia. Prevalensi hampir universal di Timur Tengah dan Asia Tengah . <ref name=WHO_2007_GTDPSA/><ref name=drain_2006/> Sunat non-religius di Asia, di luar dari Korea Selatan dan Filipina, cukup langka,<ref name=WHO_2007_GTDPSA/> dan prevalensi umumnya rendah (kurang dari 20%) di seluruh Eropa. <ref name=WHO_2007_GTDPSA/> <ref name=klavs_2008/> Perkiraan untuk masing-masing negara termasuk Taiwan sebesar 9% <ref name=ko_2007/> dan Australia 58,7 % .<ref name=richters_2006/> Prevalensi di Amerika Serikat dan Kanada diperkirakan masing-masing 75 % dan 30 %.<ref name=WHO_2007_GTDPSA/> Prevalensi di Afrika bervariasi dari kurang dari 20% di beberapa negara Afrika bagian selatan hingga hampir universal di Afrika Utara dan Barat.<ref name=drain_2006/>
The rates of routine neonatal circumcision over time have varied significantly by country. In the United States, hospital discharge surveys estimated rates at 64.7% in the year 1980, 59.0% in the year 1990, 62.4% in the year 2000, and 58.3% in the year 2010.<ref name=CDC_NCHS_EStat_2013/> These estimates are lower than the overall rates, as they do not account for non-hospital circumcisions,<ref name=CDC_NCHS_EStat_2013/> or for procedures performed for medical need;<ref name=WHO_2007_GTDPSA/><ref name=CDC_NCHS_EStat_2013/> community surveys have reported higher neonatal prevalence.<ref name=WHO_2007_GTDPSA/> Canada has seen a slow decline since the early 1970s, possibly influenced by statements from the AAP and the [[Canadian Pediatric Society]] issued in the 1970s saying that the procedure was not medically indicated.<ref name=WHO_2007_GTDPSA/> In Australia, the rate declined in the 1970s and 80s, but has been increasing slowly as of 2004.<ref name=WHO_2007_GTDPSA/> In the United Kingdom, prevalence was roughly 25% in the 1940s, but declined dramatically after the [[National Health Service]] (NHS) did not cover the costs of the procedure.<ref name=WHO_2007_GTDPSA/> The prevalence in South Korea has increased markedly in the second half of the 20th century, rising from near zero around 1950 to about 60% in 2000, with the most significant jumps in the last two decades of that time period.<ref name=WHO_2007_GTDPSA/> This is probably due to the influence of the United States, which established a trusteeship for the country following World War II.<ref name=WHO_2007_GTDPSA/>
Medical organizations can affect the neonatal circumcision rate of a country by influencing whether the costs of the procedure are borne by the parents or are covered by insurance or a national health care system.<!-- ref name=Bolnick_2012_ch1 --> Policies that require the costs to be paid by the parents yield lower neonatal circumcision rates.<!-- ref name=Bolnick_2012_ch1 --> The decline in the rates in the UK is one example; another is that in the United States, the individual states where insurance or Medicaid covers the costs have higher rates.<!-- ref name=Bolnick_2012_ch1 --><!-- ref name=Bolnick_2012_ch1 --> Changes to policy are driven by the results of new research, and moderated by the politics, demographics, and culture of the communities.<ref name=Bolnick_2012_ch1/>
==Sejarah==
{{Main|Sejarah sunat pria}}
Sunat merupakan prosedur bedah yang telah direncanakan yang paling tua di dunia, suggested by anatomist and [[hyperdiffusionism|hyperdiffusionist]] historian [[Grafton Elliot Smith]] to be over 15,000 years old, pre-dating recorded history. There is no firm consensus as to how it came to be practiced worldwide. One theory is that it began in one geographic area and spread from there; another is that several different cultural groups began its practice independently. In his 1891 work ''History of Circumcision'', physician [[Peter Charles Remondino]] suggested that it began as a less severe form of emasculating a captured enemy: [[penis removal|penectomy]] or [[castration]] would likely have been fatal, while some form of circumcision would permanently mark the defeated yet leave him alive to serve as a slave.<ref name=alanis_2004/><ref name=gollaher_2001_ch1/>
The history of the migration and evolution of the practice of circumcision is followed mainly through the cultures and peoples in two separate regions. In the lands south and east of the [[Mediterranean]], starting with [[Sudan]] and [[Ethiopia]], the procedure was practiced by the [[ancient Egypt]]ians and the [[Semitic people|Semites]], and then by the [[Judaism|Jews]] and [[Islam|Muslims]], with whom the practice traveled to and was adopted by the [[Bantu peoples|Bantu Africans]]. In Oceania, circumcision is practiced by the [[Aboriginal Australians|Australian Aborigines]] and [[Polynesians]].<ref name=gollaher_2001_ch1/> There is also evidence that it was practiced in the Americas, but little detail is available about its history.<ref name=alanis_2004/><ref name=doyle_2005/>
===Timur Tengah, Afrika, dan Eropa===
Evidence suggests that circumcision was practiced in the [[Arabian Peninsula]] by the 4th millennium BCE, when the [[Sumer]]ians and the [[Semitic people|Semites]] moved into the area that is modern-day Iraq.<ref name=doyle_2005/> The earliest historical record of circumcision comes from Egypt, in the form of an image of the circumcision of an adult carved into the tomb of Ankh-Mahor at [[Saqqara]], dating to about 2400{{endash}}2300 BCE. Circumcision was done by the Egyptians possibly for hygienic reasons, but also was part of their obsession with purity and was associated with spiritual and intellectual development. No well-accepted theory explains the significance of circumcision to the Egyptians, but it appears to have been endowed with great honor and importance as a [[rite of passage]] into adulthood, performed in a public ceremony emphasizing the continuation of family generations and fertility. It may have been a mark of distinction for the elite: the Egyptian ''[[Book of the Dead]]'' describes the sun god [[Ra]] as having circumcised himself.<ref name=alanis_2004/><ref name=gollaher_2001_ch1/>
Circumcision features prominently in the [[Hebrew Bible]]. The narrative in [[Lech-Lecha#Genesis chapter 17|Genesis chapter 17]] describes the circumcision of [[Abraham]] and his relatives and slaves, making him the first named individual to undergo the procedure. In the same chapter, Abraham's descendants are commanded to circumcise their sons on the eighth day of life. Many generations later, [[Moses]] was raised by the Egyptian elite, so circumcision was doubtless familiar to him. For the Jews of the time, circumcision was not as much a spiritual act as it was a physical sign of their [[covenant (biblical)|covenant]] with God, and a prerequisite for the fulfillment of the commandment to produce offspring. In addition to proposing that circumcision was taken up by the Jews purely as a religious mandate, scholars have suggested that Judaism's patriarchs and their followers adopted circumcision to make penile hygiene easier in hot, sandy climates; as a rite of passage into adulthood; or as a form of blood [[sacrifice]].<ref name=doyle_2005/><ref name=gollaher_2001_ch1/><ref name=encyc_judaica_2006/>
[[Alexander the Great]] conquered the Middle East in the 4th century BCE, and in the following centuries [[ancient Greece|ancient Greek]] cultures and values came to the Middle East. The Greeks abhorred circumcision, making life for circumcised Jews living among the Greeks (and later the Romans) very difficult. [[Antiochus Epiphanes]] outlawed circumcision, as did [[Hadrian]], which helped cause the [[Bar Kokhba revolt]]. During this period in history, Jewish circumcision called for the removal of only a part of the prepuce, and some [[Hellenization|Hellenized]] Jews attempted to look uncircumcised by stretching the extant parts of their foreskins. This was considered by the Jewish leaders to be a serious problem, and during the 2nd century CE they changed the requirements of Jewish circumcision to call for the complete removal of the foreskin, emphasizing the Jewish view of circumcision as intended to be not just the fulfillment of a Biblical commandment but also an essential and permanent mark of membership in a people.<ref name=gollaher_2001_ch1/><ref name=encyc_judaica_2006/>
[[File:Koceks - Surname-i Vehbi.jpg|thumb|left|[[Köçek]]s dancing at the circumcision celebration of Sultan [[Ahmed III]]'s sons (1720); miniature from the ''Surname-i Vehbi'', [[Topkapı Palace]], Istanbul]]
A narrative in the [[Christianity|Christian]] [[Gospel of Luke]] makes a brief mention of the [[circumcision of Jesus]], but the subject of physical circumcision itself is not part of the received teachings of [[Jesus]]. [[Paul the Apostle]] reinterpreted circumcision as a spiritual concept, arguing the physical one to be no longer necessary. The teaching that physical circumcision was unnecessary for membership in a divine covenant was instrumental in the separation of Christianity from Judaism. Although it is not explicitly mentioned in the [[Quran]] (early 6th century CE), circumcision is considered essential to Islam, and it is nearly universally performed among Muslims. The practice of circumcision spread across the Middle East, North Africa and Southern Europe with Islam.<ref name=gollaher_2001_ch2/>
[[File:Mangbetu Beschneidungsmesser Museum Rietberg RAC 15.jpg|thumb|c|75px|right|Circumcision knife from the Congo; wood, iron; late 19th/early 20th century]]
The practice of circumcision is thought to have been brought to the Bantu-speaking tribes of Africa by either the Jews after one of their many expulsions from European countries, or by Muslim Moors escaping after the 1492 conquest of Spain. In the second half of the 1st millennium CE, inhabitants from the North East of Africa moved south and encountered groups from Arabia, the Middle East and West Africa. These people moved south and formed what is known today as the Bantu. Bantu tribes were observed to be upholding what was described as Jewish law, including circumcision, in the 16th century. Circumcision and elements of Jewish dietary restrictions are still found among Bantu tribes.<ref name=doyle_2005/>
===Aborigin===
Compared to the available history of circumcision in the Middle East, there is little verifiable evidence for its history among the [[Aboriginal Australians]] and [[Polynesians]]. What is known comes from their oral histories and accounts of missionaries and explorers. For Aboriginal Australians and Polynesians, circumcision likely started as a blood sacrifice and a test of bravery, and became an initiation rite with attendant instruction in manhood in more recent centuries. The removal of the foreskin was done with seashells, and it is theorized that the bleeding was stopped with [[eucalyptus]] smoke.<ref name=doyle_2005/><ref name=gollaher_2001_ch3/>
Some groups in the Americas are known to have a history of circumcision. [[Christopher Columbus]] found circumcision in practice by the native Americans. It was also practiced by the [[Inca Empire|Incas]], [[Aztec]]s and [[Maya civilization|Mayans]]. It probably started among South American tribes as a blood sacrifice or ritual mutilation to test bravery and endurance, and its use later evolved into a rite of initiation.<ref name=doyle_2005/>
===Masa kini===
Circumcision did not become a common medical procedure until the late 19th century.<ref name=Darby2003>{{cite journal|last=Darby|first=Robert|title=The Masturbation Taboo and the Rise of Routine Male Circumcision: A Review of the Historiography|journal=Journal of Social History|date=Spring 2003|volume=36|issue=3|pages=737–757}}</ref> At that time, British and American doctors began recommending it primarily as a deterrent to [[masturbation]].<ref name=Darby2003/><ref>{{cite book|last=Gollaher|first=David L.|title=Circumcision: A History of the World's Most Controversial Surgery|date=2000|publisher=Basic Books|location=New York|isbn=0465026532|pages=101–104}}</ref> Prior to the mid-20th century, masturbation was believed to be the cause of a wide range of physical and mental illnesses including epilepsy, paralysis, impotence, gonorrhea, tuberculosis, feeblemindedness, and insanity.<ref>{{cite book|last=Bullough|first=Vern L.|title=Human Sexuality: An Encyclopedia|date=1994|publisher=Garland|location=New York|isbn=0824079728|page=425|coauthors=Bonnie Bullough}}</ref><ref>{{cite book|last=Conrad|first=Peter|title=Deviance and Medicalization: From Badness to Sickness|date=1992|publisher=Temple University Press|location=Philadelphia|isbn=0877229996|page=212|coauthors=Joseph W. Schneider}}</ref>
One of the first modern physicians to advocate the procedure was [[Lewis Sayre]], a founder of the [[American Medical Association]]. In 1870, Sayre began using circumcision as a purported cure for several cases of young boys presenting with paralysis or significant motor problems. He thought the procedure ameliorated such problems based on a "reflex neurosis" theory of disease, which held that excessive stimulation of the genitals was a disturbance to the equilibrium of the nervous system and a cause of systemic problems.<ref name=Darby2003/> The use of circumcision to promote good health also fit in with the germ theory of disease, which saw validation during the same time period: the foreskin was seen as harboring infection-causing [[smegma]] (a mixture of shed skin cells and oils). Sayre published works on the subject and promoted it energetically in speeches. Contemporary physicians picked up on Sayre's new treatment, which they believed could prevent or cure a wide-ranging array of medical problems and social ills. Its popularity spread with publications such as Peter Charles Remondino's ''History of Circumcision''. By the turn of the century, in both America and Great Britain, infant circumcision was nearly universally recommended.<ref name=alanis_2004/><ref name=gollaher_2001_ch4/>
After the end of [[World War II]], Britain moved to a [[publicly funded health care|nationalized health care]] system, and so looked to ensure that each medical procedure covered by the new system was cost-effective. [[Douglas Gairdner]]'s 1949 article "The Fate of the Foreskin" argued persuasively that the evidence available at that time showed that the risks outweighed the known benefits. The procedure was not covered by the national health care system, and circumcision rates dropped in Britain and in the rest of Europe. In the 1970s, national medical associations in Australia and Canada issued recommendations against routine infant circumcision, leading to drops in the rates of both of those countries. In the United States, the American Academy of Pediatrics has, over the decades, issued a series of policy statements regarding circumcision, sometimes positive and sometimes negative.<ref name=alanis_2004/><ref name=gollaher_2001_ch4/>
An association between circumcision and reduced heterosexual HIV infection rates was suggested in 1986.<ref name=alanis_2004/> Experimental evidence was needed to establish a causal relationship, so three [[randomized controlled trial]]s were commissioned as a means to reduce the effect of any [[confounding|confounding factors]].<ref name=siegfried_Cochrane_2003/> Trials took place in South Africa, [[Kenya]] and [[Uganda]].<ref name=siegfried_Cochrane_2009/> All three trials were stopped early by their monitoring boards on ethical grounds, because those in the circumcised group had a lower rate of HIV contraction than the control group.<ref name=siegfried_Cochrane_2009/> Subsequently, the World Health Organization promoted circumcision in high-risk populations as part of an overall program to reduce the spread of HIV,<ref name=WHO_HIV_2007/> although some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy.<ref name=boyle_hill_2011/><ref name=dowsett_2007/><ref name=darby_2011/><ref name=frisch_2013/> The Male Circumcision Clearinghouse website was formed by WHO, UNAIDS, FHI and AVAC to provide current evidence-based guidance, information and resources to support the delivery of safe male circumcision services in countries that choose to scale up the procedure as one component of comprehensive HIV prevention services.<ref name=NYTimes_2009/><ref name=AVAC_2012/>
==Society and culture==
===Cultures and religions {{Anchor|Cultures and religions}}===
{{See also|Religious male circumcision}}
In some cultures, males must be circumcised shortly after birth, during childhood or around puberty as part of a rite of passage. Circumcision is commonly practiced in the Jewish and Islamic faiths.<!-- the references for this, found in the following sections, are: <ref name=alsabbagh_1996/><ref name=Bolnick_2012_ch23/><ref name=Bolnick_2012_ch24/><ref name=Bolnick_2012_ch26/><ref name=clark_2011/><ref name=Columbia_encyc_2011_circ/><ref name=encyc_religion_2005/><ref name=glass_1999/><ref name=riggs_2006/><ref name=WHO_2007_GTDPSA/> !-->
====Judaism====
{{main|Brit milah}}
[[File:Covenant of Abraham.JPG|thumb|Preparing for a Jewish ritual circumcision with a Mogen shield (on the table, next to the scalpel)]]
Circumcision is very important to Judaism, with over 90% of adherents having the procedure performed as a religious obligation. The basis for its observance is found in the [[Torah]] of the Hebrew Bible, in Genesis chapter 17, in which a covenant of circumcision is made with Abraham and his descendants. Jewish circumcision is part of the ''[[brit milah]]'' ritual, to be performed by a specialist ritual circumciser (a ''[[mohel]]'') on the eighth day of a newborn son's life (with certain exceptions for poor health). Jewish law requires that the circumcision leave the glans bare when the penis is flaccid. Converts to Judaism must also be circumcised; those who are already circumcised undergo a symbolic circumcision ritual. Circumcision is not required by Judaism for one to be considered Jewish, but adherents foresee serious negative spiritual consequences if it is neglected.<ref name=glass_1999/><ref name=Bolnick_2012_ch23/>
====Islam====
{{main|Khitan (circumcision)}}
[[Image:Jongetjes in prinsenkledij voor besnijdenisfeest.JPG| thumb | right | Children in [[Turkey]] wearing traditional circumcision costumes ]]
Although there is some debate within Islam over whether it is a religious requirement, circumcision (called ''khitan'') is practiced nearly universally by Muslim males. Islam bases its practice of circumcision on the Genesis 17 narrative, the same Biblical chapter referred to by Jews. The procedure is not explicitly mentioned in the Quran, however it is a tradition established by Islam's prophet [[Muhammad]] directly (following Abraham), and so its practice is considered a ''[[sunnah]]'' (prophet's tradition) and is very important in Islam. For Muslims, circumcision is also a matter of cleanliness, purification and control over one's baser self (''[[nafs]]''). There is no agreement across the many Islamic communities about the age at which circumcision should be performed. It may be done from soon after birth up to about age 15, with it most often performed at around six to seven years of age. The timing can correspond with the boy's completion of his recitation of the whole Quran, with a coming-of-age event such as taking on the responsibility of daily prayer or betrothal. Circumcision may be celebrated with an associated family or community event. Circumcision is recommended for, but is not required of, converts to Islam.<ref name=clark_2011/><ref name=alsabbagh_1996/><ref name=Bolnick_2012_ch24/>
====Christianity====
The [[New Testament]] chapter [[Council of Jerusalem|Acts 15]] records that Christianity does not require circumcision. Christianity does not forbid it either; the [[Gospel of Luke]] mentions that [[Circumcision of Jesus|Jesus himself was circumcised]].<ref>http://gracecommentary.com/luke-2_21-24/</ref> In 1442, the leadership of the [[Catholic Church]] declared that circumcision was not necessary.<ref>[[Pope Eugene IV]]'s [[Papal Bull|bull]] [http://catholicism.org/cantate-domino.html Cantate Domino] says that "The sacrosanct Roman Church" "commands all who glory in the name of Christian, at whatever time, before or after baptism, to cease entirely from circumcision, since, whether or not one places hope in it, it cannot be observed at all without the loss of eternal salvation."</ref> [[Coptic Orthodox Church of Alexandria|Coptic Christians]] practice circumcision as a rite of passage.<ref name=WHO_2007_GTDPSA/><ref name=Columbia_encyc_2011_circ/><ref name=riggs_2006/><ref name=Bolnick_2012_ch26/> The [[Ethiopian Orthodox Tewahedo Church|Ethiopian Orthodox Church]] calls for circumcision, with near-universal prevalence among Orthodox men in Ethiopia.<ref name=WHO_2007_GTDPSA/> In South Africa, some Christian churches disapprove of the practice, while others require it of their members.<ref name=WHO_2007_GTDPSA/>
====African cultures====
Certain African cultural groups, such as the [[Yoruba people|Yoruba]] and [[Igbo people|Igbo]] of Nigeria, customarily circumcize their infant sons. The procedure is also practiced by some cultural groups or individual family lines in the Sudan, Zaire, Uganda and in southern Africa. For some of these groups, circumcision appears to be purely cultural, done with no particular religious significance or intention to distinguish members of a group. For others, circumcision might be done for purification, or it may be interpreted as a mark of subjugation. Among these groups, even when circumcision is done for reasons of tradition, it is often done in hospitals.<ref name=encyc_religion_2005/>
====Australian cultures====
Some Australian Aboriginies use circumcision as a test of bravery and self-control as a part of a rite of passage into manhood, which results in full societal and ceremonial membership. It may be accompanied by body [[scarification]] and the [[dental extraction|removal of teeth]], and may be followed later by [[penile subincision]]. Circumcision is one of many trials and ceremonies required before a youth is considered to have become knowledgeable enough to maintain and pass on the cultural traditions. During these trials, the maturing youth bonds in solidarity with the men. Circumcision is also strongly associated with a man's family, and it is part of the process required to prepare a man to take a wife and produce his own family.<ref name=encyc_religion_2005/>
===Ethical and legal issues===
{{Main|Ethics of circumcision}}
{{See also|Circumcision controversies|Circumcision and law}}
[[File:Activist.jpg|thumb|A protest against infant circumcision]]
There is a long-running and vigorous debate over ethical concerns regarding circumcision, particularly neonatal circumcision for reasons other than intended direct medical benefit. There are three parties involved in the decision to circumcise a minor: the minor as the patient, the parents (or other guardians) and the physician. The physician is bound under the ethical principles of [[beneficence (ethics)|beneficence]] (promoting well-being) and [[primum non nocere|non-maleficence]] ("first, do no harm"), and so is charged with the responsibility to promote the best interests of the patient while minimizing unnecessary harms. Those involved must weigh the factors of what is in the best interest of the minor against the potential harms of the procedure.<ref name=caga-anan_2011/>
With a newborn involved, the decision is made more complex due the principles of respect for [[autonomy]] and consent, as a newborn cannot understand or engage in a logical discussion of his own values and best interests.<ref name=caga-anan_2011/><ref name=pinto_2012/> A mentally more mature child can understand the issues involved to some degree, and the physician and parents may elicit input from the child and weigh it appropriately in the decision-making process, although the law may not treat such input as legally informative. Ethicists and legal theorists also state that it is questionable for parents to make a decision for the child that precludes the child from making a different decision for himself later. Such a question can be raised for the decision by the parents either to circumcise or not to circumcise the child.<ref name=caga-anan_2011/>
Generally, circumcision on a minor is not ethically controversial or legally questionable when there is a clear and pressing medical indication for which it is the accepted best practice to resolve. Where circumcision is the chosen intervention, the physician has an ethical responsibility to ensure the procedure is performed competently and safely to minimize potential harms.<ref name=caga-anan_2011/><ref name=pinto_2012/> Worldwide, most legal jurisdictions do not have specific laws concerning the circumcision of males,<ref name=WHO_2007_GTDPSA/> but infant circumcision is considered legal under the existing laws in countries such as Australia, Canada, New Zealand, the UK and the US.<ref name=RACP_2010/> A few countries have passed legislation on the procedure: Germany allows non-therapeutic circumcision under certain conditions,<ref name=DW_2012/> while non-religious routine circumcision is illegal in South Africa and Sweden.<ref name=WHO_2007_GTDPSA/><ref name=RACP_2010/>
Societally, circumcision is often considered for reasons other than medical need. Public health advocates of circumcision consider it to be a net benefit overall, and therefore feel increasing the circumcision rate to be an ethical imperative. They recommend performing the procedure during the neonatal period, when it is less expensive and has a lower risk of complications.<ref name=pinto_2012/> While studies show there is a modest [[epidemiology|epidemiological]] benefit to circumcision, critics argue that the number of circumcisions that would have be performed would yield an overall negative public health outcome due to the resulting number of complications or other negative effects (such as pain). Pinto (2012) writes "sober proponents and detractors of circumcision agree that there is no overwhelming medical evidence to support either side."<ref name=pinto_2012/> This type of cost-benefit analysis is highly dependent on the kinds and frequencies of health problems in the population under discussion and how circumcision affects those health problems.<ref name=caga-anan_2011/>
Parents are assumed to have the child's best interests in mind. Ethically, it is imperative that the medical practitioner inform the parents about the benefits and risks of the procedure and obtain informed consent before performing it. Practically, however, many parents come to a decision about circumcising the child before he is born, and a discussion of the benefits and risks of the procedure with a physician has not been shown to have a significant effect on the decision. Some parents request to have their newborn or older child circumcised for non-theraeputic reasons, such as the parents' desires to adhere to family tradition, cultural norms or religious beliefs. In considering such a request, the physician may consider (in addition to any potential medical benefits and harms) such non-medical factors in determining the child's best interests and may ethically perform the procedure. Equally, without a clear medical benefit relative to the potential harms, a physician may take the ethical position that non-medical factors do not contribute enough as benefits to outweigh the potential harms and refuse the perform the procedure. Medical organization such as the [[British Medical Association]] state that their member physicians are not obliged to perform the procedure in such situations.<ref name=caga-anan_2011/><ref name=pinto_2012/>
===Economic considerations===
The cost-effectiveness of circumcision has been studied to determine whether a policy of circumcising all newborns or a policy of promoting and providing inexpensive or free access to circumcision for all adult men who choose it would result in lower overall societal healthcare costs. As [[HIV/AIDS]] is an incurable disease that is expensive to manage, significant effort has been spent studying the cost-effectiveness of circumcision to reduce its spread in parts of Africa that have a relatively high infection rate and low circumcision prevalence.<ref name=doyle_2010/> Several analyses have concluded that circumcision programs for adult men in Africa are cost-effective and in some cases are cost-saving.<ref name=uthman_2010/> In Rwanda, circumcision has been found to be cost-effective across a wide range of age groups from newborn to adult,<ref name=albero_2012/><ref name=binagwaho_2010/> with the greatest savings achieved when the procedure is performed in the newborn period due to the lower cost per procedure and greater timeframe for HIV infection protection.<ref name=kim_2010/><ref name=binagwaho_2010/> Circumcision for the prevention of HIV transmission in adults has also been found to be cost-effective in South Africa, Kenya and Uganda, with cost savings estimated in the billions of US dollars over 20 years.<ref name=doyle_2010/> Hankins ''et al.'' (2011) estimated that a $1.5 billion investment in circumcision for adults in 13 high-priority African countries would yield $16.5 billion in savings.<ref name=hankins_2011/>
The overall cost-effectiveness of neonatal circumcision has also been studied in the United States, which has a significantly different cost setting from Africa in areas such as public health infrastructure, availability of medications, and medical technology and the willingness to use it.<ref name=xu_2009/> A study by the CDC suggests that newborn circumcision would be societally cost-effective in the United States based on circumcision's efficacy against the heterosexual transmission of HIV alone, without considering any other cost benefits.<ref name=AAP_2012/> The American Academy of Pediatrics (2012) recommends that neonatal circumcision in the United States be covered by third-party payers such as [[Medicaid]] and insurance.<ref name=AAP_2012/> A Johns Hopkins study (2012) that considered reported benefits of circumcision such as reduced risks from HIV, HPV, HSV-2 and UTIs calculated that if the circumcision rate in the United States were to drop from 55% to 10% (the rate in Europe), it would "increase lifetime health care costs by $407 per male and $43 per female."<ref name=kacker_2012/> The cost of the procedure is more expensive for an older male than a newborn.<ref name=sadeghi-nejad_2010/>
==Referensi==
{{Reflist|colwidth=30em|refs=
<ref name=AAP_2012>{{cite journal |author=American Academy of Pediatrics Task Force on Circumcision |title=Technical Report |journal=Pediatrics |volume=130 |issue=3 |year=2012 |pages=e756–e785 |issn=0031-4005 |pmid=22926175 |doi=10.1542/peds.2012-1990 |url=http://pediatrics.aappublications.org/content/130/3/e756.full}}
</ref>
<ref name=Bolnick_2012_ch1>Bolnick (2012), ch. 1, ''Current Circumcision Trends and Guidelines'', pp. 3-8</ref>
<ref name=caga-anan_2011>{{cite book |author=Caga-anan EC, Thomas AJ, Diekema DS, Mercurio MR, Adam MR |title=Clinical Ethics in Pediatrics: A Case-Based Textbook |page=43 |date=8 September 2011 |publisher=Cambridge University Press |isbn=978-0-521-17361-2 |url=http://books.google.com/books?id=C1T6NrSPD_AC&pg=PA43}}</ref>
<ref name=ACS_2012>{{cite web |title=Can penile cancer be prevented? |url=http://www.cancer.org/cancer/penilecancer/detailedguide/penile-cancer-prevention |work=Learn About Cancer: Penile Cancer: Detailed Guide |publisher=American Cancer Society |accessdate=2012-10-25}}</ref>
<ref name=AAFP_2007>{{cite web |title=Circumcision: Position Paper on Neonatal Circumcision |accessdate=2007-01-30 |year=2007 |publisher=American Academy of Family Physicians |url=http://www.aafp.org/online/en/home/clinical/clinicalrecs/guidelines/Circumcison.html}}</ref>
<ref name=alanis_2004>{{cite journal |author=Alanis MC, Lucidi RS |title=Neonatal circumcision: a review of the world's oldest and most controversial operation |journal=Obstet Gynecol Surv |volume=59 |issue=5 |pages=379–95 |date=May 2004 |pmid=15097799 |doi=10.1097/00006254-200405000-00026 }}</ref>
<ref name=Columbia_encyc_2011_circ>{{cite encyclopedia |year=2011 |title=Circumcision |encyclopedia=Columbia Encyclopedia |publisher=Columbia University Press |url=http://www.infoplease.com/encyclopedia/science/circumcision.html }}</ref>
<ref name=clark_2011>{{cite book |author=Clark M |title=Islam For Dummies |page=170 |date=10 March 2011 |publisher=John Wiley & Sons |isbn=978-1-118-05396-6 |url=http://books.google.com/books?id=zPXu561ZpvgC&pg=PA178}}</ref>
<ref name=Bolnick_2012_ch14>Bolnick (2012), ch. 14, ''Adult Circumcision'', pp. 165-176</ref>
<ref name=CPSBC_2009>{{cite journal |title=Professional Standards and Guidelines – Circumcision (Infant Male) |publisher=College of Physicians and Surgeons of British Columbia |date=September 2009 |accessdate=2012-09-11 |url=https://www.cpsbc.ca/files/u6/Circumcision-Infant-Male.pdf |format=PDF}}</ref>
<ref name=dinh_2010>{{cite journal |author1=Dinh MH |author2=Fahrbach KM |author3=Hope TJ |title=The role of the foreskin in male circumcision: an evidence-based review |journal=Am J Reprod Immunol |date=March 2011 |pmid=21114567 |doi=10.1111/j.1600-0897.2010.00934.x|url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3091617/}}</ref>
<ref name=CDC_2008>{{cite web |title=Male Circumcision and Risk for HIV Transmission and Other Health Conditions: Implications for the United States |publisher=Centers for Disease Control and Prevention |date=7 February 2008 |url=http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm |accessdate=15 July 2011}}</ref>
<ref name=CDC_NCHS_EStat_2013>{{cite web | url=http://www.cdc.gov/nchs/data/hestat/circumcision_2013/circumcision_2013.htm#table | title=Trends in Circumcision for Male Newborns in U.S. Hospitals: 1979–2010 | publisher=Centers for Disease Control and Prevention | date=August 22, 2013 | accessdate=22 January 2014 | author=Owings M et al.}}</ref>
<ref name=albero_2012>{{cite journal |author=Albero G, Castellsagué X, Giuliano AR, Bosch FX |title=Male Circumcision and Genital Human Papillomavirus: A Systematic Review and Meta-Analysis |journal=Sex Transm Dis |volume=39 |issue=2 |pages=104–113 |date=February 2012 |pmid=22249298 |doi=10.1097/OLQ.0b013e3182387abd}}</ref>
<ref name=CDC_HPV>{{cite web |url=http://www.cdc.gov/std/HPV/STDFact-HPV.htm |title=STD facts – Human papillomavirus (HPV) |publisher=CDC |accessdate=September 12, 2012}}</ref>
<ref name=becker_2011>{{cite journal |author=Becker K |title=Lichen sclerosus in boys |journal=Dtsch Arztebl Int |volume=108 |issue=4 |pages=53–8 |date=January 2011 |pmid=21307992 |pmc=3036008 |doi=10.3238/arztebl.2011.053}}</ref>
<ref name=aridogan_2011>{{cite journal |author=Aridogan IA, Izol V, Ilkit M |title=Superficial fungal infections of the male genitalia: a review |journal=Crit. Rev. Microbiol. |volume=37 |issue=3 |pages=237–44 |date=August 2011 |pmid=21668404 |doi=10.3109/1040841X.2011.572862}}</ref>
<ref name=AUA_2007>{{cite web |url=http://www.auanet.org/about/policy-statements/circumcision.cfm|title=Circumcision |accessdate=2008-11-02 |author=American Urological Association}}</ref>
<ref name=doyle_2005>{{cite journal |author=Doyle D |title=Ritual male circumcision: a brief history |journal=The journal of the Royal College of Physicians of Edinburgh |volume=35 |issue=3 |pages=279–285 |date=October 2005 |pmid=16402509}}</ref>
<ref name=drain_2006>{{cite journal |author=Drain PK, Halperin DT, Hughes JP, Klausner JD, Bailey RC |title=Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries |journal=BMC Infectious Diseases |volume=6 |pages=172 |year=2006 |pmid=17137513 |pmc=1764746 |doi=10.1186/1471-2334-6-172}}</ref>
<ref name=boyle_hill_2011>{{cite journal |author=Boyle GJ, Hill G |title=Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: methodological, ethical and legal concerns |journal=J Law Med |year=2011 |volume=19 |issue=2 |pages=316–34 |pmid=22320006}}</ref>
<ref name=dowsett_2007>{{cite journal |author=Dowsett GW, Couch M |title=Male circumcision and HIV prevention: is there really enough of the right kind of evidence? |journal=Reproductive Health Matters |volume=15 |issue=29 |pages=33–44 |date=May 2007 |pmid=17512372 |doi=10.1016/S0968-8080(07)29302-4 }}</ref>
<ref name=alsabbagh_1996>{{cite book |author=al-Sabbagh, Muhammad Lutfi |title=Islamic ruling on male and female circumcision |page=16 |year=1996 |publisher=World Health Organization |isbn=92-9021-216-0 |url=http://www.emro.who.int/dsaf/dsa54.pdf}}</ref>
<ref name=darby_2011>{{cite journal |author=Darby R, Van Howe R |title=Not a surgical vaccine: there is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia |journal=Australian and New Zealand Journal of Public Health |volume=35 |issue=5 |pages=459–465 |year=2011 |pmid=21973253 |doi=10.1111/j.1753-6405.2011.00761.x }}</ref>
<ref name=AVAC_2012>{{cite web |url=http://www.avac.org/ht/d/sp/i/272/pid/272 |title=About male circumcision |accessdate=December 2012 |author=AVAC: Global Advocacy for HIV Prevention}}</ref>
<ref name=Bolnick_2012_ch23>Bolnick (2012), ch. 23, ''Jewish Ritual Circumcision'', pp. 265-274</ref>
<ref name=binagwaho_2010>{{cite journal |author=Binagwaho A, Pegurri E, Muita J, Bertozzi S |title=Male circumcision at different ages in Rwanda: a cost-effectiveness study |journal=Public Library of Science |volume=7 |issue=1 |pages=e1000211 |date=Jan 2010 |pmid=20098721 |pmc=2808207 |doi=10.1371/journal.pmed.1000211 |editor1-last=Kalichman |editor1-first=Seth C}}</ref>
<ref name=Bolnick_2012_ch24>Bolnick (2012), ch. 24, ''Islam and Circumcision'', pp. 275-280</ref>
<ref name=Bolnick_2012_ch26>Bolnick (2012), ch. 26, ''Circumcision in the Early Christian Church'', pp. 291-298</ref>
<ref name="CDC_NCHS_EStat_2013">{{cite web | url=http://www.cdc.gov/nchs/data/hestat/circumcision_2013/circumcision_2013.htm#table | title=Trends in Circumcision for Male Newborns in U.S. Hospitals: 1979–2010 | publisher=Centers for Disease Control and Prevention | date=August 22, 2013 | accessdate=22 January 2014 | author=Owings M et al.}}</ref><ref name=DW_2012>{{cite news | url=http://www.dw.de/circumcision-remains-legal-in-germany/a-16399336 | title=Circumcision remains legal in Germany | work=Deutsche Welle | date=12 Dec 2012 | accessdate=11 September 2013}}</ref>
<ref name=doyle_2010>{{cite journal |author=Doyle S, Kahn J, Hosang N, Carroll P |title=The Impact of Male Circumcision on HIV Transmission |journal=Journal of Urology |volume=183 |pages=21–26 |year=2010 |pmid=19913816 |doi=10.1016/j.juro.2009.09.030 |issue=1}}</ref>
<!-- ref name=eaton_2009>{{cite journal |author=Eaton L, Kalichman SC |title=Behavioral aspects of male circumcision for the prevention of HIV infection |journal=Curr HIV/AIDS Rep |volume=6 |issue=4 |pages=187–93 |date=November 2009 |pmid=19849961 |doi=10.1007/s11904-009-0025-9 |pmc=3557929}}</ref -->
<ref name=hay_2012>{{cite book |author=Hay W, Levin M |title=Current Diagnosis and Treatment Pediatrics 21/E |pages=18–19 |date=25 June 2012 |publisher=McGraw Hill Professional |isbn=978-0-07-177971-5 |url=http://books.google.com/books?id=V8lMJniWK_QC}}</ref>
<ref name=hpv_prevalence>See: Larke ''et al.'' "Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis" (2011), Albero ''et al.'' "Male Circumcision and Genital Human Papillomavirus: A Systematic Review and Meta-Analysis" (2012), Rehmeyer "Male Circumcision and Human Papillomavirus Studies Reviewed by Infection Stage and Virus Type" (2011).</ref>
<ref name=glass_1999>{{cite journal |author=Glass JM |title=Religious circumcision: a Jewish view |journal=[[BJUI]] |volume=83 Suppl 1 |pages=17–21 |date=January 1999 |pmid=10349410 |doi=10.1046/j.1464-410x.1999.0830s1017.x }}</ref>
<ref name=krieger_2011>{{cite journal |author=Krieger JN |title=Male circumcision and HIV infection risk |journal=World Journal of Urology |volume=30 |issue=1 |pages=3–13 |date=May 2011 |pmid=21590467 |doi=10.1007/s00345-011-0696-x}}</ref>
<ref name=kim_2010>{{cite journal |last=Kim H, Li PS, Goldstein M |title=Male circumcision: Africa and beyond? |journal=Current Opinion in Urology |date=November 2010 |volume=20 |issue=6 |pages=515–9 |pmid=20844437 |doi=10.1097/MOU.0b013e32833f1b21 |first1=Howard H |last2=Li |first2=Philip S |last3=Goldstein |first3=Marc}}</ref>
<ref name=hayashi_2011>{{cite journal |author=Hayashi Y, Kojima Y, Mizuno K, Kohri K |title=Prepuce: phimosis, paraphimosis, and circumcision |journal=ScientificWorldJournal |volume=11 |pages=289–301 |year=2011 |pmid=21298220 |doi=10.1100/tsw.2011.31}}</ref>
<ref name=jagannath_2012>{{cite journal |author=Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S |title=Routine neonatal circumcision for the prevention of urinary tract infections in infancy |journal=Cochrane Database of Systematic Reviews |volume=11 |issue= |pages=CD009129 |year=2012 |pmid=23152269 |doi=10.1002/14651858.CD009129.pub2 |editor1-last=Fedorowicz |editor1-first=Zbys}}</ref>
<ref name=jagannath_2011>{{cite journal |author=Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S |title=Routine neonatal circumcision for the prevention of urinary tract infections in infancy (Protocol) |journal=Cochrane Database of Systematic Reviews |issue=5 |pages=CD009129 |year=2011 |doi=10.1002/14651858.CD009129 |editor1-last=Fedorowicz |editor1-first=Zbys}}</ref>
<ref name=KNMG_2010>{{cite web |title=Non-therapeutic circumcision of male minors (2010) |publisher=KNMG |date=12 June 2010 |url=http://knmg.artsennet.nl/Diensten/knmgpublicaties/KNMGpublicatie/Nontherapeutic-circumcision-of-male-minors-2010.htm}}</ref>
<ref name=klavs_2008>{{cite journal |author=Klavs I, Hamers FF |title=Male circumcision in Slovenia: results from a national probability sample survey |journal=Sexually Transmitted Infections |volume=84 |issue=1 |pages=49–50 |date=February 2008 |pmid=17881413 |doi=10.1136/sti.2007.027524}}</ref>
<ref name=ko_2007>{{cite journal |author=Ko MC, Liu CK, Lee WK, Jeng HS, Chiang HS, Li CY |title=Age-specific prevalence rates of phimosis and circumcision in Taiwanese boys |journal=Journal of the Formosan Medical Association=Taiwan Yi Zhi |volume=106 |issue=4 |pages=302–7 |date=April 2007 |pmid=17475607 |doi=10.1016/S0929-6646(09)60256-4}}</ref>
<ref name=gollaher_2001_ch1>Gollaher (2001), ch. 1, ''The Jewish Tradition'', pp. 1-30</ref>
<ref name=encyc_judaica_2006>{{cite encyclopedia |year=2006 |title=Circumcision |encyclopedia=Encyclopaedia Judaica |edition=2 |publisher=Macmillan Reference |location=USA |isbn=978-0-02-865928-2}}</ref>
<ref name=gollaher_2001_ch2>Gollaher (2001), ch. 2, ''Christians and Muslims'', pp. 31-52</ref>
<ref name=gollaher_2001_ch3>Gollaher (2001), ch. 3, ''Symbolic Wounds'', pp. 53-72</ref>
<ref name=gollaher_2001_ch4>Gollaher (2001), ch. 4, ''From Ritual to Science'', pp. 73-108</ref>
<ref name=frisch_2013>{{cite journal |author1=Frisch M |author2=Aigrain Y |author3=Barauskas V |author4=Bjarnason R |author5=Boddy S-A |author6=Czauderna P |author7=De Gier RPE |author8=De Jong TPVM |author9=Fasching G |author10=Fetter W |author11=Gahr M |author12=Graugaard C |author13=Greisen G |author14=Gunnarsdottir A |author15=Hartmann W |author16=Havranek P |author17=Hitchcock R |author18=Huddart S |author19=Janson S |author20=Jaszczak P |author21=Kupferschmid C |author22=Lahdes-Vasama T |author23=Lindahl H |author24=MacDonald N |author25=Markestad T |author26=Märtson M | author27=Nordhov | author28=Pälve H| author29=Petersons A |author30=Quinn F |display-authors=1 |title=Cultural Bias in the AAP's 2012 Technical Report and Policy Statement on Male Circumcision |journal=Pediatrics |year=2013 |doi=10.1542/peds.2012-2896 |volume=131 |issue=4 |pages=796–800 |pmid=23509170}}</ref>
<ref name=encyc_religion_2005>{{cite encyclopedia |year=2005 |title=Circumcision |encyclopedia=Encyclopedia of Religion |edition=2 |publisher=Gale}}</ref>
<ref name=hankins_2011>{{cite journal |author=Hankins C, Forsythe S, Njeuhmeli E |title=Voluntary medical male circumcision: an introduction to the cost, impact, and challenges of accelerated scaling up |journal=Arch Pediatr Adolesc Med |volume=8 |issue=11 |pages=e1001127 |date=Mar 2012 |pmid=22140362 |pmc=3226452 |doi=10.1371/journal.pmed.1001127 |editor1-last=Sansom |editor1-first=Stephanie L}}</ref>
<ref name=kacker_2012>{{cite journal |author=Kacker S, Frick KD, Gaydos CA, Tobian AA |title=Costs and Effectiveness of Neonatal Male Circumcision |journal=Public Library of Science |pages=1–9 |date=Aug 2012 |pmid=22911349 |doi=10.1001/archpediatrics.2012.1440 |volume=166 |issue=10 |pmc=3640353}}</ref>
<!-- ref name=larke_2010>{{cite journal |author=Larke N |title=Male circumcision, HIV and sexually transmitted infections: a review |journal=British journal of nursing (Mark Allen Publishing) |volume=19 |issue=10 |pages=629–34 |date=June 2010 |pmid=20622758}}</ref -->
<ref name=lissauer_2012>{{cite book |author=Lissauer T, Clayden G |title=Illustrated Textbook of Paediatrics, Fourth edition |pages=352–353 |date=October 2011 |publisher=Elsevier |isbn=978-0-7234-3565-5}}</ref>
<ref name=lonngvist_2010>{{cite journal |author=Lonnqvist P |title=Regional anaesthesia and analgesia in the neonate |journal=Best Pract Res Clin Anaesthesiol |volume=24 |issue=3 |pages=309–21 |date=Sep 2010 |pmid=21033009 |doi=10.1016/j.bpa.2010.02.012}}</ref>
<ref name=larke_HPV_2011>{{cite journal |author=Larke N, Thomas SL, Dos Santos Silva I, Weiss HA |title=Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis |journal=J. Infect. Dis. |volume=204 |issue=9 |pages=1375–90 |date=November 2011 |pmid=21965090 |doi=10.1093/infdis/jir523}}</ref>
<ref name=millett_2008>{{cite journal |author=Millett GA, Flores SA, Marks G, Reed JB, Herbst JH |title=Circumcision status and risk of HIV and sexually transmitted infections among men who have sex with men: a meta-analysis |journal=JAMA |volume=300 |issue=14 |pages=1674–84 |date=October 2008 |pmid=18840841 |doi=10.1001/jama.300.14.1674}}</ref>
<ref name=leber_2006>{{cite web |url=http://www.emedicine.com/derm/topic615.htm |title=Balanitis |accessdate=2008-10-14 |author=Leber M, Tirumani A |date=June 8, 2006 |publisher=EMedicine}}</ref>
<ref name=osipov_2006>{{cite web |url=http://www.emedicine.com/derm/topic615.htm |title=Balanoposthitis |accessdate=2006-11-20 |author=Osipov V, Acker S |date=November 2006 |work=Reactive and Inflammatory Dermatoses |publisher=EMedicine}}</ref>
<ref name=larke_penile_cancer_2011>{{cite journal |author=Larke NL, Thomas SL, Dos Santos Silva I, Weiss HA |title=Male circumcision and penile cancer: a systematic review and meta-analysis |journal=Cancer Causes Control |volume=22 |issue=8 |pages=1097–110 |date=August 2011 |pmid=21695385 |pmc=3139859 |doi=10.1007/s10552-011-9785-9}}</ref>
<ref name=NYTimes_2009>{{cite news |title=AIDS: New Web Site Seeks to Fight Myths About Circumcision and H.I.V. |first=Donald G. |last=McNeil, Jr. |authorlink=Donald McNeil, Jr. |url=https://www.nytimes.com/2009/03/03/health/03glob.html?_r=2&adxnnl=1&ref=scien |newspaper=The New York Times |date=March 3, 2009 |page=D6 |accessdate=February 1, 2012}}</ref>
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<ref name=rudolph_2011>{{cite book |author=Rudolph C, Rudolph A, Lister G, First L, Gershon A |title=Rudolph's Pediatrics, 22nd Edition |page=188 |date=18 March 2011 |publisher=McGraw-Hill Companies, Incorporated |isbn=978-0-07-149723-7 |url=http://books.google.com/books?id=or15PgAACAAJ}}</ref>
<ref name=sawyer_2011>{{cite book |author=Sawyer S |title=Pediatric Physical Examination & Health Assessment |pages=555–556 |date=November 2011 |publisher=Jones & Bartlett Publishers |isbn=978-1-4496-7600-1 |url=http://books.google.com/books?id=W6eRUtlujbkC&pg=PA555}}</ref>
<ref name=pinto_2012>{{cite journal |author=Pinto K |title=Circumcision controversies |journal=Pediatric clinics of North America |volume=59 |issue=4 |pages=977–986 |date=August 2012 |doi=10.1016/j.pcl.2012.05.015 |pmid=22857844}}</ref>
<ref name=WHO_2007_GTDPSA>{{cite web |title=Male circumcision: Global trends and determinants of prevalence, safety and acceptability |year=2007 |publisher=World Health Organization |url=http://whqlibdoc.who.int/publications/2007/9789241596169_eng.pdf |format=PDF}}</ref>
<ref name=siegfried_Cochrane_2009>{{cite journal |author=Siegfried N, Muller M, Deeks JJ, Volmink J |title=Male circumcision for prevention of heterosexual acquisition of HIV in men |journal=Cochrane Database of Systematic Reviews |issue=2 |pages=CD003362 |year=2009 |pmid=19370585 |doi=10.1002/14651858.CD003362.pub2 |editor1-last=Siegfried |editor1-first=Nandi}}</ref>
<ref name=uthman_2010>{{cite journal |author=Uthman OA, Popoola TA, Uthman MM, Aremu O |title=Economic evaluations of adult male circumcision for prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa: a systematic review |journal=PLoS ONE |volume=5 |issue=3 |pages=e9628 |year=2010 |pmid=20224784 |pmc=2835757 |doi=10.1371/journal.pone.0009628 |editor1-last=Van Baal |editor1-first=Pieter H. M}}</ref>
<ref name=WHO_HIV_2007>{{cite web |title=WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention |publisher=World Health Organization |date=March 2007 |url=http://www.who.int/hiv/mediacentre/news68/en/index.html}}</ref>
<ref name=wetmore_2010>{{cite journal |author=Wetmore CM, Manhart LE, Wasserheit JN |title=Randomized controlled trials of interventions to prevent sexually transmitted infections: learning from the past to plan for the future |journal=Epidemiol Rev |volume=32 |issue=1 |pages=121–36 |date=April 2010 |pmid=20519264 |pmc=2912604 |doi=10.1093/epirev/mxq010 }}</ref>
<ref name=weiss_2010_complications>{{cite journal |author=Weiss HA, Larke N, Halperin D, Schenker I |title=Complications of circumcision in male neonates, infants and children: a systematic review |journal=BMC Urol |volume=10 |pages=2 |year=2010 |pmid=20158883 |pmc=2835667 |doi=10.1186/1471-2490-10-2}}</ref>
<ref name=sexual_function>The American Academy of Pediatrics Task Force on Circumcision "Technical Report" (2012) addresses sexual function, sensitivity and satisfaction without qualification by age of circumcision. Sadeghi-Nejad ''et al.'' "Sexually transmitted diseases and sexual function" (2010) addresses adult circumcision and sexual function. Doyle ''et al.'' "The Impact of Male Circumcision on HIV Transmission" (2010) addresses adult circumcision and sexual function. Perera ''et al.'' "Safety and efficacy of nontherapeutic male circumcision: a systematic review" (2010) addresses adult circumcision and sexual function and satisfaction.</ref>
<ref name=WHO_Manual_2009>{{cite web |title=Manual for male circumcision under local anaesthesia |publisher=World Health Organization |date=December 2009 |url=http://www.who.int/hiv/pub/malecircumcision/local_anaesthesia/en/index.html}}</ref>
<ref name=WHO_adult_devices_2012>{{cite journal |year=2012 |title=Use of devices for adult male circumcision in public health HIV prevention programmes: Conclusions of the Technical Advisory Group on Innovations in Male Circumcision |publisher=World Health Organization |url=http://whqlibdoc.who.int/hq/2012/WHO_HIV_2012.7_eng.pdf |format=PDF}}</ref>
<ref name=perera_2010>{{cite journal |author=Perera CL, Bridgewater FH, Thavaneswaran P, Maddern GJ |title=Safety and efficacy of nontherapeutic male circumcision: a systematic review |journal=Annals of Family Medicine |volume=8 |issue=1 |pages=64–72 |year=2010 |pmid=20065281 |pmc=2807391 |doi=10.1370/afm.1073}}</ref>
<ref name=shockley_2011>{{cite journal |author=Shockley RA, Rickett K |title=Clinical inquiries. What's the best way to control circumcision pain in newborns? |journal=J Fam Pract |volume=60 |issue=4 |pages=233a–b |date=April 2011 |pmid=21472156}}</ref>
<ref name=wolter_2008>{{cite book |author=Wolter C, Dmochowski R |title=Handbook of Office Urological Procedures |chapter=Circumcision |pages=88- |year=2008 |publisher=Springer |isbn=978-1-84628-523-3 |url=http://books.google.com/books?id=-ek1wPWaUKkC&pg=PA88}}</ref>
<ref name=weiss_2010_HIV>{{cite journal |author=Weiss HA, Dickson KE, Agot K, Hankins CA |title=Male circumcision for HIV prevention: current research and programmatic issues |journal=AIDS |year=2010 |volume=24 Suppl 4 |pages=S61–9 |pmid=21042054 |doi=10.1097/01.aids.0000390708.66136.f4 |url=http://journals.lww.com/aidsonline/Fulltext/2010/10004/Male_circumcision_for_HIV_prevention__current.7.aspx}}</ref>
<ref name=rehmeyer_2011>{{cite journal |last=Rehmeyer C |title=Male Circumcision and Human Papillomavirus Studies Reviewed by Infection Stage and Virus Type |journal=J Am Osteopathy Assoc |volume=111 |issue=3 suppl 2 |pages=S11–S18 |year=2011 |pmid=21415373 |url=http://www.jaoa.org/content/111/3_suppl_2/S11.long |first1=CJ}}</ref>
<ref name=WHO_CandR_2007>{{cite web |title=New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications |publisher=World Health Organization |date=March 28, 2007 |url=http://www.who.int/hiv/mediacentre/MCrecommendations_en.pdf |format=PDF}}</ref>
<ref name=richters_2006>{{cite journal |author=Richters J, Smith AM, de Visser RO, Grulich AE, Rissel CE |title=Circumcision in Australia: prevalence and effects on sexual health |journal=Int J STD AIDS |volume=17 |issue=8 |pages=547–54 |date=August 2006 |pmid=16925903 |doi=10.1258/095646206778145730}}</ref>
<ref name=sansom_2010>{{cite journal |author=Sansom SL, Prabhu VS, Hutchinson AB, ''et al.'' |title=Cost-effectiveness of newborn circumcision in reducing lifetime HIV risk among U.S. males |journal=PLoS ONE |volume=5 |issue=1 |pages=e8723 |year=2010 |pmid=20090910 |pmc=2807456 |doi=10.1371/journal.pone.0008723 |editor1-last=Kissinger |editor1-first=Patricia}}</ref>
<ref name=RACP_2010>{{cite web | url=http://www.racp.edu.au/index.cfm?objectid=65118B16-F145-8B74-236C86100E4E3E8E | title=Circumcision of Infant Males | publisher=The Royal Australasian College of Physicians | date=Sept 2010 | accessdate=11 September 2013}}</ref>
<ref name=templeton_2010>{{cite journal |author=Templeton DJ, Millett GA, Grulich AE |title=Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men |journal=Current Opinion in Infectious Diseases |volume=23 |issue=1 |pages=45–52 |date=February 2010 |pmid=19935420 |doi=10.1097/QCO.0b013e328334e54d}}</ref>
<ref name=riggs_2006>{{cite book |author=Thomas Riggs |title=Worldmark Encyclopedia of Religious Practices: Religions and denominations |chapter=Christianity: Coptic Christianity |year=2006 |publisher=Thomson Gale |isbn=978-0-7876-6612-5 |url=http://books.google.com/books?id=uTMOAQAAMAAJ}}</ref>
<ref name=wiysonge_2011>{{cite journal |author=Wiysonge CS, Kongnyuy EJ, Shey M, ''et al.'' |title=Male circumcision for prevention of homosexual acquisition of HIV in men |journal=Cochrane Database of Systematic Reviews |issue=6 |pages=CD007496 |year=2011 |pmid=21678366 |doi=10.1002/14651858.CD007496.pub2 |editor1-last=Wiysonge |editor1-first=Charles Shey}}</ref>
<ref name=sadeghi-nejad_2010>{{cite journal |author=Sadeghi-Nejad H, Wasserman M, Weidner W, Richardson D, Goldmeier D |title=Sexually transmitted diseases and sexual function |journal=J Sex Med |volume=7 |issue=1 Pt 2 |pages=389–413 |date=January 2010 |pmid=20092446 |doi=10.1111/j.1743-6109.2009.01622.x}}</ref>
<ref name=weiss_2006_syphilis>{{cite journal |author=Weiss HA, Thomas SL, Munabi SK, Hayes RJ |title=Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta‐analysis |journal=Sexually Transmitted Infections |volume=82 |issue=2 |pages=101–9; discussion 110 |date=April 2006 |pmid=16581731 |pmc=2653870 |doi=10.1136/sti.2005.017442}}</ref>
<ref name=siegfried_Cochrane_2003>{{cite journal |author=Siegfried N, Muller M, Volmink J, ''et al.'' |title=Male circumcision for prevention of heterosexual acquisition of HIV in men |journal=Cochrane Database of Systematic Reviews |issue=3 |pages=CD003362 |year=2003 |pmid=12917962 |doi=10.1002/14651858.CD003362 |editor1-last=Siegfried |editor1-first=Nandi}}</ref>
<ref name=xu_2009>{{cite journal |author=Xu X, Patel DA, Dalton VK, Pearlman MD, Johnson TR |title=Can routine neonatal circumcision help prevent human immunodeficiency virus transmission in the United States? |journal=American journal of men's health |volume=3 |issue=1 |pages=79–84 |date=Mar 2009 |pmid=19430583 |doi=10.1177/1557988308323616 |pmc=2678848}}</ref>
}}
==Bibliografi==
{{Refbegin}}
* {{cite book |last=Bolnick D A, Koyle M, Yosha A |title=Surgical Guide to Circumcision |date=September 2012 |publisher=Springer |isbn=978-1-4471-2857-1 |url=http://books.google.com/books?id=w7zyKB9mdMwC}}
* {{cite book |last=Gollaher D |title=Circumcision: A History Of The World's Most Controversial Surgery |date=February 2001 |publisher=Basic Books |isbn=978-0-465-02653-1 |url=http://books.google.com/books?id=usEzSffvPBMC}}
{{Refend}}
==Pranala
{{Wikinewscat}}
{{Commons category}}
* Video bayi disunat: menggunakan [http://newborns.stanford.edu/Plastibell.html Plastibell], [http://newborns.stanford.edu/Gomco.html Gomco clamp] dan [http://newborns.stanford.edu/Mogen.html Mogen clamp] (semua dari ‘’Stanford Medical School’’)
* Sebuah [https://www.youtube.com/watch?v=Zw-124t993c Xhosa circumcision] dari ‘’National Geographic’’
{{Good article}}
{{Sunat}}
{{Male genital procedures}}
[[Kategori:Circumcision]]
[[Kategori:Cosmetic surgery]]
[[Kategori:Male genital modification]]
[[Kategori:HIV prevention tools]]
[[Kategori:Male genital procedures]]
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[[Kategori:Religion and children]]
[[Kategori:Surgical removal procedures]]
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