Circumcision Law

Circumcision of all males was one of the terms and conditions of God's agreement with ancient Israel and will be required as a part of his new agreement with them after Christ returns. But, is male circumcision required for Israelites and non-Israelites under the gospel age agreement with God the Father? Are there spiritual or physical advantages to being either circumcised or uncircumcised?

In order to understand the law of circumcision and its past, present, and future application one must understand the original intent of the law and its literal and symbolic meaning. Moreover, in order to determine whether or not male circumcision is required under the gospel age agreement between the Sovereign Father and the sons of his new creation, the following basic topic areas must be explored:

1. A review of biblical circumcision from a prophetic and historical perspective
2. An understanding of the edict of Acts 15 about circumcision
3. The apostle Paul's thoughts and teachings about circumcision

HISTORICAL AND PROPHETIC REVIEW

Abraham and the Covenant

The first biblical record of circumcision is in the Book of Genesis and seems to tell us that any male descendant of Abraham must be circumcised in order to benefit from a covenant relationship with the Creator God:

"And God said to Abraham, you shall keep my covenant, you and your seed after you in their generations. This is my covenant, which you shall keep, between me and you and your seed after you; Every male child among you shall be circumcised. And you shall circumcise the flesh of your foreskin; and it shall be a token of the covenant between me and you" (Gen.17:9-11 Para.).

The terms and conditions of the covenant between the Creator God and Abraham dictated that the act of circumcision was to be the physical evidence that there was indeed a perpetual covenant between the Creator God, Abraham, and his descendants.

"A son of eight days shall be circumcised among you, every male child in your generations, he that is born in the house, or bought with money of any stranger, which is not of your seed. He that is born in your house, and he that is bought with money, must be circumcised: and my covenant shall be in your flesh for an everlasting covenant" (Gen.17:12-13 Para.).

According to the Creator God's instructions to the Israelites, every newborn male descended from Abraham or a foreigner considered to be a member of an Israelite's household must be circumcised on the eight day of its life. Moreover, it is clear from the instruction "and he that is bought" includes the circumcision of males of all ages who are considered to be the property of an Israelite. This covenant is a perpetual covenant which is to be in force as long as there are descendants of Abraham.

"And the uncircumcised male child whose flesh of his foreskin is not circumcised, that soul shall be cut off from his people; he has broken my covenant" (Gen.17:14 Para.).

The perpetual covenant between the Creator God, Abraham, and Abraham's descendants promised many benefits for diligent adherence to its terms and conditions, but penalties for its violation.

If a male descendant of Abraham or a male who is considered property fails to be circumcised, that man is to be cut off from the benefits provided through the perpetual covenant between God, Abraham, and Abraham's descendants. Moreover, the Hebrew words used in the instruction in verse 14 strongly imply that "that soul shall be cut off " means a man who refuses circumcision was to be killed.

Moses Violates the Law

After Moses fled Egypt, he married Zapporah the daughter of a priest in the land of Midian. While he lived in Median, he fathered two sons by her. In the course of time, the Creator God revealed himself to Moses and told him what he wanted him to do about the Israelites in Egypt and sent him to do it:

"And you shall say to Pharaoh, The Lord says, Israel is my son, even my firstborn: And I say to you, Let my son go, that he may serve me: and if you refuse to let him go, Know this, because I will kill your son, even your firstborn" (Ex.4:22-23 Para.).

"And it came to pass by the way in the inn, that the Lord met Moses and had determined to kill him. Then Zipporah took a sharp stone, and cut off the foreskin of her sons, and cast it at his feet, and said, Surely a bloody husband you are to me" (Ex.4:24-25 Para.).

Although Moses was a man of great knowledge, ability, and humility, he had neglected to circumcise at least one or both of his two sons in accordance with God's law. It is not clear from the text (Ex.4:24-25) if God was going to kill Moses or Moses' sons. What is clear is that God felt this was a serious violation of his law and the offending party must die for this act of rebellion.

Zapporah understood God's law about circumcision, but did not act on it until a life was in jeopardy. Regardless of whom God was going to kill, it was Moses as the head of the family who was responsible for not having his sons circumcised in compliance with God's law.

The failure of Moses to obey God's law about circumcision shows that he did not yet fully understand the connection between obedience to God, blessings from God, and punishment for flagrant disobedience of God's law. Zapporah's quick action literally saved a life—once the circumcision was accomplished, both Moses and his sons were in compliance with God's law.

The scriptures leave out too many details about this event to make a thorough analysis; however, what is clearly shown is that compliance to the law of circumcision is an extremely important part of the covenant relationship between God and the Israelites.

The First Passover

Just before the Israelites observed the first Passover and were thrust out of Egypt, the Creator God gave them an instruction about circumcision. This instruction documents that circumcision was being practiced among the Israelites as a part of their cultural heritage.

"The Lord said to Moses and Aaron, This is the ordinance of the Passover: No foreigner shall eat of it. But every man's servant that is bought for money, when you have circumcised him, then shall he eat of it" (Ex.12:43-44 Para.).

Only those males who were considered to be an Israelite or the property of an Israelite could participate in the Passover ceremony, but only if the male was circumcised. Why was it important for all males to be circumcised before they could eat the Passover? It was important because circumcision was physical evidence that a covenant relationship existed between the Creator God and the Israelites.

National Israel

"The Lord spoke to Moses, saying, Speak to the children of Israel and say, If a woman has conceived and gives birth to a male child: then she shall be unclean seven days; according to the days of the separation for her infirmity shall she be unclean. And in the eighth day the flesh of his foreskin shall be circumcised" (Lev.12:1-3 Para.).

God reminded national Israel of the existing covenant between him and Abraham and that as inheritors of this agreement, they had to circumcise every newborn male child in the eighth day of its life in accordance with the terms and conditions of this covenant relationship.

Circumcision of an eight day old male was not for the purpose of establishing a covenant between the child and God, because when children were born into an Israelite family, they were also born into the national covenant. The children received their covenant relationship with the Creator God through birthright, not through the act of circumcision. The act of circumcision was performed as an act of compliance to the terms and conditions of the covenant.

Joshua

When the nation of Israel had crossed the Jordan river and began to claim the promised land, God ordered Joshua to perform a second national circumcision of all the males of Israel, because not all the males had been circumcised:

"At that time the Lord said to Joshua, Make sharp knives, and circumcise again the children of Israel a second time. Joshua made sharp knives, and circumcised the children of Israel at the hill of the foreskins. This is the reason why Joshua was told to perform the circumcision: All the males that came out of Egypt, that were men of war, died in the wilderness. All the males that came out were circumcised: but all the males that were born in the wilderness after they came out of Egypt had not been circumcised" (Josh.5:2-5 Para.).

The scriptures do not tell us why the newborn males were not circumcised while national Israel was being forced to wander in the wilderness for 40 years as punishment for their rebellion. We are just told that they were not and that they were to be circumcised and were to carry this evidence of their covenant relationship and obedience to the Creator God into the promised land.

John the Baptist and Jesus

Circumcision in accordance with God's law was performed on both John the Baptist and Jesus:

"Now Elisabeth's full time came that she should be delivered; and she brought forth a son. And her neighbors and her cousins heard how the Lord had showed great mercy on her; and they rejoiced with her. And it came to pass, that on the eighth day they came to circumcise the child . . ." (Lk.1:57-60 KJV).

"And when eight days were accomplished for the circumcising of the child, his name was called Jesus, which was so named of the angel before he was conceived in the womb" (Lk.2:21 KJV).

Circumcision is of the Heart

Although circumcision is a physical act, its spiritual implications were known by the Israelites:

"Behold, the heaven and the heaven of heavens is the Lord's your God, the earth also, with all that therein is. Only the Lord had a delight in your fathers to love them, and he chose their seed after them, even you above all people, as it is this day. Circumcise therefore the foreskin of your heart, and be no more stiff-necked" (Deut. 10:14-16 KJV). See also Deut.30:6; Jer.4:4.

After Christ Returns

The time setting of Ezekiel, chapter 44, is sometime after Christ returns to earth and all of the scattered tribes of Israel, including Judah have been gathered out of the nations and established as national Israel again. It is the time when God's government rules the world and a new temple and its attending priesthood and sacrificial system of worship have been reestablished in Jerusalem.

"Then he brought me to the way of the north gate before the temple: and I looked, and, behold, the glory of the Lord filled his temple: and I fell on my face. And the Lord said to me, Son of man, mark well, and behold with your eyes, and hear with your ears all that I say to you concerning all the ordinances of the Lord's temple, and all its laws; and mark well the entering into the temple, with all the exits from the sanctuary" (Ezk.44:4-6KJV Para.).

In this prophecy, Ezekiel is told to carefully note everything he sees and is told about the ordinances and the law in God's temple. Moreover, he is to carefully note the things pertaining to entering and leaving the temple area and its sanctuary.

"And you shall say to the rebellious house of Israel, This says the Lord God; O you house of Israel, let all your abominations be sufficient for you, In that you have brought into my sanctuary foreigners, uncircumcised in their heart, and uncircumcised in their flesh, to be in my sanctuary, to pollute it, even my house, when you offer my bread, the fat and the blood, and they have broken my covenant because of all your abominations" (Ezk.44:6-7 KJV Para.).

This prophecy is meant for the new nation of Israel. The Creator God reminds them of their past rebellion against him and his law and that the time of continual rebellion against him and his law has come to an end. He then reveals the two sins which caused this rebellion against him—an uncircumcised heart and an uncircumcised penis.

The following are the reasons these sins are the major causes of rebellion against God:

• Having an uncircumcised heart is symbolic of being unrighteous. The scriptures reveal that a person with an uncircumcised heart is sinful and rebellious in attitude and behavior before God. Having an uncircumcised heart is not gender-specific, because both men and women can be sinful and rebellious against God and his law. See Deut.10:12-16; 30:5-6; Jer.4:1-4.
• Being uncircumcised in the flesh prevents a male from having a covenant relationship with God under the terms and conditions of both the first and second agreements with national Israel. Moreover, this uncircumcised condition speaks to a sinful and rebellious attitude and behavior that places a barrier between God and the uncircumcised male. This makes it impossible for God to accept offerings or sacrifices from the uncircumcised male and prevents the priesthood from presenting sacrifices and offerings to God on behalf of the uncircumcised male.

Today, as we wait for Christ's return, the descendants of national Israel are scattered among the nations—a nation in exile—and are considered by God to be a nation of people who are uncircumcised of heart and flesh. See Jer.9:26.

"And you have not kept the charge of my holy things: but you have set keepers of my charge in my sanctuary for yourselves" (Ezk.44:8 KJV Para.).

God says that national Israel abandoned their responsibility in regard to the holy things he had placed in their care, which include his place of worship, the sacrificial system and all the ordinances and laws which pertained to it. Not only did they abandon their charge but they delegated these responsibilities to people who were not authorized to perform them.

"This says the Lord God; No foreigners, uncircumcised in heart, or uncircumcised in flesh, shall enter into my sanctuary, of any foreigner which is among the children of Israel" (Ezk.44:9 Para.).

After Christ returns and the temple and sacrificial system of worship are again established in Jerusalem, no non-Israelite who is uncircumcised in heart or is an uncircumcised male will be allowed to enter Jerusalem or this new temple to worship God. See Isa.52:1.

"And the Levites that are gone away far from me, when Israel went astray, which went astray away from me after their idols; they shall even bear their iniquity. Yet they shall be ministers in my sanctuary, having charge at the gates of the house, and ministering to the house: they shall kill the burnt offering and the sacrifice for the people, and they shall stand before them to minister to them" (Ezk. 44:10-11 KJV Para.).

The biblical record clearly shows that circumcision of the heart and of the flesh as specified by God were an integral part of the covenant relationship between the Creator God, Abraham, Abraham's descendants, national Israel and its citizens, and it will be apart of the new covenant relationship between God, Israelites and non-Israelites after Christ returns.

The scriptures clearly show that it is God who dictates the terms and conditions of any covenant relationship between him and those who worship and serve him. And it is clear from the holy scriptures that circumcision was required before the advent of Christ and will be required after his return.

THE EDICT OF ACTS 15

Is male circumcision required in order to have a covenant with God the Father during the gospel age of salvation? In order to answer this question we must go to the Book of Acts and see how the apostles decided this issue and how the apostle Paul carried out this edict in his ministry.

When God made the first agreement with national Israel at Mount Sinai, he required all the males to be circumcised as an outward sign of the agreement. This condition was imposed on any male who was considered to be a part of national Israel. Moreover, non-Israelite males (e.g., servants, slaves, and converts of other nationalities) who were considered a part of national Israel were to be circumcised without exception.

There is no doubt that circumcision was part of the terms and conditions of the first agreement with national Israel, and that it was a physical sign of this agreement. The reason circumcision was so important under this agreement was that it had to do with the relationship between the Creator God, each individual, and the nation. Moreover, circumcision pertained to the ability to worship God and receive his blessings. The men who asked the question regarding circumcision in Acts 15 believed it was still necessary for all males (both Israelite and Gentile) to be circumcised in order to have an agreement with God. Therefore, they said, "Except you be circumcised you cannot be saved" (Acts 15:1 KJV). However, the decision of the apostles and elders about the question of circumcision and the law of Moses proves that salvation is not tied to physical circumcision:

"Forasmuch as we have heard, that certain which went out from us have troubled you with words, subverting your souls, saying, You must be circumcised, and keep the law: to whom we gave no such commandment: It seemed good to us, being assembled with one accord, to send chosen men to you with our beloved Barnabas and Paul, Men that have hazarded their lives for the name of our Lord Jesus Christ. We have sent therefore Judas and Silas, who shall also tell you the same things by mouth. For it seemed good to the holy spirit, and to us, to lay on you no greater burden than these necessary things; That you abstain from meats offered to idols and from blood, and from things strangled, and from fornication: from which if you keep yourselves, you shall do well. Fare you well" (Acts 15:24-29 KJV).

All four of the items in the list of things the Gentiles were to avoid concern the application of God's written law about the defilement of the body, not with establishing a covenant with God the Father.

The edict of Acts, chapter 15, shows us that circumcision does not justify one before God the Father nor is circumcision required in order to establish or maintain a covenant relationship with him. Moreover, it is only through the sacrificial blood of Jesus Christ that one is reconciled to the Father and can maintain a covenant relationship with him.

PAUL AND THE LAW OF CIRCUMCISION TIMOTHY AND TITUS

Some use the example of Timothy's circumcision to argue that, even though Paul had agreed with the Jerusalem council's decision that circumcision was no longer necessary for salvation, he later decided they were wrong and went against their decision. However, this assumption is not true. See Acts 15:19-24.

Timothy

"Paul wanted to take him [Timothy] along on the journey, so he circumcised him because of the Jews who lived in the area, for they all knew that his father was a Greek" (Acts 16:3 NIV).

The reason for Timothy's circumcision is very clear. It was done because it was the wise thing to do under the circumstances. Although Timothy's mother was Jewish, the Jews considered him a Gentile because his father was Greek. Therefore, Timothy was circumcised so he would be more acceptable to the Jews.

Titus

"Fourteen years later I went up again to Jerusalem, this time with Barnabas. I took Titus along also. I went in response to a revelation and set before them the gospel that I preached among the Gentiles. But I did this privately to those who seemed to be leaders, for fear that I was running or had run my race in vain. Yet not even Titus, who was with me, was compelled to be circumcised, even though he was a Greek. This matter arose because some false brothers had infiltrated our ranks to spy on the freedom we have in Christ Jesus and to make us slaves. We did not give in to them for a moment, so that the truth of the gospel might remain with you" (Gal.2:1-5 NIV).

Paul and his companions resisted those who demanded that Titus be circumcised. This clearly shows that Paul and others of the Eldership were upholding the edict made about justification and Gentile men.

"Know that a person is not justified by observing the law, but by faith in Jesus Christ. So we, too, have put our faith in Christ Jesus that we may be justified by faith in Christ and not by observing the law, because by observing the law no one shall be justified" (Gal.2: 16 NIV Para.).

WHO IS A SPIRITUAL JEW?

"For indeed circumcision profits if you practice the law, but if you are a transgressor of the law, your circumcision becomes no circumcision. If, then, the circumcision keeps the demands of the law, will not his lack of circumcision be counted for circumcision? And will not the lack of circumcision by nature by keeping the law judge you, the one who through letter and circumcision becomes transgressor of the law? For he is not a Jew that is one outwardly, nor is circumcision that of the outwardly flesh; but he is a Jew that is one inwardly; and circumcision is of the heart, in spirit, not in letter, of whom praise is not from people, but of God" (Rom.2:25-29 Para.). See also Deut.10:14-16.

Paul wrote this letter to the Romans around 56 A.D., which was about seven years after the ministerial conference of Acts 15 held in 49 A.D..

FREEDOM IN CHRIST

"Then stand firm in the freedom with which Christ made us free, and do not again be held with a yoke of slavery. Behold, I, Paul, say to you that if you are circumcised, Christ will not profit you" (Gal.5: 1-2 Para.).

Paul warns the Galatian men against attempting to become justified before God by becoming circumcised, because anyone who does this places himself back under the law before Christ's sacrifice and shows by his actions that he does not believe Christ's sacrifice seals the breach between a sinner and God the Father.

"Behold, I, Paul, tell you that if you let yourselves be circumcised, Christ will be of no value to you at all. Again I declare to every man if circumcised that he is obligated to obey the whole law. You who are trying to be justified by law have been alienated from Christ; you have fallen away from grace" (Gal.5:2-4 NIV Para.).

Those who became circumcised in an attempt to become justified before God are fallen from grace, because they make the sacrifice of Christ void by trying to earn justification through keeping the law through their own efforts. Christ died for our justification and reconciliation to God the Father, and anyone who seeks to be justified under the conditions of the old agreement with national Israel is fallen from grace.

"For we through the spirit wait for the hope of righteousness by faith" (Gal.5:5 KJV).

Paul tells the Romans it is through the death of Christ that we are justified and put into right-standing with the Father. In addition, he says it is only through Christ's life that we can obtain salvation:

"For if being enemies, we are reconciled to God through the death of his son, much more being reconciled we shall be saved by his life" (Rom.5:10 Para.).

Physical circumcision does not bring salvation:

"For in Jesus Christ neither circumcision avails any thing, nor uncircumcision; but faith which works by love." (Gal.5:6 Para.).

Paul's statement is extremely important because he supports the decision made by the apostles and elders at the Jerusalem council pertaining to circumcision and the law. See Acts 15:19-30.

"You were running well; Who held you back that you do not obey the truth? The persuasion is not from him calling you. A little leaven leavens the whole lump. I trust as to you in the Lord that you will think nothing else, but the one troubling you shall bear the judgment, whoever it is" (Gal.5:7-10 Para.).

Paul warns the Galatians about those who were destroying them with the false teachings about circumcision and the law, and he confirms that he was not teaching circumcision as a way to obtain salvation. Moreover, Paul issues a stern warning to those who cause others to doubt their salvation through the false teaching of reconciliation through circumcision, because those who teach these things will themselves be cut off from salvation:

"But I, brothers, if I proclaim circumcision, why am I still persecuted? Then the offense of the cross has passed away. Oh' that the ones causing you to doubt will cut themselves off" (Gal.5:11-12 Para.). See also Eph.2:8-22.

"See in what large letters I write to you with my hand. As many as desire to look well in the flesh, these compel you to be circumcised; only that they may not be persecuted for the cross of Christ. For they themselves having been circumcised do not even keep the law; but they desire you to be circumcised so that they may boast in your flesh. But may it never be for me to boast, except in the cross of our Lord Jesus Christ, through whom the world has been crucified to me, and I to the world. For in Christ Jesus neither circumcision has any strength, nor the lack of circumcision; but a new creation" (Gal.6:11-15 Para.). See also Rom.3:27-30; 4:9-12; 1.Cor.7:18-19; Col.2:8-13; 3:9-11.

"When you came to Christ he set you free from your evil desires, not by a bodily operation of circumcision but by a spiritual operation, the baptism of your souls. For in baptism you see how your old, evil nature died with him and was buried with him; and then you came up out of death with him into a new life because you trusted the Word of the mighty God who raised Christ from the dead. You were dead in sins, and your sinful desires were not yet cut away. Then he gave you a share in the very life of Christ, for he forgave all your sins, and blotted out the charges proved against you, the list of his commandments which you had not obeyed. He took this list of sins and destroyed it by nailing it to Christ's cross" (Col.2:11-14 LBP).

SUMMARY

Did any action or teaching of the apostle Paul about circumcision contradict the decision of the apostles and elders noted in Acts 15? The answer is an emphatic no! All of Paul's writings show that he supported and clearly understood the edict of Acts 15.

MALE CIRCUMCISION AND ITS HEALTH BENEFITS

The Creator God did not make mistakes, everything he did and said had purpose and meaning and every instruction in the biblical record is meant for the benefit those who have the insight to obey and practice these instructions.

The benefits of obeying God's instruction for Abraham and ancient Israel to circumcise all newborn males on the eighth day of life go far beyond the intent of circumcision as evidence of a covenant relationship between the nation of Israel and God. Circumcision for a male has many lifetime benefits which are easily identifiable through a small amount of research and study into the medical and scientific data widely available on the subject.

Existing medical and scientific evidence reveals many potential health related benefits of male circumcision. However, with these potential health benefits there are also potential health risks; therefore, in order to make an informed choice parents or guardians of male children or an adult male who is contemplating circumcision should thoroughly research and analyze both the pros and the cons of male circumcision before making this important life altering decision.

Because circumcision is a life altering procedure, logic tells us that a parent, guardian, or an uncircumcised adult male would be wise to make this decision after doing the following:

• Making a thorough investigation into the various aspects involved in circumcision.
• Performing a careful review of the benefits and the risks involved in circumcision.
• Comparing both short and long term benefits and risks of circumcision.

Note:

Because of the ongoing debate among medical practitioners and scientists, as well as the publication of new research data about circumcision, the information contained in this document should not be used as a substitute for the medical advice and care of one's personal doctor or pediatrician, nor should it be considered a total explanation of the subject.

Much of the following information is taken from research data published in various reputable medical journals about the benefits and risks of circumcision and focuses primarily on the protection afforded by circumcision against infection by microorganisms, other physical benefits, such as hygiene, and risk factors involved in circumcision.

WHOSE DECISION IS IT?

Who is responsible to make the decision of whether or not to circumcise? Clearly, for a mature uncircumcised male, it is his decision; however, for the newborn male this decision rests with his parents or guardian.

Many opponents of infant circumcision believe that the male himself should be allowed to make this decision when he becomes mature enough to make it; however, research shows that male circumcision provides different benefits at different ages in a male's life [1]; therefore, it is obvious that, by the time a male is old enough to make an informed decision about his circumcision, many of circumcision's major benefits are no longer available to him. Moreover, if parents or guardians are interested in the benefits which can be derived from infant circumcision they must make this decision for the child.

What is Male Circumcision?

At birth, a boy's penis (including the shaft and the head (glands)), is covered by a fold of loose skin. This loose skin is called the foreskin. Circumcision removes the foreskin to expose the glans. Male circumcision is practiced by many different cultures with a variety of methods used to remove the foreskin.

What is Female Circumcision?

Female circumcision (i.e., female genital mutilation), is common in many cultures, but is clearly not sanctioned by any biblical law. This practice involves the removal of part or all of the clitoris and may also involve sewing up the opening of the vagina. This practice has no known medical benefit, but has many serious side effects, including disfigurement, pelvic and urinary tract infections, negative psychological effects, painful intercourse, and in some cases the inability to deliver a baby vaginally.

HEALTH AND PHYSICAL PROBLEMS

Although health and physical problems associated with the penis may develop in both circumcised and uncircumcised males, the data supplied in medical studies consistently shows that circumcised males have far fewer penile problems than the uncircumcised male.

The following information shows the significant differences in health and physical problems between circumcised and uncircumcised males.

Risk of Infection

The increased risk of infection in uncircumcised males may be attributed to the fact that the foreskin presents the penis with a large surface area, moist skin next to the glands, a thinner epidermal barrier than the drier skin of the circumcised penis, and a propensity to sustain greater trauma to the penis during sexual intercourse.

Clearly the accumulation of secretions from the penis, glands, sexual intercourse, urine, dead skin cells and smegma secretions in this warm moist environment may help facilitate the growth of microorganisms which might present an easier entry for infectious agents into the bloodstream [2,3].

Smegma

Smegma is a whitish material that is a mixture of shed skin cells, skin oils, and moisture on the foreskin.

Urinary Tract Infections

Many studies suggest that uncircumcised male infants are 10-20 times more likely than circumcised male infants to experience a urinary tract infection in the first year of life. Moreover, all studies which have examined the association between urinary tract infections and circumcision status show an increased risk in uncircumcised males, with the greatest risk in infants younger than 1 year of age. [4,5]

Penile Cancer

Although penile cancer is a rare disease, several case studies link the uncircumcised status to an increased risk for penile cancer. [6,7] Data shows about 1 male in 100,000 annually in the USA will be affected with penile cancer with a mortality rate of between 25-33%. [8,9,50]

Data also shows cancer of the penis is almost completely confined to uncircumcised men and that only 10 out of 10,000 deaths due to penile cancer between 1930 and 1991 in the USA were circumcised men and that these men were circumcised later in life. [11,12,13,50] Moreover, in 5 major studies in the United States of America since 1932, not one man with penile cancer had been circumcised as a newborn. [9,10,50]

Prostate Cancer

Studies show that uncircumcised men have twice the incidence of prostate cancer compared with circumcised men [14,15] and that this type of cancer is extremely rare among Jewish males. [16]

Balanitis and Posthitis

Balanitis is an inflammation of the foreskin or head of the penis and posthitis is an inflammation of the foreskin, both of these conditions can be very painful and are primarily limited to uncircumcised males. Balanitis is caused by a group A haemolytic streptococcus exclusively confined to uncircumcised boys. [17,18,19] Moreover, some data indicates that balanitis occurs more frequently in uncircumcised soldiers during wartime and in uncircumcised men with diabetes than in circumcised males. [20]

Phimosis

Phimosis is the inability to retract the foreskin and is normal in very young uncircumcised boys and normally only affects 2-10% of uncircumcised males after age 6. The very narrow foreskin opening can cause several problems, such as block the flow of urine and infections.

Paraphimosis

This is a condition where the retracted foreskin cannot be brought back again over the glands and is a very painful problem which can be relieved by circumcision or slitting the dorsal surface of the foreskin.

Balanoposthitis

This condition is the inflammation of the foreskin, glands, and penis. It is common in uncircumcised diabetic men owing to a weakened, shrunken penis. Data also shows that men with this condition have pain after intercourse. [20]

In elderly, uncircumcised men, infections and pain from balanoposthitis, phimosis, and paraphimosis present problems in achieving optimal hygiene.

Frenular Chordee

The condition of frenular chordee is present in about 25 percent of all uncircumcised males ^[21] and is the result of an unusually thick and often tight frenulum which prevents the foreskin from fully retracting. The frenulum may tear during intercourse which results in the formation of scar tissue which is generally more fragile and less elastic than normal tissue. This tear often reoccurs causing much pain, bleeding, and the inability to have pleasurable sexual relations. This problem can sometimes be resolved by excising the frenulum during a circumcision (i.e., Frenoplasty, which removes just the tight frenulum).

Sexually Transmitted Disease

Data regarding the relationship of circumcision to sexually transmitted disease is complex and conflicting; however, almost all studies show that sexually transmitted disease is significantly higher (3-9 times depending on the disease encountered) in sexually active, uncircumcised males and their sexual partners than in circumcised males and their sexual partners. [7,22,25] Moreover, most of the evidence shows that the sexually promiscuous uncircumcised male is much more likely to acquire or transmit a venereal disease than a circumcised male. [24]

Some studies suggest the reason for these differences is that the foreskin of the uncircumcised male traps infected vaginal or other secretions and provides a more hospitable environment for infectious substances. Also, the increased surface area of exposed skin, physical damage to the skin during intercourse, and inflammation of the penis glands may facilitate the entry of infectious substances into the male body. [25,26,27,28,29]

Clearly, most sexually transmitted diseases would be totally eliminated in a few generations if all people would heed God's law about sexual behavior regardless of male circumcision status.

Cervical Cancer

Several studies show higher rates of cervical cancer in women who have had one or more male sexual partners who were uncircumcised. Many studies indicate that the uncircumcised male is a contributor to the high rate of cervical cancer in women around the world. ^{[30,31,32,33,34,35]}

Sexual Gratification

Surveys show much conflicting data about sexual practices, pleasurable sensations, personal gratification during intercourse, and more or less sexual dysfunction between circumcised and uncircumcised, adult males. [36,37,38]

Clearly, these surveys are anecdotal and without merit because there is no known standard or benchmark against which to make scientific measurements. These types of surveys are meaningless in determining penile sensation and sexual satisfaction of the circumcised and uncircumcised male.

HYGIENE

Although the uncircumcised penis is normally easy to clean, immediately after washing under the foreskin bacteria start multiplying again in the warm moist environment and contribute along with skin secretions, to form smegma. The sad truth is that even if optimal cleansing is performed, there is no evidence that this cleansing confers any long term protection against the many types of harmful microorganisms which find optimal conditions to proliferate under the foreskin. [13,39]

Although opponents to circumcision decry the practice, they almost universally promote penile hygiene. However, many studies conclude that penile hygiene among young boys is poor at best and nonexistent at worst. [40,41]

If personal hygiene is a priority, clearly it is far easier for parents to keep their infant son's penis clean if it is circumcised. And compared to the uncircumcised penis it is clearly far easier for circumcised young and adult males to maintain a clean penis.

METHODS OF CIRCUMCISION

The most commonly used devices used to protect the penis during the removal of foreskin are the Gomco clamp, Mogen clamp, and PlastiBell or variations derived from the principles on which these devices are based. The PlastiBell method clamps the foreskin, which then falls off after a few days. This method eliminates the need to cut the foreskin off, and seems to reduce the period of discomfort for the infant. [42]

The common elements of these methods are the use of a device that allows an estimation of the amount of foreskin to be removed, the dilation of the preputial orifice in order to see the glands, and the freeing of the inner preputial epithelium from the epithelium of the glands.

Pain

Clearly, newborns who are circumcised without anaesthetic procedures experience pain and stress. Research data shows that infant responses to circumcision pain include changes in heart rate, blood pressure, oxygen saturation, and cortisol levels; [43,44] however, there is no evidence of any long-term psychological harm arising from circumcision.[45]

There are a number of safe and effective compounds and methods available to minimize pain during and after the circumcision procedure. However, each of these compounds and methods should be evaluated for their potential benefits, risks, side-effects, and complications. Moreover, one should understand these potential risks and make an informed decision about whether or not to use any of them during or after the circumcision procedure.

Risk of Damage

Circumcision is a physical procedure that has a lifelong effect. Therefore, regardless of the method used to perform the circumcision, the most important element in the procedure is the knowledge and skill of the person performing the circumcision.

Although circumcision is a simple, low-risk procedure and the risk of damage to the penis is avoidable, damage can happen with devastating results. Therefore, in order to minimize the chance of something going wrong with the circumcision and to help an insure the best possible results from the circumcision procedure, the following two things should be carefully considered:

• Make absolutely sure, to the best of your knowledge, that the person performing the procedure is technically knowledgeable and skilled in the method that is to be used for the circumcision.
• Make absolutely sure, to the best of your knowledge, that the person performing the procedure is competent and well experienced in the method that is to be used for the circumcision.

Complications

Although circumcision is a simple procedure, it is not without the risk of medical complications. The true incidence of complications after newborn circumcision is unknown; however; two very large studies suggest that the complication rate is somewhere between 0.2% and 0.6% and that most complications are minor. [42,46,47,48]

The most common complication of circumcision is excessive bleeding, which can normally be taken care of using either pressure, hemostatic agents, cautery, or sutures.

The second most common complication of circumcision is a minor infection which is normally easily cured. [42]

There are also rare reports of circumcision complications, such as recurrent phimosis, wound separation, concealed penis, inclusion cysts, sepsis, scalded skin syndrome, skin bridges, meningitis, necrotizing fasciitis, and retained Plastibell devices, as well as major surgical problems, such as urethral fistula, amputation of a portion of the glans penis, penile necrosis and urinary retention. [46,48]

THE EIGHTH DAY

"Every male shall be circumcised on the eighth day after birth. This applies to every foreign-born slave, as well as to everyone born in your household. This is a permanent part of this contract, and it applies to all your posterity. All must be circumcised. Your bodies will thus be marked as participants in my everlasting covenant. Anyone who refuses these terms shall be cut off from his people; for he has violated my contract" (Gen.17:12-13 TLB).

This instruction to Abraham to circumcise all males on their eighth day of life was also made a part of covenant between the Creator God and national Israel (See Lev.12:3). But why did God specifically require a newborn male to be circumcised on the eighth day of life instead of at birth or on some other day?

Today, we can easily know and understand the reasons why the eighth day is the optimum period of time in which to perform a circumcision. The following is a short explanation of one of these reasons.

Simply put, the human body needs vitamin K to make clotting proteins; however, a newborn babies' body does not begin to produce vitamin K until they are five days old. This lack of vitamin K results in about a 60 percent drop in the vital clotting protein prothrombin when the newborn is about three days old. Research data shows that the greatest risk of excessive bleeding for newborns occurs between the second and seventh day of life. [49]

Three days after the newborn's body begins to produce vitamin K, the prothrombin levels jump to 110 percent of the adult level, which makes the eighth day of a male's life the safest day on which to perform circumcision and minimize the risk of infection.

Male circumcision later in life is normally a very painful experience. Clearly, the optimum time for a male to be circumcised is in the eighth day of life in accordance with the biblical law of circumcision.

BENEFITS AND RISKS

Benefits

The following are major benefits of circumcision over the span of a male's lifetime:

• Reduced risk of death in the first year of life due to kidney failure as a complication of urological infection
• Reduced risk of urinary tract infections and urological problems
• Reduced problems with erections, especially at puberty
• Reduced risk of contracting certain sexually transmitted diseases
• Dramatically reduced risk of penile cancer
• Decrease in physical problems involving a tight foreskin
• Lower incidence of inflammation of the head of the penis
• Improved penile hygiene for the male
• Improved hygiene for the male's sexual partner

Major Risks

The following are major risks of circumcision:

• Excessive bleeding
• Infection shortly after circumcision
• Improperly administered surgical procedures resulting in damage to the penis
• Excessive pain
• Death due to complications

SUMMARY

It is doubtful that Abraham or the ancient Israelites understood much about the many health benefits that their obedience to the law of circumcision would bestow on them and their descendants; however, today virtually no one needs to remain ignorant of the tremendous health benefits of male circumcision because of the vast amount of research data on circumcision available and the ease with which it can be obtained.

Although there are undoubtedly some rare cases where circumcision would not be advisable for medical or physical reasons, almost all research shows many lifetime benefits of male circumcision, especially if the circumcision is performed early in the male's life.

Regardless of whether or not one makes the decision to circumcise or not, what is clear is that there are substantial benefits derived from male circumcision and that the Creator God knew exactly what he was doing when he instituted this law for the benefit of humanity.

Moses gave this reminder to the nation of Israel a short time before they were going to enter the promised land. The wisdom of God's law and the benefits derived from obedience to it apply just as much today as it did centuries ago:

"You shall be careful to do as the Lord your God has commanded you: you shall not turn aside to the right or to the left. You shall walk in all the ways which the Lord your God has commanded you, that you may live, and that it may be well with you, and that you may prolong your days in the land which you shall possess" (Deut.5: 32-33 Para.). See also Deut.10:12-13.

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3. Weiss GN. Prophylactic neonatal surgery and infectious diseases. Pediart Infect Dis J 1997; 16: 727-34
4. Wiswell TE, Smith FR, Bass JW. Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics 1985; 75: 901-3
5. Rushton HG, Mad M. Pyelonephritis in male infants: how important is the foreskin? J Urol 1992; 148: 733-6
6. Hardner GJ, Bhanalaph T, Murphy GP, et al. Carcinoma of the penis: analysis of therapy in 100 consecutive cases. J Urol. 1972;108: 428-403
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8. 66. Kochen M, McCurdy S. Circumcision and risk of cancer of the penis. A life-table analysis. Am J Dis Child 1980; 134: 484-6
9. Maden C, Sherman KJ, Beckmann AM, Huslop TK, Heh OZ, Ashley RL, Daling JR. History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J Nat Canc Inst 1993; 85: 19-24
10. Wolbarst AL. Circumcision and penile cancer. Lancet 1932; i: 150-3
11. Schoen EJ. The relationship between circumcision and cancer of the penis. CA Cancer J Clin 1991; 41:306-9
12. Wiswell TE. Neonatal circumcision: a current appraisal. Focus & Opinion Pediat 1995; 1:93-9
13. Wiswell TE. Circumcision circumspection. N Engl Med J 1997; 336: 1244-5
14. Apt A. Circumcision and prostatic cancer. Acta Med Scand 1965; 178: 493-504
15. Ewings P, Bowie C. A case-control study of cancer of the prostate in Somerset and east Devon. Br J Cancer 1996; 74: 661-6
16. Alderson M. Occupational Cancer. Butterworths, London 1986.
17. Furgusson DM, Lawton JM, Shannon FT. Neonatal circumcision and penile problems: An 8-year longitudinal study. Pediatrics 1988; 81: 537-41
18. Herzog LW, Alvarez SR. The frequency of foreskin problems in uncircumcised children. Am J Dis Child 1986; 140:254-6
19. Order B, Martin R, Franco A, I.a. G, Mendez E. Balanitis caused by group A beta-hemolytic streptoc 86; 140: 254-6 occi. Pediatr Infect Dis 1996; 15: 920-1
20. Fakjian N, Hunter S, Cole GW, Miller J. An argument for circumcision. Prevention of balanitis in the adult. Arch Dermatol 1990; 126: 1046-7
21. Griffin AS, Kroovand RL. Frenular chordee: implications and treatment. Urology 1990; 35: 133-4
22. Taylor PK, Rodin P. Herpes genitalis and circumcision. Br J Ven Dis 1975; 51: 274-7
23. Wilson RA. Circumcision and venereal disease. Can Med Ass J 1947; 56: 54-6
24. American Academy of Pediatrics. Task Force on Circumcision. Report of the Task Force on Circumcision. Pediatrics 1989; 84: 388-91
25. Kreiss JK, Hopkins SG. The association between circumcision status and human immunodeficiency virus infection among homosexual men. J Infect Dis 1993; 168: 1404-8
26. Osborne JE: HIV. The more things change, the more they stay the same. Nature Med 1995; 1: 991-3
27. Urassa M, Todd J, Boerma JT, Hayes R, Islingo R. Male circumcision and susceptibility to HIV infection among men in Tanzania. AIDS 1997; 11: 73-80
28. Weiss GN, Westbrook RC, Sanders M. The distribution and density of Langer hans cells in the human prepuce: site of a diminished immune response. Isr J Med Sci 1993; 29: 42-3
29. Whittington WL, et al. HIV-1 in patients with genital lesions attending a North American STD clinic: Assessment of risk factors. Int Conf AIDS 1989; 5: 409
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31. Barrasso R, De Brux J, Croissant O, Orth G. High prevalence of papillomavirus associated penile intraepithelial neoplasia in sexual partners of women with cervical intraepithelial neoplasia. N Engl J Med 1987; 317: 916-23
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38. Badger J. The great circumcision report part 2. Australian Forum 1989; 2 (12): 4-13
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41. Russell T. The case for circumcision. Med Observer 1993 (1 Oct issue)
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43. Talbert LM, Kraybill EN, Potter HD. Adrenal cortical response to circumcision in the neonate. Obstet Gynecol. 1976;48 :208-210
44. Williamson PS, Williamson ML. Physiologic stress reduction by local anesthetic during newborn circumcision. Pediatrics. 1983; 71: 36-40
45. Schlosberger NM, Turner RA, Irwin CE Jr. Early adolescent knowledge and attitudes about circumcision: methods and implications for research. J Adolescent Hlth 1992; 13: 293-7
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47. Harkavy KL. The circumcision debate. Pediatrics. 1987;79: 649-650
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Other Resources:

In Favor of Circumcision by Dr Brian Morris, published by University of New South Wales Press, 1999, ISBN 0-86840-537-X (104 pages). This book expands on the information on his website at (www.personal.usyd.edu.au) and includes much new material, including many personal stories from men circumcised as adults or as babies, and men who are uncircumcised.

None Of These Diseases by Drs. S.I. McMillen, David E. Stern, ISBN 0-8007-5719-X. This book contains information on circumcision and other health issues that are addressed in the Bible.

American Academy of Pediatrics website www.aap.org. An excellent source of information about circumcision and other issues related to children's health.

By B.L. Cocherell b4w10