History of circumcision, from its origins to the present day. Issues and controversies

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Circumcision is undoubtedly one of the oldest surgical procedures. In its most widespread form, it consists of the total or partial removal of the foreskin, leaving the glans penis uncovered. The practice, which dates back to antiquity if not prehistory, is carried out mainly for cultural and religious reasons, but also for allegedly hygienic and prophylactic reasons. Today, it concerns almost a billion people (around one in four).

It's worth pointing out that many ancient civilizations in the East (Sumer, Assur, Babylon, Persia) and West (Greece, Rome) either ignored the practice or vilified it. The Far East, with its brilliant civilizations from the Indus Valley to China and Japan, seems never to have known it.

For many of the societies that practice it, the procedure seems familiar and harmless. However, if you stop for a few seconds, the strangeness of this act becomes obvious. Its antiquity, the mystery that surrounds it, the aura conferred by its religious dimension, the fact that it is an absolute requirement for integration into certain groups, the string of benefits it is supposed to provide, and finally, the fact that it is usually performed on a fragile, vulnerable newborn baby - all of this cannot fail to appeal to anyone who allows themselves a moment's reflection. It's as if man were the only mammal to have to undergo an anatomical " correction ".

It's impossible to determine why circumcision was originally invented: was it first practiced as a symbolic and partial act of castration, a substitute for human sacrifice, a fertility ritual, a rite of passage, a premarital act, a stigma of belonging, or all of these at once, depending on the place and time ? Did it spread from Africa, the cradle of humanity ? Or was it born from the imagination of men in different parts of the planet ? One day, man had the surprising idea of cutting off a piece of his own penis or that of his young son, thus inflicting a " symbolic wound " on himself, but a wound nonetheless, and thus instituting a ritual that would defy time. We remain struck by its antiquity, its universality and the incredible diversity of its origins, forms and myths among peoples without writing and in the two great monotheistic religions. It is, without doubt, the oldest enigma in the history of surgery ; it appears to be one of the most enduring practices in the history of mankind.

Circumcision has been of great interest to the human sciences, particularly anthropology and psychoanalysis, which have attempted to provide explanations. While not necessarily mutually exclusive, each shed its own particular light on the subject, but none could claim to be universal. However, the study of cultures where this kind of mutilation is customary suggests that the motivations behind it are very different from the usual explanations. Their motivations have been obscured by millennia of mythological, religious, ritualistic or medical rationalizations ; it is highly unlikely that anyone could come up with a reasonable explanation of their origins. In any case, the hygienist justification remains the least convincing : before aseptic surgery, any cutting of the flesh was the least hygienic thing to do, and carried a high risk of bleeding, infection and death. None of the ancient cultures that traditionally practiced circumcision claimed that the ritual was introduced as a hygienic measure.

It was only in the ^19th century, when mass circumcision was introduced for " sanitary " reasons, that physicians sought to legitimize the new procedure by invoking continuity with the distant past and reinterpreting its origins through their own hygienic agenda. Several " reasons " were invented to replace religion in the justification of circumcision, which for almost a century, especially in the Anglo-Saxon world, has become a medicalized, trivialized, almost routine surgical procedure, emptied of all symbolic meaning, but charged, according to medical fashions, with a thousand and one prophylactic virtues. The conjunction of two recent movements in the world of medicine -evidence-based medicine on the one hand, and the extraordinary rise of bioethics on the other - has radically changed this situation. Across the Atlantic and, to a lesser extent, in Europe, circumcision is now the subject of questioning, controversy and societal struggle.

By replacing religious ideals with its own moral mythologies under the guise of medicine, the modern age has reinvented a ritual. For over a century, circumcision has been a treatment in search of something to cure, a solution in search of a problem. Historically, the compulsion to circumcise has remained constant, while the reasons for it have never ceased to change.