title: The Grand Tour

text: On 13 December , Amazon announced that "The Grand Tour" had been renewed for a fourth series. With this, Amazon and the team have retired the current studio and audience format, including talk segments such as Conversation Street, track and lap time content on The Eboladrome and other smaller features, in favour of films dedicated to road trips and adventure specials. The new format focuses on these individual adventures which see the presenters travelling from one location to another in a selection of vehicles they have chosen for the task, in a similar manner to the feature-length specials of "Top Gear", though expanding beyond cars. The first special titled "Seamen", was set on the Mekong Delta in Cambodia and Vietnam and released on 13 December 2019. The second special, set in Réunion and Madagascar and entitled "A Massive Hunt", was originally set to be released on 18 December 2020, but released a day ahead of schedule on 17 December 2020. A third special, called "Lochdown", was filmed in Scotland in October 2020 and released on 30 July 2021. A fourth special, called 'Carnage A Trois' was filmed in the United Kingdom in early 2021 and was released on 17 December 2021.


title: The Grand Tour

text: A fifth special was originally scheduled to be filmed outside of the United Kingdom in mid-2021, however, due to the COVID-19 pandemic, travel restrictions meant this couldn’t happen until March 2022, when filming for the fifth special commenced in Norway travelling through Sweden and concluding in Finland. Said fifth special, "A Scandi Flick", was released on 16 September 2022, as the first episode of the fifth series. In June 2022, filming for a sixth special began in Poland, before travelling to Czech Republic, Slovakia, Hungary and Slovenia.


title: The Grand Tour

text: Clarkson, Hammond and May had been presenters on BBC's "Top Gear". In May and Clarkson's case they had served as part of the rotating hosts of the original Top Gear, with all three including Hammond being permanent hosts for the 2002 rebooted series from the second series in 2003 (Jason Dawe having presented series one of the rebooted show alongside Clarkson and Hammond instead of May) up to the twenty second series in 2015. Under them, the show had an estimated worldwide audience of 350 million, and listed by "Guinness World Records" as the highest-viewed factual television programme. Due to , the BBC chose not to renew Clarkson's contract with the show in March 2015. Both May and Hammond affirmed they would not return to "Top Gear" without Clarkson, even though the BBC offered them lucrative salaries to remain on for additional series. Along with their departure, their long-time producer and Clarkson's classmate Andy Wilman also opted to leave at this time. BBC retooled the show for 2016, bringing in new hosts Chris Evans and Matt LeBlanc.


title: The Grand Tour

text: Shortly after his separation from the BBC, Clarkson stated his intent to start a new car show, saying "I have lost my baby but I shall create another. I don't know who the other parent will be or what the baby will be like." Rumours that Clarkson, Hammond, and May were developing a new show through discreet meetings with various networks emerged starting in April 2015. These rumors pointed to a potential American broadcaster, as the terms of Clarkson's non-compete clause with the BBC stipulated he could not make a rival car show with a BBC competitor, such as ITV. Among those that had been approached included Netflix, who felt Clarkson's team wanted too much money for what they were worth, and BT Sport, believing this show would be a better fit on a network with a more global reach.


title: The Grand Tour

text: In July 2015, Clarkson announced he had signed a deal with Amazon to develop a new car show that followed a similar format as "Top Gear", with both Hammond and May joining him as co-hosts, and Wilman producing. Other personnel from Top Gear going to the new show included director Phil Churchward, the husband of "Fifth Gear"'s Vicki Butler-Henderson. The deal included 36 episodes across three series which would be available to Amazon Prime members starting in 2016. Wilman stated that Amazon promised them to have the freedom they wanted to make the show how they wanted along with the necessary budget. Additionally, by using a subscription-based service over an advert-based network, they would not be beholden to commercial pressure from their advertisers. Jeff Bezos, CEO of Amazon, said he was "very excited" about bringing this programme to Amazon, and that producing the show would be "very, very, very expensive", but added, "[Clarkson, Hammond and May are] worth a lot and they know it." According to insider information reported by "The Daily Mirror", Amazon paid for all three series. Wilman denied the show cost this much, but did admit the show was costly, partially due to Amazon's intent to have it filmed in 4K resolutions. The production of this show would be based in the United Kingdom, and done by W Chump & Sons, a company set up by Wilman, Clarkson, Hammond and May.


title: The Grand Tour

text: The show's name, "The Grand Tour", was revealed in May 2016. Clarkson said the name brought to mind the tradition of Grand Tours, and reflected how the show would travel to several different countries to film. There was speculation that the show could be called "Gear Knobs" after a trademark application was made for that name by an associated company, but Clarkson stated in October 2015 that this would not be the title. He explained in April 2016 that the word "Gear" could not be used for legal reasons.


title: The Grand Tour

text: Initially, the show's format was to present individual television films, using location shooting without studio segments. They later came up with the idea of using a travelling tent to provide a mobile "studio", to go along with "The Grand Tour" name. They would be able to use local audience members, and would give the hosts the opportunity to explore the local culture around cars. According to Wilman, the idea to film audience segments in a tent came from Clarkson, who had seen an episode of "True Detective" that took place at a Baptist revival ceremony.


title: The Grand Tour

text: On 13 December 2018, while shooting the final episode for Series 3, it was announced that the show had been renewed for a fourth series. However they would ditch the tent and release big budget car specials, on staggered dates rather than regular episodes.


title: The Grand Tour

text: Wilman said that lawyers for Amazon were very mindful of any perceived similarities in segments to "Top Gear", requiring changes to the format and regular segments. Named elements from "Top Gear" like The Star in a Reasonably Priced Car, the Cool Wall, and the Stig could not be used at all, but they also had to clear other legal concerns. For example, the lawyers said they could test cars on a test track, but they could not post the times using hand-written signs as they had done on "Top Gear"; instead, they used a digital leaderboard. Wilman said that some of the lawyers' concerns "got funnier and funnier", such as whether May could say "cock", or whether during one of their exotic roadtrips, if they could stop and admire the scenery by saying "it's beautiful" as they frequently did on "Top Gear".


title: The Grand Tour

text: Many outlets falsely reported that the BBC had explicitly told the crew they could not have celebrities come on the show and race around a track. This was later confirmed to be false, with the crew admitting that the real reason for the nature of the segment was a last-minute panic.


title: The Grand Tour

text: "Celebrity Brain Crash" was replaced in series two by "Celebrity Face Off" where two celebrities compete to be the fastest around a track, avoiding legal complications with the BBC.


title: The Grand Tour

text: An episode was censored by Amazon Prime Video in India because it included footage that could have been construed as offensive by the Indian audience. The footage showed a windscreen that was made of a cow's body organs and removal of the footage resulted in a significant reduction in the length of an episode.


title: The Grand Tour

text: During the first series, the studio segments were filmed in various locations around the world. Studio recording for the first series began in Johannesburg, South Africa on 17 July 2016. Recording in the United States took place on 25 September 2016 in Southern California, with further recording taking place in Nashville on 21 November 2016. Studio recording in the United Kingdom took place in Whitby on 13 October 2016, with further recordings taking place at Loch Ness in December 2016. Further studio recording took place in Rotterdam on 22 October 2016 and Lapland on 3 November 2016. Stuttgart (Ludwigsburg) was also a filming location. The final studio filming took place in Dubai in December 2016.


title: The Grand Tour

text: For the second series, following Clarkson's pneumonia and Hammond's car crash, the producers decided that there would no longer be a travelling tent. Instead the tent would be in one location near Clarkson's home in the Cotswolds as this would be more convenient for the crew to operate. It also would be useful for new features such as Celebrity Face Off. In September 2017, West Oxfordshire District Council gave planning permission for three months of filming from a fixed tent location on the Great Tew Estate, near Chipping Norton. Two-hundred parking spaces already used for hosting the Cornbury Music Festival on the same site would be used to accommodate 350 guests per week, plus 80 members of staff. The time window allowed for the series 2 filming was between October and December 2017. For the third series, the tent was allowed to remain at the Great Tew Estate, with filming taking place between October and December 2018.


title: The Grand Tour

text: Filming for the fourth series began in June 2019. Clarkson made the announcement on Instagram. By mid-June, filming had taken place in Cambodia. Later that month, Clarkson, Hammond, and May were spotted filming in Vietnam Another fourth series special was shot in Madagascar around November 2019, though its post-production to a final product was delayed due to the COVID-19 pandemic. There were plans to film in north Russia in March 2020, but those were delayed for at least a year due to the pandemic.


title: The Grand Tour

text: Following the public naming of the show, Amazon offered new customers a £20 discount for their first year on Amazon Prime during 14–16 May 2016.


title: The Grand Tour

text: A trailer announcing the release date of the show as 18 November 2016 was posted on the show's YouTube channel on 15 September 2016. A second, full-length trailer, was released on 6 October 2016. Trailers for series one have used the music "Come with Me Now" by Kongos. while series two trailers have used "Live and Let Die" by Wings.


title: The Grand Tour

text: As part of their marketing campaign, Amazon placed crashed Toyota Prius cars at Hackescher Markt in Berlin, in front of London King's Cross railway station, and on the Hollywood Walk of Fame outside the Dolby Theatre in Los Angeles.


title: The Grand Tour

text: In mid-2016 DHL began sponsoring the transport costs of the tent and mobile studio. In June 2016, in connection with the sponsorship deal, the presenters had uploaded videos of themselves attempting to assemble DHL-branded shipping boxes. The first episode stated that "promotional consideration" had been given by the Breitling Jet Team, DHL and Samsung. Eight of the Breitling Jet aircraft took part in the opening sequence flyovers.


title: The Grand Tour

text: For episode 2, the list included 5.11 Tactical. A DHL Boeing 757 was featured in the opening sequence of episode 5, the tent was located in Rotterdam, and the DHL logo is featured on part of the crash barrier at the Eboladrome.


title: The Grand Tour

text: the show has received positive reviews from critics, with "The Guardian" saying "Jeremy Clarkson and co leave the BBC in their dust". On the review aggregation website "Rotten Tomatoes", the first series of "The Grand Tour" has a "fresh" rating of 86%, based on 7 reviews, with an average rating of 8.0/10. "The Grand Tour" received a nomination in the Original OTT Streamed category at the 2017 Television and Radio Industries Club Awards.


title: The Grand Tour

text: However, BBC Arts Editor, Will Gompertz said of the opening that "there is no irony. It feels uncomfortably hubristic" but once the presenters were in the tent "Normal service has been resumed" and that "It seemed to me that Grand Tour is a TV show that wants to be – and quite possibly should be – a movie". "The Independent" described "The Grand Tour" as "the best of "Top Gear" but with a greater budget".


title: The Grand Tour

text: "TheWrap" reported an estimate by Symphony Advanced Media that the opening weekend viewer count for "The Grand Tour" was three times the size of the opening weekend of "The Man in the High Castle".


title: The Grand Tour

text: Episode 2 was somewhat less favourably received by fans and critics. "The Telegraph" wrote about the Jordan segment: "[...] a tedious action movie segment suggested that they were in danger of losing the run of themselves slightly and that Amazon's hands-off policy towards the production had potential downsides." "Radio Times" said that "many of the viewers were disgruntled to say the least, branding the show as dull and not funny."


title: The Grand Tour

text: Kevin Yeoman of "Screen Rant" gave the show a positive review, stating "Fans can rest assured Top Gear hasn't gone anywhere, it's just hiding out at Amazon under a different name." Sonia Saraiya of "Variety" was also positive of the show, stating "When it comes to the cars, The Grand Tour delivers gearhead porn in spades... Clarkson, Hammond, and May's love for machinery... is still present, pure, and appealing, even with the shift in networks and formats."


title: The Grand Tour

text: Conversely, in April 2017 Brad Anderson of "CarScoops" stated that he prefers "Top Gear" to "The Grand Tour". According to Anderson, "Top Gear" had "become even better", whereas "The Grand Tour" "seemed more scripted, less natural and at stages, forced... attention is often skewed away from the cars as the presenters, namely Clarkson, seemed to chase controversy and headlines". Anderson continues that in-studio segments became repetitive quickly, particularly "Celebrity Brain Crash", also noting that all three hosts seem to spend far too much time needling each other, and test driver Mike Skinner offers no worthwhile commentary.


title: The Grand Tour

text: "Digital Spy" was positive of series 2, episode 1, calling it "An understated premiere for a show that feels like it's finding its feet." "The Times" was also positive, giving the show 4 out of 5 stars, stating "Some parts of the show are flat but mostly it works, the production values remain high and it has clearly been hit with a juggernaut of money." "The Daily Telegraph", while not as positive, still approved of the episode, stating "The writing is still rather ropey. Clarkson's suggestion of a new nickname for May – "Dingleberry Handpump" – failed to raise a titter even among the super-fans gathered for the London premiere" but also said that "for each wobble, there are just as many moments when The Grand Tour manages the clever trick Top Gear could pull off at its best: raising a chuckle while sneaking in a bit of serious journalism at the same time." and ultimately gave the episode 3 out of 5 stars. Jeremy Clarkson himself believed that they had "hit the ground running with series 2 of the Grand Tour".


title: The Grand Tour

text: Richard Hammond was criticised by "Stonewall" and Peter Tatchell for a comment he made in the sixth episode of the first series where he implied that men who eat ice cream and people who like grilling outside are homosexual. It was later revealed that the comment may have been an in-joke for the Finnish audience as a reference to a controversial TV commercial that aired in Finland many years earlier.


title: The Grand Tour

text: "Radio Times" criticised the gender balance of guests on the "Celebrity Face Off" segment during an episode, with Paris Hilton as the only female guest.


title: The Grand Tour

text: Australian free-to-air network Seven Network started broadcasting the first series of "The Grand Tour" in mid-October 2017. Series 2 and 3 have not been broadcast.


title: The Grand Tour

text: French channel RMC Découverte started broadcasting the first series with the Namibian special episodes on 29 November 2017 and L'Équipe (TV channel) broadcast episodes 1 and 13 on 15 January 2018.


title: The Grand Tour

text: At the start of 2018, high-speed Eurostar train services between Paris or Brussels and London began to feature "The Grand Tour" as part of the available on board entertainment package.


title: The Grand Tour

text: On 15 January 2019, Amazon Game Studios released a companion video game for PlayStation 4 and Xbox One, to coincide with the third series of the programme, entitled "The Grand Tour Game". Designed as an episodic, casual racing game, players take on a series of challenges based upon those from the series and using the same cars involved - for each new episode of the series, an episode of the game is simultaneously released with approximately 15 new challenges for the player to undertake. The game includes single player mode alongside local split-screen multiplayer for several of the challenges, with footage from the programme included in each episode's release. The presenters Clarkson, May, and Hammond provided voice-overs for the game. Since the game's release, "The Grand Tour Game" has been met with mixed reviews from critics and positive reviews from fans of the show.


title: Circumcision

text: Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. Topical or locally injected anesthesia is generally used to reduce pain and physiologic stress. It is usually elective, performed as preventive healthcare, a religious rite, or cultural practice. It is also an option for cases of phimosis, other pathologies that do not resolve with other treatments, and chronic urinary tract infections (UTIs). The procedure is contraindicated in cases of certain genital structure abnormalities or poor general health.


title: Circumcision

text: Circumcision is associated with reduced rates of sexually transmitted infections and urinary tract infections. This includes decreasing the incidence of cancer-causing forms of human papillomavirus (HPV) and significantly reducing HIV transmission among heterosexual men within high risk populations. The World Health Organization (WHO) and UNAIDS recommend circumcision as part of a comprehensive HIV transmission program in areas with high endemic rates of HIV. The WHO does not recommend circumcision for HIV prevention in men who have sex with men; effectiveness of using circumcision to prevent HIV in the developed world is unclear. Neonatal circumcision also decreases the risk of rare penile cancer. Complication rates are higher when the procedure is performed on older people. A 2010 review found circumcisions performed by medical providers to have a typical complication rate of 1.5% for babies and 6% for older children, with few cases of severe complications. Bleeding, infection, and the removal of either too much or too little foreskin are the most common acute complications. Meatal stenosis is the most common long term complication. Major medical organizations hold widely variant perspectives on the bioethics, cost-effectiveness, and the prophylactic efficacy related to the elective circumcision of minors. The World Health Organization (WHO), UNAIDS, and American medical organizations take the position that it carries prophylactic health benefits which outweigh small risks, while European medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk.


title: Circumcision

text: Prophylactic circumcision originated in England during the 1850s, becoming initially established as a way to preventing sexually transmitted infections. Beyond use as a prophylactic or treatment option in healthcare, circumcision also plays a major role in many of the world's cultures and religions; it is most prominently performed in Judaism and Islam. Circumcision is among the most important commandments in Judaism. There are varying cultural, ethical, and social views on the practice. Campaigns of Jewish ethnic, cultural, and religious persecution have repeatedly included bans on the practice as an attempted means of forceful assimilation, conversion, and ethnocide, including in the Maccabean Revolt. It has also played a major role in Christian history and theology, although among the vast majority of Christian denominations it is not considered a practice that is obligatory or recommended for religious reasons. Circumcised men are presently estimated to constitute around 38% of the world's male population. It is widespread in Australia, Canada, Africa, parts of Southeast Asia, the United States, South Korea, and New Zealand. It is relatively rare for non-religious reasons in Latin America, parts of Southern Africa, Europe, and most of Asia. The origin of circumcision is not known with certainty; the oldest documentation comes from ancient Egypt.


title: Circumcision

text: Around half of all circumcisions worldwide are performed for reasons of prophylactic healthcare. In the United States neonatal circumcision is among the most common types of elective surgery.


title: Circumcision

text: There is a consensus among the world's major medical organizations that circumcision is an efficacious intervention for HIV prevention in high risk populations if carried out by medical professionals under safe conditions. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that they recommended adolescent and adult circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV, as long as the program includes "informed consent, confidentiality, and absence of coercion" ― known as voluntary medical male circumcision, or VMMC. In 2010, this was expanded to routine neonatal circumcision, as long as those undergoing the procedure received assent from their parents. In 2020, the World Health Organization again concluded that male circumcision is an efficacious intervention for HIV prevention and that the promotion of male circumcision is an essential strategy, in addition to other preventive measures, for the prevention of heterosexually acquired HIV infection in men. Eastern and southern Africa had a particularly low prevalence of circumcised males. This region has a disproportionately high HIV infection rate, with a significant number of those infections stemming from heterosexual transmission. As a result, the promotion of prophylactic circumcision has been a priority intervention in that region since the WHO's 2007 recommendations.


title: Circumcision

text: The International Antiviral Society–USA also suggests circumcision be discussed with men who have insertive anal sex with men, especially in regions where HIV is common. There is evidence that circumcision is associated with a reduced risk of HIV infection for such men, particularly in low-income countries.


title: Circumcision

text: The finding that circumcision significantly reduces female-to-male HIV transmission has prompted medical organizations serving communities affected by endemic HIV/AIDS to promote circumcision as an additional method of controlling the spread of HIV.


title: Circumcision

text: Major medical organizations hold widely varying positions on the prophylactic efficacy, bioethics, and cost-effectiveness of elective circumcision of minors in the context of developed countries. Literature on the matter is polarized, with the cost-benefit analysis being highly dependent on the kinds and frequencies of health problems in the population under discussion and how circumcision affects them.


title: Circumcision

text: The World Health Organization (WHO), UNAIDS, and American medical organizations take the position that it carries prophylactic health benefits which outweigh small risks, while European medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk. The procedure's relationship to other prophylactic procedures, along with the concepts of group rights, consent, and religious freedom, are frequently discussed in academic literature. Public health advocates of circumcision consider it to have a net health benefit, and therefore feel that increasing the circumcision rate is imperative. They recommend performing it during the neonatal period when it is less expensive and has a lower risk of complications. The American Academy of Pediatrics and Centers for Disease Control and Prevention stated that the benefits of circumcision outweigh the risks. In 2014, the CDC recommended circumcision in a policy statement.


title: Circumcision

text: Worldwide, around half of all circumcisions are performed for religious or cultural reasons. Circumcision plays a major role in many of the world's cultures and religions. When performed for religious reasons, it is most common among Muslims and Jews (among whom it is near-universal) and the members of the Coptic, Ethiopian, and Eritrean Orthodox Churches. Circumcision is an integral or established practice for members of these faiths, as well as amongst Samaritans and Druze. Male circumcision is also widely practiced among Christian communities in the Anglosphere countries, Oceania, South Korea, the Philippines, the Middle East and Africa. The United States and the Philippines are the largest majority Christian countries in the world to extensively practice circumcision. In some African and Eastern Christian denominations male circumcision is an integral or established practice, and require that their male members undergo circumcision.


title: Circumcision

text: Circumcision is also used to treat various pathologies. These include pathological phimosis, refractory balanoposthitis and chronic or recurrent urinary tract infections (UTIs).


title: Circumcision

text: These include infants with certain genital structure abnormalities, such as a misplaced 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 premature infants and those who are not clinically stable and in good health. If an individual is known to have or has a family history of serious bleeding disorders such as hemophilia, it is recommended that the blood be checked for normal coagulation properties before the procedure is attempted.


title: Circumcision

text: The foreskin extends out from the base of the 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, and 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. For adult medical circumcision, superficial wound healing takes up to a week, and complete healing 4 to 6 months. For infants, healing is usually complete within one week.


title: Circumcision

text: For infant circumcision, devices such as the Gomco clamp, Plastibell and Mogen clamp are commonly used in the USA. These follow the same basic procedure. First, the amount of foreskin to be removed is estimated. The practitioner opens the foreskin via the preputial orifice to reveal the glans underneath and ensures it is normal before bluntly separating the inner lining of the foreskin (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 amputated. For older babies and adults, circumcision is often performed surgically without specialized instruments, and alternatives such as Unicirc or the Shang ring are available.


title: Circumcision

text: The circumcision procedure causes pain, and for neonates this pain may interfere with mother-infant interaction or cause other behavioral changes, so the use of analgesia is advocated. Ordinary procedural pain may be managed in pharmacological and non-pharmacological ways. Pharmacological methods, such as localized or regional pain-blocking injections and topical analgesic creams, are safe and effective. The 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 EMLA (eutectic mixture of local anesthetics) cream, which is more effective than a placebo. Topical creams have been found to irritate the skin of low birth weight infants, so penile nerve block techniques are recommended in this group.


title: Circumcision

text: 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, but the American Academy of Pediatrics (AAP) states that such methods are insufficient alone and should be used to supplement more effective techniques. 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. The available evidence does not indicate that post-procedure pain management is needed. For adults, topical anesthesia, ring block, dorsal penile nerve block (DPNB) and general anesthesia are all options, and the procedure requires four to six weeks of abstinence from masturbation or intercourse to allow the wound to heal.


title: Circumcision

text: There is strong evidence that circumcision reduces the risk of men acquiring HIV infection in areas of the world with high rates of HIV. This evidence is principally derived from three randomized controlled studies conducted in Africa in 2002. Evidence among heterosexual men in sub-Saharan Africa shows an absolute decrease in risk of 1.8% which is a relative decrease of between 38% and 66% over two years, and in this population studies rate it cost-effective. Whether it is of benefit in developed countries is undetermined.


title: Circumcision

text: There are plausible explanations based on human biology for how circumcision can decrease the likelihood of female-to-male HIV transmission. The superficial skin layers of the penis contain Langerhans cells, 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 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.


title: Circumcision

text: The WHO and the 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 (parents' consent for their infant boys). 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 condoms. The joint WHO/UNAIDS recommendation also notes that circumcision only provides partial protection from HIV and should not replace known methods of HIV prevention.


title: Circumcision

text: Male circumcision provides only indirect HIV protection for heterosexual women. The WHO does not recommend circumcision as a protection for male-to-male HIV transmission. Evidence is lacking with regards to circumcision reducing HIV risk for receptive anal intercourse.


title: Circumcision

text: Human papillomavirus (HPV) is the most commonly transmitted sexually transmitted infection, affecting both men and women. While most infections are asymptomatic and are cleared by the immune system, some types of the virus cause genital warts, and other types, if untreated, cause various forms of cancer, including cervical cancer, and penile cancer. Genital warts and cervical cancer are the two most common problems resulting from HPV.


title: Circumcision

text: Circumcision is associated with a reduced prevalence of 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. It also decreases the likelihood of multiple infections. there was no strong evidence that it reduces the rate of new HPV infection, but the procedure is associated with increased clearance of the virus by the body, which can account for the finding of reduced prevalence.


title: Circumcision

text: 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.


title: Circumcision

text: Studies evaluating the effect of circumcision on the rates of other sexually transmitted infections have generally, found it to be protective. A 2006 meta-analysis found that circumcision was associated with lower rates of syphilis, chancroid and possibly genital herpes. A 2010 review found that circumcision reduced the incidence of 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. It may also possibly protect against syphilis in MSM.


title: Circumcision

text: Phimosis is the inability to retract the foreskin over the glans penis. At birth, the foreskin cannot be retracted due to 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 three. Less than one percent are still having problems at age 18. If the inability to do so becomes problematic (pathological phimosis) circumcision is a treatment option. This pathological phimosis may be due to scarring from the skin disease balanitis xerotica obliterans (BXO), repeated episodes of balanoposthitis or forced retraction of the foreskin. Steroid creams are also a reasonable option and may prevent the need for surgery including in those with mild BXO. The procedure may also be used to prevent the development of phimosis. Phimosis is also a complication that can result from circumcision.


title: Circumcision

text: An inflammation of the glans penis and foreskin is called balanoposthitis, and the condition affecting the glans alone is called balanitis. Most cases of these conditions occur in uncircumcised males, affecting 411% of that group. 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. Both conditions are usually treated with topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams. Circumcision is a treatment option for refractory or recurrent balanoposthitis, but in the twenty-first century the availability of the other treatments has made it less necessary.


title: Circumcision

text: A UTI affects parts of the urinary system including the urethra, bladder, and kidneys. There is about a one percent 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 of babies 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 310 times (100 circumcisions prevents one UTI). Circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects, and may be used to treat recurrent UTIs.


title: Circumcision

text: 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 bacterial population.


title: Circumcision

text: 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 in most developed countries, 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 Eswatini). The number of new cases is also high in some South American countries including Paraguay and Uruguay, at about 4.3 per 100,000. It is least common in Israeli Jews—0.1 per 100,000—related in part to the very high rate of circumcision of babies.


title: Circumcision

text: 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. Childhood or adolescent circumcision is associated with a reduced risk of invasive squamous cell carcinoma in particular. 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. Penile cancer has been observed to be nearly eliminated in populations of males circumcised neonatally.


title: Circumcision

text: Important risk factors for penile cancer include phimosis and HPV infection, both of which are mitigated by circumcision. 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. Circumcision is also associated with a reduced prevalence of cancer-causing types of HPV in men and a reduced risk of cervical cancer (which is caused by a type of HPV) in female partners of men. As penile cancer is rare (and may become increasingly rare as HPV vaccination rates rise), and circumcision has risks, the practice is not considered to be valuable solely as a prophylactic measure against penile cancer in the United States.


title: Circumcision

text: There is some evidence that circumcision is associated with lower risk of prostate cancer. A 2015 meta-analysis found a reduced risk of prostate cancer associated with circumcision in black men. A 2016 meta-analysis found that men with prostate cancer were less likely to be circumcised.


title: Circumcision

text: A 2017 systematic review found consistent evidence that male circumcision prior to heterosexual contact was associated with a decreased risk of cervical cancer, cervical dysplasia, HSV-2, chlamydia, and syphilis among women. The evidence was less consistent in regards to the potential association of circumcision with women's risk of HPV and HIV.


title: Circumcision

text: Circumcision does not affect sexual function, sensation, desire, or pleasure. Although consistently rejected in the academic literature and by major medical organizations, there are various popular misconceptions and cultural myths that circumcision benefits or adversely affects sexual function and libido. A 2013 systematic review published in the "Asian Journal of Andrology" found that circumcision did not appear to adversely affect or prevent pain with intercourse, premature ejaculation, time until ejaculation, erectile dysfunction or difficulties with orgasm. However, the study found that the existing evidence is insufficient to make conclusive determinations. The effect of circumcision on sexual partners' experiences is unclear as this has not been well studied.


title: Circumcision

text: Neonatal circumcision is generally a safe, low-risk procedure when done by an experienced practitioner.


title: Circumcision

text: The most common acute complications are bleeding, infection and the removal of either too much or too little foreskin. These complications occur in approximately 0.13% of procedures, with bleeding being the most common acute complication in the United States. Minor complications are reported to occur in three percent of procedures. Severe complications are rare. A specific complication rate is difficult to determine due to scant data on complications and inconsistencies in their classification. 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. Significant acute complications happen rarely, occurring in about 1 in 500 newborn procedures in the United States. Severe to catastrophic complications, including death, are so rare that they are reported only as individual case reports. Where a Plastibell device is used, the most common complication is the retention of the device occurring in around 3.5% of procedures. Other possible complications include buried penis, chordee, phimosis, skin bridges, urethral fistulas, and meatal stenosis. These complications may be partly avoided with proper technique, and are often treatable without requiring surgical revision. The most common long-term complication is meatal stenosis, this is almost exclusively seen in circumcised children, it is thought to be caused by ammonia producing bacteria coming into contact with the meatus in circumcised infants. It can be treated by meatotomy.


title: Circumcision

text: Effective pain management should be used during the procedure. Inadequate pain relief may carry the risks of heightened pain response for newborns. Newborns that experience pain due to being circumcised have different responses to vaccines given afterwards, with higher pain scores observed. For adult men who have been circumcised, there is a risk that the circumcision scar may be tender.


title: Circumcision

text: It is unclear what the psychological outcomes of circumcision are. Studies have shown positive, neutral, or negative effects. There is debate in the literature over whether the pain of circumcision has lasting psychological impact, with only weak underlying data available. There is no good evidence that circumcision affects cognitive abilities.


title: Circumcision

text: Approximately 38% of males worldwide are circumcised as of 2016. Around half for reasons of prophylactic healthcare and half for religious or cultural reasons. It is most often practiced between infancy and the early twenties. This is an increase from 2007, when WHO estimated that 664,500,000 males aged 15 and over were circumcised (30–33% global prevalence), and that 70% of circumcised men were Muslim. A study on male circumcision prevalence in 118 developing countries found that 69% of circumcised men were Muslim.


title: Circumcision

text: Circumcision is most common in the Australia, Canada, Israel, New Zealand, the Muslim world, South Korea, the United States, and parts of Southeast Asia and Africa. It is relatively rare for non-religious reasons in Europe, Latin America, parts of Southern Africa and Oceania and most of non-Muslim Asia. Prevalence is near-universal in the Middle East and Central Asia. Non-religious circumcision in Asia, outside the Republic of Korea and the Philippines, is fairly rare, and prevalence is generally low (less than 20%) across Europe. Estimates for individual countries include Taiwan at 9% and Australia 58.7%. Prevalence in the United States and Canada is estimated at 75% and 30% respectively. Prevalence in Africa varies from less than 20% in some southern African countries to near universal in North and West Africa.


title: Circumcision

text: Rates of circumcision over time have varied by country. As of 2021, "Wolters Kluwer Health" estimates that around 80% of male neonates are circumcised before leaving the hospital in the United States, with the large majority of these being for prophylactic reasons. Circumcision incidence in the U.S. has likely risen since 2012, when the AAP released a policy statement that was more positive on the topic. Hospital discharge surveys in the U.S. show lower numbers, although this is likely due to miscoding, circumcisions performed after hospital discharge, and those performed later in life. Canada has seen a slow decline since the early 1970s, possibly influenced by past statements from the AAP and the Canadian Pediatric Society in the 1970s that stated it was not medically necessary. In Australia, the rate declined in the 1970s and 80s, but has been increasing slowly as of 2004. In the United Kingdom, prevalence was likely to have been 20–30% in the 1940s but declined at the end of that decade. One possible reason may have been a 1949 "British Medical Journal" article which argued that there was no good medical reason for routine circumcision. The overall prevalence of circumcision 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.


title: Circumcision

text: 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. Policies that require the costs to be paid by the parents yield lower circumcision rates. The decline in the rates in the UK is one example; another is that in United States, with states where insurance or Medicaid covers the costs having higher rates. Changes to policy are driven by the results of new research, and moderated by the politics, demographics, and culture of the communities.


title: Circumcision

text: "(Yosha & Bolnick & Koyle, 2012)" projects a "worldwide increase in circumcision rates in the first half of the twenty-first century."


title: Circumcision

text: Circumcision is the world's oldest planned surgical procedure, suggested by anatomist and 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: 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. Other explanations for its origin include it acting as a religious sacrifice or a rite of passage marking a boy's entrance into adulthood.


title: Circumcision

text: 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 Egyptians and the Semites, and then by the Jews and Muslims, with whom the practice travelled to and was adopted by the Bantu Africans. In Oceania, circumcision is practiced by the Australian Aboriginals and Polynesians. There is also evidence that circumcision was practiced among the Aztec and Mayan civilizations in the Americas, but little detail is available about its history.


title: Circumcision

text: At Oued Djerat, in Algeria, engraved rock art with masked bowmen, which feature male circumcision and may be a scene involving ritual, have been dated to earlier than 6000 BP amid the Bubaline Period; more specifically, while possibly dating much earlier than 10,000 BP, rock art walls from the Bubaline Period have been dated between 9200 BP and 5500 BP. The cultural practice of circumcision may have spread from the Central Sahara, toward the south in Sub-Saharan Africa and toward the east in the region of the Nile. Based on engraved evidence found on walls and evidence from mummies, circumcision has been dated to at least as early as 6000 BCE in ancient Egypt. Some ancient Egyptian mummies, which have been dated as early as 4000 BCE, show evidence of having undergone circumcision.


title: Circumcision

text: Evidence suggests that circumcision was practiced in the Middle East by the fourth millennium BCE, when the Sumerians and the Semites moved into the area that is modern-day Iraq from the North and West. 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 24002300 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.


title: Circumcision

text: Circumcision features prominently in the Hebrew Bible. The narrative in Genesis chapter 17 describes the circumcision of Abraham and his relatives and slaves. In the same chapter, Abraham's descendants are commanded to circumcise their sons on the eighth day of life as part of a covenant with God. In addition to proposing that circumcision was taken up by the Israelites 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.


title: Circumcision

text: Campaigns of ethnic, cultural, and religious persecution have frequently included bans on the practice as a means of forceful assimilation, conversion, and ethnocide. Alexander the Great conquered the Middle East in the fourth century BCE, and in the following centuries 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. Restrictions on the Jewish practice by European governments have occurred several times in world history, including the Seleucid Empire under Antiochus IV and the Roman Empire under Hadrian, where it was used as a means of forceful assimilation and conversion. Antiochus IV's restriction on Jewish circumcision was a major factor in the Maccabean Revolt. Hadrian's prohibition has also been considered by some to have been a contributing cause of the Bar Kokhba revolt. According to Silverman (2006), these restrictions were part of a "broad campaign" by the Romans to "civilize" the Jewish people, viewing the practice as replusive and analogous to castration. His successor, Antoninus Pius, altered the edict to permit "Brit Milah". During this period in history, Jewish circumcision called for the removal of only a part of the prepuce, and Hellenized Jews often 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 second 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.


title: Circumcision

text: A narrative in the 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. Circumcision has played an important role in Christian history and theology. Paul the Apostle reinterpreted circumcision as a spiritual concept, arguing the physical one to be unnecessary for Gentile converts to Christianity. The teaching that physical circumcision was unnecessary for membership in a divine covenant was instrumental in the separation of Christianity from Judaism. While the circumcision of Jesus is celebrated as a feast day in the liturgical calendar of many Christian denominations.


title: Circumcision

text: Although it is not explicitly mentioned in the Quran (early seventh 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.


title: Circumcision

text: Genghis Khan and the following Yuan Emperors in China forbade Islamic practices such as halal butchering and circumcision.


title: Circumcision

text: 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 reconquest of Spain. In the second half of the first 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.


title: Circumcision

text: Circumcision is practiced by some groups amongst Australian Aboriginal peoples, Polynesians, and Native Americans. Little information is available about the origins and history of circumcision among these peoples, compared to circumcision in the Middle East.


title: Circumcision

text: 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. Often seashells were used to remove the foreskin, and the bleeding was stopped with eucalyptus smoke.


title: Circumcision

text: Christopher Columbus reported circumcision being practiced by Native Americans. It probably started among South American tribes as a blood sacrifice or ritual to test bravery and endurance, and its use later evolved into a rite of initiation.


title: Circumcision

text: Circumcision first began to be advocated as a means of "prophylaxis" in 1855, primarily as a means of preventing the transmission of sexually transmitted infections. At this time, renowned British physician Jonathan Hutchinson published his findings that Jews had a lower prevalence of certain venereal diseases in the city of London. Hutchinson's study suggested that circumcision acted as an effective means against contracting sexually transmitted disease. While pursuing a successful career as a general practitioner, Hutchinson went on to advocate circumcision for health reasons for the next fifty years, and eventually earned a knighthood for his overall contributions to medicine.


title: Circumcision

text: Shortly afterwards in the United States, circumcision was popularized by American physician 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 diagnosed 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. At that time, British and American doctors such as Hutchinson and Sayre also began recommending it in a mistaken belief it would act as a deterrent to masturbation. Prior to the 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. The use of circumcision to promote good health also fit in with the germ theory of disease during that time, which saw the foreskin as being filled with infection-causing smegma. Sayre published works on the subject and promoted it energetically in speeches. By the late 19th century, it had become a common medical procedure throughout a large majority of the core Anglophonic world: Australia, Canada, the United States, and the United Kingdom.


title: Circumcision

text: Contemporary physicians picked up on the 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 infant circumcision was near universally recommended in America and Great Britain, amid other parts of the Anglosphere. Historian David Gollaher proposes that "Americans found circumcision appealing not merely on medical grounds, but also for its connotations of science, health, and cleanliness—newly important class distinctions" in a country where 17 million immigrants arrived between 1890 and 1914.


title: Circumcision

text: After the end of World War II, Britain implemented a National Health Service, and so looked to ensure that each medical procedure covered by the new system was cost-effective and the procedure for non-medical reasons was not covered by the national healthcare system. Douglas Gairdner's 1949 article "The Fate of the Foreskin" argued that the evidence available at that time showed that the risks outweighed the known benefits. In contrast to Gairdner, the famed American pediatrician and political activist Benjamin Spock argued in favor of circumcision in his work "The Common Sense Book of Baby and Child Care"; rates in the United States continued to rise.


title: Circumcision

text: 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. The United States made similar statements in the 1970s, but stopped short of recommending against it, simply stating that it has no medical benefit. Since then they have amended their policy statements several times, with the current recommendation being that the benefits outweigh the risks, but they do not recommend it routinely.


title: Circumcision

text: An association between circumcision and reduced heterosexual HIV infection rates was first suggested in 1986.


title: Circumcision

text: Experimental evidence was needed to establish a causal relationship, so three randomized controlled trials were commissioned as a means to reduce the effect of any confounding factors. Trials took place in South Africa, Kenya and Uganda. All three trials were stopped early by their monitoring boards because those in the circumcised group had a substantially lower rate of HIV contraction than the control group, and hence it was seen as unethical to withhold the procedure, in light of strong evidence of prophylactic efficacy. WHO assessed these as "gold standard" studies and found "strong and consistent" evidence from later studies that confirmed the results of the studies. A scientific consensus subsequently developed that circumcision reduces heterosexual HIV infection rates in high-risk populations; the WHO, along with other major medical organization, have since promoted the widespread adoption of circumcision in high-risk populations as part of an overall program to reduce the spread of HIV. The "Male Circumcision Clearinghouse" website was formed in 2009 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.


title: Circumcision

text: Many societies hold cultural, ethical, or social views on the practice, with perspectives ranging widely. In some cultures, males are generally required to 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 and Druze faiths and in Coptic Christianity and the Ethiopian Orthodox Church and the Eritrean Orthodox Tewahedo Church. In contrast, some religions, such as Mandaeism and Hinduism and Sikhism, strongly prohibit the practice of routine circumcision.


title: Circumcision

text: Circumcision rates are near-universal among Jews. The "mitzvah" of circumcision on the eighth day of life is considered among the most important commandments in Judaism. Barring extraordinary circumstances, failure to undergo the rite is seen by followers of Judaism as leading to a state of "Kareth": the extinction of the soul and denial of a share in the world to come.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 leaves the glans bare when the penis is flaccid. Converts to Conservative and Orthodox 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 mainstream Judaism foresees serious negative spiritual consequences if it is neglected. Circumcision is not considered a universal moral law within Judaism. Rather, the commandment to circumcise is seen as only applying to Jewish people. Those who are Gentiles are believed to have a portion in the "World to Come" as long as they follow the tenets of the Seven Laws of Noah. There are also certain exceptions for Jews with poor health.


title: Circumcision

text: According to traditional Jewish law, in the absence of an adult free Jewish male expert, a woman, a slave, or a child who has the required skills is also authorized to perform the circumcision, provided that they are Jewish. However, most streams of non-Orthodox Judaism allow female mohels, called "mohalot" (, the plural of "mohelet", feminine of "mohel"), without restriction. In 1984 Deborah Cohen became the first certified Reform mohelet; she was certified by the Berit Mila program of Reform Judaism.


title: Circumcision

text: All major rabbinical organizations make the recommendation that male infants should be circumcised. The issue of converts remains controversial in Reform and Reconstructionist Judaism; circumcision of converts is not mandatory in either.


title: Circumcision

text: Despite its common practice in Muslim-majority nations, circumcision is considered to be "sunnah" (tradition) and not required for a life directed by Allah. According to historians of religion and scholars of Religious studies, the Islamic tradition of circumcision was derived from the Pagan practices and rituals of pre-Islamic Arabia. Although there is some debate within Islam over whether it is a religious requirement or mere recommendation, 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").


title: Circumcision

text: 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; most often it is 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.


title: Circumcision

text: The majority of Christians have traditionally not been circumcised, viewing the practice as being succeeded by Baptism, with the New Testament chapter Acts 15 recording that Christianity did not require circumcision from new converts. Mainstream Christian denominations generally hold a neutral position on circumcision for prophylactic, cultural, and social reasons, while strongly opposing it for religious reasons. This includes the Catholic Church, which explicitly banned the practice of religious circumcision in the Council of Florence, and maintains a neutral position on the practice of circumcision for other reasons. A majority of other Christian denominations take a similar position on circumcision, prohibiting it for religious observance, but neither explicitly supporting or forbidding it for other reasons.


title: Circumcision

text: Thus, circumcision rates of Christians are predominately determined by the surrounding cultures in which they live in. In some African and Eastern Christian denominations circumcision is an established practice, and generally men undergo circumcision shortly after birth as part of a rite of passage. Circumcision is near-universal among Coptic Christians, and they practice circumcision as a rite of passage. The Ethiopian Orthodox Church calls for circumcision, with near-universal prevalence among Orthodox men in Ethiopia. Eritrean Orthodox practice circumcision as a rite of passage, and they circumcise their sons "anywhere from the first week of life to the first few year". Some Christian churches in South Africa disapprove of the practice, while others require it of their members.


title: Circumcision

text: Circumcision is practiced in some predominantly Christian countries and Christian communities. Christian communities in Africa, the Anglosphere countries, the Philippines, the Middle East, South Korea and Oceania have high circumcision rates, while Christian communities in Europe and South America have low circumcision rates, although none of these are performed out of perceived religious obligation. Scholar Heather L. Armstrong writes that, as of 2021, about half of Christian males worldwide are circumcised, with most of them being located in Africa, Anglosphere countries, and the Philippines.


title: Circumcision

text: Circumcision is widely practiced by the Druze; Druze practice Druzism, an Abrahamic, monotheistic, syncretic, and ethnic religion. The procedure is practiced as a cultural tradition, and has no religious significance in the Druze faith. There is no special date for this act in the Druze faith: male Druze infants are usually circumcised shortly after birth, however some remain uncircumcised until the age of ten or older.


title: Circumcision

text: Some Druses do not circumcise their male children, and refuse to observe this "common Muslim practice".


title: Circumcision

text: Circumcision is forbidden in Mandaeism, and the sign of the Jews given to Abraham by God, circumcision, is considered abhorrent by the Mandaeans. According to the Mandaean doctrine a circumcised man cannot serve as a Mandaean priest.


title: Circumcision

text: Circumcision is not required in Yazidism, but is practised by some Yazidis due to regional customs. The ritual is usually performed soon after birth, it takes place on the knees of the kerîf (approximately "godfather"), with whom the child will have a life-long formal relationship.


title: Circumcision

text: Sikhism does not require the elective circumcision of its followers and strongly criticizes the practice.


title: Circumcision

text: For example, Bhagat Kabir criticizes the practise of circumcision in the following hymn of Guru Granth Sahib:


title: Circumcision

text: Circumcision is prevalent among 92% of men in North Africa and around 62% in Sub-Saharan Africa. In western and northern parts of Africa it is mainly performed for religious reasons, whereas in southern parts of Africa it rarely performed in neonates, instead being a rite of passage into manhood. Certain African cultural groups, such as the Yoruba and the Igbo of Nigeria, customarily circumcise their infant sons. The procedure is also practiced by some cultural groups or individual family lines in Sudan, Democratic Republic of the Congo, 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.


title: Circumcision

text: The Maasai people, who live predominantly in Kenya and Tanzania, use circumcision as a rite of passage. It is also used for distinguished age groups. This is usually done after every fifteen years where a new "age set" are formed. The new members are to undergo initiation at the same time. Whenever new age groups are initiated, they will become novice warriors and replace the previous group. The new initiates will be given a unique name that will be an important marker of the history of the Maasai. No anesthesia is used, and initiates have to endure the pain or be called flinchers.


title: Circumcision

text: The Xhosa community practice circumcision as a sacrifice. In doing so, young boys will announce to their family members when they are ready for circumcision by singing. The sacrifice is the blood spilt during the initiation procedure. Young boys will be considered an "outsiders" unless they undergo circumcision. It is not clear how many deaths and injuries result from non-clinical circumcisions.


title: Circumcision

text: Some Australian Aborigines 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 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.


title: Circumcision

text: In the Philippines, circumcision is known as "tuli" and is generally viewed as a rite of passage. An overwhelming majority of Filipino men are circumcised. Often this occurs, in April and May, when Filipino boys are taken by their parents. The practice dates back to the arrival of Islam in 1450. Pressure to be circumcised is even in the language: one Tagalog word for 'uncircumcised' is "supot", meaning 'coward' literally. A circumcised eight or ten year-old is no longer considered a boy and is given more adult roles in the family and society.


title: Circumcision

text: 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 (promoting well-being) and 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.


title: Circumcision

text: With a newborn involved, the decision is made more complex due to 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. 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.


title: Circumcision

text: 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-therapeutic 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 to perform the procedure. Medical organizations such as the British Medical Association state that their member physicians are not obliged to perform the procedure in such situations.


title: Circumcision

text: In 2012, the International NGO Council on Violence against Children identified non-therapeutic circumcision of infants and boys as being among harmful practices that constitute violence against children and violate their rights. The German Academy for Pediatric and Adolescent Medicine (Deutsche Akademie für Kinder- und Jugendmedizin e.V., DAKJ) recommend against routine non-medical infant circumcision. The Royal Dutch Medical Association questions why the ethics regarding male genital alterations should be viewed any differently from female genital alterations. The Danish College of General Practitioners has stated that circumcision should "only [be done] when medically needed, otherwise it is a case of mutilation."


title: Circumcision

text: 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. Worldwide, most legal jurisdictions do not have specific laws concerning the circumcision of males, but infant circumcision is not illegal in many countries. A few countries have passed legislation on the procedure: Germany allows routine circumcision, while non-religious routine circumcision is illegal in South Africa and Sweden. The religious circumcision of minors is legal in every polity.


title: Circumcision

text: No major medical organization recommends circumcising all males, and no major medical organization recommends banning the procedure. Among critics of the practice, there is an agreement that an outright ban would be predominately ineffective. A consensus to keep the procedure within the purview of medical professionals is found across all major medical organizations, who advise medical professionals to yield to some degree to parental preferences in their decision to agree to circumcise. The Royal Dutch Medical Association, which expresses some of the strongest opposition to routine neonatal circumcision, argues that while there are valid reasons for banning it, doing so could lead parents who insist on the procedure to turn to poorly trained practitioners instead of medical professionals.


title: Circumcision

text: 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. Several analyses have concluded that circumcision programs for adult men in Africa are cost-effective and in some cases are cost-saving. In Rwanda, circumcision has been found to be cost-effective across a wide range of age groups from newborn to adult, 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. 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. 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.


title: Circumcision

text: The overall cost-effectiveness of neonatal circumcision has also been studied in the United States, which has a different cost setting from Africa in areas such as public health infrastructure, availability of medications, and medical technology and the willingness to use it. 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 transmission of HIV alone during coitus, without considering any other cost benefits. 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. A 2014 review that considered reported benefits of circumcision such as reduced risks from HIV, HPV, and HSV-2 stated that circumcision is cost-effective in both the United States and Africa and may result in health care savings. A 2014 literature review found that there are significant gaps in the current literature on male and female sexual health that need to be addressed for the literature to be applicable to North American populations.


title: Iran–Contra affair

text: The Iran–Contra affair (, ), often referred to as the Iran–Contra scandal, the McFarlane affair (in Iran), or simply Iran–Contra, was a political scandal in the United States that occurred during the second term of the Reagan administration. Between 1981 and 1986, senior administration officials secretly facilitated the sale of arms to Iran, which was the subject of an arms embargo. The administration hoped to use the proceeds of the arms sale to fund the Contras, a right-wing rebel group, in Nicaragua. Under the Boland Amendment, further funding of the Contras by the government had been prohibited by Congress.


title: Iran–Contra affair

text: The official justification for the arms shipments was that they were part of an operation to free seven American hostages being held in Lebanon by Hezbollah, an Islamist paramilitary group with Iranian ties connected to the Islamic Revolutionary Guard Corps. The idea to exchange arms for hostages was proposed by Manucher Ghorbanifar, an expatriate Iranian arms dealer. Some within the Reagan administration hoped the sales would influence Iran to get Hezbollah to release the hostages.


title: Iran–Contra affair

text: In late 1985, Lieutenant Colonel Oliver North of the National Security Council diverted a portion of the proceeds from the Iranian weapon sales to fund the Contras, a group of anti-Sandinista rebels, in their insurgency against the socialist government of Nicaragua. North later claimed that Ghorbanifar had given him the idea for diverting profits from TOW and HAWK missile sales to Iran to the Nicaraguan Contras. While President Ronald Reagan was a vocal supporter of the Contra cause, the evidence is disputed as to whether he personally authorized the diversion of funds to the Contras. Handwritten notes taken by Defense Secretary Caspar Weinberger on 7 December 1985 indicate that Reagan was aware of potential hostage transfers with Iran, by Israel, as well as the sale of HAWK and TOW missiles to "moderate elements" within that country. Weinberger wrote that Reagan said "he could of illegality but he couldn't that 'big strong President Reagan passed up a chance to . After the weapon sales were revealed in November 1986, Reagan appeared on national television and stated that the weapons transfers had indeed occurred, but that the United States did not trade arms for hostages. The investigation was impeded when large volumes of documents relating to the affair were destroyed or withheld from investigators by Reagan administration officials. On 4 March 1987, Reagan made a further nationally televised address, taking full responsibility for the affair and stating that "what began as a strategic opening to Iran deteriorated, in its implementation, into trading arms for hostages".


title: Iran–Contra affair

text: The affair was investigated by the U.S. Congress and by the three-person, Reagan-appointed Tower Commission. Neither investigation found evidence that President Reagan himself knew of the extent of the multiple programs. Additionally, United States Deputy Attorney General Lawrence Walsh was appointed Independent Counsel in December 1986 to investigate possible criminal actions by officials involved in the scheme. In the end, several dozen administration officials were indicted, including then-Secretary of Defense Caspar Weinberger. Eleven convictions resulted, some of which were vacated on appeal.


title: Iran–Contra affair

text: The rest of those indicted or convicted were all pardoned in the final days of the presidency of George H. W. Bush, who had been Vice President at the time of the affair. Former Independent Counsel Walsh noted that in issuing the pardons, Bush appeared to have been preempting being implicated himself by evidence that came to light during the Weinberger trial, and noted that there was a pattern of "deception and obstruction" by Bush, Weinberger and other senior Reagan administration officials. Walsh submitted his final report on August 4, 1993, and later wrote an account of his experiences as counsel, "Firewall: The Iran-Contra Conspiracy and Cover-Up".


title: Iran–Contra affair

text: The United States was the largest seller of arms to Iran under Mohammad Reza Pahlavi, and the vast majority of the weapons that the Islamic Republic of Iran inherited in January 1979 were American-made. To maintain this arsenal, Iran required a steady supply of spare parts to replace those broken and worn out. After Iranian students stormed the American embassy in Tehran in November 1979 and took 52 Americans hostage, U.S. President Jimmy Carter imposed an arms embargo on Iran. After Iraq invaded Iran in September 1980, Iran desperately needed weapons and spare parts for its current weapons. After Ronald Reagan took office as President on 20 January 1981, he vowed to continue Carter's policy of blocking arms sales to Iran on the grounds that Iran supported terrorism.


title: Iran–Contra affair

text: A group of senior Reagan administration officials in the Senior Interdepartmental Group conducted a secret study on 21 July 1981, and concluded that the arms embargo was ineffective because Iran could always buy arms and spare parts for its American weapons elsewhere, while at the same time the arms embargo opened the door for Iran to fall into the Soviet sphere of influence as the Kremlin could sell Iran weapons if the United States would not. The conclusion was that the United States should start selling Iran arms as soon as it was politically possible to keep Iran from falling into the Soviet sphere of influence. At the same time, the openly declared goal of Ayatollah Khomeini to export his Islamic revolution all over the Middle East and overthrow the governments of Iraq, Kuwait, Saudi Arabia, and the other states around the Persian Gulf led to the Americans perceiving Khomeini as a major threat to the United States.


title: Iran–Contra affair

text: In the spring of 1983, the United States launched Operation Staunch, a wide-ranging diplomatic effort to persuade other nations all over the world not to sell arms or spare parts for weapons to Iran. This was at least part of the reason the Iran–Contra affair proved so humiliating for the United States when the story first broke in November 1986 that the U.S. itself was selling arms to Iran.


title: Iran–Contra affair

text: At the same time that the American government was considering its options on selling arms to Iran, Contra militants based in Honduras were waging a guerrilla war to topple the Sandinista National Liberation Front (FSLN) revolutionary government of Nicaragua. Almost from the time he took office in 1981, a major goal of the Reagan administration was the overthrow of the left-wing Sandinista government in Nicaragua and to support the Contra rebels. The Reagan administration's policy towards Nicaragua produced a major clash between the executive and legislative branches as Congress sought to limit, if not curb altogether, the ability of the White House to support the Contras. Direct U.S. funding of the Contras insurgency was made illegal through the Boland Amendment, the name given to three U.S. legislative amendments between 1982 and 1984 aimed at limiting U.S. government assistance to Contra militants. By 1984, funding for the Contras had run out; and, in October of that year, a total ban came into effect. The second Boland Amendment, in effect from 3 October 1984 to 3 December 1985, stated:During the fiscal year 1985 no funds available to the Central Intelligence Agency, the Department of Defense or any other agency or entity of the United States involved in intelligence activities may be obligated or expended for the purpose of or which may have the effect of supporting directly or indirectly military or paramilitary operations in Nicaragua by any nation, organization, group, movement, or individual. In violation of the Boland Amendment, senior officials of the Reagan administration continued to secretly arm and train the Contras and provide arms to Iran, an operation they called "the Enterprise". Given the Contras' heavy dependence on U.S. military and financial support, the second Boland Amendment threatened to break the Contra movement, and led to President Reagan ordering in 1984 that the National Security Council (NSC) "keep the Contras together 'body and soul, no matter what Congress voted for.


title: Iran–Contra affair

text: A major legal debate at the center of the Iran–Contra affair concerned the question of whether the NSC was one of the "any other agency or entity of the United States involved in intelligence activities" covered by the Boland Amendment. The Reagan administration argued it was not, and many in Congress argued that it was. The majority of constitutional scholars have asserted the NSC did indeed fall within the purview of the second Boland Amendment, though the amendment did not mention the NSC by name. The broader constitutional question at stake was the power of Congress versus the power of the presidency. The Reagan administration argued that because the constitution assigned the right to conduct foreign policy to the executive, its efforts to overthrow the government of Nicaragua were a presidential prerogative that Congress had no right to try to halt via the Boland Amendments. By contrast Congressional leaders argued that the constitution had assigned Congress control of the budget, and Congress had every right to use that power not to fund projects like attempting to overthrow the government of Nicaragua that they disapproved of. As part of the effort to circumvent the Boland Amendment, the NSC established "the Enterprise", an arms-smuggling network headed by a retired U.S. Air Force officer turned arms dealer Richard Secord that supplied arms to the Contras. It was ostensibly a private sector operation, but in fact was controlled by the NSC. To fund "the Enterprise", the Reagan administration was constantly on the look-out for funds that came from outside the U.S. government in order not to explicitly violate the letter of the Boland Amendment, though the efforts to find alternative funding for the Contras violated the spirit of the Boland Amendment. Ironically, military aid to the Contras was reinstated with Congressional consent in October 1986, a month before the scandal broke.


title: Iran–Contra affair

text: In his 1995 memoir "My American Journey", General Colin Powell, the U.S. Deputy National Security Advisor wrote that the weapons sales to Iran were used "for purposes prohibited by the elected representatives of the American people...in a way that avoided accountability to the President and Congress. It was wrong."


title: Iran–Contra affair

text: In 1985, Manuel Noriega offered to help the United States by allowing Panama as a staging ground for operations against the Sandinistas, and offering to train Contras in Panama, but this would later be overshadowed by the Iran–Contra affair itself.


title: Iran–Contra affair

text: At around the same time, the Soviet Bloc also engaged in arms deals with ideologically opponent buyers, possibly involving some of the same players as the Iran–Contra affair. In 1986, a complex operation involving East Germany's Stasi and the Danish-registered ship "Pia Vesta" ultimately aimed to sell Soviet arms and military vehicles to South Africa's Armscor, using various intermediaries to distance themselves from the deal. Manuel Noriega of Panama was apparently one of these intermediaries but backed out on the deal as the ship and weapons were seized at a Panamanian port. The "Pia Vesta" led to a small controversy, as the Panama and Peru governments in 1986 accused the United States and each other of being involved in the East Germany-originated shipment.


title: Iran–Contra affair

text: As reported in "The New York Times" in 1991, "continuing allegations that Reagan campaign officials made a deal with the Iranian Government of Ayatollah Ruhollah Khomeini in the fall of 1980" led to "limited investigations." However "limited," those investigations established that "Soon after taking office in 1981, the Reagan Administration secretly and abruptly changed United States policy." Secret Israeli arms sales and shipments to Iran began in that year, even as, in public, "the Reagan Administration" presented a different face, and "aggressively promoted a public campaign... to stop worldwide transfers of military goods to Iran." "The New York Times" explains: "Iran at that time was in dire need of arms and spare parts for its American-made arsenal to defend itself against Iraq, which had attacked it in September 1980," while "Israel [a U.S. ally] was interested in keeping the war between Iran and Iraq going to ensure that these two potential enemies remained preoccupied with each other." Maj. Gen. Avraham Tamir, a high-ranking Israeli Defense Ministry official in 1981, said there was an "oral agreement" to allow the sale of "spare parts" to Iran. This was based on an "understanding" with Secretary Alexander Haig (which a Haig adviser denied). This account was confirmed by a former senior American diplomat with a few modifications. The diplomat claimed that "[Ariel] Sharon violated it, and Haig backed away...". A former "high-level" CIA official who saw reports of arms sales to Iran by Israel in the early 1980s estimated that the total was about $2 billion a year – but also said, "The degree to which it was sanctioned I don't know."


title: Iran–Contra affair

text: On 17 June 1985, National Security Adviser Robert McFarlane wrote a National Security Decision Directive which called for the United States of America to begin a rapprochement with the Islamic Republic of Iran. The paper read:


title: Iran–Contra affair

text: Dynamic political evolution is taking place inside Iran. Instability caused by the pressures of the Iraq-Iran war, economic deterioration and regime in-fighting create the potential for major changes inside Iran. The Soviet Union is better positioned than the U.S. to exploit and benefit from any power struggle that results in changes from the Iranian regime ... The U.S should encourage Western allies and friends to help Iran meet its import requirements so as to reduce the attractiveness of Soviet assistance ... This includes provision of selected military equipment.


title: Iran–Contra affair

text: Defense Secretary Caspar Weinberger was highly negative, writing on his copy of McFarlane's paper: "This is almost too absurd to comment on ... like asking Qaddafi to Washington for a cozy chat." Secretary of State George Shultz was also opposed, stating that having designated Iran a State Sponsor of Terrorism in January 1984, how could the United States possibly sell arms to Iran? Only the Director of the Central Intelligence Agency William Casey supported McFarlane's plan to start selling arms to Iran.


title: Iran–Contra affair

text: In early July 1985, the historian Michael Ledeen, a consultant of National Security Adviser Robert McFarlane, requested assistance from Israeli Prime Minister Shimon Peres for help in the sale of arms to Iran. Having talked to an Israeli diplomat David Kimche and Ledeen, McFarlane learned that the Iranians were prepared to have Hezbollah release American hostages in Lebanon in exchange for Israelis shipping Iran American weapons. Having been designated a State Sponsor of Terrorism since January 1984, Iran was in the midst of the Iran–Iraq War and could find few Western nations willing to supply it with weapons. The idea behind the plan was for Israel to ship weapons through an intermediary (identified as Manucher Ghorbanifar) to the Islamic Republic as a way of aiding a supposedly moderate, politically influential faction within the regime of Ayatollah Khomeini who was believed to be seeking a rapprochement with the United States; after the transaction, the United States would reimburse Israel with the same weapons, while receiving monetary benefits. McFarlane in a memo to Shultz and Weinberger wrote:


title: Iran–Contra affair

text: The short term dimension concerns the seven hostages; the long term dimension involves the establishment of a private dialogue with Iranian officials on the broader relations ... They sought specifically the delivery from Israel of 100 TOW missiles ...


title: Iran–Contra affair

text: The plan was discussed with President Reagan on 18 July 1985 and again on 6 August 1985. Shultz at the latter meeting warned Reagan that "we were just falling into the arms-for-hostages business and we shouldn't do it."


title: Iran–Contra affair

text: The Americans believed that there was a moderate faction in the Islamic Republic headed by Akbar Hashemi Rafsanjani, the powerful speaker of the "Majlis" who was seen as a leading potential successor to Khomeini and who was alleged to want a rapprochement with the United States. The Americans believed that Rafsanjani had the power to order Hezbollah to free the American hostages and establishing a relationship with him by selling Iran arms would ultimately place Iran back within the American sphere of influence. It remains unclear if Rafsanjani really wanted a rapprochement with the United States or was just deceiving Reagan administration officials who were willing to believe that he was a moderate who would effect a rapprochement. Rafsanjani, whose nickname is "the Shark" was described by the British journalist Patrick Brogan as a man of great charm and formidable intelligence known for his subtlety and ruthlessness whose motives in the Iran–Contra affair remain completely mysterious. The Israeli government required that the sale of arms meet high-level approval from the United States government, and when McFarlane convinced them that the U.S. government approved the sale, Israel obliged by agreeing to sell the arms.