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Islamic Sex Education: by Islamic Education & Services Institute (View All Articles by: Islamic Education & Services Institute)

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It's very natural to be slightly embarrassed or uncomfortable in the face of this issue but we have to admit that sex is a natural part of our existence. Also, teens and adolescents will be curious and they will search for answers. If they have nowhere or no one reliable to go to because of embarrassment, they will go to more readily available but unreliable or unIslamic sources. This might end updoing more harm than good. I hope providing this information will benefit everyone - parents and youth alike.

1. Basic bedroom fiqh
2. Turning Sex Into Sadaqa
3. Sexual Relations Between Husband & Wife
4. Sex - a means of keeping the heart pure
5. Human Sexuality and the Shariah
6. Sex Is Good For You
7. More about Sex & Islam
8. Is your Ghusl Correct?
9. Circumcision may prevent AIDS
10. Medical benefits from circumcision (male)
11. Female Circumcision
12. Taking pictures whilst naked or having intercourse
13. Reading sexual advice in books on Internet
14. Learning about abortion and veneral diseases
15. Abortion of babies with genetic diseases
16. Is In Vitro Fertilization Allowed?
17. Masturbation: Halal or Haram?
18. Mutual Masturbation between spouses
19. Advice for one who wakes up masturbating
20. Masturbating to avoid pornography
21. Drinking one's wife's milk during foreplay
22. Oral Sex
23. Family Planning
24. Reproductive Issues
25. Flirtation and Love Affairs
26. Lowering our Gaze
27. Islamic Perspective on Homosexuality
28. Private Schools Promoting Homosexuality
29. Homosexuality. The Cost to Society 
30. Qaradawi on Free-Mixing of Men and Women
31. Anal Sex
32. Condoms
33. Viagra
34. Transplanting Testicles
35. Sterility Operations

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Basic bedroom fiqh

Question: I just got married, and would like to know the essential fiqh of bedroom relations. I wanted to know the fiqh of intimacy with one's spouse. Specifically what is haram, makrooh, mubah, halal..etc...

Answer:

It is disliked to:
 

• Face the qibla. (Ibn `Abidin)
• Be in the presence of a mature child. (Ibn `Abidin)
• Talk, for it is from the sunna not to talk excessively during intercourse. (Ibn `Abidin)


It is proper to cover up a Qur’an in the bedroom. (Ibn `Abidin)

It is best to avoid looking at each other’s private parts, though some Companions held that it is fine because it increases desire. (Durar)

Ibn al-Hajj al-Maliki mentioned in al-Madkhal:
 

• The beginning of the night is better…
• One must avoid intercourse with one’s wife before any foreplay, because it has been interdicted. Rather, one should play around with her and jest with kisses, touches and the like. Then, one sees that she is ready, prepared, and desirous of him, only then should he initiate intercourse. The wisdom of the Lawgiver in this is evident, for the woman derives pleasure as a man does. If he approaches her while she is unprepared, he may fulfill his need, but she may not, and would feel frustrated…
• Before penetration, one should say, Bismillah Allahumma Jannibna al-Shaytan, wa Jannib ish-Shaytanu ma Razaqtana, as has been authentically reported in the sunna…
• One should be careful to fulfill the rights of the wife with regards to intercourse, and to safeguard her religion. One should fulfill oneself [=orgasm] after she has achieved fulfillment, to be under the general rubric of the Prophet’s saying (Allah bless him and give him peace), “Allah is in the assistance of a servant as long as he is in the assistance of his fellow.”
• One should not have intercourse without covers…
• It is best to perform ghusl before sleeping after intercourse. Or, at least to do wudu and wash the private parts. [f: One should not, at the very least, leave washing the private parts.]


These are general guidelines. Ruqayya Waris Maqsood’s book on marriage goes into some detail on the subject, as does Imam al-Ghazali’s work.

Anal sex is, of course haram.

Mutual hand stimulation is permitted.

Sexual fluids are najis, so oral sex is detested.

During mentruation (hayd), intercourse is haram. So is direct skin contact between the wife’s navel and knee. Everything else, however, remains permitted.

And Allah knows best.

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Turning Sex Into Sadaqa
An excerpt from 'The Muslim Marriage Guide', By Ruqaiyyah Waris Maqsood (Amana Publications), reprinted in Beliefnet.com

"Women shall have rights similar to the rights upon them; according to what is equitable and just; and men have a degree of advantage over them." (Quran, 2:216)

They do indeed! This passage of the Holy Quran was revealed in connection with the rights of women following a divorce, but it also has a general sense. One basic right of every person taking on a contract never to have sex other than with their own legitimate partner is that each spouse should therefore provide sexual fulfillment (imta') to the other, as part of the bargain.

Now, every man knows what sexual things please him--but some men, particularly those who have not been married before and are therefore lacking experience, don't seem to know much about how to give the same pleasure to the woman; even worse, some men do know but they can't be bothered to make the effort. Yet this is vital if a marriage is to succeed and not just be a disappointing burden for the woman, and it is a vital part of one's Islamic duty.

It is not acceptable for a Muslim man just to satisfy himself while ignoring his wife's needs. Experts agree that the basic psychological need of a man is respect, while that of a woman is love. Neither respect nor love are things that can be forced--they have to be worked for, and earned. The Prophet (s) stated that in one's sexual intimacy with one's life partner there is sadaqa (worship through giving):

God's Messenger(s) said: "In the sexual act of each of you there is a sadaqa." The Companions replied: "0 Messenger of God! When one of us fulfils his sexual desire, will he be given a reward for that?" And he said, "Do you not think that were he to act upon it unlawfully, he would be sinning? Likewise, if he acts upon it lawfully he will be rewarded." (Muslim)

This hadith only makes sense if the sexual act is raised above the mere animal level.

What is the magic ingredient that turns sex into sadaqa, that makes it a matter of reward or punishment from Allah? It is by making one's sex life more than simple physical gratification; it is by thought for pleasing Allah by unselfish care for one's partner. A husband that cannot understand this will never be fully respected by his wife.

Neither spouse should ever act in a manner that would be injurious or harmful to their conjugal life. Nikah is the sacred tie between husband and wife, that sincere and devoted love without which they cannot attain happiness and peace of mind.

"Of His signs is this: that He created for you spouses that you might find rest in them, and He ordained between you love and mercy." (Quran, 30:21)

Now, every Muslim knows that a man has a right on his wife. However, because nikah is a contract never to seek sexual satisfaction outside the marriage bond, Islam commands not only the women but the men in this respect, and makes it clear that if a husband is not aware of the urges and needs of his wife, he will be committing a sin by depriving her of her rights.

According to all four orthodox jurists, it is incumbent upon the husband to keep his wife happy and pleased in this respect. Likewise, it is essential for the wife to satisfy the desire of the husband. Neither should reject the other, unless there is some lawful excuse. 

Now, it is fairly easy for a woman to satisfy a man and make herself available to him, even if she is not really in the mood. It is far harder for a man to satisfy a woman if he is not in the mood, and this is where an important aspect of male responsibility needs to be brought to every Muslim man's attention, and stressed strongly.

The jurists believed that a woman's private parts needed "protecting" (tahsin). What they meant was that it was important for a Muslim husband to satisfy his wife's sexual needs so that she would not be tempted to commit zina out of despair or frustration.

A Muslim wife is not merely a lump of flesh without emotions or feelings, just there to satisfy a man's natural urges. On the contrary, her body contains a soul no less important in God's sight than her husband's. Her heart is very tender and delicate, and crude or rough manners would hurt her feelings and drive away love. The husband would be both foolish and immoral to act in any way unpalatable to her natural temperament, and a man selfishly seeking his own satisfaction without considering that of his wife is a selfish boor. In fact, according to a hadith:

"Three things are counted inadequacies in a man. Firstly, meeting someone he would like to get to know, and taking leave of him before learning his name and his family. Secondly, rebuffing the generosity that another shows to him. And thirdly, going to his wife and having intercourse with her before talking to her and gaining her intimacy, satisfying his need from her before she has satisfied her need from him." (Daylami)

This is another of the things implied by the saying that one's wife is "a tilth unto you." (Quran, 2:223) The imagery is that of a farmer taking care of his fields. According to Mawlana Abul-Ala Mawdudi:

"The farmer sows the seed in order to reap the harvest, but he does not sow it out of season or cultivate it in a manner which will injure or exhaust the soil. He is wise and considerate, and does not run riot." (Afzalur Rahman, Quranic Sciences, London 1981, p.285)

Likewise, in the case of husband and wife, the husband should not just:

“Take hold of his wife and rub the seed and finish the business of procreation. The damage in this case could sometimes be irreparable, because a woman, unlike a farm, is very sensitive and has emotions, feelings, and strong passions which need full satisfaction and attention in a proper and appropriate manner.” (Afzalur Rahman, Quranic Sciences, London 1981, p. 286)

If this is not taken into consideration, and the wife is not properly prepared to start lovemaking, or is unsatisfied when it is finished, there could be many psychological and physiological complications leading to frigidity and other abnormalities. Indeed, many husbands eventually become disappointed with their wives, believing them to be frigid or unable to respond to their activities (unlike the sirens on the film or TV screen), and they wonder what is wrong with them. A possible explanation will follow in a moment.

Allah created male and female from a single soul in order that man might live with her in serenity (Quran, 7:189), and not in unhappiness, frustration and strife. If your marriage is frankly awful, then you must ask yourself how such a desperate and tragic scenario could be regarded by anyone as "half the Faith." According to a hadith:

"Not one of you should fall upon his wife like an animal; but let there first be a messenger between you." "And what is that messenger?" they asked, and he replied: "Kisses and words." (Daylami)

These "kisses and words" do not just include foreplay once intimacy has commenced. To set the right mood, little signals should begin well in advance, so that the wife has a clue as to what is coming, and is pleasantly expectant, and also has adequate time to make herself clean, attractive and ready. As regards intimacy itself, all men know that they cannot achieve sexual fulfillment if they are not aroused. They should also realise that it is actually harmful and painful for the female organs to be used for sex without proper preparation. In simple biological terms, the woman's private parts need a kind of natural lubrication before the sexual act takes place. For this, Allah has created special glands, known to modern doctors as the Bartholin glands, which provide the necessary "oils."

It is still possible to read old-fashioned advice to husbands that a desirable wife should be "dry"--which is remarkable ignorance and makes one really grieve for the poor wives of such inconsiderate men. Just as no one would dream of trying to run an engine without the correct lubricating fluids, it is the same, through the creative will of Allah, with the parts of the female body designed for sexual intimacy. A husband should know how to stimulate the production of these "oils" in his wife, or at the very least allow her to use some artificial "oils." This lack of knowledge or consideration is where so many marital problems frequently arise.

As Imam al-Ghazali says: "Sex should begin with gentle words and kissing," and Imam al-Zabidi adds: "This should include not only the cheeks and lips; and then he should caress the breasts and nipples, and every part of her body." (Zabidi, Ithaf al-Sada al Muttaqin, V 372) Most men will not need telling this; but it should be remembered that failure to observe this Islamic practice is to neglect or deny the way Allah has created women.

Insulting a wife with bad marital manners.

Firstly, a husband must overcome his shyness enough to actually look at his wife, and pay attention to her. If he cannot bring himself to follow this sunna, it is an insult to her, and extremely hurtful. Personal intimacy is a minefield of opportunities to hurt each other--glancing at the watch, a yawn at the wrong moment, appearing bored, and so on. A husband's duty is to convince his wife that he does love her--and this can only be done by word (constantly repeated word, I might add--such is the irritating nature of women!), and by looking and touching.

Many people believe that the expression in the eyes reveals much of the human soul. Certainly the lover's gaze is a most endearing and treasured thing. Many wives yearn for that gaze of love, even after they have been married for years. If you cannot bring yourself to look at her while paying attention to her, she can only interpret this as a sign that you do not really love her. And even though it may be irritating to you, and seem quite superfluous, most women are deeply moved when a man actually tells her that he loves her.

Sex is clean!

A modest upbringing is part of good character. The Prophet (s) himself said: "Modesty brings nothing but good." (Bukhari and Muslim) But another, also important, part of Islamic teaching says that all of Allah's creation is beautiful and pure, particularly when it is part of the body of human beings, who are designed as His deputies upon the earth. In some religions, people traditionally believed that the woman's private parts are in some way unclean, or dirty, or even evil.

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Sexual Relations Between Husband & Wife

Date: 18 MAY 1996
Newsgroups: soc.religion.islam
Subject: Re: Sexual Relations Between Husband & Wife

XXXX wrote: Hello. As a recently married Muslim, I was hoping someone could refer me to sources which can guide me as to what is permissible in Islam between a man and his wife. I once heard of an Islamic book called "Perfumed Garden"? Is there such a publication? Or could someone suggest other sources. In particular, I needed to know what the five schools of thought advised on oral sex or fellatio. Please email or post responses. Thank you.

Reply

alssalaamu 3alaykum

May Allah bless you and your wife with his blessing and unite you in harmony and happiness.

The book you mentioned, "The Perfumed Garden", was written in Tunisia in the 16th century A.D. by Cheikh 'Omar bin Sidi en-Nefzawi. It is a sort of marriage manual written in a rather provocative and lewd style. Even the author himself acknowledges its lascivious nature by ending it with these words: "I have indeed committed a sin by writing this book. Forgive me O Thou to whom we call not in vain. O Allah, do not confound me for this on the Day of Judgment. And you, O Reader, I beg you to say 'Amen'." The book is an interesting historical and cultural oddity; it is not to be recommended as an educational manual for married couples.

The principles of conjugal love in Islam are few and uncomplicated.

1. Sexual relations are for the pleasure of both the husband and the wife and for the procreation of children. Sexual intercourse is not limited to vaginal penetration but includes other forms of sexual caressing, such as kissing and fondling of various kinds.

2. Nothing should be done that is offensive or harmful to either person. Each has a duty to be sexually available to the other, but neither has the right to disgust or injure the other.

3. With a few exceptions, the couple can engage in any activities that they like, in any manner and in any position. Allah rewards such activities as surely as he punishes sinful activities. The Qur'an says, "Women are your fields. Go then into your fields as you please." (2:223)

4. It is forbidden to have vaginal intercourse while a woman is menstruating (Qur'an 2:222). According to the Sunnah of the Prophet (God's grace and peace be upon him), a man and his menstruating wife can however give one another pleasure so long as the woman's genitals are avoided.

5. There are ahadith that forbid anal intercourse and scholars generally agree that it is not permissible. However, in his tafsir (commentary) Tabaari (3d century A.H.) while forbidding sodomy, says that earlier authorities were divided on the question.

6. The Qur'an and the Sunnah are generally silent as to the various forms that sexual relations may take. Most authorities consider that it is up to the husband and wife in love and mutual respect to decide how to physically express their sexual desires.

7. What goes on in bedroom, is a private matter and should not be discussed or revealed to other persons unless there is some necessity, such as health or safety. Abu Hurairah narrates that the Prophet (pbuh) said this about people who reveal and discuss openly their sexual practices: "Do you know what those who do this are like? Those who do this are like a male and female devil who meet each other on the road and satisfy their desire while the people look on."

Therefore, in Islam the husband and the wife choose their sexual activities according to the sure teaching of the Qur'an, in the light of the Sunnah as we are able to understand and appreciate it, in mutual respect for one another and knowing that the only witness to the expression of their desires will be Allah the Exalted, who will judge them according to their deeds and their heartfelt intentions.

The question of the lawfulness of oral-genital contact is difficult because there are many opinions. For some, it is forbidden. For others, tolerated. For some it is lawful. Some consider it to be lawful as long as the couple use such contacts as foreplay and conclude their love-making with vaginal intercourse.

I believe that this is a matter to be decided by the husband and wife together after seeking the guidance of Allah, who alone knows best.

Peace to all who seek God's face.
 

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Sex - a means of keeping the heart pure
Taken from "The Proper Conduct of Marriage in Islam" ('Adaab an-Nikaah), Book 12 of Imam Ghazalis "Ihya 'Ulum ad-Din", Translated by Muhtar Holland. Al-Baz Publishing, 1998, ISBN: 1-882216-14-8.

Al-Junaid used to say: "I need sexual intercouse just as I need food." The wife is in fact nourishment and a means of keeping the heart pure. That is why Allah's Messenger (Allah bless him and give him peace) commanded anyone who caught site of a woman, and desired her, to couple with his wife, since that would dispel the temptation from his soul. (Page 24)

It is likewise related of Ibn 'Umar (may Allah be well pleased with him), who was one of the more ascetic and scholarly Companions, that he used to break his fast with sexual intercourse before eating. He would sometimes copulate before bathing and performing the sunset prayer. All this he did so as to leave his heart clear to worship Allah, and to dispose of Satan's power to distract him. (Page 25)

After the death of Fatima (peace be upon her), her husband 'Ali (may Allah be well pleased with him) remarried in seven days. (Page 26)

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Human Sexuality and the Shariat
by Professor Dr. Omar Hassan Kasule Sr.

GENDER IDENTITY

Separate Gender Identity

Allah created 2 different and distinct genders as a pair (75:39, 53:45, 92:3). The male is different from the female (3:36) although ultimately both are from the same source (4:1, 7:189, 16:72, 30:12, 39:6). Each gender is encouraged to maintain its biological, psychological, emotional, and social identity. This is for the purpose of facilitating and regulating relations between the two genders for the good of the whole society. Parity, a basic phenomenon of creation, requires that men and women complement one another each bringing to the relationship unique features of the respective gender identity. This complementation would be meaningless if the two genders lost their separate identities. On the demographic level, there should exist equal numbers of men and women. This is maintained in a normal social setting. In abnormal situations the balance may be lost leading to social problems. One of the signs of the impending last day, yawm al qiyamat, will be gender imbalance with too many women for few men (KS p. 106). This will be followed by a lot of adultery, zina (KS p. 264). Gender awareness develops very early in children. Sexual awareness develops towards puberty.

Gender Discrimination

Gender separation has been used in a wrong way to discriminate against women on the basis of their sexuality. In contemporary western society the woman's body is sometimes treated as a sexual object to be exploited in the commercial advertisement and entertainment industries. In pre-Islamic Arabia, jahiliyyat, there was despise for females, idhlaal al nisa. There was preference for male births and hatred for females (6:137, 6:140, 6:151, 17:31, 60:12, 81:8-9, 16:58-59). Parents were sad on birth of a daughter (16:58-59, 43:17). Infant daughters were considered a blemish, aar (16:58-59, 43:17) and were buried alive, wa'ad al banaat (6:137, 6:140, 6:151, 16:58-59, 17:31, 60:12, 81:8-9). Women were inherited as goods (4:19) and were denied the good things of life (6:139). In Christendom, women were blamed fior the original sin of Adam and Hawa and suffered discrimination as a result. Islam has emphasized gender identity while rejecting all forms of discrimination against the woman on the basis of her sexuality. The Qur'an makes it clear that both Adam and Hawa were misled (2:36, 7:22, 20:121). They both sought forgiveness from Allah and were forgiven (7:23). In 2 verses it is Adam and not Hawa who is mentioned as seeking forgiveness (2:37, 20:122). Human sexuality could be a cause of corruption. Women because of their sexual attractiveness can be a source of fitnat (MB #1837 Qur'an 64:14). This has been misunderstood as derogatory to the moral standards of women. In practice it is men who are more often the active or aggressive party in sexual corruption and should take the blame. Any situation of corruption involves both a man and a woman and both are morally guilty. The law equalizes their guilt and their punishment (24:2). In the same way Islam equalizes their reward for good work (3:195, 4:124, 16:97, 40:40, 33:35). Men can also be a sexual attraction as the Qur'an tells us in the story of Yusuf (PBUH). His beauty was a temptation, fitnat, for women (12:26).

Trans-sexuality

The law considers any blurring of the gender distinction between males and females as highly undesirable. This applies to the way of dressing, talking, behaving and socializing. Effeminate men must not be allowed to enter homes (MB #948). Severe punishment is reserved for men who try to appear like women, mukhannath, and women who try to appear like men, mutarajjil, (KS p. 190, KS p. 540). The law specifies acceptable clothing and other bodily ornamentation for men and women (KS p. 266, KS p. 466). Only women can use silk (MB p. 947, KS p. 465) and gold (KS p. 213). It is recommended for men to grow a beard as a sign of their masculinity (KS p. 468).
 

EXPRESSION OF HUMAN SEXUALITY

Human Sexuality is Normal

Allah created sexual desire, shahwat, in humans (3:14, 7:81, 27:55). It is as normal as is the desire for food or shelter. Like other desires that Allah created in humans it is powerful and can overwhelm a weak human (23:106). Sexual desire like the desire for food can be satisfied legally or illegally. It is illegal to satisfy the sexual desire outside marriage or with a partner of the same gender (7:81, 27:55), or with animals or inanimate things. Humans differ from animals in that their sexual desire is there all the time. Animals develop the desire only in the period just before copulation and in their reproductive season or phase. This period is called estrus in apes. It is clear that human sexual desire is not only for reproduction but also for pleasure. In animals sexual desire is strictly related to the reproductive function. Expression of human sexuality involves the male and female together. This has been the convention since the creation of Adam. The mutual needs of men and women for one another are illustrated in the case of Adam and Hawa (KS p.41). Allah told him to settle in heaven with his wife.

Monasticism is Forbidden

Islam forbids complete rejection and suppression of the sexual instinct (MB #1828, 1829, 1830, KS p. 253). The prophet forbade his companions from castrating themselves so that they may be devoted to worship, ibadat, all the time. Monasticism as practiced in some Christian sects and other religions is a human invention (57:27) that goes against basic human nature.

Sexual Attraction

Allah has created in each gender features that attract the other gender. These include the physical beauty of the body (shape, size, movements, texture, color), the voice (pitch and depth), scalp and body hair (length, distribution, texture). Studies in animals have shown the existence of pheromones. These are chemical sexual attractants emitted by females. Their existence in humans is being studied. Physical beauty is appreciated by Islam and is considered one of the 4 reasons for marrying a woman (MB #1835). The intending spouses must see one another before marriage (MB #1846). This is to ensure that there is enough sexual attraction between them and prevents the regrets that may occur after marriage. Physical beauty deteriorates with age. Virginity enhances female sexual attraction and is considered desirable (56:36, 66:5). Marrying virgins is preferred (MB #1831) but there is no prejudice against the elderly widowed (2:234-235) or divorced (2:232) women. Aisha was the only wife of the Prophet who was a virgin. Shaitan exploits the sexual attraction between the genders to inflame passions that lead to sexual transgression. Each person always has shaitan with him or her (KS p. 48). The sexual attractiveness of the woman is generally more than that of the man. Thus in sexual relations it is the male who usually seeks out the female. The extra beauty and attractiveness of the woman can be a temptation for both her and for men (12:23-24 & 12:30-34). A woman conscious of her beauty may exploit it by being flirtous and thus exposing herself to men. Men will be attracted by her beauty and may lose control and commit sexual transgression.

Enhancing Sexual Attractiveness

Human sexual attraction is enhanced in many ways; some are legal whereas others are not. Clothes enhance physical appearance besides the functions of covering nakedness and protecting the body against the elements of the weather. Perfumes and other good smells perhaps play the role of pheromones in humans. Women and men can dye their hair (KS p. 215). It is however forbidden to dye the hair black or to use artificial hair. Circumcision (khitaan) is exercised in many societies for both men and women. Some societies consider that it enhances sexuality whereas others consider it to decrease sexuality and use it to control sexual transgression. Islam did not forbid it but requires that it be moderate and considerate (KS p. 214). Circumcision of men is of hygienic importance.
 

REGULATION OF HUMAN SEXUALITY

Sexual Hygiene

The 2 hollow organs will lead most people to hell: the mouth, fam, and the genitals, farj (KS p. 178). Both are involved in sexual corruption one negotiates whereas the other commits the crime. The law has regulations for proper conduct of sexual relations. These either aim at decreasing sexual stimulation or removing antecedents of adultery. Normal functioning of society requires that marriageable men and women interact. Both genders, in their appearance and behavior, can stimulate sexual passions. This results into a higher likelihood of sexual transgression. The physical acts of sexual transgression are preceded by acts that may not innately be illegal. They are however forbidden or restricted because they could lead to or facilitate the commitment of sexual transgression. These restrictions come under the rubric of prevention of approaching adultery, qurb al zina (6:151, 17:32). The severe punishment for adultery, hadd al zina, (24:2-3) is a social or public deterrent in cases of flagrant violation of the law. Under normal circumstances, actual regulation should be social exercised by the family and not the state.

Control of Sexuality

It is wrong to consider control of human sexuality. It must be expressed. The issue is the manner in which it is expressed. This may be right or wrong. For the youths who are not able to marry, fasting is recommended as a means of controlling the sexual urge for a short time (MB 440). For the married fasting should not be overused. The fasting person must remember that the family has rights (MB p 454). Thus conjugal rights of the husband or wife can not be abolished on the basis of non-obligatory, nafil, fasting. The individual can exercise control over the sexual urge even in the presence of extreme provocation. A husband and wife need not be separated in situations in which coitus if forbidden like pilgrimage, fasting, or menstruation. A fasting couple are not allowed to engage in behavior that may make them lose control and engage in coitus. Kissing of spouses in fasting is allowed provided there is no fear of transgression otherwise it is forbidden (KS p. 138).

Psychological Barriers

The family and society must erect psychological barriers that make the commission of sexual transgression difficult. Severe punishment is reserved in the hereafter for a person who allows sexual misconduct in his or her family, duyuuth (KS p. 263). There should exist in society a psychological revulsion to sexual corruption. Sexual misbehavior, fahishat, should not be allowed to broadcast openly (4:148, 24:19). Thus accusations of marital infidelity, al qadhaf, should not be made without proof and severe punishment is reserved for the accuser who can not produce 4 witnesses (KS p. 435, 24:4, 24:11-19, 24:23). Talking about sexual infidelity openly and lightly will eventually make the crime look ordinary and common and thus easier to commit. Those who committed sexual transgression should be socially isolated by not allowing them to marry chaste people but to marry only among themselves.

Non-coital Adultery

Adultery is a major sin. It has antecedents and if these are avoided the major ultimate sin may be avoided. The sexual urge is so strong that many people involved in an antecedent of zina may not be able to control themselves from going on to commit the illegal coitus. The concept of non-coital adultery refers to acts and behaviours that lead to zina. The various organs of the body can therefore be said to commit non-coital zina, zina al jawarih (MB #2061, KS p. 264). The eye, the ear, the mouth, and even the legs that walk from place to place can be accessories to the ultimate sin of illegal coitus. Thus there are regulations to prevent people from ever getting near adultery (17:32). The measures that protect the genitals from the ultimate crime are referred to as hifdh al farj (70:29-30) and inhsan al furuj (21:91, 24:33, 66:12). Men who protect their genitals are called al muhswinin and women are called al muhswinat (4:24-25, 5:5, 24:4, 24:23.

Shyness, Haya

The Islamic term haya is not perfectly translated by the English term, shyness. Haya is an inner spiritual protective device that makes a person shun sin and what may lead to it. It is not bashfulness or being introvert as some may think of it. Haya is considered part of faith, iman (KS p. 206). It is the morality of Islam (KS p. 206). Haya is always for the good and can never be negative (KS p. 206). It is a characteristic attribute of all messengers (KS p. 206). The Qur'an describes in detail the haya of the daughters of Shuaib in their meeting with Musa (PBUH) which should serve as a model for other women (28:23-28).

Covering Nakedness, Satr al Awrat

Awrat are those parts of the body that could elicit sexual stimulation if seen. Covering awrat prevents sexual corruption. Nudity of varying degrees is found in societies according to their level of sexual morality. Both men and women must cover the awrat. The awrat of men is different from that of women. The woman's awrat is all her body except the face and the hands. The man's awrat is confined to what is between the navel, surrat, and the knee, rukbat. The extent of covering awrat also depends on the person likely to see and the person being seen (24:31). More of the awrat could be exposed to close relatives within the confines of the home (24:31, 33:55). A close male relative is not allowed to see a woman's nakedness except what is between the navel and the knee. The regulations of hijab are relaxed for an elderly woman with no hope of marriage (24:60). The laws on exposing nakedness start applying to children from the age of 7. They should seek permission before entering rooms of adults in the home for fear of accidental exposure of awrat. Male and female children should not share beds after the age of 7. The law regulates the use of public baths. Where it is not possible to cover awrat, public baths are forbidden (KS p. 203). Naked persons are not allowed in such baths (KS p. 203). The laws of hijab contain special provisions for women as was described in the verses on hijab (KS p. 541). It is not enough for the woman to cover her nakedness. The law of hijab specifies in detail how that nakedness has to be covered. For example it must be covered in such a way that the shape of the body is not definable. Clothes through which the color of the skin can be seen are not permitted. In general the woman should cover all of her body except the face and the hands. In cases of high temptation due to her beauty she may have to wear a full veil covering her face as well.

Seclusion, Khalwat

It is forbidden for a women to be alone with a marriageable man (KS p. 540, MB # 1868). Whenever a man is with a woman in seclusion, shaitan comes between them. Shaitan is always trying to misguide as he did with Adam and Hawa (2:36, 7:22, 7:27). Seclusion is defined as a man being with a marriageable woman who is not his wife in a place where others can not see them.

Mixing, Ikhtilat

The law prohibits men and women mixing without necessity. When men and women are together the natural sexual attractiveness could lead them into temptation. When mixing is unavoidable for societal necessity, certain etiquette have been prescribed by the law to guide male-female interaction. Awrat must be covered as prescribed by the law, satr al awrat (24:31). The regulations of hijab for women must be followed. Men and women who are strangers to one another have to lower their gaze, ghadh al basar(24:31), and not look at each other fixedly and for a prolonged time. Both genders must have haya (28: 23-25). If a man and woman talk to one another they must be serious, jidiyyat al takhatub (33:32) and not engage in frivolous talk that could lead to temptation. An atmosphere of solemnity, wiqaar, must be maintained during the whole period of interaction (24:31).

Sexual Display, Tabarruj

Women are supposed to conceal their ornamentation from public display (24:31). Women are discouraged from going out of their homes heavily adorned with attractive ornamentation (KS p 539). This includes wearing very heavy perfume in public. Such ornamentation should be reserved for the home. The ruling is more severe for a wife whose husband is absent (KS p. 540).
 

Privacy of the Home, Hurmat al Bayt

A stranger is not allowed to enter a home unless given permission. This is to preserve the privacy of the occupants. The stranger may enter unannounced and find them in various degrees of nakedness. Thus permission to enter ensures that the house occupants' nakedness will not be exposed accidentally (MB #2060). A wife can not admit a stranger to her home without the permission of her husband (KS p. 542). Rooms within the home are also private territory that should not be entered before asking for permission.
 
 

HUMAN SEXUALITY AND MARRIAGE

Marriage and Satisfaction of Sexuality

Marriage is a natural human institution. Adam and Hawa were the first couple (2:35). Marital relations have continued ever since. A spouse is a source of psychological tranquillity (30:21, 25:74, 7:189). Marriage is the only institution that allows full expression of human sexuality in a responsible way. It is described by the Qur'an as a deep and serious relationship (4:21). The spouses give good company to one another, mu'asharat (4:19). Islam encourages marriage for all (KS p. 546). Marriage is protection against sexual immorality (KS p. 547, 60:10). If a man sees an attractive woman he should go to his wife immediately because that protects him from potential sin (KS p. 155). Marriage also serves the purpose of procreation to maintain the human race and rear children until adulthood (3:47, 4;1, 16:72, 19:20). Marriage is a public affair that must be announced and known in the community that a couple are husband and wife to avoid any suspicions that arise in secret marriages (KS p. 547, 2:235). The spouses must freely consent to enter into a marital relation (4:191). Desire for sexual satisfaction is a major reason for marriage. It is considered offensive by the law for a person who has no sexual desire at all to get married. A person who has desire for sexual satisfaction but has impediments like poverty or physical disability (disease, impotence) should control the desire by fasting. The sexual relation in marriage is wider that coitus. It involves mutual enjoyment such as kissing and fondling. The marital relation is much wider than a sexual relation. It involves social and psychological bonding. The husband and wife have to be close physically, psychologically and emotionally. Mutual good treatment and sympathetic consideration sustain love after the initial period of passionate involvement (4:19). The husband and wife can bathe together and see each other's nakedness (MB p 123/p). The husband can not keep away from contact with the wife because of menstruation. He can sleep with his menstruating wife provided both can control themselves to avoid copulation (MB p. 147). It is forbidden for a wife to withhold sexual favors from her husband without a valid reason (KS p. 542). The wife can not fast nafilat without the permission of the husband (MB #1860) because that would deny him his conjugal rights.

Prohibition of Temporary Sexual Relations

There are 4 types of temporary sexual relations: (a) temporary marriage, mut'at (b) prostitution, bighaa (c) adultery between consenting adults, zina and (d) marriage with the hidden intention to divorce after a time, zawaaj bi niyyat al talaq. They are forbidden because they reduce the sexual relation to its physical form without regard to the emotional, psychological, and social dimensions. They undermine and destroy the fabric of society. Temporary marriage, mut'at, is forbidden by law (MB #1844, KS p. 549). This is a type of marriage contracted by both parties for a fixed period of time. It violates the need for children to be reared in a permanent family. Humans require at least 15 years to be reared to adulthood. Prostitution is the exchange of sexual favors for money. It is physical enjoyment without emotional or psychological involvement. The law prohibits forcing girls into prostitution (24:33) for the sake of money. Adultery, zina, may have some form of emotional and psychological involvement besides the physical enjoyment but these are temporary. Some scholars have quoted evidence on the permissibility of marriage with the intention of divorcing. In our view the practice involves dishonesty on the part of the husband by failing to disclose his full intentions to the partner. Disclosure would of course turn this type of marriage into a form of mut'at marriage.

Privacy of the Sexual Relationship

The sexual attributes of a woman are private between and her husband. It is forbidden for one women to describe the sexual details of another women to her husband (MB #1869, KS p. 539). It is forbidden for both spouses to disclose their sexual experiences to any outside parties (KS p. 540).

Sexual Attractiveness in Marriage

The sexual attractiveness is a continuous process that is necessary to bind the 2 spouses together. Some people misunderstand this to mean that a woman is attractive before marriage in order to attract the man and need not maintain her attractiveness after that. A married women must always look attractive to her husband (KS 540). This prevents him from being tempted by other women. The prophet forbade the return of a husband from a trip at night because he may surprise his wife who will not be able to prepare herself and be in the most attractive form (MB #1871). The wife is entitled to articles of hygiene to maintain her beauty. This however does not include cosmetics.

Ghiirat

The word ghiirat has been translated incorrectly into English as jealousy. It is more than simple sexual jealousy. It is a drive in the spouse and other members of the family to protect the chastity of both males and females. Ghiirat is commendable (MB p. 904 chapter #30) and is necessary for proper functioning of society. Too much of it could be destructive.

Prohibited marriages, Maharim

For proper functioning of the extended family, free and easy social intercourse must exist among its members. More intimate contacts will occur among the family members that is possible with outsiders. Sexual attraction and the sexual desire being human and natural could also exist within the extended family. The door to this was closed by the law by declaring degrees of relatives who are not marriageable (4:23) and with whom close social intercourse is allowed within the family.
 
 

COITUS

Purpose

Coitus serves 2 purposes: reproduction and sexual enjoyment. It is the most intimate and intense physical expression of human sexuality. All other expressions of sexuality precede or prepare for it. Sexual enjoyment in marriage, al istimtau fo al zawaj, is normal and is encouraged (4:24). Some scholars have argued that this enjoyment is confined to vaginal coitus. The majority argue that the enjoyment covers all parts of the body unless specifically prohibited by law.

Benefits

Coitus is necessary for child-bearing. Children are a bounty from Allah, n'imat al dhuriyyat (25:27, 42:49). It is difficult to describe the benefits of health to physical and psychological health. It is however known that its deprivation for prolonged periods of time leads to psychological and emotional disorders

Consummation of Marriage

Marriage is annulled when coitus is physically impossible and there is no hope for a medical or surgical solution. This may be due to anatomical or physiological anomalies in both the male and the female. With recent developments in surgery some of these may be correctable. Psychogenic factors may cause vaginismus or frigidity in female and impotence in males. Appropriate treatment may be undertaken to prevent marital annulment. In cases of male impotence a grace period of 1 year is allowed while treatment is being sought. After that the marriage has to be annulled because it can no longer fulfil the fundamental purpose of protecting chastity of both partners. The marriage is considered consummated when successful coitus is achieved at least once. Coital failure after that is not an automatic annulment of marriage. The marriage payment, mahr, is not due in marriages annulled before sexual consummation.

Conjugal Rights

Both husband and wife have rights to sexual satisfaction. The conjugal rights are enforceable by law. None of the spouses can refuse under reasonable conditions. The refusal of a wife is considered rebellion, nushuuz, and the law has prescribed remedial measures for it.

Frequency

Like all other human activities there should be a balance between too little and too much coitus. Too much indulgence could be harmful in both the physical and psychological dimensions. Too little could be similarly harmful. The law does not stipulate any particular frequency. Each couple should find out for themselves what frequency is sufficient to satisfy and protect, ihswaan,, them from sexual corruption. Some jurists have argued that once every 4 days is the ideal based on the reasoning that a man with 4 wives can rotate among them in 4 days. Omar decreed that no soldier would be kept away from his wife for longer than 6 months which perhaps sets the upper limit of sexual deprivation.

Conditions in which Coitus is Forbidden

There are a few conditions in which coitus is prohibited for health or religious reasons. Coitus with menstruating women is forbidden (2:222). The same applies to women in the period of post-natal or post-abortion bleeding, nifaas. Coitus is prohibited during the day for fasting persons but is allowed at night (2:187). It is prohibited at all times during the period of ihram in pilgrimage, hajj (2:197). Coitus is forbidden in the mosque (2:187). A divorced woman is required by law to stay in her former husband's home for 3 months. He is prohibited from having sexual relations with her during this time and if he does the divorce automatically lapses. There are disputes about the permissibility of coitus with a lactating woman, ghayla. The best opinion is that it is permissible. It is inconceivable that sexual relations could be stopped for the period of 2 years that the Qur'an recommends for breast-feeding.

Actions Prohibited in Sexual Ritual Impurity, Janabat

After coitus and before ritual bath, ghusl, the following acts are forbidden: (a) reciting the Qur'an (KS p. 163), (b) prayer, salat, (c) circumbulating the kaaba, tawaaf.

Adab of Sexual Conduct

Coitus is an act of love and not mere physical satisfaction. It should be approached with that end in mind. Foreplay is a sunnat and it allows both parties to be psychologically and physiologically prepared. It is preferable that there is desire in both parties. Preparation for coitus includes reciting the (KS p. 154) and a supplication, dua, (MB# 1854, KS p. 155). There is no control of the manner or postures of coitus provided it is vaginal (KS p. 154) and is natural. Coitus interruptus ('azl) is permitted (KS p. 154). It is considered offensive, makruh (KS p. 155). It can not done without the permission of the wife (KS p. 155). Coitus with women is vaginal. Anal intercourse is forbidden with both women ( ) and men (KS p. 155). It is recommended to make wudhu if coitus is repeated ( ). Ritual bath, ghusl, is required after coitus. It has to be undertaken by mere contact of the male and female genitalia even if no fluids were emitted.

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Sex Is Good For You

Information Taken From: Natural Healing With the Medicine of The Prophet, Translated & Emendation from original Arabic by Muhammad Al-Akili. Edited by the webmaster, because it was androcentric (male centred) in its original form. It takes two to have sex. Some men forget the pleasure is not only theirs.

The sexual aspect of life has three basic purposes:

1. Conservation of the human race, and continuity of its kind until it reaches the total number of human beings intended by Allah’s (SWT) leave to experience life in this world, to fulfill the divine purpose, and to show gratitude to its Creator.

2. Ejection of bodily fluids from the body, otherwise, suppression or retention of congested semen can cause various kinds of serious illnesses.

3. Fulfillment of one’s desire, satisfaction of one's sexual pleasure, and enjoyment of this blessing.

The latter is the only pleasure of such intercourse which is also provided in the heavenly paradise, whereby, therein three is neither ejaculation, natural discharge of bodily fluids, nor reproduction.
 

Sex is Good for You

Learned physicians find that sexual intercourse yields essential health benefits.

Galen attributes semen to the elements of fire and air, and describes its humors as hot and moist. This is because semen is rich in prostaglandins, which are hormonelike fatty acids found throughout the body and particularly in semen. Prostaglandins are primary nutrients that affect essential body processes, including blood pressure, metabolism, and body temperature among others. Hence, understanding the value of this most unmitigated and purest form of blood an its preciousness requires great consideration in discharging it.

This means to wisely value the reasons behind dispensing of this precious water of life for either conceiving a child, or emitting it through lawful sexual intercourse upon congestion.

In fact, congested semen which are retained for an extended period can cause various illnesses and infirmities, including obsession, habitude, lunacy, and even insanity, and sometimes, engaging in lawful sexual intercourse may aid in the recovery from such illnesses.

On the other hand, congestion and prevalence of semen for an extended period can cause its corruption, and turns it into a harmful toxin that the body cannot easily dispose of. However, sometimes, nature produces a spontaneous and involuntary emission of excess semen, usually during sleep, and without sexual intercourse.

Some learned predecessors have concluded that the human being should pledge:
 

1. To walk at least a certain minimum distance every day.

2. To feed his stomach at regular intervals, and not to extend fasting from food beyond the religious requirement.

3. Not to abstain from having lawful sexual intercourse, for a water well drains out if its water if its not used regularly.

Imam Muhammad ibn Zakariyya once said:

"Abstaining from sexual intercourse for an extended period weakens one’s nervous system, can cause obstruction of the urethra, and shrinks the penis."

He added when he observed some people who vowed temporary abstention from sexual intercourse, that their sexual energy diminished, they suffered general weakness of their bodies, became doleful, lost their desire, and their digestive system became corrupt.
 

Hold on....Only Lawful Sex

Other benefits of lawful sexual intercourse include protecting one’s eyes from looking at what is unlawful, preserving one’s chastity, controlling one’s desire and lust against what is unlawful, and providing the same for his or her spouse. This will certainly provide the believing man and woman with innumerable benefits in this world and in the hereafter. Imam Ahmad alluding to abstention from sex, once said:

"I exercise patience when fasting from food and drink, though it is still difficult."

He also reported in his collection of correct prophetic traditions that Allah’s Messenger (SAW) encouraged the believers to get married, saying:

"Get married, and conceive many children for I shall take pride in your number on the day of judgment."

Ibn Abbass (RA) narrated that Allah’s Messenger (SAW) said:

"I get married, eat meat, sleep, stand up in night prayers, fast, and break my fast. Whoever disdains from my traditions (Sunnah) is not one of my followers."

He (SAW) also said:

"O young men whoever among you has the means to establish a family, he should get married, for marriage preserves the chastity of one’s eyes and sexual organ, and whoever cannot afford to establish a family, he must fast from desiring sex, for abstention in that
case will protect him from sin."

Ibn Abbass (RA) one said:

"We recognize that marriage is the best solution for two people who are in love."

It is also narrated in the two collections of correct prophetic traditions that Allah’s Messenger (SAW) said:

Allah’s Messenger (SAW) also encouraged people to choose the young and fertile. On this subject, Mu’qal bin Yasar related that a man said to Allah’s Messenger (SAW):

"I found a beautiful woman from a noble family but she cannot bear children, should I marry her? Allah’s Messenger (SAW) replied, "Nay." The man came back and asked a third time and asked the same question, Allah’s Messenger (SAW) turned to his companions and said: "Choose in your wives the fertile and the affectionate, for I shall take pride in your number on the day of judgment."
 

Hmmm...So how about some Tips?

Imam al-Tirmithi narrated that Allah’s Messenger (SAW) said:

"It is among the traditions of Allah’s Messengers to marry, to brush their teeth, to anoint themselves with perfume, and to be circumcised."

Prior to engaging in sexual intercourse, it is necessary for the husband to express his affection and love for his wife by touching her, caressing her, kissing her, and sometimes sucking her tongue. Jabir bin ‘Abdullah narrated that Allah’s Messenger (SAW) enjoined upon a man not to engage in sexual intercourse before caressing his wife.

It is also a prophetic tradition to take a complete ritual ablution (ghusl) after engaging in sexual intercourse and before retiring to sleep, and at least, to take a ritual ablution (wudu), should that man desire to reengage in sexual intercourse anew.

Upon climax, the innate heat transfuses throughout the entire body, and by taking a complete ritual ablution, the water refreshes one’s spirit, and ensures cleanliness and ritual purity. It also rejuvenates the body’s innate heat, musters its caloricity, and helps the gametogenous process. Almighty Allah (SWT) says:

"Verily, We have created man from Nutfah drops of mixed semen (discharge of man and woman), in order to try him, so We made him hearer, seer. (Al-Insan 76:2)

 

More About Sex In Islam
Information taken from Questions and Answers About Women's Rights In Islam, Compiled by Lea Zaitoun

The Right to Adequate Sexual Relations

Since the purpose of marriage is to be a mutual source of comfort, peace, and enjoyment for each other, like a garment that protects and covers, the sexual aspect of marriage is an extension of this. The husband is asked to be gentle, considerate and loving with his wife, and to try to satisfy her needs.

The wife must reserve herself exclusively for her husband, and make efforts to be attractive, as well as making herself available to him whenever he is in need of her. This latter obligation also applies to the husband.

In Islam, any sexual relations are reserved EXCLUSIVELY for the confines of marriage. Both husband and wife are also obligated to honor the privacy of the intimate relations between them, and should not speak of them to anyone.
 
 

The Prohibition of Sex when She is Menstruating

It is forbidden for a Muslim man to have sexual intercourse with his wife when she is menstruating. The Quran is clear on this subject:

"They ask you concerning menstruation. Say: that is an Adha (a harmful thing for a husband to have a sexual intercourse with his wife while she is having her menses), therefore keep away from women during menses and go not unto them till they have purified (from menses and have taken a bath). And when they have purified themselves, then go in unto them as Allah has ordained for you (go in unto them in any manner as long as it is in their vagina)…" (Al-Baqarah 2:222)
 
 

The Prohibition of Sodomy

Allah (SWT) will not look at the man who commits sodomy with a man or a woman (reported in Sahih Al-Tirmithi (Al-Baaniy) Vol. 1 No. 341).

Malik related to me that he asked Ibn Shihab about someone who committed sodomy. Ibn Shihab said,

"He is to be stoned, whether or not he is muhsan." (Reported in Malik’s Muwatta)

It is forbidden for a Muslim man to enter his wife in her anus. Allah (SWT) says in the Quran:

"Your wives are a tilth for you, so go to your tilth (have sexual relations with your wives in any manner as long as it is in the vagina and not in the anus), when or how you will, and send (good deeds, or ask Allah to bestow you pious offspring) before you for your ownselves. And fear Allah, and know that you are to meet Him (in the Hereafter), and give good tidings to the believers [O Muhammad (SAW)]. (Al-Baqarah 2:223)

What is understood from the above verse is that a tilth can only refer to a place where something might grow. Therefore, what is meant here is the entry which produces children.

Other sayings of the Prophet Muhammad (SAW) on the subject:
"He is cursed who has anal intercourse (with his wife)." (Reported by Ibin Maja)

"Whoever has sexual intercourse with a menstruating woman, or woman in her anus… has disbelieved in that which was revealed to Muhammad (SAW)." (Reported by Al-Tirmithi)

It can not be stressed too strongly that even animals do not satisfy their sexual urges in this unnatural way. Human beings who are guilty of sodomy are, thus, even lower than animals.
 
 

Purification between 2 acts of Sexual Intercourse

In Islam, when a husband has had sexual intercourse with his wife in the legal manner, and then wishes to return another time, it is preferable that he first performs another ablution (wudu).

Meaning: it is better if he does not commence sexual intercourse in an unclean physical state. In the words of the Prophet Muhammad (SAW):

"This way is purer, cleaner and better." (Reported by Abu Dawud)

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IS YOUR GHUSL CORRECT?
From The Waterval Islamic Institute

CHECK THESE FACTS: ALL YOUR PRAYERS ARE INVALID IF YOUR GHUSL IS NOT CORRECT. CLEANLINESS IS HALF OF FAITH. HERE IS THE METHOD OF GHUSL ACCORDING TO SUNNAH.

Before making Ghusl one should make Niyyah (intention) thus: - "I am performing Ghusl so as to become Paak." Without Niyyah, there is no Thawaab (reward) although Ghusl will be valid. Ghusl should be made in a place of total privacy and one should not face towards the Kiblah while making Ghusl. Ghusl may be performed standing or seated, preferably seated. Use sufficient water, don't skimp nor be wasteful. One should abstain from speaking while performing Ghusl. It is better not to read any Kalimah or Aayah while bathing. Be aware of these rules whilst making Ghusl.

 

PROCEDURE FOR PERFORMING GHUSL:
 

• Wash both hands up to and including wrists.

• Wash the private parts. The hands and private parts should be washed even if one is not in the state of Janaabat or Najaasat.

• If there is Najaasat elsewhere on the body, it should now be washed off.

• Perform Wudhu (Read separate pamphlet for Wudhu according to Sunnah). If making Ghusl on a stool or platform where water will rapidly flow away, and then perform the complete Wudhu. If there is fear of the feet being immersed in wastewater during the Ghusl then postpone the washing of the feet to the end of the Ghusl. Ensure that the mouth and nostrils are thoroughly rinsed thrice.

• After performing Wudhu, pour water over the head thrice, then pour thrice over right shoulder and thrice again over left shoulder. Now pour water over entire body and rub. If the hair of the head is not plaited, it is compulsory to wet all the hair up to the very base. If a single hair is left dry, Ghusl will not be valid. If the hair of a woman is plaited, she is excused from loosening her plaited hair, but it is compulsory for her to wet the base of each and every hair. If one fails to do this then the Ghusl will not be valid. As for men who grow long hair and plait them, they are NOT excused from leaving their hair dry. If a woman experiences difficulty or is unable to wet the very bottom of her plaited hair, then it is necessary for her to unplaite her hair and wash her entire head. It is Mustahab (preferable) to clean the body by rubbing it. All parts of the body should be rubbed with the hand so as to ensure that water has reached all parts of the body, and that no portion is left dry. Rings and earrings, etc. should be moved so as to ensure that no portion covered by them is left dry. Ensure that the navel and the ears are all wetted. If they are not wet Ghusl will be incomplete.

• On completion one should confine oneself to a clean place. If, while performing Wudhu, the feet had been washed, it is not necessary to wash them again. Dry the body with a clean towel, and dress as hastily as possible.

If, after Ghusl, one recalls that a certain portion of the body is left dry, it is not necessary to repeat the Ghusl, but merely wash the dry portion. It is not sufficient to pass a wet hand over the dry place. If one has forgotten to rinse the mouth or the nostrils, these too could be rinsed when recalled after Ghusl has been performed.


 

The three Faraa'ids (compulsory acts) of Ghusl are: -

• To rinse the mouth in such a manner that water reaches the entire mouth.
• To rinse the nostrils up to the ending of the fleshy part.
• To completely wet the whole body. When one performs these Faraa'id intentionally or unintentionally Ghusl will be valid.

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Study finds circumcision may protect men from HIV
Channel News Asia, 31 January 2000
http://www.channelnewsasia.com/archive/2000/1/31/world19439.htm

Circumcision may somehow protect men from sexual transmission of the AIDS virus, researchers said on Sunday, but they admitted they do not have a clue why.

A study in Uganda aimed at examining how couples infect one another found two things seemed to protect people - being older and being circumcised.

"Acquisition of HIV did not occur in any of the circumcised men," Dr. Thomas Quinn of Johns Hopkins University in Baltimore, who led the study, told the 7th Conference on Retroviruses and Opportunistic Infections, a meeting of AIDS researchers.

"Age, independent of viral load, appeared to have a protective effect," Quinn added. The highest transmission rate was in people 15 to 29 years old.

Quinn's team, working with 15,000 people in the Rakai district of Uganda, also found that people did not pass on the virus to their partners if they had a naturally low level of HIV in the blood - in this case, 1,500 copies according to standard measures.

He found that the more virus people had in their blood, the more likely they were to pass it on. There were no differences in women infecting men or men infecting women.

Quinn said his team was one of the first to actually go out and test the idea where HIV is raging the worst. More than 23 million people in sub-Saharan Africa are infected with HIV.

The findings might suggest ways of stemming the epidemic.

Telling people to abstain from sex or use condoms has not worked, and the drugs that keep the virus at bay in some patients in rich countries are not available in the poor countries hardest hit by the epidemic.

But the study suggests that using drugs to keep the virus at lower levels, or a vaccine that might do the same without quite curing a patient, might help.

Quinn said he was at a loss to explain why circumcision might affect a man's risk of being infected by a woman.
 
 

 

Circumcision hailed as way to curb Aids
Bryan Appleyard
The Sunday Times, UK
http://www.sunday-times.co.uk

NEW evidence suggests that circumcision of all male babies could help to halt the global Aids epidemic. With 50m living cases and more than 16m deaths, the disease is now the worst human health disaster since the Black Death.

The thesis - laid out in a scientific paper to be published soon - seems likely to create huge controversy as it represents a complete change in accepted ideas about the transmission of Aids.

One of the paper's authors, Roger Short, professor of obstetrics at Melbourne University and a respected scientist with long experience of Aids-ravaged areas, has been told he cannot address the subject at a forthcoming international conference.

Short and his co-author, Dr Robert Szabo, are convinced that a high level of receptors - sites to which invading organisms attach themselves - on the inside of the foreskin make it responsible for transmission.

Short and Szabo noted a sharp difference in the prevalence of HIV infection in the "Aids belt" countries in sub-Saharan Africa. In some areas the infection rates are as high as 25%, in others as low as 1%. The lower infection rates were clearly associated with the practice of male circumcision.

"The presence of an intact foreskin," says the Short-Szabo paper, "has consistently been shown to be the single most significant factor associated with the much higher prevalence of HIV in countries of the Aids belt."

The link is stronger than with more familiar indicators such as promiscuity, other sexually transmitted diseases and multiple marriage.

Even more startling evidence came from a recent study in Uganda, reported in February. This showed that among a large group of "discordant couples" - where one is infected and one not - no circumcised males became infected over 30 months, even though their wives were HIV-positive. Short describes these results as "staggeringly significant".

Outside Africa there is the same pattern. Countries with low circumcision rates, such as Thailand, India and Cambodia, have between 10 and 50 times the rates of infection compared with countries with high circumcision rates, such as the Philippines, Bangladesh and Indonesia.

Once they get ethical clearance in Australia, Short and Szabo intend to test their conclusions by applying live HIV virus to newly removed foreskins to check its rate of uptake. They could have definite results within weeks.

If experimentally confirmed, the implications are radical. Short and Szabo believe that about 80% of male HIV infections in the world happen through the foreskin.

Short is not advocating adult circumcision, a painful and potentially dangerous operation. But future generations could be saved if mass circumcision began now.

Short believes his findings should be spread globally, as rapidly as possible.

"There has been insufficient focus on prevention," he said, "and too much emphasis on the search for a vaccine." Despite the billions poured into research, there is still no sign of an Aids vaccine.

The crisis in sub-Saharan Africa - where life expectancy rates at birth as a result of Aids have dropped from 59 to 44 - is out of control.

"The whole of my life's prejudice has been anti-circumcision," said Short.

"I've written papers against it. I didn't believe the benefits outweighed the costs. If God had made us the way we were, why remove a sound organ? But I have been totally converted."

 

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Medical Benefits of Circumcision

Circumcision is the removal of a fold of loose skin (the foreskin) that covers the head (glans) of the unerect penis. The amount of this skin varies from virtually none, to a considerable amount that droops down from the end of the flaccid penis. The practice is common amongst many divergent human cultures. A variety of methods are, moreover, used and the amount of foreskin removed also varies.

Historically circumcision has been a topic of emotive and often irrational debate. At least part of the reason is that a sex organ is involved. (Compare, for example, ear piercing.) During the past two decades the medical profession in Australia have tended to advise parents not to circumcise their baby boys. In fact there have even been reports of harrassment by medical professionals of new mothers, especially those belonging to religious groups that practice circumcision, in an attempt to stop them having this procedure carried out. Such attitudes are a far cry from the situation years ago when baby boys were circumcised routinely in Australia. But over the past 20 years the rate has declined to as low as 16-19% [55].

However, a reversal of this trend is starting to occur. In the light of an increasing volume of medical scientific evidence pointing to the benefits of neonatal circumcision a new policy statement was formulated by a working party of the Australian College of Paediatrics in August 1995 and adopted by the College in May 1996 [5]. In this document medical practitioners are now urged to fully inform parents of the benefits of having their male children circumcised. Similar recommendations were made recently by the Canadian Paediatric Soc iety who also conducted an evaluation of the literature, although concluded that the benefits and harms were very evenly balanced. The American College of Pediatrics has moved far closer to an advocacy position and many recognised authorities in the USA strongly advocate circumcision of all newborn boys. More details of their statements appear below.

In the present literature review I would like to focus principally on the protection afforded by circumcision against infection by micro-organisms, some of which can cause disease and even death, but will also touch on other aspects, including sexual benefits. I might add that I am a university academic who teaches medical and science students and who does medical research, including that involving genital cancer virology, as well as molecular biology and genetics. I am not Jewish, nor a medical practitioner or lawyer, so have no religious bias or medico-legal concerns that might impede a rational presentation of the information that has been published in reputable journals.

Why the foreskin increases infection risk

The increased risk of infection in the uncircumcised may be a consequence of the fact that the foreskin presents the penis with a larger surface area, the moist skin under it represents a thinner epidermal barrier than the drier, more cornified skin of the circumcised penis (the glans of which develops a thick stratum corneum layer), the presence of a prepuce is likely to result in greater microtrauma during sexual intercourse, thereby permitting an entry point into the bloodstream for infectious agents, and, as one might expect, the warm, moist mucosal environment under the foreskin favours growth of micro-organisms. The preputial sac has even been referred to by Dr Gerald Weiss, an American surgeon, as a 'cesspool for infection', as its unfortunate anatomy draped around the end of the penis results in accumulation of secretions, excretions (urine), dead cells and growths of bacteria. Parents are told not t o retract the foreskin of male infants which makes cleaning difficult. Even if optimal cleansing is performed there is no evidence that it confers protection [96][97].

History

Circumcision has been practiced widely in Western countries this century. From at least the mid -1940s to mid-1970s over 90% of boys in the USA and Australia were circumcised soon after birth. The major benefits at that time were seen as improved lifetime genital hygeine, elimination of phimosis (inability to retract the foreskin) and prevention of penile cancer. The trend not to circumcise started in the mid to late 1970s, after the American Academy of Paediatrics Committee for the Newborn stated, in 1971, that there are 'no valid medical indications for circumcision'. In 1975 this was modified to 'no absolute valid ... ', which remained in the 1983 statement, but in 1989 it changed significantly to 'New evidence has suggested possible medical benefits ...' [3].

Dr Edgar Schoen, Chairman of the Task Force on Circumcision of the American Academy of Pediatrics, has stated that the benefits of routine circumcision of newborns as a preventative health measure far exceed the risks of the procedure [77]. During the period 1985-92 there was an increase in the frequency of postnewborn circumcision and during that same time Schoen points out that the association of lack of circumcison and urinary tract infection has moved from 'suggestive' to 'conclusive' [77]. Moreover, it heralded the finding of associations with other infectious agents, including HIV. In fact he goes on to say that 'Current newborn circumcision may be considered a preventative health measure analogous to immunization in that side effects and complications are immediate and usually minor, but benefits accrue for a lifetime' [61], reduction in balanitis (inflammation of the glans, the head of the penis) [24], reduced urinary tract infections, problems with erections at puberty, decrease in certain sexually transmitted diseases (STDs) such as HIV, and, in older men, elimination of penile cancer and a decrease in urological problems and infections [reviewed in [2][5] [25][47] [73] [76]. Therefore the benefits are different at different ages.

Different specialists see different things

Neonatologists only see the problems of the operation itself. Moreover such problems occur in only a minor proportion of boys, and generally because of poor technique by an inexperienced operator. However, urologists who see and have to treat the problems of uncircumcised men cannot understand why all newborns are not circumcised [76][77]. Other health care workers in hospitals and aged care homes also have adverse comments about the uncircumcised penises they see. The demand for circumcision later in childhood has increased, but, with age, problems, such as anaesthetic risk, are higher. Thus Schoen states 'Current evidence concerning the life-time medical benefit of newborn circumcision favours an affirmative choice' [77].

Anti-circumcision lobby groups

In a letter written by Dr Schoen to Dr Terry Russell in Brisbane in 1994 Schoen derides an organization known as 'NOCIRC' for their use of 'distortions, anecdotes and testimonials to try to influence professional and legislative bodies and the public, stating that in the past few years they have become increasingly desperate and outrageous as the medical literature has documented the benefits. For example they have compared circumcision with female genital mutilation, which is equivalent to cutting off the penis. In 1993 the rate of circumcision had risen to 80% in the USA and Schoen suggests that 'Perhaps NOCIRC has decided to export their "message" to Australia since their efforts are proving increasingly futile in the US'. One only has to do a search on the World Wide Web to read the statements from this group and others like it and any intelligent person can quickly make up their own mind about the quality of their material and the message they are trying to promulgate. Some of these people mean well and some are intelligent, but lack a broad perspective. Dr Schoen also noted that when Chairman of the Task Force his committee was bombarded with inaccurate and misleading communications from this group. They even publish their own journals, e.g. 'Cicumcision'. Another of these groups is 'UNCIRC', which promotes procedures to reverse circumcision, by, for example, stretching the loose skin on the shaft of the retracted penis or the use of surgery. This has led to genital mutilation [88]. Claimed benefits of 'increased sensitivity' in reality appear to be a result of the friction of the foreskin, whether intact or newly created, on the moist or sweaty glans and undersurface of the prepuce in the unaroused state and would obviously in the 're-uncircumcised' penis have nothing to do with an increase in touch receptors. Indeed, nerves do not regenerate. Moreover, the sensitivity during sexual intercourse is in fact identicle, according to men circumcised as adults.

Benefits outweigh the risks

Dr Tom Wiswell, a respected authority in the USA was a strong opponent, but then switched camps as a result of his own research findings and the findings of others. This is what he has to say: 'As a pediatrician and neonatologist, I am a child advocate and try to do what is best for children. For many years I was an outspoken opponent of circumcision ... I have gradually changed my opinion' [93] [94]. This ability to keep an open mind on the issue and to make a sound judgement on the balance of all available information is to his credit ­ he did change his mind!

Wiswell looked at the complication rates of having or not having it performed in a study of 136,000 boys born in US army hospitals between 1980 and 1985. 100,000 were circumcised and 193 (0.19%) had complications, with no deaths, but of t he 36,000 who were not circumcised the complication rate was 0.24% and there were 2 deaths [98]. A study by others found that of the 11,000 circumcisions performed at New York's Sloane Hospital in 1989, only 6 led to complications, none of which were fatal [73].

A retrospective study of boys aged 4 months to 12 years found significantly greater frequency of penile problems (14% vs 6%; P < 0.001) and medical visits for penile problems (10% vs 5%; P < 0.05) among those who were uncircumcised, compared with those who were circumcised [36]

Pain and memory

No adverse psychological aftermath has been demonstrated [75]. It must be recognised that there are many painful experiences encountered by the child before, during and after birth [54]. Circumcision, if performed without anaesthetic is just one of these. Cortisol levels have registered an increase during and shortly after the procedure, indicating that the baby is not unaware of having had something done in its unanaesthetized state and one has to weigh up the need to inflict this short term pain in the context of a lifetime of gain from prevention or reduction of subsequent problems. Anaesthetic creams and other means appear to be at least partially effective in reducing trauma and some babies show no signs of distress at all when the procedure is performed without anaesthetic. Many, however, do, and this may be contributed by the restraining procedure, as well as the surgery itself.

Penile hygeine

The proponents of not circumcising nevertheless stress that lifelong penile hygeine is required. This acknowledges that something harmful or unpleasant is happening under the prepuce. Moreover, a study of British schoolboys found that penile hygeine does not exist [73]. Furthermore, Dr Terry Russell, an Australian medical practitioner states 'What man after a night of passion is going to perform penile hygeine before rolling over and snoring th e night away (with pathogenic organisms multiplying in the warm moist environemnt under the prepuce)'[73]. The bacteria start multiplying again immediately after washing and explain the whitish film, termed 'smegma', that is found under the foreskin. Bacteria give off an offensive odour, necessitating several showers a day by uncircumcised men, some of whom, together with their partners, find the stench so unpleasant that this smell has caused these men to seek a circumcision on this basis alone. For mothers and fathers, it is far easier to maintain cleanliness of their son's penis if it is circumcised. If their son isn't the messages are confusing: 'leave it alone', 'clean under it', 'pull it back sometimes', 'irrigate occasionally'!

What motivates parents to get their baby boy circumcised and the rates

The reasons for circumcision, at least in a survey carried out as part of a study at Sydney Hospital, were: 3% for religious reasons, 1-2% for medical, with the remainder suggested by the researchers as 'to be like dad' or a preference of one or both parents for whatever reason [22]. The main reason may have more to do with hygeine and appearance, as will be discussed later in the section on socio-sexual aspects. The actual proportion of men who were circumcised when examined at this clinic was 62%. Of those studied, 95% were Caucasian, with younger men just as likely to be circumcised as older men. In Adelaide, South Australia, a similar proportion has been noted, with 55% of younger men being circumcised. In Britain, however, the rate is only 7-10%, much like Europe. Rates in Africa, Asia and India vary according to religion and cuture, with higher rates amongst Muslims and certain tribes and low rates amongst other groups and nations. In the USA, as indicated above, the rate of circumcision has always been high, although differs in different regions: the rates for 1991, 1992, 1993 and 1994 in the northeast region were 62%, 68%, 65% and 70%, in each respective year; for the midwest they were 78%, 78%, 74% and 80%, respectively; for the southern region: 64%, 63%, 61% and 65%; and for the western region: 41%, 38%, 36% and 34% [58]. The actual rates are higher than indicated by this data, as they represent only the numbers reported, whereas not all are. In Canada the rate varies markedly between different regions. Even in the same state, Ontario, for example, the rate between different districts ranges from 2% to 70%, with a mean of around 50%.

Physical problems

Phimosis (inability to retract the foreskin) affects 2-10% of uncircumcised males, and can lead to urinary retention, vesico-ureteral reflux and hypertension. Paraphimosis (where the retracted foreskin cannot be brought back again over the glans) is a very painful problem, relieved by circumcision or slitting the dorsal surface of the foreskin. To paediatric surgeons, the most obvious medical reasons for circumcision are balanitis (inflammation of the glans) and posthitis (inflammation of the foreskin), which are very painful conditions virtually limited to uncircumcised males. In babies, balanitis is caused by soiled diapers, playing and sitting in dirty areas, antibiotic therapy, as well as yeast and other micro-organisms. Balanoposthitis (inflammation of the foreskin and glans) is common in uncircumcised diabetic men owing to a weakened, shrunken penis [24] and such men also have more problems associated with intercourse. Diabetes is common and inherited, so a family history of this disease may add to considerations in favour of circumcision at birth. Uncircumcised boys may entrap their foreskin in zippers, resulting in pain, trauma, swelling and scarring of this appendage. In elderly men, infections and pain from balanoposthitis, phimosis and paraphimosis are seen and carers report problems in achieving optimal hygeine in uncircumcised men. The need for an appliance for urinary drainage in quadraplegics and in senile men is facilitated if they are circumcised. Boys and men who are not circumcised can be a source of irritation if they do not retract the foreskin when they urinate, as 'splatter' will occur. Although not a medical problem, it is a source of annoyance for other people (such as a parent or partner) if it is they that have the job of cleaning the bathroom. Foreskin problems also mean intercourse is painful.

Neonatal uninary tract infections

In 1982 it was reported that 95% of urinary tract infections (UTIs) in boys aged 5 days to 8 months were in uncircumcised infants [32]. This was confirmed by Wiswell [100] and a few years later Wiswell and colleagues found that in 5261 infants born at one US Army hospital, 4% of UTI cases were in uncircumcised males, but only 0.2% in those who were circumcised [101]. Wiswell then went on to examine the records for 427,698 infants (219,755 boys) born in US Armed Forces hospitals from 1975-79 and found that the uncircumcised had an 11-fold higher incidence of UTIs [98]. During this decade the frequency of circumcision in the USA decreased from 84% to 74% and this decrease was associated with an increase in rate of UTI [102]. Reviews by others in the mid-80s concluded there was a lower incidence in circumcised boys [50][71]. The rate in girls was stable during the period it was increasing in boys, in whom circumcision was in a decline. In a 1993 study by Wiswell of 209,399 infants born between 1985 and 1990 in US Army hospitals world-wide, 1046 (496 boys) got UTI in their first year of life [99]. The number was equal for boys and girls, but was 10-times higher for uncircumcised boys. Among the uncircumcised boys younger than 3 months, 23% had bacteraemia, caused by the same organism responsible for the UTI. It should be noted that these studies gave figures for infants admitted to hospital for UTI, so that the actual rate would undoubtedly have been higher. The infection can travel up the urinary tract to affect the kidney and a higher rate of problems such as pye lonephritis and renal scarring (seen in 7.5% [92]) is reported in uncircumcised children [72][82]. These and other reports [e.g., [29] [35][72] [82] all point to the benefits of circumcision in reducing UTI.

Indeed, Wiswell performed a meta-analysis of all 9 studies that had been published up until 1992 and observed that every one had found an increase in UTI in the uncircumcised [99]. The average was 12-fold higher and the range was 5 to 89-fold, with 95% confidence intervals of 11-14 [99]. Meta-analyses by others have reached similar conclusions. There have been other studies since then that have added further support. One of these was in Sydney and involved boys under 5 years of age (mean 6 months). It found that 6% of uncircumcised boys got a UTI, but only 1% of circumcised [16].

The benefit appears to extend beyond childhood and into adult life. In a study of men aged, on average, 30 years, and matched for race, age and sexual activity, the circumcised had a lower rate of UTI [81].

The fact that fimbriated strains of the bacterium Escherichia coli which are pathogenic to the urinary tract and pyelonephritogenic, have been shown to be capable of adhering to the foreskin, satisfies one of the criteria for causality [27] [30][40] [41][82] [102][103]. Thus in infancy and childhood the prepuce becomes colonized with bacteria. Fimbriated strains of Proteus mirabilis, non-fimbriated Pseudomonas , as well as species of Klebsiella and Serratia also bind closely to the mucosal surface of the foreskin within the first few days of life [27][30] [103]. Circumcision prevents such colonization and subsequent ascending infection of the urinary tract [71].

Since the absolute risk of UTI in uncircumcised boys is approx. 1 in 25 (0.05) and in circumcised boys is 1 in 500 (0.002), the absolute risk reduction is 0.048. Thus 20 baby boys need to be circumcised to prevent one UTI. However, the potential seriousness and pain of UTI, which can in rare cases even lead to death, should weigh heavily on the minds of parents. The complications of UTI that can lead to death are: kidney failure, meningitis and infection of bone marrow. The data thus show that much suffering has resulted from leaving the foreskin intact. Lifelong genital hygeine in an attempt to reduce such infections is also part of the price that would have to be paid if the foreskin were to be retained. However, given the difficulty in keeping bacteria at bay in this part of the body [63][77], not performing circumcision would appear to be far less effective than having it done in the first instance [77].

Sexually-transmitted diseases

In 1947 a study of 1300 consecutive patients in a Canadian Army unit showed that being uncircumcised was associated with a 9-fold higher risk of syphilis and 3-times more gonorrhea [91]. Work in the mid-70s showed higher chancroid, syphilis, papillomavirus and herpes in uncircumcised men [85]. At the University of Western Australia a 1983 study showed twice as much herpes and gonorrhea, 5-times more candidiasis and 5-fold greater incidence of syphilis [64]. Others have reported higher rates of nongonococcal urethritis in uncircumcised men [80]. In South Australia a study in 1992 showed that uncircumcised men had more chlamidia (odds ratio 1.3) and gonoccocal infections (odds ratio 2.1). Similarly in 1988 a study in Seattle of 2,800 heterosexual men reported higher syphilis and gonnorrhea in uncircumcised men, but no difference in herpes, chlamidia and non-specific urethritis (NSU). Like this report, a study in 1994 in the USA, found higher gonnorhea and syphilis, but no difference in other common STDs [15]. In the same year Dr Basil Donovan and associates reported the results of a study of 300 consecutive heterosexual male patients attending Sydney STD Centre at Sydney Hospital [22]. They found no difference in genital herpes, NSU, seropositivity for HSV-2 and genital warts (i.e., the benign, so-called 'low-risk' human papillomavirus types 6 and 1 1, which are visible on physical examination, unlike the 'high -risk' types 16 and 18, which are not). As mentioned above, 62% were circumcised and the two groups had a similar age, number of partners and education. Gonorrhea, syphilis and hepatitis B were too uncommon in this Sydney study for them to conclude anything about these other STDs. Similar findings were obtained in the National Health and Social Life Survey in the USA, which asked about gonnorrhea, syphilis, chlamidia, nongonoccocal urethritis, herpes and HIV (which is more often aquired intravenously) [48], although some under-reporting by uncircumcised men was likely as they tended to be less educated. Also, circumcision at birth was assumed, so that the number who sought circumcision later in life for problems, such as STDs and/or other infections, and therefore had switched group, was not taken into account. Design aspects of a number of the studies have in fact been criticised. As a result there is still no overwhelming agreement. Nevertheless, on the bulk of evidence it would seem that at least some STDs could be more common in the uncircumcised, but this conclusion is by no means absolute in Western settings, and the incidence may be influenced by factors such as the degree of genital hygeine, availability of running water and socioeconomic group being studied. In some more recent studies in developed nations, in which hygeine is good, no difference was apparent.

Cancer of the penis

The incidence of penile cancer in the USA is 1 per 100,000 men per year (i.e., 750-1000 cases annually) and mortality rate is 25-33% [44][51]. It represents approximately 1% of all malignancies in men in the USA. This data has to be viewed, moreover, in the context of the high proportion of circumcised men in the USA, especially in older age groups, and the age group affected, where older men represent only a portion of the total male population. Thus 1 in 100,000 per year of life translates to 75 in 100,000 during each man's lifetime, but since it occurs almost entirely in uncircumcised men, if we assume that these represent 30% of males in the USA, the chance an uncircumcised man will get it would be 75 per 30,000 = 1 in 400. In a study in Melbourne in 1990, although 60% of affected men were over 60 years of age, 40% were under 60 [74]. In 5 major series in the USA since 1932 [104], not one man with penile cancer had been circumcised neonatally [51], i.e., this disease is almost completely confined to uncircumcised men and, less commonly, in those circumcised after the newborn period. The finite residual risk in those circumcised later is the major contributing factor to estimates of lifetime risk in the total population of circumcised men of 1 in 50,000 to 1 in 12,000,000 [96][97]. The predicted life-time risk for an uncircumcised man has been estimated as 1 in 600 in the USA and 1 in 900 in Denmark [44]. In underdeveloped countries the incidence is higher: approx. 3-6 cases per 100,000 per year [44] and in Uganda it is the most common malignancy in males, leading to calls for greater circumcision in that country [21]. In Australia, the most recent figures of the New South Wales Cancer Council (for 1993) show 28 cases per year (including one in a child), with 5 deaths, which is similar to the 1 in 100,000 figure above and applies to a population in which the majority of the older men are circumcised. The rate is set to escalate, however, as more of the males who were not circumcised during the period after the mid 1970s reach the ages when this cancer generally begins to appear.

The so-called 'high-risk' papillomavirus types 16 and 18 (HPV 16/18) are found in a large proportion of cases and there is good reason to suspect that they are involved in the causation of penile cancer [53], as is true for most, if not all, cases of cervical cancer (see below). HPV 16 and 18 are, moreover, more common in uncircumcised males [60]. These types of HPV produce flat warts that are normally only visible by application of dilute acetic acid (vinegar) to the penis and the data on high-risk HPVs should not be confused with the incidence figures for genital warts, which although large and readily visible, are caused by the relatively benign HPV types 6 and 11 [42]. Other factors, such as smoking, poor hygeine and other STDs have been suspected as contributing to penile cancer as well [11][51], but it would seem lack of circumcision is the primary prerequisite, with such other factors adding to the risk in the uncircumcised man. Financial considerations are, moreover, not inconsiderable. In the USA it was estimated that the cost for treatment and lost earnings in a man of 50 with cancer in 1980 was $103,000 [34]. The amount today is higher.

In Australia between 1960 and 1966 there were 78 deaths from cancer of the penis and 2 from circumcision. (Circumcision fatalities today are virtually unknown.) At the Peter McCallum Cancer Institute 102 cases of penile cancer were seen between 1954 and 1984, with twice as many in the latter decade compared with the first. Moreover, several authors have linked the rising incidence of penile cancer to a decrease in the number of neonatal circumcisions [17] [74]. It would thus seem that 'prevention by circumcision in infancy is the best policy'. Indeed it would be an unusual parent who did not want to ensure their child was completely protected by this simple procedure.

There is also some data to suggest that circumcised males may have half the incidence of prostate cancer, which is very common (27% of new cancers in males and 7% of all deaths [59]).

Cervical cancer in female partners of uncircumcised men

A number of studies have documented higher rates of cervical cancer in women who have had one or more male sexual partners who were uncircumcised. These studies have to be looked at critically, however, to see to what extent cultural and other influences might be contributing in groups with different ci rcumcision practices. In a study of 5000 cervical and 300 penile cancer cases in Madras between 1982 and 1990 the incidence was low amongst Muslim women, when compared with Hindu and Christian, and was not seen at all in Muslim men [31]. In a case-control study of 1107 Indian women with cervical cancer, sex with uncircumcised men or those circumcised after the age of 1 year was reported in 1993 to be associated with a 4-fold higher risk of cervical cancer, after controlling for factors such as age, age of first intercourse and education 1.

Another study published in 1993 concerning various types of cancer in the Valley of Kashmir concluded that universal male circumcsion in the majority community was responsible for the low rate of cervical cancer compared with the rest of India [18]. In Israel, a 1994 report of 4 groups of women aged 17-60 found that gynaecologically healthy Moshav residents had no HPV 16/18, whereas healthy Kibbutz residents had a 1.8% incidence [38]. Amongst those with gynaecological complaints HPV 16/18 was found in 9% of Jewish and 12% of non-Jewish women. So-called 'high-risk' HPV types 16, 18 and some rarer forms are responsible for virtually every case of cervical cancer [87]. These same high-risk HPVs also cause penile intraepithelial neoplasia (PIN). In a study published in the New England Journal of Medicine in 1987 it was found that women with cervical cancer were more likely to have partners with PIN, the male equivalent of cervical intraepithelial neoplasia (CIN) [9]. CIN may lead to cancer or, more often, it goes away. Thus co-factors are suspected. Interestingly, smegma (the film of bacteria, secretions and other material under the foreskin), obtained from human and horse has been shown to be capable of producing cervical cancer in mice in one study [67], but not in another [70]. Thus the epidemic of cervical cancer in Australia, and indeed most countries in the world, would appear to be contributed, at least in part, by the uncircumcised male and would therefore be expected to get even worse as the large proportion of men that were born in the past 10-20 years and not circumcised reach sexual maturity.

AIDS virus

In the USA the estimated risk of HIV per heterosexual exposure is 1 in 10,000 to 1 in 100,000. If one partner is HIV positive and otherwise healthy then a single act of unprotected vaginal sex carries a 1 in 300 risk for a woman and as low as a 1 in 1000 risk for a man [12]. (The rates are very much higher for unprotected anal sex and intravenous injection). In Africa, however, the rate of HIV infection is up to 10% in some cities. (A possible reason for this big difference will be discussed later.) In Nairobi it was first noticed that among 340 men being treated for STDs they were 3-times as likely to be HIV positive if they had genital ulcers or were uncircumcised (11% of these men had HIV) [79]. Subsequently another report showed that amongst 409 African ethnic groups spread over 37 countries the geographical distribution of circumcision practices indicated a correlation of lack of circumcision and high incidence of AIDS [10]. In 1990 Moses in the International Journal of Epidemiology reported that amongst 700 African societies involving 140 locations and 41 countries there was a considerably lower incidence of HIV in those localities where circumcision was practiced [56][57]. Truck drivers, who generally exhibit more frequent prostitute contact, have shown a higher rate of HIV if uncircumcised. Interestingly, in a West African setting, men who were circumcised but had residual foreskin were more likely to be HIV-2 positive than those in whom circumcision was complete [65].

Of 33 cross-sectional studies, 22 have reported statistically significant association [e.g., [20] [37][39] [68][88], by univariate and multivariate analysis, between the presence of the foreskin and HIV infection (4 of these were from the USA). 5 reported a trend (including 1 US s tudy). The 6 that saw no difference were 4 from Rwanda and 2 from Tanzania. In addition there have been 5 prospective studies and 2 from Kenya and 1 from Tanzania reported statistically significant association. The increased risk in the significant studies ranged from 1.5 to 9.6. The findings have, moreover, led various workers such as Moses and Caldwell to propose that circumcision be used as an important intervention strategy in order to reduce AIDS [12][26] [37][43] [52][56] [57]. Such advice has been taken up, with newspaper advertisements from clinics in Tanzania offering this service to protect against AIDS.

Perhaps the most interesting study of the risk of HIV infection imposed by having a foreskin is that by Cameron, Plummer and associates published as a large article in Lancet in 1989 [13]. It was conducted in Nairobi. Rather than look at the existing infection rate in each group, these workers followed HIV negative men until they became infected. The men were visiting prostitutes, numbering approx. 1000, amongst whom there had been an explosive increase in the incidence of HIV from 4% in 1981 to 85% in 1986. These men were thus at high risk of exposure to HIV, as well as other STDs. From March to December 1987, 422 men were enrolled into the study. Of these, 51% had presented with genital ulcer disease (89% chancroid, 4% syphilis, 5% herpes) and the other 49% with urethritis (68% being gonorrhea). 12% were initially positive for HIV-1.