Knowledge Attitude and Perception of Circumcision Among Males in Lebanon: A Cross-Sectional Study

Knowledge Attitude and Perception of Circumcision Among Males in Lebanon: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge Attitude and Perception of Circumcision Among Males in Lebanon: A Cross-Sectional Study elio louka, gregory tohme, Shafika assaad This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6577857/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Male circumcision (MC) is a widely practiced surgical procedure with potential health benefits and associated controversies. In Lebanon, the sociocultural and medical perspectives surrounding MC remain underexplored. Objectives To assess the knowledge, attitudes and perceptions of male circumcision among young adult males in Lebanon and determine whether personal circumcision status influence their attitudes regarding circumcision of future children. Materials and Methods A cross-sectional study was conducted among 174 Lebanese males aged 18–30 using a self-administered questionnaire adapted from validated tools and culturally adjusted. Data were analyzed descriptively and presented as percentages. Results Most participants were aged 18–21 (85.1%) and were university students (73%). A majority were uncircumcised (63.8%). Among circumcised individuals, 69.8% were inclined to circumcise future children, while 51.35% of uncircumcised participants opposed it. Medical knowledge was limited; 44.8% denied its role in reducing STD risk. Additionally, 40.2% believed proper hygiene alone was sufficient for disease prevention. Conclusion The findings highlight a significant knowledge gap and mixed perceptions about circumcision among Lebanese males. Personal circumcision status notably influenced future intentions. Increased educational efforts are needed to support informed decision-making on this sensitive health issue. Male Circumcision Knowledge attitude perception public health Lebanon Introduction Male circumcision (MC) is one of the oldest and most widely practiced surgical procedures, involving the partial or total removal of the prepuce (foreskin) from the male genitalia [1][2]. The World Health Organization (WHO) estimates that approximately 30–33% of men worldwide aged 15 and above are circumcised [3]. The procedure is commonly performed for medical, cultural, and personal reasons, with documented health benefits such as reduced risks of urinary tract infections (UTIs), sexually transmitted infections (STIs), and HIV transmission [2] [4–7]. Despite these advantages, circumcision remains a subject of ethical and scientific debate [1]. While literature supports circumcision for its potential hygienic and protective benefits [1][8], concerns have been raised regarding bodily autonomy, surgical risks, and potential psychological consequences. Critics argue that circumcision provides no substantial medical benefit relative to its possible complications, which include hemorrhage, adhesions, infections, and cosmetic dissatisfaction [10][11]. Beyond these physical risks, circumcision may have psychological implications, particularly when performed outside infancy. Recent research suggests that circumcision during early childhood (ages three to six) may lead to acute psychological distress, while its impact in adulthood varies, influencing self-esteem and emotional well-being differently across individuals and cultural settings [3][12][13]. Despite its medical and cultural relevance, circumcision remains an under-researched topic in Lebanon, particularly concerning its psychological and social implications. The absence of comprehensive scientific data makes it difficult for healthcare providers to offer well-informed counseling and guidance on the procedure. The findings may serve as a valuable resource for healthcare professionals, public health policymakers, and individuals seeking to make informed choices regarding circumcision. Addressing misconceptions and increasing awareness about the medical dimensions of circumcision will help ensure that individuals receive balanced and evidence-based information when making personal and medical decisions [11]. This research aims to assess how personal circumcision status influences attitude and decision-making regarding circumcision of future children as well as to evaluate the level of knowledge and perception about circumcision among emerging adults. Materials and methods This study is a cross-sectional study involving 174 participants aged 18–30 designed to analyze attitude, perception and knowledge of male circumcision and among Lebanese men. The questionnaire was adapted from two validated questionnaire used in published literature (et al Akugizibwe [14] and et al Bilgili [15]) and was adopted to the Lebanese culture. Data was collected through a self-administered questionnaire consisting of demographic information (age, education, circumcision status) and medical knowledge, and perceptions of circumcision (beliefs about the medical necessity, potential health benefits of circumcision ). Attitude and decision-making factors (questions on future circumcision decisions for children). The data collected were systematically analyzed and the results were expressed as percentages to provide a clear and concise representation of the findings. Ethical Approval: The participant’s consent was taken prior to answering the questionnaire. Participants were assured that the data collected will remain confidential and anonymous according to the Helsinki code of ethics. The research protocol was reviewed and approved by the Research Ethics Committee (REC) of the Higher Center for Research (HCR) at USEK, with the reference number HCR/EC 2025-014. The study was evaluated in a meeting held on 18/02/2025, and ethical approval was granted in accordance with the HCR Code of Ethics. Results Table 1 represent the participants gender, age and level of education ; A total of 174 males participated in the study. The majority were aged between 18 and 21 years (85.1%). The majority were university students (73%). Table 2 represents the participants circumcision status and their attitude regarding circumcision of future children. Of the total responses, most male participants were not circumcised (63.8%). The study aimed to determine whether personal circumcision status influenced participants’ intentions regarding circumcising future children. 69.8% of circumcised participants supported the intent to circumcise future children whereas around half of uncircumcised participants 51.35% refuted circumcision for future children. Additionally, 32.43% of the uncircumcised participants remained unsure compared to 22.2% among circumcised. Table 3 represent participants medical knowledge and perception. Concerning circumcision and hygiene 40.2% of the participants agreed that proper state of hygiene is sufficient for protection against diseases which obviate the need for circumcision. When asked about the association between circumcision and certain medical conditions, around half of the participants did not know whether circumcision was necessary for good reproductive health, 37.4% did not know if circumcision reduces the incidence of urinary tract infections, 44.8% disagreed that circumcision reduce the risk of contracting sexually transmitted diseases and 37.4% disagreed that circumcision is used as a medical treatment. Discussion In our study, 85.1% of the participants were between 18–21 years old and 73% of all participants attended university. Similarly in another study, 80–85% of participants were aged between 21–25 years old, who also attended universities. Our findings indicated that circumcision prevalence (36.2%) was similarly close to that of the World Health Organization (WHO) which estimated that 30–33% of men worldwide aged 15 and above are circumcised [3]. Concerning attitude related question, among those that are circumcised, 69.8% would circumcise their future children and for those who are uncircumcised, 51.35% would not undergo circumcision for their male offsprings. Comparing those results to other studies, we noticed that 90.8% of circumcised participants would have their son circumcised, meanwhile 47.2% of the uncircumcised would not do the surgery to their son [4]. In another study, approximately 50% of the circumcised father’s sons had undergone surgery and between the uncircumcised fathers, 55% of their sons were uncircumcised [9]. Additionally, other findings show that most respondents (86.4%) strongly agreed on the necessity of the procedure [1]. As for the knowledge and perception about circumcision, when asked if circumcision is necessary for achieving a good reproductive life, 49.4% of our participants denied this claim. But in another study, parents were asked that same question and 41.7% of them said yes while approximately 96% of pediatricians and general practitioners said no [15]. For our next question, 37.4% of participants did not know if circumcision reduces the incidence of UTIs and 33.9% said yes it does. Contradictorily, in another study, 60.4% of participants said yes [15]. Additionally, 69.5% participants of different study agreed that circumcision prevents UTIs [1]. Moreover, our participants were asked if circumcision can reduce the risk of contracting STDs (like HIV) where 44.8% of them said no. This result was reflected in a study where 67% of participants also said no [11], and another one where participants had no idea of the effect of circumcision on STDs [3]. When asked if proper hygiene is sufficient for protection from venereal diseases which makes circumcision unnecessary, 40.2% of our participants said no. Similarly, a study also showed that 60.4% of parents said no to the same question, as well as 38% of general practitioners and pediatricians [15]. 37.4% of our participants did not think that circumcision is used as a medical treatment for conditions such as tightness in the foreskin, bonded foreskin and paraphimosis which is the opposite result of another study as 77.1% of their participants knew that it was a medical treatment for those conditions [3]. Strength This is the first study to assess the knowledge, perception and attitude of male circumcision in Lebanon. Limitations : The study depends on a Self-reported data that may introduce personal bias or social desirability effects. Given the sensitive nature of circumcision, some participants may be reluctant to share personal experiences, affecting sample size. Conclusion Circumcision remains an under-researched topic, particularly in Lebanon, where religious and cultural traditions strongly influence health-related decisions This study has shown that young Lebanese adults lacked knowledge and perception about the practice of circumcision whether they had undergone the surgery or not. This is mainly due to a lack of proper education and awareness about circumcision from experts and pediatricians to parents, adolescents and the rest of the Lebanese population. An increase in conferences, awareness campaigns and teaching about this topic in school, universities and social media about its benefits as well as its risks can help solve the problem of absence of knowledge especially for people that are waiting for a son on the way. Declarations No conflict of interest Ethical Approval: The participant’s consent was taken prior to answering the questionnaire. Participants were assured that the data collected will remain confidential and anonymous according to the Helsinki code of ethics. Funding Self-funded Author Contribution All authors contributed equally Acknowledgement N/A Data Availability the questionnaire was distributed as a Google Form document; all data available are accessed by the corresponding author , and are available upon request . References Al-Maghlouth, A.K., Zakaria, O.M. Parental perception of male circumcision: a local cross sectional study in a Muslim community. Afr J Urol 31 , 9 (2025). https://doi.org/10.1186/s12301-025-00480-3 American Academy of Pediatrics Task Force on Circumcision. Male circumcision. Pediatrics. 2012 Sep;130(3):e756-85. doi: 10.1542/peds.2012-1990. Epub 2012 Aug 27. PMID: 22926175. Akçay Didişen, Nurdan & Karakul, Atiye & Çevi̇k Özdemi̇r, Hamide. (2021). Determining the Knowledge Level of Parents Relating to Circumcision. The Journal of Pediatric Research. 8. 424-431. 10.4274/jpr.galenos.2021.57689. George C, Roberts R, Deveaux L, Brennen DFP, Read SE. "Getting to Zero New HIV Infections in the Caribbean": Knowledge and Attitudes Toward Male Circumcision Among Adolescent Males in The Bahamas. Am J Mens Health. 2019 Jul-Aug;13(4):1557988319872074. doi: 10.1177/1557988319872074. PMID: 31431104; PMCID: PMC6704421. Yudice KM, Rodriguez VJ, Jones DL, Mweemba O, Bowa K, Zulu R, Kamboyi R, Kaminsky CJ, Weiss SM. Early Infant Male Circumcision Decisions in Zambia: Demographic and Familial Influences. AIDS Behav. 2024 Oct;28(10):3543-3548. doi: 10.1007/s10461-024-04426-8. Epub 2024 Jul 23. PMID: 39039397; PMCID: PMC11427522. Matoga MM, Kudowa E, Tsidya M, Tseka J, Ndalama B, Bonongwe N, Mathiya E, Jere E, Yatina D, Kamtambe B, Hosseinipour MC, Chasela CS, Jewett S. Acceptability, feasibility and appropriateness of intensified health education, SMS/phone tracing and transport reimbursement for uptake of voluntary medical male circumcision in a sexually transmitted infections clinic in Malawi: A mixed methods study. PLoS One. 2025 Jan 24;20(1):e0301952. doi: 10.1371/journal.pone.0301952. PMID: 39854431; PMCID: PMC11760565. Alkhenizan A, Elabd K. Non-therapeutic infant male circumcision. Evidence, ethics, and international law perspectives. Saudi Med J. 2016 Sep;37(9):941-7. doi: 10.15537/smj.2016.9.14519. PMID: 27570848; PMCID: PMC5039612. Leeson C, Vigil H, Witherspoon L. Foreskin care: Hygiene, importance of counselling, and management of common complications. Can Fam Physician. 2025 Feb;71(2):97-102. doi: 10.46747/cfp.710297. PMID: 39965976. Lee SD, Park E, Choe BM. Parental concerns on the circumcision for elementary school boys: a questionnaire study. J Korean Med Sci. 2003 Feb;18(1):73-9. doi: 10.3346/jkms.2003.18.1.73. PMID: 12589091; PMCID: PMC3054978. Kalyenci B, Benlioglu C, Ölçücü MT, Teke K, Sever S, Çift A, Yücel MÖ. Retrospective analysis of clinical outcomes and early complications of conventional circumcision techniques and thermocautery-assisted circumcision. Sci Rep. 2025 Feb 28;15(1):7139. doi: 10.1038/s41598-025-91730-5. PMID: 40021714; PMCID: PMC11871139. Cooblal AS, Rampersad B. About the Foreskin: Parents' Perceptions and Misconceptions. West Indian Med J. 2014 Sep;63(5):484-9. doi: 10.7727/wimj.2012.251. Epub 2014 Jul 7. PMID: 25781287; PMCID: PMC4655674. Ferris JA, Richters J, Pitts MK, Shelley JM, Simpson JM, Ryall R, Smith AM. Circumcision in Australia: further evidence on its effects on sexual health and wellbeing. Aust N Z J Public Health. 2010 Apr;34(2):160-4. doi: 10.1111/j.1753-6405.2010.00501.x. PMID: 23331360. Aydogmus Y, Semiz M, Er O, Bas O, Atay I, Kilinc MF. Psychological and sexual effects of circumcision in adult males. Can Urol Assoc J. 2016 May-Jun;10(5-6):E156-E160. doi: 10.5489/cuaj.3364. Epub 2016 May 12. PMID: 27790295; PMCID: PMC5065403. Akugizibwe L, Benyumiza D, Nekesa C, Kumakech E, Kigongo E, Ashaba N, Kabunga A, Tumwesigye R. Knowledge, Perception, and Practice of Safe Medical Circumcision on HIV Infection Risk Reduction among Undergraduate Students of a Public University in Northern Uganda: A Cross-Sectional Study. Biomed Res Int. 2024 Apr 9;2024:1534139. doi: 10.1155/2024/1534139. PMID: 38633241; PMCID: PMC11022510. Bilgili, Doruk & UÇARCI, Duygu & Güvenç, Haluk. (2024). Perceptions & Decision Making Regarding Male Circumcision Amongst Parents and Medical Personnel. Journal of Pediatric Surgery Open. 9. 10.1016/j.yjpso.2024.100181. Tables Tables 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6577857","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":452481389,"identity":"c952de71-a0a2-493d-ab71-5a2bd2e6bfc5","order_by":0,"name":"elio louka","email":"data:image/png;base64,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","orcid":"","institution":"Holy Spirit University of Kaslik","correspondingAuthor":true,"prefix":"","firstName":"elio","middleName":"","lastName":"louka","suffix":""},{"id":452481390,"identity":"d38bb362-ea9f-4951-bf9b-04ea44f88642","order_by":1,"name":"gregory tohme","email":"","orcid":"","institution":"Holy Spirit University of Kaslik","correspondingAuthor":false,"prefix":"","firstName":"gregory","middleName":"","lastName":"tohme","suffix":""},{"id":452481391,"identity":"a814bafd-2bbe-44c1-b529-b1d10b1c3fe1","order_by":2,"name":"Shafika assaad","email":"","orcid":"","institution":"Holy Spirit University of Kaslik","correspondingAuthor":false,"prefix":"","firstName":"Shafika","middleName":"","lastName":"assaad","suffix":""}],"badges":[],"createdAt":"2025-05-02 11:08:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6577857/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6577857/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84282318,"identity":"cdbf1ea6-a6ac-4abd-82a0-9f89bdb9866d","added_by":"auto","created_at":"2025-06-10 06:54:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":332393,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6577857/v1/a8a597d4-ab0d-41bc-ac4f-a7f2225ac5ab.pdf"},{"id":82344538,"identity":"c9e23424-4ba1-48a4-903d-1597f7e94e0c","added_by":"auto","created_at":"2025-05-09 09:51:45","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18835,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6577857/v1/c11c4eb8cda802f0a53eafc4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge Attitude and Perception of Circumcision Among Males in Lebanon: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMale circumcision (MC) is one of the oldest and most widely practiced surgical procedures, involving the partial or total removal of the prepuce (foreskin) from the male genitalia [1][2]. The World Health Organization (WHO) estimates that approximately 30\u0026ndash;33% of men worldwide aged 15 and above are circumcised [3]. The procedure is commonly performed for medical, cultural, and personal reasons, with documented health benefits such as reduced risks of urinary tract infections (UTIs), sexually transmitted infections (STIs), and HIV transmission [2] [4\u0026ndash;7]. Despite these advantages, circumcision remains a subject of ethical and scientific debate [1].\u003c/p\u003e \u003cp\u003eWhile literature supports circumcision for its potential hygienic and protective benefits [1][8], concerns have been raised regarding bodily autonomy, surgical risks, and potential psychological consequences. Critics argue that circumcision provides no substantial medical benefit relative to its possible complications, which include hemorrhage, adhesions, infections, and cosmetic dissatisfaction [10][11]. Beyond these physical risks, circumcision may have psychological implications, particularly when performed outside infancy. Recent research suggests that circumcision during early childhood (ages three to six) may lead to acute psychological distress, while its impact in adulthood varies, influencing self-esteem and emotional well-being differently across individuals and cultural settings [3][12][13].\u003c/p\u003e \u003cp\u003eDespite its medical and cultural relevance, circumcision remains an under-researched topic in Lebanon, particularly concerning its psychological and social implications. The absence of comprehensive scientific data makes it difficult for healthcare providers to offer well-informed counseling and guidance on the procedure. The findings may serve as a valuable resource for healthcare professionals, public health policymakers, and individuals seeking to make informed choices regarding circumcision. Addressing misconceptions and increasing awareness about the medical dimensions of circumcision will help ensure that individuals receive balanced and evidence-based information when making personal and medical decisions [11].\u003c/p\u003e \u003cp\u003eThis research aims to assess how personal circumcision status influences attitude and decision-making regarding circumcision of future children as well as to evaluate the level of knowledge and perception about circumcision among emerging adults.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThis study is a cross-sectional study involving 174 participants aged 18\u0026ndash;30 designed to analyze attitude, perception and knowledge of male circumcision and among Lebanese men.\u003c/p\u003e \u003cp\u003eThe questionnaire was adapted from two validated questionnaire used in published literature (et al Akugizibwe [14] and et al Bilgili [15]) and was adopted to the Lebanese culture.\u003c/p\u003e \u003cp\u003eData was collected through a self-administered questionnaire consisting of demographic information (age, education, circumcision status) and medical knowledge, and perceptions of circumcision (beliefs about the medical necessity, potential health benefits of circumcision ). Attitude and decision-making factors (questions on future circumcision decisions for children).\u003c/p\u003e \u003cp\u003eThe data collected were systematically analyzed and the results were expressed as percentages to provide a clear and concise representation of the findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participant\u0026rsquo;s consent was taken prior to answering the questionnaire. Participants were assured that the data collected will remain confidential and anonymous according to the Helsinki code of ethics.\u003c/p\u003e\n\u003cp\u003eThe research protocol was reviewed and approved by the Research Ethics Committee (REC) of the Higher Center for Research (HCR) at USEK, with the reference number HCR/EC 2025-014. The study was evaluated in a meeting held on 18/02/2025, and ethical approval was granted in accordance with the HCR Code of Ethics.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;1 represent the participants gender, age and level of education ; A total of 174 males participated in the study. The majority were aged between 18 and 21 years (85.1%). The majority were university students (73%).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;2 represents the participants circumcision status and their attitude regarding circumcision of future children. Of the total responses, most male participants were not circumcised (63.8%). The study aimed to determine whether personal circumcision status influenced participants\u0026rsquo; intentions regarding circumcising future children. 69.8% of circumcised participants supported the intent to circumcise future children whereas around half of uncircumcised participants 51.35% refuted circumcision for future children. Additionally, 32.43% of the uncircumcised participants remained unsure compared to 22.2% among circumcised.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;3 represent participants medical knowledge and perception. Concerning circumcision and hygiene 40.2% of the participants agreed that proper state of hygiene is sufficient for protection against diseases which obviate the need for circumcision.\u003c/p\u003e\u003cp\u003eWhen asked about the association between circumcision and certain medical conditions, around half of the participants did not know whether circumcision was necessary for good reproductive health, 37.4% did not know if circumcision reduces the incidence of urinary tract infections, 44.8% disagreed that circumcision reduce the risk of contracting sexually transmitted diseases and 37.4% disagreed that circumcision is used as a medical treatment.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, 85.1% of the participants were between 18\u0026ndash;21 years old and 73% of all participants attended university. Similarly in another study, 80\u0026ndash;85% of participants were aged between 21\u0026ndash;25 years old, who also attended universities.\u003c/p\u003e\u003cp\u003eOur findings indicated that circumcision prevalence (36.2%) was similarly close to that of the World Health Organization (WHO) which estimated that 30\u0026ndash;33% of men worldwide aged 15 and above are circumcised [3]. Concerning attitude related question, among those that are circumcised, 69.8% would circumcise their future children and for those who are uncircumcised, 51.35% would not undergo circumcision for their male offsprings. Comparing those results to other studies, we noticed that 90.8% of circumcised participants would have their son circumcised, meanwhile 47.2% of the uncircumcised would not do the surgery to their son [4]. In another study, approximately 50% of the circumcised father\u0026rsquo;s sons had undergone surgery and between the uncircumcised fathers, 55% of their sons were uncircumcised [9]. Additionally, other findings show that most respondents (86.4%) strongly agreed on the necessity of the procedure [1].\u003c/p\u003e\u003cp\u003eAs for the knowledge and perception about circumcision, when asked if circumcision is necessary for achieving a good reproductive life, 49.4% of our participants denied this claim. But in another study, parents were asked that same question and 41.7% of them said yes while approximately 96% of pediatricians and general practitioners said no [15]. For our next question, 37.4% of participants did not know if circumcision reduces the incidence of UTIs and 33.9% said yes it does. Contradictorily, in another study, 60.4% of participants said yes [15]. Additionally, 69.5% participants of different study agreed that circumcision prevents UTIs [1]. Moreover, our participants were asked if circumcision can reduce the risk of contracting STDs (like HIV) where 44.8% of them said no. This result was reflected in a study where 67% of participants also said no [11], and another one where participants had no idea of the effect of circumcision on STDs [3]. When asked if proper hygiene is sufficient for protection from venereal diseases which makes circumcision unnecessary, 40.2% of our participants said no. Similarly, a study also showed that 60.4% of parents said no to the same question, as well as 38% of general practitioners and pediatricians [15]. 37.4% of our participants did not think that circumcision is used as a medical treatment for conditions such as tightness in the foreskin, bonded foreskin and paraphimosis which is the opposite result of another study as 77.1% of their participants knew that it was a medical treatment for those conditions [3].\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eStrength\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThis is the first study to assess the knowledge, perception and attitude of male circumcision in Lebanon.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eLimitations\u003c/span\u003e:\u003c/p\u003e\u003cp\u003eThe study depends on a Self-reported data that may introduce personal bias or social desirability effects. Given the sensitive nature of circumcision, some participants may be reluctant to share personal experiences, affecting sample size.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCircumcision remains an under-researched topic, particularly in Lebanon, where religious and cultural traditions strongly influence health-related decisions\u003c/p\u003e\u003cp\u003eThis study has shown that young Lebanese adults lacked knowledge and perception about the practice of circumcision whether they had undergone the surgery or not. This is mainly due to a lack of proper education and awareness about circumcision from experts and pediatricians to parents, adolescents and the rest of the Lebanese population. An increase in conferences, awareness campaigns and teaching about this topic in school, universities and social media about its benefits as well as its risks can help solve the problem of absence of knowledge especially for people that are waiting for a son on the way.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eNo conflict of interest\u003c/p\u003e\n\u003ch2\u003eEthical Approval:\u003c/h2\u003e\n\u003cp\u003eThe participant\u0026rsquo;s consent was taken prior to answering the questionnaire. Participants were assured that the data collected will remain confidential and anonymous according to the Helsinki code of ethics.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eSelf-funded\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAll authors contributed equally\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003ethe questionnaire was distributed as a Google Form document; all data available are accessed by the corresponding author , and are available upon request .\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e Al-Maghlouth, A.K., Zakaria, O.M. Parental perception of male circumcision: a local cross sectional study in a Muslim community. \u003cem\u003eAfr J Urol\u003c/em\u003e \u003cstrong\u003e31\u003c/strong\u003e, 9 (2025). https://doi.org/10.1186/s12301-025-00480-3\u003c/li\u003e\n\u003cli\u003e American Academy of Pediatrics Task Force on Circumcision. Male circumcision. Pediatrics. 2012 Sep;130(3):e756-85. doi: 10.1542/peds.2012-1990. Epub 2012 Aug 27. PMID: 22926175.\u003c/li\u003e\n\u003cli\u003e Akçay Didişen, Nurdan \u0026amp; Karakul, Atiye \u0026amp; Çevi̇k Özdemi̇r, Hamide. (2021). Determining the Knowledge Level of Parents Relating to Circumcision. The Journal of Pediatric Research. 8. 424-431. 10.4274/jpr.galenos.2021.57689.\u003c/li\u003e\n\u003cli\u003e George C, Roberts R, Deveaux L, Brennen DFP, Read SE. \"Getting to Zero New HIV Infections in the Caribbean\": Knowledge and Attitudes Toward Male Circumcision Among Adolescent Males in The Bahamas. Am J Mens Health. 2019 Jul-Aug;13(4):1557988319872074. doi: 10.1177/1557988319872074. PMID: 31431104; PMCID: PMC6704421.\u003c/li\u003e\n\u003cli\u003e Yudice KM, Rodriguez VJ, Jones DL, Mweemba O, Bowa K, Zulu R, Kamboyi R, Kaminsky CJ, Weiss SM. Early Infant Male Circumcision Decisions in Zambia: Demographic and Familial Influences. AIDS Behav. 2024 Oct;28(10):3543-3548. doi: 10.1007/s10461-024-04426-8. Epub 2024 Jul 23. PMID: 39039397; PMCID: PMC11427522.\u003c/li\u003e\n\u003cli\u003e Matoga MM, Kudowa E, Tsidya M, Tseka J, Ndalama B, Bonongwe N, Mathiya E, Jere E, Yatina D, Kamtambe B, Hosseinipour MC, Chasela CS, Jewett S. Acceptability, feasibility and appropriateness of intensified health education, SMS/phone tracing and transport reimbursement for uptake of voluntary medical male circumcision in a sexually transmitted infections clinic in Malawi: A mixed methods study. PLoS One. 2025 Jan 24;20(1):e0301952. doi: 10.1371/journal.pone.0301952. PMID: 39854431; PMCID: PMC11760565.\u003c/li\u003e\n\u003cli\u003e Alkhenizan A, Elabd K. Non-therapeutic infant male circumcision. Evidence, ethics, and international law perspectives. Saudi Med J. 2016 Sep;37(9):941-7. doi: 10.15537/smj.2016.9.14519. PMID: 27570848; PMCID: PMC5039612.\u003c/li\u003e\n\u003cli\u003e Leeson C, Vigil H, Witherspoon L. Foreskin care: Hygiene, importance of counselling, and management of common complications. Can Fam Physician. 2025 Feb;71(2):97-102. doi: 10.46747/cfp.710297. PMID: 39965976.\u003c/li\u003e\n\u003cli\u003e Lee SD, Park E, Choe BM. Parental concerns on the circumcision for elementary school boys: a questionnaire study. J Korean Med Sci. 2003 Feb;18(1):73-9. doi: 10.3346/jkms.2003.18.1.73. PMID: 12589091; PMCID: PMC3054978.\u003c/li\u003e\n\u003cli\u003e Kalyenci B, Benlioglu C, Ölçücü MT, Teke K, Sever S, Çift A, Yücel MÖ. Retrospective analysis of clinical outcomes and early complications of conventional circumcision techniques and thermocautery-assisted circumcision. Sci Rep. 2025 Feb 28;15(1):7139. doi: 10.1038/s41598-025-91730-5. PMID: 40021714; PMCID: PMC11871139.\u003c/li\u003e\n\u003cli\u003e Cooblal AS, Rampersad B. About the Foreskin: Parents' Perceptions and Misconceptions. West Indian Med J. 2014 Sep;63(5):484-9. doi: 10.7727/wimj.2012.251. Epub 2014 Jul 7. PMID: 25781287; PMCID: PMC4655674.\u003c/li\u003e\n\u003cli\u003e Ferris JA, Richters J, Pitts MK, Shelley JM, Simpson JM, Ryall R, Smith AM. Circumcision in Australia: further evidence on its effects on sexual health and wellbeing. Aust N Z J Public Health. 2010 Apr;34(2):160-4. doi: 10.1111/j.1753-6405.2010.00501.x. PMID: 23331360.\u003c/li\u003e\n\u003cli\u003e Aydogmus Y, Semiz M, Er O, Bas O, Atay I, Kilinc MF. Psychological and sexual effects of circumcision in adult males. Can Urol Assoc J. 2016 May-Jun;10(5-6):E156-E160. doi: 10.5489/cuaj.3364. Epub 2016 May 12. PMID: 27790295; PMCID: PMC5065403.\u003c/li\u003e\n\u003cli\u003e Akugizibwe L, Benyumiza D, Nekesa C, Kumakech E, Kigongo E, Ashaba N, Kabunga A, Tumwesigye R. Knowledge, Perception, and Practice of Safe Medical Circumcision on HIV Infection Risk Reduction among Undergraduate Students of a Public University in Northern Uganda: A Cross-Sectional Study. Biomed Res Int. 2024 Apr 9;2024:1534139. doi: 10.1155/2024/1534139. PMID: 38633241; PMCID: PMC11022510.\u003c/li\u003e\n\u003cli\u003e Bilgili, Doruk \u0026amp; UÇARCI, Duygu \u0026amp; Güvenç, Haluk. (2024). Perceptions \u0026amp; Decision Making Regarding Male Circumcision Amongst Parents and Medical Personnel. Journal of Pediatric Surgery Open. 9. 10.1016/j.yjpso.2024.100181.\u003c/li\u003e\n\u003c/ol\u003e\n"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Male Circumcision, Knowledge, attitude, perception, public health, Lebanon","lastPublishedDoi":"10.21203/rs.3.rs-6577857/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6577857/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMale circumcision (MC) is a widely practiced surgical procedure with potential health benefits and associated controversies. In Lebanon, the sociocultural and medical perspectives surrounding MC remain underexplored.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eTo assess the knowledge, attitudes and perceptions of male circumcision among young adult males in Lebanon and determine whether personal circumcision status influence their attitudes regarding circumcision of future children.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted among 174 Lebanese males aged 18\u0026ndash;30 using a self-administered questionnaire adapted from validated tools and culturally adjusted. Data were analyzed descriptively and presented as percentages.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMost participants were aged 18\u0026ndash;21 (85.1%) and were university students (73%). A majority were uncircumcised (63.8%). Among circumcised individuals, 69.8% were inclined to circumcise future children, while 51.35% of uncircumcised participants opposed it. Medical knowledge was limited; 44.8% denied its role in reducing STD risk. Additionally, 40.2% believed proper hygiene alone was sufficient for disease prevention.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings highlight a significant knowledge gap and mixed perceptions about circumcision among Lebanese males. Personal circumcision status notably influenced future intentions. Increased educational efforts are needed to support informed decision-making on this sensitive health issue.\u003c/p\u003e","manuscriptTitle":"Knowledge Attitude and Perception of Circumcision Among Males in Lebanon: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 09:51:40","doi":"10.21203/rs.3.rs-6577857/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce255b31-a55c-44f1-8cf7-ec11ea7c0470","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-10T06:54:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-09 09:51:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6577857","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6577857","identity":"rs-6577857","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}