- The ritual of circumcision, known as tuli, is common in the Philippines where 93 per cent of men are circumcised
- Marikana City, in the eastern suburbs of Manila, has cornered the market in mass circumcisions
- In 2011 the city attempted to get in the Guinness Book of Records when 1,500 boys were circumcised
- Guinness Records rejected the bid, saying they do not accept mass operations on 'hygiene' grounds
In the Philippines circumcision is a tradition for boys who are just about to enter their teenage years. Uncircumcised boys often end up being teased by their peers but as these images show, the price of social acceptance is a painful one.
Circumcision is traditionally associated with Muslim and Jewish culture but the ritual of 'tuli' is common in the Philippines, where the majority of people are Roman Catholic.
This week 300 boys began the traditional journey into adulthood in a single mass circumcision exercise at a school in Marikina City, east of the Filipino capital Manila.
Afterwards they are encouraged to wear loose skirt-like clothing and in the local Tagalog language the swelling which follows the operation is known as pangangamatis, which translates as 'becoming like a tomato'.
The World Health Organization reports estimates 30 to 33 per cent of men aged 15 or over are circumcised but in the Philippines the figure is 93 per cent.
Five years ago 1,500 boys were circumcised on the same day in Marikina City but the Guinness Book of Records rejected an application 'due to hygiene considerations and risks'.
Be a big brave boy: A youth grimaces as a doctor in the Philippines carries out a circumcision operation on top of a classroom table at a school in Marikina City, east of the capital Manila
What have we left ourselves in for? The looks on these little boys' faces say it all. They look on in horror as one of their classmates goes under the knife. Circumcision involves the removal of the foreskin with a very sharp knife under local anaesthetic.
It will all be over soon, son: A father comforts his son a nurse performs the operation on his foreskin. Classrooms were converted into operating rooms during a school holiday for the mass circumcision in Marikana City this week
Blood brothers: Circumcision, known as tuli, is a coming of age ritual for boys in the Philippines. Although it is a Catholic country it is thought the tradition dates from the middle ages, when the archipelago was largely Muslim
The gentler sex: A doctor and a nurse perform the operation on a boy in a school building, where sheets provide a modicum of privacy. The Philippines government funds an annual Operation Tuli to ensure circumcisions are carried out hygienically
Back to school: Most of April is traditionally a holiday in the Philippines and schools are often converted into makeshift operating theatres to enable as many circumcisions as possible to be performed. Let us hope they clean up properly afterwards
A stitch in time: Traditionally those undergoing circumcision were given some guava leaves to chew but nowadays the boys are given local anaesthetics to numb the groin area
All in this together: A boy pulls a face as his classmates also undergo circumcision. The World Health Organization says circumcision can reduce the risk of heterosexual men getting HIV by 60 per cent
No classes today: School desks were converted into operating tables for the mass circumcision in Marikana City. The town, just east of Manila, is known as being the shoemaking capital of the Philippines
I can't face it: The circumcision operation can be done in only a few minutes. But it probably seems like an eternity for this young lad
Holy hell: A young boy writhes in pain as a doctor carries out the operation. Circumcision was encouraged in 19th century Britain by the Victorian authorities who believed it might discourage masturbation, which they believed to be a sin
Family support: Fathers and mothers accompany their sons as they wait their turn for the operation. Uncircumcised boys are sometimes teased by their peers so the pain is worth it for the social acceptance
Will it be over soon? The vast majority of boys are circumcised in the Philippines. But a British judge ruled this week that boys in the UK should not be circumcised until they are old enough to make the choice for themselves
Glad that's over: A Filipino boy beams with delight when the circumcision operation is completed. He might not be smiling like that when the local anaesthetic wears off