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Tuli was introduced into the Philippine Islands hundreds of years ago, when the Islands were controlled by Muslims. Every since adult [[circumcised]] men have reenacted their own [[trauma]] on boys as reported by Vanderkolk.<ref name="vanderkolk1989">{{VanderKolkBA 1989}}</ref>
Boyle & Ramos (2019) studied boys in the Philippine Islands who had undergone medical circumcision and others who had suffered the traditional "''tuli''" circumcision. Of the boys who had a medical circumcision, 51 percent exhibited symptoms of [[PTSD]]. Of the boys who had a ''tuli'' circumcision, 69 percent exhibited symptoms of PTSD.<ref name="ramos-boyle2001">{{REFbook |last=Ramos |first=Samuel |init=S |author-link= |last2=Boyle |first2=Gregory J. |init2=GJ |author2-link=Gregory J. Boyle |year=2001 |title=Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder |url=https://www.researchgate.net/publication/300649237_Ritual_and_Medical_Circumcision_among_Filipino_Boys |work=Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem |editor=Denniston GC, Hodges FM, Milos M |edition= |volume= |chapter= |pages=253-70 |location=New York |publisher=Kluwer Academic/Plenum Publishers |isbn= |quote= |accessdate=2022-11-05 |note=}}</ref> <ref name="ramos2019">{{REFjournal
|last=Boyle
|first=Gregory J.
|last2=Ramos
|first2=Samuel
|init2=SShttps://www.researchgate.net/publication/300649237_Ritual_and_Medical_Circumcision_among_Filipino_Boys
|author2-link=
|etal=no