The lucky ones survive with mutilated penises and shameful scars for the rest of their lives, but that's the high price boys in rural South Africa pay to become a man.
In the Eastern Cape province, the ethnic Xhosa boys graduate to manhood through a sacrosanct ritual of circumcision.
But every year, the custom among the country's second-largest ethnic group sees young initiates die of complications from botched circumcisions by ill-trained traditional surgeons.
Boys still flock to traditional initiation schools in the bush, because the faster and less painful medical method can result in a lifetime of rejection.
"When you are uncircumcised regardless of your age, society will never regard you as a man, you will always be a boy. No one wants to live with that," said Athenkosi Mtirara, who is about to undergo the procedure.
Mtirara says he wanted to follow in the footsteps of all the men in his family who have been through the ritual.
"In my family no one has ever died from a circumcision gone wrong. My older brother has counselled me about things to avoid in order to have a smooth operation," said the 18-year-old.
After completing the circumcision rites, Mtirara will dispose of all his old clothes, a symbol of beginning his new life as man.
But if he fails to complete the course or ends up in hospital, he will live with the stigma of not being man enough.
More than 200 boys have died from botched circumcisions in the last 15 years, and 90 have lost their penises, according to the department of health.
"This is a very large number, given the fact that these deaths are concentrated in one region," said Sizwe Kupelo, spokesman for the Eastern Cape department of health.
As a general policy, South Africa is starting to encourage circumcision for men, which has been shown to halve their risk of contracting HIV -- a major goal in the country with more AIDS cases than any other.
Zulu King Goodwill Zwelithini announced last week that he wanted to revive the practise among South Africa's biggest ethnic group to fight HIV.
The challenge is how to reconcile traditional practises with modern medicine and the law.
Kupelo blames the deaths in the Eastern Cape on uncertified traditional surgeons, particularly in rural areas "who have no idea how to cut the boys and take care of them while they heal".
"Boys are only sent to hospitals when it's too late. There is also pressure to complete the process," said Kupelo.
In June, a 16-year-old boy was admitted to hospital with a rotting penis, after developing an infection which was ignored by his traditional surgeon.
"The majority of the boys who have had their penises amputated usually end up committing suicide. They can't live with the shame," said Kupelo.
Traditional tools are used to cut the foreskin of the boy's manhood, without anaesthetic or sterilising equipment.
The surgeons receive no particular training; it is an art passed down within families from generation to generation.
After the skin has been cut, boys spend up to four weeks healing while learning about social values and the responsibilities of being an adult.
With limited access to food and water, health authorities say boys often suffer dehydration and even bleed to death.
Eight years ago, South Africa passed a law which sets the legal age for circumcision at 18, but boys eager to prove their manhood as young as 15 still seek the practise from bogus surgeons who are willing to flout the law.
Fake surgeons normally charge a fee as little as 100 rand (13 dollars,9 euros), but a bottle of brandy or a fowl can be accepted as payment.
In his book, "A Man Who Is Not a Man", which tackles the pain and stigma that comes with botched circumcision, Thando Mgqolozana describes this secretive ritual as a story of hurt and suffering.
"Some of the survivors get ostracised from their community because they did not complete the rite of passage in the expected way."
"They too, because of their supposed failure, hide in silence, as though silence was a sanctuary," said Mgqolozana, who has gone through the ritual himself.
In November, the health department held a summit to urge traditional leaders in the region to help stop the deaths and mutilation of the initiates, by taking up practises as simple as sterilising knives.
"We tried to make them understand that as government we do no want to take away their custom, all we want is the application of health standards in the process to end deaths," said Kupelo.