Five traditional surgeons have been arrested by South African police after the deaths of some 20 youths from botched circumcisions in the past few weeks.
Another 100 have been injured - some having been severely beaten during the initiation rituals.
The young men in the eastern Cape belong to the Xhosa ethnic group for whom circumcision is considered part of the passage into manhood.
The authorities say the problem stems from the growth of illegal initiation schools.
The BBC's Carolyn Dempster in South Africa says demands are growing for tighter regulations to control initiation practices.
A law was recently introduced requiring initiation schools to be licensed and only allowing circumcisions to be performed on youths aged 18 and older.
But Eastern Cape provincial Health Department spokesman Sizwe Kupelo told Reuters news agency that boys as young as 11 had died.
Each year thousands of young men go into the bush alone, without water, to attend initiation schools.
Many do not survive the ordeal.
In some cases circumcisions are performed with blunt, unsterilised knives, and there are severe punishment beatings for forgetting parts of rituals.
The operations are performed in the winter when South African schools are on holiday.