Difference between revisions of "Circumcision"

Revision as of 13:55, 13 September 2024

"Male circumcision (from Latin circumcidere, meaning "to cut around") is the surgical removal or amputation of the foreskin (prepuce), a major part of the human penis. The foreskin comprises more than fifty percent of the epithelium of the penis.^[1] When the "cutting around" is performed, the foreskin falls off, so amputation and mutilation is the result. The amputation destroys the many protective, immunological, sexual, and sensory physiological functions of the foreskin, so it is a very harmful and painful surgery.^[2]

Posthectomy is the more accurate medical term that more accurately reflects the injury and loss of functional body tissue, but the Biblical euphemism, circumcision, is more commonly used. With reference to involuntary, non-therapeutic circumcision of children, Child Genital Cutting (CGC) is a newer term that has been introduced to avoid issues associated with more traditional terms. Bollinger (2023) identifed CGC as an adverse childhood experience.^[3]

Deacon & Muir (2022) have reviewed the evidence and concluded that "there is no medical justification for performing a circumcision prior to an age that he can assess the known risks and potential benefits, and choose to give or withhold informed consent himself."^[4]

Circumcision was popularized in English-speaking nations in the nineteenth century. The practice of non-therapeutic circumcision of boys now has greatly declined in Australia, Canada, New Zealand and the United Kingdom. It has been gradually declining since 1985 in the United States. It has never been a popular practice in other western nations.

Circumcision is classified as a form of genital mutilation.

1 Historical background
2 Rationale
3 Non-medical indications for circumcision
4 Circumcision methods
5 Pain
6 Risks and effects
7 Complications
- 7.1 Possible operative and postoperative complications
- 7.2 Death
8 Forced circumcision
- 8.1 Non-therapeutic circumcision of male children
9 Recommendations of medical authorities
10 British family court opinion
11 Rights and ethics
- 11.1 Consent by surrogates
12 Tipping point
13 Financial and other costs
14 Video
15 See also
16 External links
17 References

Historical background

The amputation of the foreskin is a very old ritual, whose exact origin cannot be verified beyond doubt. Circumcision is believed to have originated in east Africa near the Red Sea well before the dawn of recorded history.^[5] Medical historians assume that circumcision already served in ancient history as a way to control the sexuality of slaves and members of the lower classes without compromising their ability to reproduce. In religious history circumcision may be seen as a substitute for human sacrifice. In prehistoric times it was not uncommon to placate the gods with human sacrifice. Castration of slaves or conquered enemies was common as well. Following religious changes this sacrifice was altered, and only a part of the very organ responsible for the creation of new life was sacrificed.

For the Aborigines, the Australian natives, the tradition of circumcision is said to go back to 10,000 BC. On the African continent, the first circumcisions are assumed to have emerged around 6000 BC. From ancient Egypt hints of various forms of circumcision date back to the time around 3000-2000 BC. The oldest known depiction^[6] is an Egyptian tomb relief from the 6th dynasty, approximately 2300-2000 BC. It is not known precisely who was circumcised and why in those times.

In many cultures circumcision during puberty serves as a rite of passage, bringing adolescents into the community. As with other painful or humiliating initiation rites, proof of courage and mastering of critical situations are the key motivations. From some African tribes it is also known that the amputation of the foreskin is seen as the removal of an inborn piece of femininity from the boys, thus making them men.

Judaism

In Judaism, the tradition of circumcision goes back to the Abrahamic covenant in a passage in the Book of Genesis (17:10-14). It was seen as a covenant between God and man, dating back to the patriarch Abraham.^[2] The validity of this passage is increasingly being questioned.

“

10 This is my covenant with you and your descendants after you, the covenant you are to keep: Every male among you shall be circumcised. 11 You are to undergo circumcision, and it will be the sign of the covenant between me and you. 12 For the generations to come every male among you who is eight days old must be circumcised, including those born in your household or bought with money from a foreigner—those who are not your offspring. 13 Whether born in your household or bought with your money, they must be circumcised. My covenant in your flesh is to be an everlasting covenant. 14 Any uncircumcised male, who has not been circumcised in the flesh, will be cut off from his people; he has broken my covenant.”
– Bible (Gen 17, 10-14, NIV)

According to the anthropologist and sociologist Rabbi Nissan Rubin, the Jewish form of circumcision, called brit mila, during the first two millennia did not include the later customary periah, namely the complete scraping of the inner foreskin from the glans. This was only added around 135 AD, to make it almost impossible to restore the foreskin by stretching, which became popular in the wake of Hellenic influence. While originally only the tip of the foreskin was cut off, periah removes the entire foreskin.

In the Greek society of the day, a denuded glans was considered obscene and risible. In ultra-orthodox communities, circumcision is followed by the mohel, the ritual circumciser, sucking blood from the wound with his mouth. This practice is highly controversial, as it can result in an infection with herpes simplex type 1. In New York City, between 2000 and 2011 eleven children were infected with herpes, 10 of whom had to be treated in hospital. Two of them suffered permanent brain damage, two others died. In the 12th century, the Jewish philosopher and doctor Maimonides claimed that circumcision was necessary, as it diminished sexual desires and reduced the pleasure to a degree just sufficient for mere reproduction.

Christianity

Jesus was born into a Jewish family in Israel, where Judaism was the prevailing religion, so He was circumcised on the eighth day.^[7]

The first Christians had been born Jewish, so a question arose whether one must be circumcised to be a Christian. When Christian leaders met at the Council at Jerusalem in the First Century to decide what was required to be a Christian, a letter was written to explain the requirements, but circumcision was omitted from the requirements.^[8]

In Christianity, circumcision is practiced only in the Coptic denomination. There is no general belief that circumcision is a requirement of Christianity.^[9]

Nevertheless, Christian moral notions had decisive influence on the spread of this practice. In the puritan influenced USA, circumcision of children was popular in the 19th century as a means to prevent masturbation. In those days, this so-called ‘self-abuse‘ was not only considered immoral, but was supposedly responsible for a variety of diseases. Masturbation, however, is not mentioned anywhere in the Holy Bible, so there is no support for the belief that it is somehow immoral or sinful.

Even the mere existence of a foreskin was falsoly linked to many illnesses. Among them one could find syphilis, epilepsy, paralysis of the spine, bed wetting, scoliosis (spinal deformity), paralysis of the bladder, club foot, nerve pain in the lower abdomen, tuberculosis and lazy eye. One of the best known advocates of child circumcision was John Harvey Kellogg, co-inventor of the corn flakes bearing his name. In 1888, he wrote:

“

A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should be performed by a surgeon without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement, and preventing the recurrence of the practice in those whose will-power has become so weakened that the patient is unable to exercise entire self-control.
– John Harvey Kellogg^[10]

Islam

In Islam, circumcision is also religiously founded, even though there is no mention of it in the Koran itself. According to tradition, the Prophet Mohammed was born without a foreskin. It is seen as a sign of prophets that they are born without a foreskin already. It is considered an honour to "resemble the example of the Prophet", meaning to be circumcised. In Islam, unlike Judaism, there is no specific age at which the circumcision should be performed. Most circumcisions take place at ages between 6 and 10 years, but the range goes from birth to adulthood.

Rationale

Reasons for performing circumcision range widely by culture, religion, location, and age.

Cultural

Many cultures perform circumcision as a rite of passage into manhood. This is common in the Middle East and amongst some indigenous African and Southeast Asian peoples.

The United States and Israel are the only industrialized countries in the world to have a high incidence of non-therapeutic infant male circumcision. The vast majority of infant circumcisions performed in the United States are for non-religious, non-medical reasons. See History of circumcision.

Religious

The circumcision of newborn boys is seen as a divine commandment in the Jewish faith. Though absent in the Koran, male circumcision is considered a religious requirement in Islam, and it is performed on male children of varying ages. Converts to these faiths may also choose to undergo circumcision, but it is not always required.

Medical indication

There are no medical indications for circumcision of the newborn. The circumcision industry offers circumcision of the newborn to the public because of the financial incentive.

The form of circumcision adopted by the medical community essentially was equivalent to the Jewish form with periah, so it inflicts the maximum injury and physical trauma.

In a few cases with older patients, circumcision is legitimately indicated; a patient may be suffering recurring infection, and other methods of treatment have failed. In other cases, a patient may be suffering from a severe case of phimosis. Overall, the actual medical necessity for circumcision is extremely rare since many conditions respond to conservative treatment. All circumcisions injure the patient by amputating the foreskin its with many protective, immunological, sensory, and sexual functions.

Deformed or malformed foreskin. A foreskin so deformed or malformed that it does not function properly may be removed by circumcision.

Traumatically injured foreskin. A foreskin so traumatically damaged foreskin that it cannot be surgically repaired is a valid medical reason for circumcision.

Diseased foreskin. A foreskin that is diseased is a valid indication for circumcision. Some diseases that qualify are malignancy, lichen sclerosis, yeast infection in men with diabetes, and recurrent balanoposthitis.

In such cases, the benefit of removing the problem foreskin may exceed the maleficial harms of tissue and function destruction.

Arguments of prophylaxia

Though the practice of ritual circumcision of males, both consenting and non-consenting, has existed for millenia, the search for "potential medical benefits" began relatively recently. {Potential means to exist in possibility, but not in actuality, so a "potential benefit" is not a genuine proven benefit.) The discussion of circumcision in the Ninth Edition of the Encyclopǽdia Britannica (1876) made no mention of any prophylactic, medical, or therapeutic value or function.^[11]

Initially, circumcision was adopted in the 19th century as a way to stop boys and men from masturbating, when masturbation was claimed to be the cause for many diseases. As the myth that circumcision prevented masturbation became debunked, advocates of circumcision began the great search to find the "medical benefits" of circumcision.

Male and female circumcision involves the removal and disruption of normal anatomical structures that are primary areas of sexual sensation.^[1] In the past, some advocates of mass circumcision have considered the prepuce to be a "mistake of nature," but this notion has no validity because the prepuce is ubiquitous in primates and because it provides functional advantages.^[12]

All claims that circumcision prevents future disease are false.^[13] They are made to enable a physician to perform circumcision and collect a fee.

Prophylactic reasons

Some people claim that circumcision has prophylactic benefits. Especially in the USA those arguments have persisted for more then a 100 years, with ever changing diseases circumcision is said to protect against. At first, these were diseases where masturbation was believed to be the cause. After bacteria and viruses had been discovered, arguments changed, and one after another miscellaneous diseases were cited.

Phimosis: as mentioned earlier, true phimosis is rare and can be treated effectively without surgery. According to a study by Blalock et al. (2003)^[14], 2.9% of those circumcised develop a post-operative phimosis, in which the circumcision scar constricts. In intact patients, the rate of phimosis is only 1% (see also the study by Jakob Øster). Therefore, circumcision is not a preventive measure for phimosis.
Sexually Transmitted Diseases (STDs): a vast number of studies has been conducted on the subject of transmission of STDs.
First, it has to be noted that any form of protection against these diseases only affects people who are sexually active. Circumcision in childhood cannot be justified on these grounds, since any assumed protective effect will not occur before the boy is already old enough to decide about circumcision for himself.
As mentioned above, the foreskin keeps the glans moist. This subpreputial moisture contains, among other substances, the enzyme lysozyme, which breaks up the cell wall of bacteria, thereby providing a natural antibacterial screen. This explains the results of several studies, such as Laumann et al.^[15], which found a higher rate of infection with bacterial venereal diseases in circumcised than in intact men.
The studies by Fleiss et al. (1998) support this.^[16] According to the AAP, the general sexual behaviour of the male — such as frequent change in partners and the use of condoms — has a much higher impact on sexually transmitted diseases then the circumcision status.^[17]
HIV / AIDS: in the recent past, the argument that circumcision could help to contain the spread of HIV has been stated numerous times.
First, two notes: for one, the use of condoms is still by far the most effective protection against an infection. During intercourse with that preventive measure, circumcision status does not make a difference.

Secondly, the assumed protection would only affect healthy men who have intercourse with an infected woman. An infected man can infect a women by transmission of his bodily fluids, so that his circumcision status is irrelevant. Therefore, the use of condoms remains vital in containing the spread of HIV, which in return renders circumcision unnecessary
Due to the inevitable loss of sensitivity as a result of circumcision, there is also the temptation to go without condoms, in order not to lose even more sensitivity.^[18]^[19]^[20]
Two studies that have been published in early 2007^[21]^[22], which investigated the effectiveness of circumcision as a means of reducing the spread of HIV from infected women to heterosexual men in African high risk areas, have been repeatedly subjected to strong criticism. Both studies were ended prematurely, which distorted the results. The men who had been circumcised for the study had to stay sexually inactive during the wound healing, which gave the intact control group more relative opportunity to become infected. These African randomized clinical trials have been demonstrated to have very serious methodological and statistical errors that distort the results in favor of circumcision.^[23]

The fact that the USA has both the highest percentage of circumcised males in the western world, as well as the highest HIV infection rate, makes the studies look dubious. Besides that, several other studies concluded that circumcision does not have a significant impact on the risk of infection with HIV.^[24]^[25]^[26]^[27]^[28]

Urinary tract infections (UTI): a UTI can be effectively treated with antibiotics, this was also proven by studies.^[29]^[30] A Swedish study^[31] found that, during the first 6 years of life, the incidence of UTIs in boys was 1.8%, but in girls was 6.6%. UTIs are less common in boys after the first year of life. Mueller et al. ^[32] did not find a significant difference in UTI rates between circumcised and intact boys with normal urinary tract anatomy.
Other studies suggest that circumcision is more likely to raise than to lower the generally low risk of acquiring UTI: multiple studies from Israel showed a strong correlation between ritual circumcision on the 8th day of life and postoperative UTI.^[33]^[34]^[35]
It can be concluded that circumcision is ineffective as a preventive measure against UTI.
Penile and cervical cancer / HPV: first studies on those diseases and their assumed prevention by circumcision date back to 1932, a time when the cause for those illnesses was not yet fully understood.^[36] Today, it is known that sexually transmitted human papillomavirus (HPV) is a major risk factor^[37], as well as smoking^[38]. Studies have shown that there is no significant difference in the risk of getting penile cancer between circumcised and intact men. To prevent a single case of penile cancer, it would statistically take 600 to 900 circumcisions^[39]. The influence of circumcision on the infection risk of the female partner with cervical cancer has been refuted several times as well. HPV vaccination is an effective measure against carcinoma of the cervix.

In conclusion, circumcision does not provide any proven benefits in preventive medicine.

Non-medical indications for circumcision

Apart from the medical indication of pathological phimosis, there also are other reasons for circumcision.

Aesthetic reasons

The visual appearance of the penis is changed radically after circumcision. In this case, personal taste is decisive whether an intact or a circumcised penis is more appealing. Since a circumcision cannot be undone, it is essential to be fully informed about the risks and possible later complications before embarking on an aesthetically motivated circumcision, to decide whether the appearance will justify such bodily modification.

It should be noted that every circumcision operation leaves a life-long circumcision scar that encircles the shaft of the penis. In addition, there frequently a a color change at the circumcision scar which results in a two-tone appearance.

Since this modification and its possible late effects will be the lifelong burden of the person who undertakes an aesthetically motivated circumcision to suit his personal preferences, a valid decision to proceed can only be made by the person to be circumcised himself, once he has reached the necessary age and level of maturity to make that decision. This should normally be the case when adulthood is reached.

Financial reasons

In the United States, payment for non-therapeutic circumcision is made by most third-party payers without question of necessity. Doctors frequently perform medically-unnecessary, non-therapeutic circumcision of infants and children simply to collect a fee for the surgical operation. The only beneficiary of such surgery is the bank account of the medical doctor.

Moral reasons

With the foreskin, circumcision removes approximately 70% of the sensitive tissue of the penis, lowering the potential for sexual stimulation accordingly. Due to the loss of around 50% of the entire penile skin, the penis loses the reserve skin that provides cutaneous mobility in the erect penis and the gliding action.

In the past, this circumstance was used to make it harder for boys to masturbate and masturbation less fun, as masturbation was viewed as immoral and was assumed to cause a variety of mental diseases, caused by the thinking of immoral thoughts! More on that can be found in the chapter "Historical background". Today, it is known that masturbation has no negative health effects, but can contribute positively to the child's sexual development. Sexuality is no longer a taboo nowadays, while masturbation is considered to be a natural part of human sexuality and is no longer seen as immoral. Therefore, circumcision for moral reasons — which would only affect boys too young to give informed consent — is no longer justifiable nowadays.

Hygiene reasons

Hygiene refers to health and only secondarily to cleanliness.

One should note that the human foreskin is endowed by nature with immunological functions that serve to protect the human body from disease.^[16] The glans penis receives blood through the frenular artery.^[40] These facts are generally overlooked in arguments for alleged hygienic benefits of circumcision.

A common reason stated for circumcision is the assumption of hygienic benefits. This argument has to be viewed in the context of the environment the person in question grows up in. It is commonly known that bad hygienic circumstances, especially insufficient access to clean drinking water, pose a serious problem. The situation in disaster areas or refugee camps in the so-called third world keep reminding us of that.

In western industrial nations, however, this problem does not exist, in view of the availability of clean water for daily personal hygiene. If the cleaning of the genitals is performed on a daily basis — and that may be assumed — no pathogens can accumulate under the foreskin. Cleaning of the glans and the preputial sac underneath the foreskin is easy — they are simply washed with warm water along with the rest of the body, just like the areas between the toes.

In small boys, where the foreskin cannot be retracted yet, cleaning is not necessary, since the membrane that fuses the foreskin to the glans prevents the accumulation of micro-organisms. The so-called " ballooning", where the foreskin inflates during urination, is not a concern.

The opening of the foreskin in small boys is often quite narrow and serves as a one-way valve, allowing the urine to flow out, but preventing entry of microbes, for example from a dirty diaper. As long as the child is able to pass water, everything works as nature intended.

But even in areas where there are poorer hygienic conditions and an insufficient access to medical care, the benefits of easier cleaning of a circumcised penis are to be viewed with a critical eye. Although even longer periods without personal hygiene will not result in an accumulation of germs under the foreskin, circumcision itself is not without risk of complications. If the operation is carried out without proper sterility, there is a high risk of an infection of the wound. This also applies to the treatment of common complications like post-operative bleeding.

The benefit of easier cleaning must be balanced against the risk of promoting serious infections — among others HIV — during the operation. In parts of Africa, several dozen of one tribe's boys die each year as a result of their circumcision.

Circumcision methods

The Circumcision methods are discussed in a separate article.

Pain

It is too dangerous to administer general anesthesia to newborn infants, so infant boys experience severe pain during circumcision.^[41] In the past, advocates of circumcision claimed that a newborn child's nerve system was not yet fully developed, and that as a result, the child felt no pain during the circumcision procedure. Anand & Hickey (1987) have shown that newborn children do in fact feel pain, and more acutely than adults.^[42] This has led American health associations to recommend doctors take measures to reduce the pain of circumcision in infants.

The Circumcision Policy Statement (1999) states quite clearly that "There is considerable evidence that newborns who are circumcised without analgesia experience pain and physiologic stress". Furthermore, the pain is quite severe, and requires injections for proper pain management. Sucrose and Acetaminophen "cannot be recommended as the sole method of analgesia". Topical cream is no longer thought sufficient as "the analgesic effect is limited during the phases associated with extensive tissue trauma such as...tightening of the clamp".^[43]

The AAFP (2002) states quite simply in their position paper, "Newborns experience pain during circumcision".^[44] This is not a debatable fact, and yet, it is not widely accepted, even by some doctors. It might be hard for some doctors to accept, as they may have been taught that the infant does not feel pain, and may have performed countless circumcisions with this idea. Usage of anesthesia for infant circumcision is still by no means the rule.

Penile injections of local anesthetic are now recommended by all of the major medical institutions if a circumcision is to be performed. In their Report 10 of the Council on Scientific Affairs, the AMA states "When the decision is made to proceed with circumcision, local anesthesia should be provided for the procedure. Ring block or dorsal penile nerve block [injections] are most effective. EMLA cream has limited utility". Alarmingly, "Despite the clear evidence that newborn males generate brisk pain responses during circumcision, a recent survey of residency training programs found that 26% of programs that taught circumcision provided no instruction on the use of local anesthesia". The AMA reports that "Of physicians performing circumcision, 45% use anesthesia, 71% of pediatricians, 56% of family practitioners, and 25% of obstetricians".^[45]

The AAP's Heatlhy Children website suggests "Your pediatrician (or your obstetrician) should discuss the forms of analgesia that are available".^[46] Be that as it may, few forms of analgesia are recommended. There are basically two types of injections to choose from, and the website does not go into the difference between a 'dorsal nerve block' and a 'ring block' injection.

Given what is known from aforementioned official documents, the AAP website may be more informative and effective if it would say "Make sure your doctor knows of the ineffectiveness of anything short of local anesthesia, and make sure your baby is given an injection. This is your responsibility, because your doctor may or may not be up to date on the latest understandings of infant sensitivity to pain during circumcision." The AAP may be holding back, however, perhaps because this would upset the doctor/parent power relationship, and may cause too much questioning of doctors in general. One may not expect to find this kind of advice on such a website, and yet, anything less than this is a dangerously weak statement.

To control pain, some physicians that circumcise use Tylenol, sugar,^[47]^[48] a topical cream,^[49] and/or a local anaesthetic injection called a dorsal penile ring block.^[50] Topical anaesthetic only serves to numb the area to lessen the pain of the injection, but studies have shown that a dorsal penile nerve block is only partially effective in stopping the pain of circumcision.^[51]^[52] During circumcision, somp physicians give children sugar pacifiers to "reduce the perception of pain",^[53] but in at least one study, data shows that giving sugar to a child doesn't help to reduce the perception of pain in the child.^[54] Post-operative pain and the pain the child must endure during recovery is hardly, if ever, addressed by professionals.

It has been shown that an infant's response to pain can be altered for years as a consequence of circumcision.^[55]^[56]

However, none of the above three procedures totally eliminate pain. A baby boy will still experience some pain despite any of those analgesic procedures. Prevention of pain requires protecting a boy from elective neonatal non-therapeutic circumcision. Only boys who are protected from the medically unnecessary circumcision surgery experience no pain or trauma.

Risks and effects

Just like tonsil or appendix surgery, circumcision is a surgical intervention and brings the usual risks related to surgical operations, alongside several specific risks of complications and late effects.^[41] Uberoi et al. (2022) report "some men are experiencing a complex negative constellation of psychological, physical, and sexual associations that lead to significant emotional distress directed both internally and externally. The posts also reveal a discovery phenomenon wherein men discover the physical and psychological manifestations of the decisions made by others to modify their genitals."^[57]

Physical effects

Bodily harm
Circumcision scar is an invariable effect.
Hair on the penis is a common effect.
An unavoidable effect of any circumcision is the permanent loss of sexual sensitivity.^[41] This is partly due to the removal of sensory tissue. The foreskin contains very many nerve endings and touch receptors, which account for the major part of male sexual sensation. If the foreskin is removed, they can no longer provide sexual stimulation. It is also partly due to the fact that the surface of the glans reacts to the missing protection from friction and drying out by developing a callus layer. This reduces the sensitivity of the remaining nerves in the glans gradually over the years. The study conducted by Sorrells et al.^[58] found a significant reduction of sensitivity to touch for circumcised compared to intact penises in adult males. Other studies revealed that circumcised men use condoms significantly less often than intact men, since they further limit the sexual sensitivity (see above).

Painful tension can occur when there is too little reserve skin left to support a full erection^[1]. This risk is partly dependent on the anatomy of the penis. While some penises already have the majority of their full size when flaccid (Flesh Penis, or "shower"), others are rather short when flaccid and double or more their size during an erection (Blood Penis, or "grower"). Especially in children's circumcision, where the penis is not yet fully developed, the amount of reserve skin needed in adulthood cannot be estimated.

Erectile dysfunction: Both the damage inflicted to the blood vessels in the foreskin and the reduced sexual sensitivity can be causes for reduced erectile function with advancing age.^[59]

Orgasm problems: In the wake of reduced sexual sensitivity, due to the loss of sensory tissue and gradual keratinization of the surface of the glans, orgasm problems may develop with increasing age. In this case, the sexual arousal created by intercourse or masturbation is not enough to achieve orgasm. A preliminary stage of this late effect is the prolonged time circumcised] men need to reach an orgasm. This is often fielded as the "cut men have more endurance" argument for circumcision.
Vaginal dryness: Due to the loss of the natural gliding action, which comes from the mobility of the foreskin and shaft skin, a much increased friction between penis and vagina occurs during intercourse. This can make intercourse painful for both partners and lead to abrasions^[60]^[61] The prolonged time it takes circumcised men to reach orgasm, as well as the often longer and more vigorous thrusting movements - compared to intact men - play a part in this.^[62]^[63]

Lymphoedema of the penis is a normal and expected complication of male circumcision.

Meatal stenosis, a pathological narrowing of the opening of the urethra, which mostly occurs in infancy and early childhood. It is one of the most common complications of infant circumcision. A study from 2006 found meatal stenosis exclusively in previously circumcised boys. The incidence rate after a circumcision is approximately 10 to 20 percent.^[64]^[65]^[66]

Shorter adult penile length was reported by Park et al. (2016) as a result of NMC (newborn male circumcision).

“	In conclusion, second to fourth digit ratio, flaccid penile length, and age of circumcision were significant predictive factors for erectile penile length. Furthermore, the penile lengths of the NMC group were shorter than those of the non-NMC group. – Park et al.^[67]

Sexual effects

Cepeda-Emiliani et al (2023) cited six reports in the literature of detrimental effects of circumcision, including erectile function, sensation, masturbatory pleasure, orgasm, and sexual satisfaction. The authors also cited three studies of severe distress in circumcised men, due to their infant circumcision, with complaints of glans insensitivity, delayed ejaculation, and unpleasant sensation.^[68]

Circumcision and frenectomy remove tissues with heightened erogenous sensitivity.^[41]^[68] ^[69] They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."

The amputation of the prepuce results in the loss of the majority of fine-touch neuroreceptors found in the penis, leaving only the uninhibited protopathic sensibility of the artificially externalized glans penis. The imbalance caused by not having the input from the now ablated fine-touch receptors may be a leading cause of the changes in sexual behavior noted in circumcised human males.^[70]

Histology of the male circumcision scar shows amputation neuromas, Schwann cell proliferation and the bulbous collection of variably sized neurites. Amputation neuromas do not mediate normal sensation and are notorious for generating pain.^[62] Cepeda-Emiliani et al. (2023) commented:

Taking the sleve technique as an example of surgical flexibility during circumcision, to the extent that this technique is of such versatility that it allows highly variable quantities of cutaneous and subcutaneous tissue to be excised directly from the penile body, and to the extent that the prepuce is still conceived by segments of the medical community as "just a small piece of skin", we are concerned that aggressive circumcisions are intentionally or unintentionally being performed in pediatric and adult patients in the belief that "redundant" or " extra" tissue is being excised, or in the belief that "excesive sensitivity" is being reduced to augment ejaculatory latency time.^[68]

The un-anesthetized and un-sedated newborn infant is restrained by being strapped to a special plastic board called the circumstraint. The procedure is most often an elective, non-therapeutic surgery without medical indication performed on neonates and children for religious and cultural reasons in violation of the child's human rights to physical integrity, but in older patients may be rarely indicated for therapeutic reasons. It is a radical treatment option for pathological phimosis, refractory balanoposthitis and chronic urinary tract infections (UTIs); it is contraindicated in cases of certain genital structure abnormalities or poor general health.

See Sexual effects of circumcision for more information.

Psychological effects

Psychological late effects are also possible after a circumcision, especially if the operation was carried out in childhood.^[41] On this occasion a variety of trauma may occur, which depend, among others, on age and circumstances of the circumcision. For example, whether the circumcision took place with or without sufficient anaesthesia, if the individual has been informed about the operation beforehand, if he was circumcised against his will or without his consent, and also, in the case of infant circumcision, if he was told about it during childhood or had to find it out coincidentally on his own.

The psychological late effects of circumcision are not yet fully researched, and many studies took place on rather a small scale. This situation needs to be rectified, because the available studies, as well as the histories of negatively affected men, suggest that these late effects may have more impact than previously assumed.

It was observed that infants, following circumcision without pain control, had a disturbed bond with their mother^[71], as well as problems with nurturing, up to the point of refusal to be fed. The sleeping habits of these babies were also disturbed, with prolonged non-REM sleep and increased waking.

In boys circumcised in childhood, post-traumatic stress disorder (PTSD) could be diagnosed. In a study on Philippine boys, in whom no PTSD was found prior to the operation, 69% of the boys circumcised in the traditional ritual and 51% of those circumcised by standard medical procedures (including anaesthesia) fulfilled the DSM-IV criteria for PTSD following the operation.^[72]
Circumcisions, especially those that happen without consent, can spark feelings of helplessness and alienation, which can persist as trauma. These feeling can also be triggered later, when someone circumcised as an infant becomes aware of his circumcision. In an online study, interviewed men stated they felt betrayed - 55% by the mother, 50% by the father, and 58% by the doctor, and 73% felt that their human rights had been violated.^[73]
It can frequently be found that the loss is denied, much as happens with the loss of other body parts. This denial can lead to fathers having their sons circumcised in order not to be reminded of their own loss. In this process, their own body is defined as "normal" and the foreskin redefined as a foreign object. Their own parents are seen as "good", so that this image is projected onto the circumcision their parents carried out as well, in order to keep the positive emotion intact. The father wants to be a "good" father later in life as well, and so, following an idealised image of his own parents, circumcision, which has been redefined as a "good thing", is passed on to his son by having him circumcised as well.^[74]^[75]
If the circumcised male feels incomplete, or due to the missing foreskin disadvantaged compared to intact males, an inferiority complex and depression may occur. This can be accompanied by conscious recognition of his own incompleteness, or the deficiency may remain completely subconscious^[76]. In an online study, 75% of those interviewed stated that they felt incomplete, and 66% said they felt inferior compared with intact males.^[73]
Cases in which children felt ill treated or punished have been documented as well. G. Cansever found in her study on 12 boys aged between 4 and 7 years, who had previously been prepared for their impending circumcision, that the children experienced the operation as an aggressive assault on their bodies.^[77]
Fear of being alone or darkness.^[78]
Fear of doctors, clinics and also closed rooms.^[78]
Relapse into the state of bed-wetting, even if the child was already dry before.^[78]
Circumcised males who become fathers frequently manifest adamant father syndrome.

Intact America (2019) called circumcision an adverse childhood experience,^[79]

Complications

Possible operative and postoperative complications

Circumcision is surgery. Surgical complications of circumcision generally may be classified as hemorrhage, infection, or surgical misadventure up to and including loss of the penis and death.^[4]^[80]

Intolerance or allergic reactions to the narcotics used.
Especially in newborns, where the bodily pain reduction mechanisms are not yet fully developed, local anaesthesia is often insufficient for the operation. Even in conjunction with regional anaesthesia of the dorsal nerve of the penis, the rate of failure to provide sufficient anaesthetic even for experienced anaesthetists is still 5-10%. The general anaesthesia that would be needed for newborns, however, poses significant risks for the child, and, therefore, is only likely to be used in emergencies. A surgical operation without proper pain control can lead to the development of a specific pain memory^[81]. In unsedated and partially sedated infants increased secretion of the stress hormone cortisol could be observed for months after the operation. Overall, their pain threshold was lower and the risk of chronic pain increased. Regardless of these findings, infant circumcisions with insufficient or no anaesthetic are still common practice^[82]^[83]^[84]. During procedures which take several minutes, babies tend to fall into a state of stupor, which in the past was falsely interpreted as peaceful sleep, nurturing the belief that babies felt no pain. Measurements taken in those cases revealed a typically 3- to 4-fold increase in cortisol levels, which equals a state of severe shock.^[85]
Postoperative wound pain, in the case of children's circumcisions conceivably worsened by the forceful breaking of the preputial adhesions.
Postoperative pain from the exposure of the sensitive glans penis to clothing. This pain will endure for several weeks or even longer in some cases.
Postoperative bleeding of the wound. This can have severe consequences especially for very young infants, if they are not treated promptly. Their blood volume is only about 85 ml per kilogram of body weight, and even moderate blood loss can lead to hypovolaemia, hypovolaemic shock and even death.^[86]^[87] ^[88]^[89]
Post operative lymphoedema.
Postoperative infections. This includes both local infections, which can be treated with local therapy, and systemic infections, requiring systemic antibiotic treatment.^[90]
Wound dehiscence, meaning the separation of the edges of the wound or the tissue after suturing.
Adhesion between the surface or rim of the glans with the neighbouring penile skin, causing skin pockets and bridges, as well as visually unpleasant results like uneven scars, which make a re-circumcision necessary.
Postoperative phimosis: a phimotic ring can develop during scarring, which makes a re-circumcision necessary. According to a study by Blalock et al.^[91], the prevalence is 2.9%, according to Leitch^[92] 5.5%.
Sudden Infant Death Syndrome (SIDS).
Knot formation of the veins. If the dorsal vein, which originates in the tip of the foreskin, is cut during circumcision without being clamped and sutured at its origin separately, it starts to develop new branches over time, which can lead to the development of knots.
Possible deformities due to circumcision include hypoplasia of the penis (micro-penis) and induratio penis plastica (skewed penis).
Medical malpractice can also not be ruled out. Injuries, partly or entirely severing the glans or the penis can occur.
In rare cases, necrosis, gangrene, ischaemia, keloid formation, and circulatory problems may also occur.
When the circumcision is followed by the ultra-orthodox Jewish ritual of Metzitzah B'Peh (which consists of sucking blood from the wound with the mouth), there is a risk of infection with herpes simplex type 1, which can lead to brain damage or death.^[93]

Death

There is indeed a risk of death from non-therapeutic neonatal circumcision,^[41] although the circumcision industry takes care to not reveal it. A study in 2010 estimated approximately 117 neonatal circumcision-related deaths occur annually in the United States, about one out of every 77 male neonatal deaths, more than suffocation, auto accidents, or even SIDS.^[94]^[95] See also the list of fatalities.

Forced circumcision

Non-therapeutic circumcision of male children

Human babies, because they are not yet in possession of language, are incapable of giving or refusing consent to be circumcised. The element of force has led some scholars to view the circumcision of baby boys as a category of forced circumcision.^[96] There are, however, physicians in the United States who argue strongly for non-therapeutic circumcision of newborn babies; and circumcision is widely accepted as a postnatal procedure in American hospitals.^[97] Parental consent is required.^[98] A statement published by the American Academy of Pediatrics in 1999 claimed that "parents should determine what is in the best interest of the child... It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in additions to the medical factors, when making a decision."^[99] however surrogate consent for non-therapeutic circumcision is now viewed as unethical.

In the United Kingdom, where non-therapeutic circumcision has now become far less prevalent than in the United States, the written consent of both parents is required, if a physician is to perform a non-therapeutic circumcision of a child.^[100] (The National Health Service does not provide non-therapeutic circumcision.)

In recent years, legal writers in several English-speaking countries have been questioning the practice of acceding to parental wishes.^[101] For example, critics have pointed out that, in the United States, more than 1.3% of male neonatal deaths are attributable to the complications of non-therapeutic circumcision surgery.^[94]

Recommendations of medical authorities

Hill (2007) said:

Male circumcision is harmful because it excises healthy tissue and permanently impairs beneﬁcial physiological functions. Male circumcision also causes psychological problems that tend to perpetuate the cycle of abuse. Male circumcision is a costly diversion of medical resources away from beneﬁcial services. Male circumcision violates legal rights, human rights, and ethical standards. Finally, we must remember that males are the more vulnerable and sensitive of the two genders and, therefore, deserve the greater degree of protection from traumatic, invasive, injurious,and unnecessary surgery. For all of these reasons the non-therapeutic circumcision of boys should not be performed and the genital integrity of all children should be respected and protected.^[102]

Andrew E. MacNeiiy, Head, Division of Pediatric Urology, Department of Urological Sciences, University of British Columbia, Vancouver, BC, (2008) said:

Newborn circumcision remains an area of controversy. Social, cultural, aesthetic and religious pressures form the most common reasons for non-therapeutic circumcision. Although penile cancer and UTIs are reduced compared with uncircumcised males, the incidence of such illness is so low that circumcision cannot be justified as prophylaxis. The role of the foreskin in HIV transmission in developed countries is unclear, and safe sexual practice remains the cornerstone of prevention. There remains a lack of knowledge regarding what constitutes the normal foreskin both among parents and among primary care providers. This lack of knowledge results in a burden of costs to our health care system in the form of unnecessary urological referrals, expansion of wait times and circumcisions. Routine circumcision of all infants is not justified from a health or cost-benefit perspective.^[103]

The Royal Dutch Medical Association (KNMG) (2010) said:

The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity. Contrary to popular belief, circumcision can cause complications – bleeding, infection, urethral stricture and panic attacks are particularly common. KNMG is therefore urging a strong policy of deterrence. KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications.^[104]

The Royal Australasian College of Physicians (2010) said:

Ethical and human rights concerns have been raised regarding elective infant male circumcision because it is recognised that the foreskin has a functional role, the operation is non-therapeutic and the infant is unable to consent.
After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand. However it is reasonable for parents to weigh the benefits and risks of circumcision and to make the decision whether or not to circumcise their sons.^[105]

The American Academy of Pediatrics (AAP) has not re-affirmed its disastrous, failed 2012 Circumcision Policy Statement, which expired in 2017, so currently has no position on child circumcision.

Medical historian Robert Darby (2014) wrote simply:

"To avoid circumcision complications, avoid circumcision."^[106]

The Canadian Paediatric Society (CPS) (2015) said:

In most jurisdictions, authority is limited only to interventions deemed to be medically necessary. In cases in which medical necessity is not established or a proposed treatment is based on personal preference, interventions should be deferred until the individual concerned is able to make their own choices.^[107]

The Canadian Urological Association (CUA) considered the matter of circumcision and issued a statement in February 2018. The CUA concluded:

"Given the socioeconomic, educational status, and health demographics of our population, universal neonatal circumcision cannot be justified based on the current evidence available.^[108]

British family court opinion

The issue of non-therapeutic circumcision of male children came before the court in the case of Re B and G (children) (No 2) EWFC 3 (2015) . In that case, Judge Sir James Munby ruled that circumcision of male children caused significant harm.

Rights and ethics

The rights situation is discussed in a separate article.

The intact and circumcised human penis, side by side.

The term "circumcision" without a gender qualifier refers specifically to male circumcision. It means "to cut around," and it refers to the excision of the foreskin from the penis. The term is inaccurate and a euphemism because the operation actually cuts off or amputates the foreskin, which in adults comprises about fifteen square inches of highly functional erogenous tissue.

Circumcision is most often performed in healthy males for religious or cultural reasons. The procedure may be performed on consenting adults, but it is most often performed on non-consenting minors, particularly newborn children, which is why the ritual is so controversial. Opponents of circumcision consider the circumcision of non-consenting minors to be unethical and a human rights violation, unless there is concrete medical indication.

Consent by surrogates

Medical ethics has long recognized limitations on the power of consent by surrogates.^[109] ^[110] ^[111]

Two ethicists, Myers & Earp (2020), have conducted a detailed review and analysis of the claimed medical benefits of non-therapeutic circumcision. They have determined than the alleged benefits are not material, so they do not support granting of consent by a surrogate. In other words, Non-therapeutic circumcision is not truly healthcare. Moreover, they comment that even the most perfectly executed surgery produces trauma and harm to the patient. Circumcision also produces tissue loss and loss of function, therefore, circumcision should be performed only after the individual reaches the age of consent. Consent by a surrogate for a non-therapeutic circumcision of a minor child is an unethical practice.^[112]

Tipping point

Intact America (2024) argues that public opinion regarding non-therapeutic circumcision of children is approaching or at a "tipping point" at which intact genitals would be preferred over the circumcised variety.^[113]

Intact America (2024) points out the need for reform in the American media false portrayal of infant circumcision as a benign procedure.^[114]

Financial and other costs

Infant male circumcision is an extra-cost option after birth. There are no medical indications for it. It is a medically-unnecessary, non-therapeutic, non-beneficial irreversible amputation of a functional body part, so medical insurance may or may not pay for it. There are several financial costs associated with infant circumcision. There is a hospital fee, a set-up fee, pharmaceutical fees, a separate fee for the medical doctor who performs the amputation, and various possible additional costs for the treatment of complications.^[115]

Bollinger estimated the total cost of circumcision in 2012 for Americans, when all costs are included, to be $3.6 billion annually.^[116] He has since updated his estimate of total annual cost in 2020 to be $5,685,000,000 or nearly six billion dollars per year.^[117]

There also are additional non-financial costs, which include sexual and sensory losses that adversely impact on the sexual experience in adult life, and psychological losses such as PTSD, and grieving of losses.

Video

Is circumcision healthy?

The video Is Circumcision Healthy is recommended for parental viewing.

Dr. Christopher Guest discusses circumcision

Dr. Eric discusses circumcision

Dr. Eric understates the numerous functions of the foreskin.

Plastibel circumcision

Stanford University has published a video of an actual non-therapeutic plastibell circumcision. The infant has received two injections of local anesthesia to deaden the dorsal nerves. The ventral nerves were not deadened so the infant still feels pain. One can his cries on the soundtrack.

Plastibell Technique

Gomco clamp circumcision

Not for the squeamish:

This is a video of an actual circumcision with a Gomco clamp. The infant boy received two dorsal penile nerve block (DPNB) analgesic injections but they did not seem to work.

Circumcision video

External links

Garcia, Francisco (11 December 1995). What exactly is circumcision and what is it not?. Retrieved 8 September 2020.
Fleiss P. The foreskin is necessary. Mothering. January 1997; : 36-45. Retrieved 29 June 2020.
Ball, Peter (9 August 2003). Losses from Circumcision, 15 Square. Retrieved 23 February 2023.
Winkel, Rich (12 May 2005). Male Circumcision in the USA: A Human Rights Primer. Retrieved 27 January 2021.
Peres, Judy (9 January 2007)."Circumcision circumspection: Weigh the facts before making the call", Chicago Tribune. Retrieved 28 July 2014.
Quote: Ethan, a Chicagoan who asked that his last name not be used, said he and his wife decided not to circumcise their two sons, now ages 5 and 1. "We didn't think it was a good idea to impose an operation on a baby that was not medically necessary," he said.
Guthmann, Edward (21 June 2007)."Circumcision losing favor with U.S. parents", San Francisco Chronicle. Retrieved 28 July 2024.
Quote: According to the Centers for Disease Control and Prevention, the circumcision rate in the United States dropped to 55.9 percent in 2003 — an all-time postwar low.
White, Garry (8 July 2007)."In Last Four Decades, Circumcision Has Lost Popularity in United States", Lakeland Ledger. Retrieved 28 July 2024.
Quote: Opponents of circumcision say the procedure is doubly harmful, inflicting pain at the time of surgery and reducing sexual pleasure later through the removal of the nerve-rich foreskin.
Lee-St. John, Jeninne (2 November 2007)."Making the Cut", Time Magazine. Retrieved 28 July 2024.
Quote: But intactivism is also gaining traction among educated, middle-class whites. As University of Virginia sociologist Brad Wilcox observes, "It's these new parents that are unwilling to let kids suffer."
Facciolo, Christine (30 November 2007)."Parents reconsider routine circumcision", Cincinnati Enquirer.
Quote: But foes of removing the penis foreskin argue that the procedure provides minimal benefits, causes extreme pain and produces long-term psychological and sexual trauma.

Testa, Patrick, Block, Walter E.. Libertarianism and circumcision. Int J Health Poiicy Manag. 26 May 2014; 3: 33-40. PMID. PMC. DOI.

Simone, Judy (26 July 2020). What is circumcision?, https://intaction.org/, Intaction. Retrieved 4 October 2020.
Deacon M, Muir G. What is the medical evidence on non-therapeutic child circumcision?. Int J Impot Res. 8 January 2022; PMID. DOI. Retrieved 30 April 2023.
Garrett CJ (10 November 2023). Pros and Cons of Circumcision (Spoiler: You’ve Been Lied to), Intact America. Retrieved 22 March 2024.
Garrett, Connor (24 January 2024). The 4 Authority Figures and Groups Who Will Pressure You to Circumcise (and What You Can Do), Intact America. Retrieved 27 January 2024.
Garrett, Connor (24 January 2024). Keeping Your Son’s Penis Intact: A Guide for Parents, Intact America. Retrieved 29 January 2024.
Garrett, Connor (2 February 2024). A Timeline of Circumcision Suffering: A Detailed Look, Intact America. Retrieved 9 February 2024.
Garner, Bryan (26 August 2024). The Circumcision Decision: Unpackaging Anger and Resentment, Intact America. Retrieved 5 September 2024.

References

↑ ^a ^b ^c Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol. 1996; 77: 291-5. PMID. DOI. Retrieved 23 September 2019.
↑ ^a ^b Garrett, Connor (10 November 2023). Pros and Cons of Circumcision (Spoiler: You’ve Been Lied to), Intact America. Retrieved 2 June 2024.
↑ Bollinger D. Adverse Childhood Experiences, Dysfunctional Households, And Circumcision.. Kindred. 28 February 2023; Retrieved 1 March 2023.
↑ ^a ^b Deacon M, Muir G. What is the medical evidence on non-therapeutic child circumcision?. Int J Impot Res. 8 January 2022; PMID. DOI. Retrieved 30 January 2022.
↑ DeMeo (1997): The geography of sexual mutilations. Work: Sexual Mutilations: A Human Tragedy. George C. Denniston, Marilyn Milos (eds.). New York: Plenum. ISBN 0-306-45589-7. Retrieved 13 November 2021.
↑ File:Circumcision Sakkara 3.jpg. Retrieved 12 October 2019.
↑ Luke. Gospel of Luke, Bible Gateway, NASB. Retrieved 10 November 2019.
Quote: And when eight days had passed, before His circumcision, His name was then called Jesus, the name given by the angel before He was conceived in the womb.
↑ Luke. Acts 15:1-30. Retrieved 10 November 2019.
↑ Hill, George (29 August 2004). The Holy Bible, Circumcision, False Prophets, and Christian Parents , Circumcision Reference Library. Retrieved 10 November 2019.
Quote: The falseness of those who advocate circumcision is a recurrent theme in the New Testament.
↑ Kellogg JH (1888): Treatment for Self-abuse and Its Effects, in: Plain Facts for Old and Young. Burlington, Iowa: F. Segner & Co.. P. 107.
↑ Cheyne, T. K. (1876). Circumcision, Circumcision Reference Library, Encyclopǽdia Brittanica. Retrieved 10 November 2019.
↑ Cold C, McGrath K (1999): Anatomy and histology of the penile and clitoral prepuce in primates, in: Male and female circumcision: medical, legal, and ethical considerations in pediatric practice. New York ISBN 0306461315. Retrieved 12 October 2019.
↑ Anonymous (2016). Conclusions, Doctors Opposing Circumcision. Retrieved 22 October 2023.
↑ Blalock HJ, Vemulakonda V, Ritchey ML, Ribbeck M. Outpatient management of phimosis Following newborn circumcision. J Urol. 2003; 169(6): 2332-4. Retrieved 7 November 2019.
↑ Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA. 1997; 277: 1052-7. Retrieved 6 November 2019.
↑ ^a ^b Fleiss P, Hodges F, Van Howe RS. Immunological functions of the human prepuce. Sex Trans Infect. October 1998; 74(5): 364-67. PMID. PMC. DOI. Retrieved 14 January 2022.
↑ Task Force on Circumcision. Circumcision policy statement. Pediatrics. 1999; 103(3): 686-93. Retrieved 15 November 2019.
↑ Hooykaas C, van der Velde FW, van der Linden MM, et al. The importance of ethnicity as a risk factor for STDs and sexual behaviour among heterosexuals. Genitourin Med. 1991; 67(5): 378-83. Retrieved 15 November 2019.
↑ Michael RT, Wadsworth J, Feinleib J, et al. Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison. Am J Public Health. 1998; 88(5): 749-54. Retrieved 15 November 2019.
↑ Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA. 1997; 277: 1052-7. Retrieved 6 November 2019.
↑ Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial. Lancet. 24 February 2007; 369(9562): 657-66. PMID. DOI. Retrieved 31 December 2021.
↑ Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial. Lancet. 24 February 2007; 369(9562): 643–56. PMID. DOI. Retrieved 31 December 2021.
↑ Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns . Thompson Reuter. December 2011; 19(2): 316-34. PMID. Retrieved 30 December 2020.
↑ Grosskurth H, Mosha F, Todd J, et al. A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results. AIDS. 1995; 9(8): 927-34. Retrieved 15 November 2019.
↑ Barongo LR, Borgdorff MW, Mosha FF, et al. The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania. AIDS. 1992; 6(12): 1521-8.
↑ Changedia SM, Gilada IS: Role of male circumcision in HIV transmission insignificant in conjugal relationship (abstract no. ThPeC7420), Barcelona, Spain. (7 July 2002–12 July 2002) Presented at the Fourteenth International AIDS Conference.
↑ Connolly CA, Shishana O, Simbayi L, Colvin M: HIV and circumcision in South Africa (Abstract No. MoPeC3491), Bangkok, Thailand. (11 July 2004–16 July 2004) Presented at the 15th International AIDS Conference.
↑ Thomas AG, Bakhireva LN, Brodine SK, Shaffer RA: Prevalence of male circumcision and its association with HIV and sexually transmitted infections in a U.S. navy population (Abstract no. TuPeC4861), Bangkok, Thailand. (11 July 2004–16 July 2004) Presented at the 15th International AIDS Conference. Retrieved 15 November 2019.
↑ McCracken G. Options in antimicrobial management of urinary tract infections in infants and children. Pediatr Infect Dis J. 1989; 8(8): 552-5. Retrieved 19 November 2019.
↑ Larcombe J. Urinary tract infection in children. BMJ. 1999; 319: 1173-5.
↑ Mårild S, Jodal U. Incidence rate of first–time symptomatic urinary tract infection in children under 6 years of age. Acta Paediatr. 1998; 87(5): 549-52.
↑ Mueller ER, Steinhardt G, Naseer S. The incidence of genitourinary abnormalities in circumcised and uncircumcised boys presenting with an initial urinary tract infection by 6 months of age. Pediatrics. 1997; 100 (Supplement): 580.
↑ Menahem S. Complications arising from ritual circumcision: pathogenesis and possible prevention. Isr J Med Sci. 1981; 17(1): 45-8.
↑ Cohen HA, Drucker MM, Vainer S, et al. Postcircumcision urinary tract infection. Clin Pediatr. 1992; 31(6): 322-4.
↑ Goldman M, Barr J, Bistritzer T, Aladjem M. Urinary tract infection following ritual Jewish circumcision. Isr J Med Sci. 1996; 32: 1098-1102.
↑ Wolbarst AL. Circumcision and penile cancer. Lancet. 16 January 1932; 1(5655): 150-3. DOI. Retrieved 13 March 2022.
↑ McCance DJ, Kalache A, Ashdown K, et al. Human papillomavirus types 16 and 18 in carcinomas of the penis from Brazil. Int J Cancer. 1986; 37(1): 55-9.
↑ Harish K, Ravi R. The role of tobacco in penile carcinoma. Brit J Urol. 1995; 75(3): 375-7.
↑ Position Paper on Neonatal Circumcision, American Academy of Family Physicians (Leawood, Kansas). (14 February 2002).
↑ Persad R, Sharma S, McTavish J, et al. Clinical presentation and pathophysiology of meatal stenosis following circumcision. Brit J Urol. 1995; 75(1): 91-3. PMID. DOI. Retrieved 26 November 2019.
↑ ^a ^b ^c ^d ^e ^f Garrett, Connor (9 January 2024). 10 Disadvantages of Circumcision & Horrifying Facts, Intact America. Retrieved 4 June 3034.
↑ Anand, KJS, Hickey, PR. Pain and its effects in the human neonate and fetus. New Engl J Med. 19 November 1987; 317(21): 1321-9. PMID. DOI. Retrieved 8 November 2019.
Quote: However, in decisions about the use of these techniques, current knowledge suggests that humane considerations should apply as forcefully to the care of neonates and young, nonverbal infants as they do to children and adults in similar painful and stressful situations.
↑ American Academy of Pediatrics: Circumcision Policy Statement; Task Force on Circumcision. Pediatrics. March 1999; 103(3): 686-93. Retrieved 26 November 2019.
↑ Circumcision: Position Paper on Neonatal Circumcision. Board Approved: August 2007 Reaffirmed, Official American Academy of Family Physicians Website. Retrieved 2 May 2011.
↑ Report 10 of the Council on Scientific Affairs (I-99): Neonatal Circumcision, American Medical Association Official Website. Retrieved 4 May 2011.
↑ (23 March 2011). Where We Stand: Circumcision, AAP. Retrieved 12 October 2019.
↑ Parents' Guide to Circumcision. Retrieved 8 April 2011.
Quote: To calm the baby during the procedure, a sugar filled gauze pacifier soaked with sweet juice is used, and soothing music is played in the room.
↑ (8 April 2011). Before the Circumcision. Retrieved 8 April 2011.
Quote: During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions.
↑ (8 April 2011). Before the Circumcision. Retrieved 8 April 2011.
Quote: Then in our office, he will have topical anesthetic applied to his penis.
↑ Parents' Guide to Circumcision. Retrieved 8 April 2011.
Quote: We use extensive pain control methods including Tylenol, a sugar solution (to reduce pain perceptions), a topical freezing cream, and a local anesthetic injection.
↑ Taeusch HW, Martinez AM, Partridge JC, Sniderman S, Armstrong-Wells J, Fuentes-Afflick E. Pain During Mogen or Plastibell Circumcision. Journal of Perinatology. April 2002; 22(3): 214-8. Retrieved 8 April 2011.
Quote: ...more than half of the study group had what we considered excessive pain/discomfort over the course of the entire procedure.
↑ Williamson PS, Evans ND. Neonatal Cortisol Response to Circumcision with Anesthesia. Clinical Pediatrics. August 1986; 25(8): 412-6. Retrieved 8 April 2011.
Quote: The adrenal cortisol response to surgery was not significantly reduced by the administration of lidocaine.
↑ (8 April 2011). Before the Circumcision. Retrieved 8 April 2011.
Quote: During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions.
↑ Slater R, Cornelissen L, Fabrizi L, Patten D, Yoxen J, Worley A, Boyd S, Meek J, Prof. Fitzgerald M. Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial. The Lancet. 9 October 2010; 376(9748): 1225-32. Retrieved 8 April 2011.
Quote: Our data suggest that oral sucrose does not significantly affect activity in neonatal brain or spinal cord nociceptive circuits, and therefore might not be an effective analgesic drug. The ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief.
↑ Taddio A, Goldbach M, Ipp M, Stevens B, Koren G. Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet. 1995; 345: 291-292. PMC. DOI. Retrieved 15 November 2022.
↑ Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1 March 1997; 349: 599-603. PMC. DOI. Retrieved 15 November 2022.
↑ Uberoi M, Abdulcadir J, Ohi DA, Santiago JE, et al. Potentially under-recognized late-stage physical and psychosexual complications of non-therapeutic neonatal penile circumcision: a qualitative and quantitative analysis of self-reports from an online community forum. Int J Impot Res. 23 October 2022; PMID. DOI. Retrieved 8 January 2023.
↑ Sorrells ML, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N, Van Howe RS. Fine‐touch pressure thresholds in the adult penis. BJUI. 19 March 2007; 99(4): 864-9. PMID. DOI. Retrieved 10 January 2021.
↑ Money J, Davison J. Adult penile circumcision: Erotosexual and cosmetic sequelae. Journal of Sex Research. 1983; 19: 289-92.
↑ Frisch M, Lindholm M, Grønbæk M. Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark. Int J Epidemiol. 14 June 2011; 40(5): 1367-81. PMID. DOI. Retrieved 26 September 2021.
↑ Cortés-González J, Arratia-Maqueo J, Gómez-Guerra L. Does circumcision has an effect on female's perception of sexual satisfaction?. Rev Invest Clin. 2008; 60(3): 227. PMID.
↑ ^a ^b Cold CJ, Taylor JR. The prepuce. BJU Int. January 1999; 83, Suppl. 1: 34-44. PMID. DOI. Retrieved 8 July 2021.
↑ Fink KS, Carson CC, DeVellis RF. Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction. J Urol. 2002; 167(5): 2113-6.
↑ Van Howe RS. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr (Phila). January 2006; 45(1): 49-54. Retrieved 15 December 2019.
↑ Stenram A, Malmfors G, Okmian L. Circumcision for phimosis: a follow-up study. Scandinavian journal of urology and nephrology. 1986; 20(2): 89. PMID.
↑ Meatal Stenosis, Medscape. Retrieved 11 October 2019.
↑ Park JK, Doo AR, Kim JH, Park HS, et al. Prospective investigation of penile length with newborn male circumcision and second to fourth digit ratio.. Can Urol Assoc J. September 2016; 10(9-10) PMID. PMC. DOI. Retrieved 4 September 2022.
↑ ^a ^b ^c Cepe da-Emiliani A, Gándara-Cortés M, Otero-Alén M, García H, Suárez-Quintanilla J, García-Caballero T, Gallego R, García-Caballero R. Immunohistological study of the density and distribution of human penile neural tissue: gradient hypothesis. Int J Impot Res. 2 May 2023; 35(3): 286-305. PMID. DOI. Retrieved 26 November 2023.
↑ Winkelmann RK. The erogenous zones: their nerve supply and significance. Mayo Clin Proc. 21 January 1959; 34(3): 39-47. PMID. Retrieved 4 June 2021.
↑ Van Howe RS, Cold CJ. Advantages and Disadvantages of Neonatal Circumcision. The Journal of the American Medical Association. 2 April 1997; 277(13): 1052-7. PMID.
↑ Marshall RE, Porter FL, Rogers AG, et al. Circumcision: II effects upon mother-infant interaction. Early Hum Dev. 1982; 7(4): 367-74. Retrieved 1 February 2020.
↑ Ramos S, Boyle GJ (2001): Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder, in: Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem. George C. Denniston, Frederick M. Hodges, Marilyn Fayre Milos (eds.). New York: Kluwer Academic/Plenum Publishers. Pp. 253-70.
↑ ^a ^b Global Survey of Circumcision Harm. Retrieved 12 October 2019.
↑ van der Kolk BA. The compulsion to repeat the trauma: re-enactment, revictimization, and masochism. Psychiatr Clin North Am. June 1989; 12(2): 389-411. PMID. Retrieved 10 November 2022.
↑ Goldman R. The psychological impact of circumcision. BJU Int. 1999; 83(Suppl. 1): 93-103. Retrieved 12 October 2019.
↑ Rhinehart J. Neonatal circumcision reconsidered. Transactional Analysis J. 1999; 29(3): 215-21. Retrieved 12 October 2019.
↑ Cansever G. Psychological effects of circumcision. Brit. J. Med. Psychol. 1965; 38: 321-31. Retrieved 12 October 2019.
↑ ^a ^b ^c Levy DM. Psychic trauma of operations in children; and a note on combat neurosis. American Journal of Diseases of Children. 1945; 69: 7-25. Retrieved 12 October 2019.
↑ Bollinger, Dan / Georganne Chapin: Child genital cutting as an adverse childhood experience , Intact America (Tarrytown). (August 2019). Retrieved 2 November 2021.
↑ Williams N, Kapilla L. Complications of circumcision. Brit J Surg. October 1993; 80(10): 1231-6. PMID. DOI. Retrieved 27 November 2019.
↑ Prof. Dr. med. Boris Zernikow (12 August 2012). Kinderschmerz-Experte warnt: Rituelle Beschneidung verändert das Gehirn der Kinder [Children's pain expert warns: Ritual circumcision changes the brain of children] (German), Spiegel Online. Retrieved 11 October 2019.
↑ Garry T. Circumcision: a survey of fees and practices. OBG Management. 1994; October: 34-6.
↑ Howard CR, Howard FM, Garfunkel LC, de Blieck EA, Weitzman M. Neonatal circumcision and pain relief: current training practices. Pediatrics. 1998; 101: 423-8.
↑ Stang HJ, Snellman LW. Circumcision practice patterns in the United States. Pediatrics. 1998; 101(e5)
↑ Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology. 1981; 6(3): 269-75. Retrieved 26 November 2019.
↑ (2000) Paediatric Handbook. Smart J, Nolan T. (eds.). Edition: 6. VIC, Australia: Blackwell Science Asia. P. 82.
↑ Wetli, CV: Autopsy of Demetrius Manker, Contribution: Case 93-1711, Miami: Dade County Medical Examiner Department. (23 June 1993).
↑ Hiss J, Horowitz A, Kahana T. Fatal haemorrhage following male ritual circumcision. J Clin Forensic Med. 2000; 7: 32-4. Retrieved 6 November 2019.
↑ Newell, TEC: Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan, Burnaby, B.C.: B.C. Coroner's Service. (19 January 2004). Retrieved 26 November 2019.
↑ Dr. med. Hartmann, Wolfgang: Stellungnahme zur Anhörung am 26. November 2012 [Opinion on the hearing on 26 November 2012] (German), Rechtsausschuss des Bundestages [Legal Committee of the Bundestag] (German). (26 November 2012)
↑ Blalock HJ, Vemulakonda V, Ritchey ML, Ribbeck M. Outpatient management of phimosis Following newborn circumcision. J Urol. 2003; 169(6): 2332-4. Retrieved 26 November 2019.
↑ Leitch IOW. Circumcision - a continuing enigma. Aust Paediatr J. 1970; 6: 59-65. Retrieved 15 December 2019.
↑ Robbins, Liz (7 March 2012). Baby’s Death Renews Debate Over a Circumcision Ritual. Retrieved 11 October 2019.
↑ ^a ^b Bollinger D, Boy's Health Advisory. Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths. Thymos: Journal of Boyhood Studies. 26 April 2010; 4(1): 78-90. DOI. Retrieved 12 October 2019.
↑ (26 April 2010). Infant circumcision causes 100 deaths each year in US, International Coalition for Genital Integrity, ICGI.
↑ For example, Frederick M. Hodges, a medical historian, writes: "In the late 1970s, as the Americans were growing increasingly aware of the abuses of power rampant throughout the nation's social institutions, influential grass-roots movements protesting the forced circumcision of American children sprang up nationwide." F. Hodges, "A Short History," p. 31; see also Glick, Marked in Your Flesh, pp. 273-281.
↑ Fletcher CR (1999): Section 5, in: Circumcision in America in 1998: Attitudes, Beliefs, and Charges of American Physicians. Work: Male and Female Circumcision. George C. Denniston, Frederick M. Hodges, Marilyn Fayre Milos (eds.). New York: Kluwer Academic/Plenum Publishers. Pp. 259-71. Retrieved 12 October 2019.
Note: ID 10.1007/978-0-585-39937-9_19
↑ See, e.g., Shephard and Shephard, The Complete Guide, p. 125.
↑ Lannon and Bailey, "Circumcision Policy Statement," p. 691.
↑ Re J (child's religious upbringing and circumcision). Family Court Reports. 2000; 1: 307-14. Retrieved 12 October 2019.
↑ See, e.g., Somerville, "Therapeutic and Non-Therapeutic Medical Procedures"; Poulter, English Criminal Law; Chessler, "Justifying the Unjustifiable"; Smith, "Male Circumcision."
↑ Hill G. The case against circumcision. Journal of Men's Health and Gender. 2007; 4(3): 318-23. Retrieved 30 May 2021.
↑ MacNeily, Andrew. Routine circumcision: the opposing view. Can Urol Assoc J. November 2007; 1(4): 395-7. PMID. DOI. Retrieved 8 November 2021.
↑ Non-therapeutic circumcision of male minors , Royal Dutch Medical Association. (2010). Retrieved 8 November 2021.
↑ Circumcision of Infant Males , The Royal Australasian College of Physicians. (1 September 2010). Retrieved 8 November 2021.
↑ Darby R. To avoid circumcision complications, avoid circumcision. Can Urol Assoc J. 14 August 2014; 8(7-8): 231. DOI. Retrieved 16 December 2022.
↑ Sorokin ST, Finlay, JC, Jeffries, AL, et al. Newborn male circumcision. Paediatr Child Health. August 2015; 20(6): 311-20. PMID. PMC. DOI. Retrieved 27 October 2019.
↑ Dave S, et al. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (abridged version). Can Urol Assoc J. February 2018; 12(2): 18-28. Retrieved 9 November 2021.
↑ Committee on Bioethics, American Academy of Pediatrics. Informed consent, parental permission, and assent in pediatric practice. Pediatrics. 1995; 95(2): 314-17. PMID. Retrieved 21 May 2023.
↑ Committee on Bioethics. Informed Consent in Decision-Making in Pediatric Practice . Pediatrics. August 2016; 138(2): e20161485. PMID. DOI. Retrieved 21 May 2023.
↑ Committee on Bioethics. Informed Consent in Decision-Making in Pediatric Practice . Pediatrics. August 2016; 138(2): e20161484. PMID. DOI. Retrieved 21 May 2023.
↑ Myers A, Earp BD. What is the best age to circumcise? A medical and ethical analysis. J Biosoc Sci. September 2020; 34(7): 560-72. PMID. DOI. Retrieved 18 May 2023.
↑ Anonymous (23 March 2024). Public Opinion on Circumcision: Can Intactivists Hit A Tipping Point?, Intact America. Retrieved 9 April 2024.
↑ Alissa, Kristel (12 September 2024). The Dark Side of Circumcision: Why the Media Needs to Speak Up, Intact America. Retrieved 13 September 2024.
↑ Garrett, Connor (21 December 2023). The Economics of Circumcision: A Full Breakdown of This Penis Business, Intact America. Retrieved 15 May 2024.
↑ Bollinger, Dan (2012). High Cost of Circumcision: $3.6 Billion Annually, https://www.academia.edu, Academia. Retrieved 21 June 2024.
Quote: As the saying goes, follow the money. Now you know why neither the American Academy of Pediatrics, American Medical Association, American Academy of Family Physicians, or the American College of Obstetricians and Gynecologists haven’t condemned this unnecessary surgery, and why their physician members are quick to recommend the procedure to expectant parents.
↑ Anonymous (2024): Skin in the Game. Intact America. P. 28. Retrieved 28 August 2024.

[taylor1996-1] Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol. 1996; 77: 291-5. PMID. DOI. Retrieved 23 September 2019.

[garrett2023-11-10-2] Garrett, Connor (10 November 2023). Pros and Cons of Circumcision (Spoiler: You’ve Been Lied to), Intact America. Retrieved 2 June 2024.

[bollinger2023-3] Bollinger D. Adverse Childhood Experiences, Dysfunctional Households, And Circumcision.. Kindred. 28 February 2023; Retrieved 1 March 2023.

[deacon2022-4] Deacon M, Muir G. What is the medical evidence on non-therapeutic child circumcision?. Int J Impot Res. 8 January 2022; PMID. DOI. Retrieved 30 January 2022.

[demeo1997-5] DeMeo (1997): The geography of sexual mutilations. Work: Sexual Mutilations: A Human Tragedy. George C. Denniston, Marilyn Milos (eds.). New York: Plenum. ISBN 0-306-45589-7. Retrieved 13 November 2021.

[6] File:Circumcision Sakkara 3.jpg. Retrieved 12 October 2019.

[7] Luke. Gospel of Luke, Bible Gateway, NASB. Retrieved 10 November 2019.
Quote: And when eight days had passed, before His circumcision, His name was then called Jesus, the name given by the angel before He was conceived in the womb.

[8] Luke. Acts 15:1-30. Retrieved 10 November 2019.

[hill2004-9] Hill, George (29 August 2004). The Holy Bible, Circumcision, False Prophets, and Christian Parents , Circumcision Reference Library. Retrieved 10 November 2019.
Quote: The falseness of those who advocate circumcision is a recurrent theme in the New Testament.

[10] Kellogg JH (1888): Treatment for Self-abuse and Its Effects, in: Plain Facts for Old and Young. Burlington, Iowa: F. Segner & Co.. P. 107.

[11] Cheyne, T. K. (1876). Circumcision, Circumcision Reference Library, Encyclopǽdia Brittanica. Retrieved 10 November 2019.

[cold-mcgrath1995-12] Cold C, McGrath K (1999): Anatomy and histology of the penile and clitoral prepuce in primates, in: Male and female circumcision: medical, legal, and ethical considerations in pediatric practice. New York ISBN 0306461315. Retrieved 12 October 2019.

[13] Anonymous (2016). Conclusions, Doctors Opposing Circumcision. Retrieved 22 October 2023.

[blalock2003-14] Blalock HJ, Vemulakonda V, Ritchey ML, Ribbeck M. Outpatient management of phimosis Following newborn circumcision. J Urol. 2003; 169(6): 2332-4. Retrieved 7 November 2019.

[15] Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA. 1997; 277: 1052-7. Retrieved 6 November 2019.

[fleiss-hodges-vanhowe1998-16] Fleiss P, Hodges F, Van Howe RS. Immunological functions of the human prepuce. Sex Trans Infect. October 1998; 74(5): 364-67. PMID. PMC. DOI. Retrieved 14 January 2022.

[17] Task Force on Circumcision. Circumcision policy statement. Pediatrics. 1999; 103(3): 686-93. Retrieved 15 November 2019.

[18] Hooykaas C, van der Velde FW, van der Linden MM, et al. The importance of ethnicity as a risk factor for STDs and sexual behaviour among heterosexuals. Genitourin Med. 1991; 67(5): 378-83. Retrieved 15 November 2019.

[19] Michael RT, Wadsworth J, Feinleib J, et al. Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison. Am J Public Health. 1998; 88(5): 749-54. Retrieved 15 November 2019.

[20] Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA. 1997; 277: 1052-7. Retrieved 6 November 2019.

[21] Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial. Lancet. 24 February 2007; 369(9562): 657-66. PMID. DOI. Retrieved 31 December 2021.

[22] Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial. Lancet. 24 February 2007; 369(9562): 643–56. PMID. DOI. Retrieved 31 December 2021.

[boyle-hill2011-23] Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns . Thompson Reuter. December 2011; 19(2): 316-34. PMID. Retrieved 30 December 2020.

[24] Grosskurth H, Mosha F, Todd J, et al. A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results. AIDS. 1995; 9(8): 927-34. Retrieved 15 November 2019.

[25] Barongo LR, Borgdorff MW, Mosha FF, et al. The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania. AIDS. 1992; 6(12): 1521-8.

[26] Changedia SM, Gilada IS: Role of male circumcision in HIV transmission insignificant in conjugal relationship (abstract no. ThPeC7420), Barcelona, Spain. (7 July 2002–12 July 2002) Presented at the Fourteenth International AIDS Conference.

[27] Connolly CA, Shishana O, Simbayi L, Colvin M: HIV and circumcision in South Africa (Abstract No. MoPeC3491), Bangkok, Thailand. (11 July 2004–16 July 2004) Presented at the 15th International AIDS Conference.

[28] Thomas AG, Bakhireva LN, Brodine SK, Shaffer RA: Prevalence of male circumcision and its association with HIV and sexually transmitted infections in a U.S. navy population (Abstract no. TuPeC4861), Bangkok, Thailand. (11 July 2004–16 July 2004) Presented at the 15th International AIDS Conference. Retrieved 15 November 2019.

[29] McCracken G. Options in antimicrobial management of urinary tract infections in infants and children. Pediatr Infect Dis J. 1989; 8(8): 552-5. Retrieved 19 November 2019.

[30] Larcombe J. Urinary tract infection in children. BMJ. 1999; 319: 1173-5.

[31] Mårild S, Jodal U. Incidence rate of first–time symptomatic urinary tract infection in children under 6 years of age. Acta Paediatr. 1998; 87(5): 549-52.

[32] Mueller ER, Steinhardt G, Naseer S. The incidence of genitourinary abnormalities in circumcised and uncircumcised boys presenting with an initial urinary tract infection by 6 months of age. Pediatrics. 1997; 100 (Supplement): 580.

[33] Menahem S. Complications arising from ritual circumcision: pathogenesis and possible prevention. Isr J Med Sci. 1981; 17(1): 45-8.

[34] Cohen HA, Drucker MM, Vainer S, et al. Postcircumcision urinary tract infection. Clin Pediatr. 1992; 31(6): 322-4.

[35] Goldman M, Barr J, Bistritzer T, Aladjem M. Urinary tract infection following ritual Jewish circumcision. Isr J Med Sci. 1996; 32: 1098-1102.

[36] Wolbarst AL. Circumcision and penile cancer. Lancet. 16 January 1932; 1(5655): 150-3. DOI. Retrieved 13 March 2022.

[37] McCance DJ, Kalache A, Ashdown K, et al. Human papillomavirus types 16 and 18 in carcinomas of the penis from Brazil. Int J Cancer. 1986; 37(1): 55-9.

[38] Harish K, Ravi R. The role of tobacco in penile carcinoma. Brit J Urol. 1995; 75(3): 375-7.

[39] Position Paper on Neonatal Circumcision, American Academy of Family Physicians (Leawood, Kansas). (14 February 2002).

[40] Persad R, Sharma S, McTavish J, et al. Clinical presentation and pathophysiology of meatal stenosis following circumcision. Brit J Urol. 1995; 75(1): 91-3. PMID. DOI. Retrieved 26 November 2019.

[garrett2024-01-09-41] ↑ ^a ^b ^c ^d ^e ^f Garrett, Connor (9 January 2024). 10 Disadvantages of Circumcision & Horrifying Facts, Intact America. Retrieved 4 June 3034.

[anand-hickey1987-42] Anand, KJS, Hickey, PR. Pain and its effects in the human neonate and fetus. New Engl J Med. 19 November 1987; 317(21): 1321-9. PMID. DOI. Retrieved 8 November 2019.
Quote: However, in decisions about the use of these techniques, current knowledge suggests that humane considerations should apply as forcefully to the care of neonates and young, nonverbal infants as they do to children and adults in similar painful and stressful situations.

[43] American Academy of Pediatrics: Circumcision Policy Statement; Task Force on Circumcision. Pediatrics. March 1999; 103(3): 686-93. Retrieved 26 November 2019.

[44] Circumcision: Position Paper on Neonatal Circumcision. Board Approved: August 2007 Reaffirmed, Official American Academy of Family Physicians Website. Retrieved 2 May 2011.

[45] Report 10 of the Council on Scientific Affairs (I-99): Neonatal Circumcision, American Medical Association Official Website. Retrieved 4 May 2011.

[46] (23 March 2011). Where We Stand: Circumcision, AAP. Retrieved 12 October 2019.

[47] Parents' Guide to Circumcision. Retrieved 8 April 2011.
Quote: To calm the baby during the procedure, a sugar filled gauze pacifier soaked with sweet juice is used, and soothing music is played in the room.

[48] (8 April 2011). Before the Circumcision. Retrieved 8 April 2011.
Quote: During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions.

[49] (8 April 2011). Before the Circumcision. Retrieved 8 April 2011.
Quote: Then in our office, he will have topical anesthetic applied to his penis.

[50] Parents' Guide to Circumcision. Retrieved 8 April 2011.
Quote: We use extensive pain control methods including Tylenol, a sugar solution (to reduce pain perceptions), a topical freezing cream, and a local anesthetic injection.

[Journal_of_Perinatology_April.2FMay_2002-51] Taeusch HW, Martinez AM, Partridge JC, Sniderman S, Armstrong-Wells J, Fuentes-Afflick E. Pain During Mogen or Plastibell Circumcision. Journal of Perinatology. April 2002; 22(3): 214-8. Retrieved 8 April 2011.
Quote: ...more than half of the study group had what we considered excessive pain/discomfort over the course of the entire procedure.

[Clinical_Pediatrics_August_1986-52] Williamson PS, Evans ND. Neonatal Cortisol Response to Circumcision with Anesthesia. Clinical Pediatrics. August 1986; 25(8): 412-6. Retrieved 8 April 2011.
Quote: The adrenal cortisol response to surgery was not significantly reduced by the administration of lidocaine.

[53] (8 April 2011). Before the Circumcision. Retrieved 8 April 2011.
Quote: During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions.

[Lancet.2C_The_2010-10-09-54] Slater R, Cornelissen L, Fabrizi L, Patten D, Yoxen J, Worley A, Boyd S, Meek J, Prof. Fitzgerald M. Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial. The Lancet. 9 October 2010; 376(9748): 1225-32. Retrieved 8 April 2011.
Quote: Our data suggest that oral sucrose does not significantly affect activity in neonatal brain or spinal cord nociceptive circuits, and therefore might not be an effective analgesic drug. The ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief.

[55] Taddio A, Goldbach M, Ipp M, Stevens B, Koren G. Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet. 1995; 345: 291-292. PMC. DOI. Retrieved 15 November 2022.

[56] Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1 March 1997; 349: 599-603. PMC. DOI. Retrieved 15 November 2022.

[uberoi2022-57] Uberoi M, Abdulcadir J, Ohi DA, Santiago JE, et al. Potentially under-recognized late-stage physical and psychosexual complications of non-therapeutic neonatal penile circumcision: a qualitative and quantitative analysis of self-reports from an online community forum. Int J Impot Res. 23 October 2022; PMID. DOI. Retrieved 8 January 2023.

[58] Sorrells ML, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N, Van Howe RS. Fine‐touch pressure thresholds in the adult penis. BJUI. 19 March 2007; 99(4): 864-9. PMID. DOI. Retrieved 10 January 2021.

[59] Money J, Davison J. Adult penile circumcision: Erotosexual and cosmetic sequelae. Journal of Sex Research. 1983; 19: 289-92.

[60] Frisch M, Lindholm M, Grønbæk M. Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark. Int J Epidemiol. 14 June 2011; 40(5): 1367-81. PMID. DOI. Retrieved 26 September 2021.

[61] Cortés-González J, Arratia-Maqueo J, Gómez-Guerra L. Does circumcision has an effect on female's perception of sexual satisfaction?. Rev Invest Clin. 2008; 60(3): 227. PMID.

[ColdCJ_TaylorJR_1999-62] Cold CJ, Taylor JR. The prepuce. BJU Int. January 1999; 83, Suppl. 1: 34-44. PMID. DOI. Retrieved 8 July 2021.

[63] Fink KS, Carson CC, DeVellis RF. Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction. J Urol. 2002; 167(5): 2113-6.

[vanhowe2006-64] Van Howe RS. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr (Phila). January 2006; 45(1): 49-54. Retrieved 15 December 2019.

[65] Stenram A, Malmfors G, Okmian L. Circumcision for phimosis: a follow-up study. Scandinavian journal of urology and nephrology. 1986; 20(2): 89. PMID.

[66] Meatal Stenosis, Medscape. Retrieved 11 October 2019.

[67] Park JK, Doo AR, Kim JH, Park HS, et al. Prospective investigation of penile length with newborn male circumcision and second to fourth digit ratio.. Can Urol Assoc J. September 2016; 10(9-10) PMID. PMC. DOI. Retrieved 4 September 2022.

[cepeda2023-68] Cepe da-Emiliani A, Gándara-Cortés M, Otero-Alén M, García H, Suárez-Quintanilla J, García-Caballero T, Gallego R, García-Caballero R. Immunohistological study of the density and distribution of human penile neural tissue: gradient hypothesis. Int J Impot Res. 2 May 2023; 35(3): 286-305. PMID. DOI. Retrieved 26 November 2023.

[winkleman1959-69] Winkelmann RK. The erogenous zones: their nerve supply and significance. Mayo Clin Proc. 21 January 1959; 34(3): 39-47. PMID. Retrieved 4 June 2021.

[70] Van Howe RS, Cold CJ. Advantages and Disadvantages of Neonatal Circumcision. The Journal of the American Medical Association. 2 April 1997; 277(13): 1052-7. PMID.

[71] Marshall RE, Porter FL, Rogers AG, et al. Circumcision: II effects upon mother-infant interaction. Early Hum Dev. 1982; 7(4): 367-74. Retrieved 1 February 2020.

[72] Ramos S, Boyle GJ (2001): Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder, in: Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem. George C. Denniston, Frederick M. Hodges, Marilyn Fayre Milos (eds.). New York: Kluwer Academic/Plenum Publishers. Pp. 253-70.

[GSoCH-73] Global Survey of Circumcision Harm. Retrieved 12 October 2019.

[74] van der Kolk BA. The compulsion to repeat the trauma: re-enactment, revictimization, and masochism. Psychiatr Clin North Am. June 1989; 12(2): 389-411. PMID. Retrieved 10 November 2022.

[75] Goldman R. The psychological impact of circumcision. BJU Int. 1999; 83(Suppl. 1): 93-103. Retrieved 12 October 2019.

[76] Rhinehart J. Neonatal circumcision reconsidered. Transactional Analysis J. 1999; 29(3): 215-21. Retrieved 12 October 2019.

[77] Cansever G. Psychological effects of circumcision. Brit. J. Med. Psychol. 1965; 38: 321-31. Retrieved 12 October 2019.

[Levy1945-78] Levy DM. Psychic trauma of operations in children; and a note on combat neurosis. American Journal of Diseases of Children. 1945; 69: 7-25. Retrieved 12 October 2019.

[79] Bollinger, Dan / Georganne Chapin: Child genital cutting as an adverse childhood experience , Intact America (Tarrytown). (August 2019). Retrieved 2 November 2021.

[williams-kapilla1993-80] Williams N, Kapilla L. Complications of circumcision. Brit J Surg. October 1993; 80(10): 1231-6. PMID. DOI. Retrieved 27 November 2019.

[81] Prof. Dr. med. Boris Zernikow (12 August 2012). Kinderschmerz-Experte warnt: Rituelle Beschneidung verändert das Gehirn der Kinder [Children's pain expert warns: Ritual circumcision changes the brain of children] (German), Spiegel Online. Retrieved 11 October 2019.

[82] Garry T. Circumcision: a survey of fees and practices. OBG Management. 1994; October: 34-6.

[83] Howard CR, Howard FM, Garfunkel LC, de Blieck EA, Weitzman M. Neonatal circumcision and pain relief: current training practices. Pediatrics. 1998; 101: 423-8.

[84] Stang HJ, Snellman LW. Circumcision practice patterns in the United States. Pediatrics. 1998; 101(e5)

[85] Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology. 1981; 6(3): 269-75. Retrieved 26 November 2019.

[86] (2000) Paediatric Handbook. Smart J, Nolan T. (eds.). Edition: 6. VIC, Australia: Blackwell Science Asia. P. 82.

[87] Wetli, CV: Autopsy of Demetrius Manker, Contribution: Case 93-1711, Miami: Dade County Medical Examiner Department. (23 June 1993).

[88] Hiss J, Horowitz A, Kahana T. Fatal haemorrhage following male ritual circumcision. J Clin Forensic Med. 2000; 7: 32-4. Retrieved 6 November 2019.

[89] Newell, TEC: Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan, Burnaby, B.C.: B.C. Coroner's Service. (19 January 2004). Retrieved 26 November 2019.

[90] Dr. med. Hartmann, Wolfgang: Stellungnahme zur Anhörung am 26. November 2012 [Opinion on the hearing on 26 November 2012] (German), Rechtsausschuss des Bundestages [Legal Committee of the Bundestag] (German). (26 November 2012)

[91] Blalock HJ, Vemulakonda V, Ritchey ML, Ribbeck M. Outpatient management of phimosis Following newborn circumcision. J Urol. 2003; 169(6): 2332-4. Retrieved 26 November 2019.

[92] Leitch IOW. Circumcision - a continuing enigma. Aust Paediatr J. 1970; 6: 59-65. Retrieved 15 December 2019.

[93] Robbins, Liz (7 March 2012). Baby’s Death Renews Debate Over a Circumcision Ritual. Retrieved 11 October 2019.

[Bollinger_2010-94] Bollinger D, Boy's Health Advisory. Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths. Thymos: Journal of Boyhood Studies. 26 April 2010; 4(1): 78-90. DOI. Retrieved 12 October 2019.

[95] (26 April 2010). Infant circumcision causes 100 deaths each year in US, International Coalition for Genital Integrity, ICGI.

[96] For example, Frederick M. Hodges, a medical historian, writes: "In the late 1970s, as the Americans were growing increasingly aware of the abuses of power rampant throughout the nation's social institutions, influential grass-roots movements protesting the forced circumcision of American children sprang up nationwide." F. Hodges, "A Short History," p. 31; see also Glick, Marked in Your Flesh, pp. 273-281.

[97] Fletcher CR (1999): Section 5, in: Circumcision in America in 1998: Attitudes, Beliefs, and Charges of American Physicians. Work: Male and Female Circumcision. George C. Denniston, Frederick M. Hodges, Marilyn Fayre Milos (eds.). New York: Kluwer Academic/Plenum Publishers. Pp. 259-71. Retrieved 12 October 2019.
Note: ID 10.1007/978-0-585-39937-9_19

[98] See, e.g., Shephard and Shephard, The Complete Guide, p. 125.

[99] Lannon and Bailey, "Circumcision Policy Statement," p. 691.

[100] Re J (child's religious upbringing and circumcision). Family Court Reports. 2000; 1: 307-14. Retrieved 12 October 2019.

[101] See, e.g., Somerville, "Therapeutic and Non-Therapeutic Medical Procedures"; Poulter, English Criminal Law; Chessler, "Justifying the Unjustifiable"; Smith, "Male Circumcision."

[hill2007-102] Hill G. The case against circumcision. Journal of Men's Health and Gender. 2007; 4(3): 318-23. Retrieved 30 May 2021.

[103] MacNeily, Andrew. Routine circumcision: the opposing view. Can Urol Assoc J. November 2007; 1(4): 395-7. PMID. DOI. Retrieved 8 November 2021.

[104] Non-therapeutic circumcision of male minors , Royal Dutch Medical Association. (2010). Retrieved 8 November 2021.

[racp2010-105] Circumcision of Infant Males , The Royal Australasian College of Physicians. (1 September 2010). Retrieved 8 November 2021.

[106] Darby R. To avoid circumcision complications, avoid circumcision. Can Urol Assoc J. 14 August 2014; 8(7-8): 231. DOI. Retrieved 16 December 2022.

[CPS2015-107] Sorokin ST, Finlay, JC, Jeffries, AL, et al. Newborn male circumcision. Paediatr Child Health. August 2015; 20(6): 311-20. PMID. PMC. DOI. Retrieved 27 October 2019.

[cua2018-108] Dave S, et al. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (abridged version). Can Urol Assoc J. February 2018; 12(2): 18-28. Retrieved 9 November 2021.

[109] Committee on Bioethics, American Academy of Pediatrics. Informed consent, parental permission, and assent in pediatric practice. Pediatrics. 1995; 95(2): 314-17. PMID. Retrieved 21 May 2023.

[110] Committee on Bioethics. Informed Consent in Decision-Making in Pediatric Practice . Pediatrics. August 2016; 138(2): e20161485. PMID. DOI. Retrieved 21 May 2023.

[111] Committee on Bioethics. Informed Consent in Decision-Making in Pediatric Practice . Pediatrics. August 2016; 138(2): e20161484. PMID. DOI. Retrieved 21 May 2023.

[myers2020-112] Myers A, Earp BD. What is the best age to circumcise? A medical and ethical analysis. J Biosoc Sci. September 2020; 34(7): 560-72. PMID. DOI. Retrieved 18 May 2023.

[113] Anonymous (23 March 2024). Public Opinion on Circumcision: Can Intactivists Hit A Tipping Point?, Intact America. Retrieved 9 April 2024.

[114] Alissa, Kristel (12 September 2024). The Dark Side of Circumcision: Why the Media Needs to Speak Up, Intact America. Retrieved 13 September 2024.

[garrett2023-12-21-115] Garrett, Connor (21 December 2023). The Economics of Circumcision: A Full Breakdown of This Penis Business, Intact America. Retrieved 15 May 2024.

[116] Bollinger, Dan (2012). High Cost of Circumcision: $3.6 Billion Annually, https://www.academia.edu, Academia. Retrieved 21 June 2024.
Quote: As the saying goes, follow the money. Now you know why neither the American Academy of Pediatrics, American Medical Association, American Academy of Family Physicians, or the American College of Obstetricians and Gynecologists haven’t condemned this unnecessary surgery, and why their physician members are quick to recommend the procedure to expectant parents.

[117] Anonymous (2024): Skin in the Game. Intact America. P. 28. Retrieved 28 August 2024.

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@@ Line 1: / Line 1: @@
-{{Construction Site}}
+{{GraphicWarning}}
+"Male '''circumcision''' (from Latin ''circumcidere'', meaning "to cut around") is the surgical removal or [[amputation]] of the [[foreskin]] (prepuce), a major part of the human [[penis]]. The foreskin comprises ''more than fifty percent'' of the epithelium of the [[penis]].<ref name="taylor1996">{{TaylorJR LockwoodAP TaylorAJ 1996}}</ref> When the "cutting around" is performed, the foreskin falls off, so [[amputation]] and [[mutilation]] is the result. The amputation destroys the [[Foreskin#Physiological_functions| many protective, immunological, sexual, and sensory physiological functions]] of the foreskin, so it is a very harmful and [[Pain| painful]] surgery.<ref name="garrett2023-11-10">{{REFweb
+ |url=https://intactamerica.org/pros-and-cons-of-circumcision/
+ |title=Pros and Cons of Circumcision (Spoiler: You’ve Been Lied to)
+ |last=Garrett
+ |first=Connor
+ |init=
+ |author-link=Connor Judson Garrett
+ |publisher=Intact America
+ |date=2023-11-10
+ |accessdate=2024-06-02
+}}</ref>
-"Male '''circumcision''' (from Latin ''circumcidere'', meaning "to cut around") is the surgical removal of the [[foreskin]] (prepuce) from the human [[penis]]. [...] The procedure is most often an elective surgery performed on neonates and children for religious and cultural reasons, but in other cases may be indicated for both therapeutic and prophylactic reasons.  It is a treatment option for pathological phimosis, refractory balanoposthitis and chronic urinary tract infections (UTIs); it is contraindicated in cases of certain genital structure abnormalities or poor general health." (Source: [http://en.wikipedia.org/wiki/Circumcision Wikipedia])
+'''Posthectomy''' is the more accurate medical term that more accurately reflects the injury and loss of functional body tissue, but the Biblical [[euphemism]], ''circumcision'', is more commonly used.
+With reference to involuntary, non-therapeutic circumcision of children, [[Child Genital Cutting (CGC)]] is a newer term that has been introduced to avoid issues associated with more traditional terms. Bollinger (2023) identifed CGC as an [[Adverse Childhood Experiences (ACEs)| adverse childhood experience]].<ref name="bollinger2023">{{REFjournal
+ |last=Bollinger
+ |init=D
+ |author-link=Dan Bollinger
+ |last2=
+ |init2=
+ |author2-link=
+  |url=https://kindredmedia.org/2023/02/adverse-childhood-experiences-dysfunctional-households-and-circumcision/
+ |title=Adverse Childhood Experiences, Dysfunctional Households, And Circumcision.
+ |journal=Kindred
+ |date=2023-02-28
+ |volume=
+ |issue=
+ |pages=
+ |accessdate=2023-03-01
+}}</ref>
+Deacon & Muir (2022) have reviewed the evidence and concluded that "there is no medical justification for performing a circumcision prior to an age that he can assess the known risks and potential benefits, and choose to give or withhold [[informed consent]] himself."<ref name="deacon2022">{{REFjournal
+ |last=Deacon
+ |first=Matthew
+ |init=M
+ |author-link=
+ |last2=Muir
+ |first2=Gordon
+ |init2=G
+ |author2-link=
+ |etal=no
+ |title=What is the medical evidence on non-therapeutic child circumcision?
+ |journal= Int J Impot Res
+ |date=2022-01-08
+ |url=https://www.nature.com/articles/s41443-021-00502-y
+ |pubmedID=34997197
+ |DOI=10.1038/s41443-021-00502-y
+ |accessdate=2022-01-30
+}}</ref>
------
+Circumcision was popularized in English-speaking nations in the nineteenth century. The practice of non-therapeutic circumcision of boys now has greatly declined in [[Australia]], [[Canada]], [[New Zealand]] and the [[United Kingdom]]. It has been gradually declining since 1985 in the [[United States]]. It has ''never'' been a popular practice in other western nations.
+Circumcision is classified as a form of [[genital mutilation]].
-''The following text is taken from the [[Circumpendium]].''
+== Historical background ==
-== Non-medical indications for circumcision ==
+The [[amputation]] of the [[foreskin]] is a very old ritual, whose exact origin cannot be verified beyond doubt. Circumcision is believed to have originated in east Africa near the Red Sea well before the dawn of recorded history.<ref name="demeo1997">{{REFbook
+ |last=DeMeo
+ |first=
+ |author-link=
+ |year=1997
+ |title=The geography of sexual mutilations
+ |url=https://www.academia.edu/4212007/The_Geography_of_Male_and_Female_Genital_Mutilations
+ |work=Sexual Mutilations: A Human Tragedy
+ |editors=George C. Denniston, Marilyn Milos
+ |edition=
+ |volume=
+ |chapter=
+ |pages=
+ |location=New York
+ |publisher=Plenum
+ |isbn=0-306-45589-7
+ |quote=
+ |accessdate=2021-11-13
+ |note=
+}}</ref> Medical historians assume that circumcision already served in ancient history as a way to control the sexuality of slaves and members of the lower classes without compromising their ability to reproduce. In religious history circumcision may be seen as a substitute for human sacrifice. In prehistoric times it was not uncommon to placate the gods with human sacrifice. Castration of slaves or conquered enemies was common as well. Following religious changes this sacrifice was altered, and only a part of the very organ responsible for the creation of new life was sacrificed.
-Apart from the medical indication of pathological phimosis, there also are other reasons for circumcision.
+[[Image:Circumcision Sakkara 3.jpg|200px|right]] For the [[Aborigines]], the [[Australia| Australian]] natives, the tradition of circumcision is said to go back to 10,000 BC. On the African continent, the first circumcisions are assumed to have emerged around 6000 BC. From ancient Egypt hints of various forms of circumcision date back to the time around 3000-2000 BC. The oldest known depiction<ref>{{REFweb
+ |url=https://commons.wikimedia.org/wiki/File:Circumcision_Sakkara_3.jpg
+ |title=File:Circumcision Sakkara 3.jpg
+ |accessdate=2019-10-12
+}}</ref> is an Egyptian tomb relief from the 6th dynasty, approximately 2300-2000 BC. It is not known precisely who was circumcised and why in those times.
-=== Aesthetic reasons ===
+In many cultures circumcision during puberty serves as a rite of passage, bringing adolescents into the community. As with other painful or humiliating initiation rites, proof of courage and mastering of critical situations are the key motivations. From some African tribes it is also known that the [[amputation]] of the [[foreskin]] is seen as the removal of an inborn piece of femininity from the boys, thus making them men.
-The visual appearance of the [[penis]] is changed radically after circumcision. In this case, personal taste is decisive whether an intact or a cut [[penis]] is more appealing. Since a circumcision cannot be undone, it is essential to be fully informed about the risks and possible later complications before embarking on an aesthetically motivated circumcision, to decide whether the appearance will justify such bodily modification.
+===Judaism===
-Since this modification and its possible late effects will be the lifelong burden of the person who undertakes an aesthetically motivated circumcision to suit his personal preferences, a valid decision to proceed can only be made by the person to be circumcised himself, once he has reached the necessary age and level of maturity to make that decision. This should normally be the case when adulthood is reached.
+In [[Judaism]], the tradition of [[Brit Milah| circumcision]] goes back to the [[Abrahamic covenant]] in a passage in the Book of Genesis (17:10-14). It was seen as a covenant between God and man, dating back to the patriarch Abraham.<ref name="garrett2023-11-10" /> The validity of this passage is increasingly being questioned.
-=== Moral reasons ===
+{{Citation
+ |Text=10 This is my covenant with you and your descendants after you, the covenant you are to keep: Every male among you shall be circumcised. 11 You are to undergo circumcision, and it will be the sign of the covenant between me and you. 12 For the generations to come every male among you who is eight days old must be circumcised, including those born in your household or bought with money from a foreigner—those who are not your offspring. 13 Whether born in your household or bought with your money, they must be circumcised. My covenant in your flesh is to be an everlasting covenant. 14 Any [[uncircumcised]] male, who has not been circumcised in the flesh, will be cut off from his people; he has broken my covenant.”
+ |Author=Bible
+ |Source=Gen 17, 10-14, NIV
+}}
-With the [[foreskin]], circumcision removes approximately 70% of the sensitive tissue of the [[penis]], lowering the potential for sexual stimulation accordingly. Due to the loss of around 50% of the entire penile skin, the [[penis]] loses the reserve skin that provides cutaneous mobility in the erect [[penis]] and the gliding action.
+According to the anthropologist and sociologist Rabbi Nissan Rubin, the [[Jewish circumcision| Jewish form of circumcision]], called ''[[Brit Milah| brit mila]]'', during the first two millennia did not include the later customary ''[[periah]]'', namely the complete scraping of the inner [[foreskin]] from the [[Glans penis|glans]]. This was only added around 135 AD, to make it almost impossible to restore the [[foreskin]] by [[stretching]], which became popular in the wake of Hellenic influence. While originally only the tip of the [[foreskin]] was cut off, ''[[periah]]'' removes the entire [[foreskin]].
-In the past, this circumstance was used to make it harder for boys to masturbate, as masturbation was viewed as immoral and was assumed to cause a variety of diseases. More on that can be found in the chapter "[[Circumcision#Historical_background|Historical background]]". Today, it is known that masturbation has no negative health effects, but can contribute positively to the child's sexual development. Sexuality is no longer a taboo nowadays, while masturbation is considered to be a natural part of human sexuality and is no longer seen as immoral. Therefore, circumcision for moral reasons - which would only affect boys too young to give informed consent - is no longer justifiable nowadays.
+In the Greek society of the day, a denuded [[Glans penis|glans]] was considered obscene and risible. In ultra-orthodox communities, circumcision is followed by the ''[[mohel]]'', the ritual circumciser, sucking blood from the wound with his mouth. This practice is highly controversial, as it can result in an [[infection]] with [[herpes]] simplex type 1. In New York City, between 2000 and 2011 eleven children were infected with [[herpes]], 10 of whom had to be treated in hospital. Two of them suffered permanent brain damage, two others died. In the 12th century, the Jewish philosopher and doctor [[Moses Maimonides| Maimonides]] claimed that circumcision was necessary, as it diminished sexual desires and reduced the pleasure to a degree just sufficient for mere reproduction.
-=== Hygiene reasons ===
+===Christianity===
+Jesus was born into a Jewish family in [[Israel]], where [[Judaism]] was the prevailing religion, so He was [[circumcised]] on the eighth day.<ref>{{REFweb
+ |url=https://www.biblegateway.com/passage/?search=Luke+2%3A21&version=NASB
+ |title=Gospel of Luke
+ |last=Luke
+ |first=
+ |publisher=NASB
+ |website=Bible Gateway
+ |date=
+ |accessdate=2019-11-10
+ |format=
+ |quote=And when eight days had passed, before His circumcision, His name was then called Jesus, the name given by the angel before He was conceived in the womb.
+}}</ref>
-A common reason stated for circumcision is the assumption of hygienic benefits. This argument has to be viewed in the context of the environment the person in question grows up in. It is commonly known that bad hygienic circumstances, especially insufficient access to clean drinking water, pose a serious problem. The situation in disaster areas or refugee camps in the so-called third world keep reminding us of that.
+The first Christians had been born Jewish, so a question arose whether one must be [[circumcised]] to be a Christian. When Christian leaders met at the [[Council at Jerusalem]] in the First Century to decide what was required to be a Christian, a letter was written to explain the requirements, but circumcision was omitted from the requirements.<ref>{{REFweb
+ |url=https://www.biblegateway.com/passage/?search=Acts+15%3A1-30&version=NASB
+ |title=Acts 15:1-30
+ |last=Luke
+ |first=
+ |accessdate=2019-11-10
+}}</ref>
-In western industrial nations, however, this problem does not exist, in view of the availability of clean water for daily personal hygiene. If the cleaning of the genitals is performed on a daily basis - and that may be assumed - no pathogens can accumulate under the [[foreskin]]. Cleaning of the [[Glans penis|glans]] and the area underneath the [[foreskin]] is easy - they are simply washed along with the rest of the body, just like the areas between the toes.
+In Christianity, circumcision is practiced only in the Coptic denomination. There is no general belief that circumcision is a requirement of Christianity.<ref name="hill2004">{{REFweb
+ |url=https://www.cirp.org/pages/cultural/christian.php
+ |title=The Holy Bible, Circumcision, False Prophets, and Christian Parents
+ |last=Hill
+ |first=George
+ |author-link=George Hill
+ |publisher=Circumcision Reference Library
+ |website=
+ |date=2004-08-29
+ |accessdate=2019-11-10
+ |format=HTML
+ |quote=The falseness of those who advocate circumcision is a recurrent theme in the New Testament.
+}}</ref>
-In small boys, where the [[foreskin]] cannot be retracted yet, cleaning is not necessary, since the membrane that fuses the [[foreskin]] to the [[Glans penis|glans]] prevents the accumulation of micro-organisms. The so-called "ballooning", where the [[foreskin]] inflates during urination, is not a serious problem.
+Nevertheless, Christian moral notions had decisive influence on the spread of this practice. In the puritan influenced USA, circumcision of children was popular in the 19th century as a means to prevent [[masturbation]]. In those days, this so-called ‘self-abuse‘ was not only considered immoral, but was supposedly responsible for a variety of diseases. Masturbation, however, is not mentioned anywhere in the Holy Bible, so there is no support for the belief that it is somehow immoral or sinful.
-The opening of the [[foreskin]] in small boys is often quite narrow and serves as a one-way valve, allowing the urine to flow out, but preventing entry of microbes, for example from a dirty diaper. As long as the child is able to pass water, everything works as nature intended.
+Even the mere existence of a [[foreskin]] was falsoly linked to many illnesses. Among them one could find syphilis, epilepsy, paralysis of the spine, bed wetting, scoliosis (spinal deformity), paralysis of the bladder, club foot, nerve pain in the lower abdomen, tuberculosis and lazy eye. One of the best known advocates of child circumcision was [[John Harvey Kellogg]], co-inventor of the corn flakes bearing his name. In 1888, he wrote:
-But even in areas where there are poorer hygienic conditions and an insufficient access to medical care, the benefits of easier cleaning of a circumcised [[penis]] are to be viewed with a critical eye. Although even longer periods without personal hygiene will not result in an accumulation of germs under the [[foreskin]], circumcision itself is not without risk of complications. If the operation is carried out without proper sterility, there is a high risk of an infection of the wound. This also applies to the treatment of common complications like post-operative bleeding.
+{{Citation
+ |Text=A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of [[phimosis]]. The operation should be performed by a surgeon without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. In females, the author has found the application of pure carbolic acid to the [[clitoris]] an excellent means of allaying the abnormal excitement, and preventing the recurrence of the practice in those whose will-power has become so weakened that the patient is unable to exercise entire self-control.
+ |Author=[[John Harvey Kellogg]]
+ |Source=
+ |ref=<ref>{{REFbook
+ |last=Kellogg
+ |first=John Harvey
+ |init=JH
+ |author-link=John Harvey Kellogg
+ |url=https://archive.org/details/plainfaorold00kell/page/290
+ |chapter=Treatment for Self-abuse and Its Effects
+ |title=Plain Facts for Old and Young
+ |location=Burlington, Iowa
+ |publisher=F. Segner & Co.
+ |year=1888
+ |page=107
+}}</ref>
+}}
-The benefit of easier cleaning must be balanced against the risk of promoting serious infections - among others HIV - during the operation. In parts of Africa, several dozen of one tribe's boys die each year as a result of their circumcision.
+===Islam===
+In [[Islam]], circumcision is also religiously founded, even though there is no mention of it in the Koran itself. According to tradition, the Prophet Mohammed was born without a [[foreskin]]. It is seen as a sign of prophets that they are born without a [[foreskin]] already. It is considered an honour to "resemble the example of the Prophet", meaning to be [[circumcised]]. In Islam, unlike [[Judaism]], there is no specific age at which the circumcision should be performed. Most circumcisions take place at ages between 6 and 10 years, but the range goes from birth to adulthood.
+== Rationale ==
-=== Prophylactic reasons ===
+Reasons for performing circumcision range widely by culture, religion, location, and age.
-Some people claim that circumcision has prophylactic benefits. Especially in the USA those arguments have persisted for more then a 100 years, with ever changing diseases circumcision is said to protect against. At first, these were diseases where masturbation was believed to be the cause. After bacteria and viruses had been discovered, arguments changed, and one after another miscellaneous diseases were cited.
+===Cultural===
-* [[Phimosis]]: as mentioned earlier, true [[phimosis]] is rare and can be treated effectively without surgery. According to a study by Blalock et.al. (2003)<ref>Blalock HJ, Vemulakonda V, Ritchey ML, Ribbeck M. Outpatient management of [[phimosis]] Following newborn circumcision. J Urol 2003;169(6):2332-4.</ref>, 2.9% of those circumcised develop a post-operative [[phimosis]], in which the circumcision scar constricts. In intact patients, the rate of [[phimosis]] is only 1% (see also the study by Jakob Øster above). Therefore, circumcision is not a preventive measure for [[phimosis]].
+Many cultures perform circumcision as a rite of passage into manhood. This is common in the Middle East and amongst some indigenous African and Southeast Asian peoples.
-* Sexually Transmitted Diseases (STDs): a vast number of studies has been conducted on the subject of transmission of STDs.
-* First, it has to be noted that any form of protection against these diseases only affects people who are sexually active. Circumcision in childhood cannot be justified on these grounds, since any assumed protective effect will not occur before the boy is already old enough to decide about circumcision for himself.
-* As mentioned above, the [[foreskin]] keeps the [[Glans penis|glans]] moist. This subpreputial moisture contains, among other substances, the enzyme lysozyme, which breaks up the cell wall of bacteria, thereby providing a natural antibacterial screen. This explains the results of several studies, such as Laumann et.al.<ref>Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA 1997;277:1052-7.</ref>, which found a higher rate of infection with bacterial venereal diseases in circumcised than in intact men.
-* The studies by Fleiss et.al.<ref>Fleiss PM, Hodges FM, Van Howe RS. Immunological functions of the human prepuce. Sex Transm Inf 1998;74:364-7.</ref>  support this. According to the [[AAP]], the general sexual behaviour of the male - such as frequent change in partners and the use of condoms - has a much higher impact on sexually transmitted diseases then the circumcision status.<ref>Task Force on Circumcision. Circumcision policy statement. Pediatrics 1999;103(3):686-93.</ref>
-* HIV / AIDS: in the recent past, the argument that circumcision could help to contain the spread of HIV has been stated numerous times.
-*:First, two notes: for one, the use of condoms is still by far the most effective protection against an infection. During intercourse with that preventive measure, circumcision status does not make a difference.
-*:Secondly, the assumed protection would only affect healthy men who have intercourse with an infected woman. An infected man can infect a women by transmission of his bodily fluids, so that his circumcision status is irrelevant. Therefore, the use of condoms remains vital in containing the spread of HIV, which in return renders circumcision unnecessary
-* Due to the inevitable loss of sensitivity as a result of circumcision, there is also the temptation to go without condoms, in order not to lose even more sensitivity.<ref>Hooykaas C, van der Velde FW, van der Linden MM. et al. The importance of ethnicity as a risk factor for STDs and sexual behaviour among heterosexuals. Genitourin Med 1991; 67(5): 378-83.</ref><ref>Michael RT, Wadsworth J, Feinleib J, et al. Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison. Am J Public Health 1998;88(5):749-54.</ref><ref>Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA 1997;277:1052-7.</ref>
-* Two studies that have been published in early 2007<ref>Gray RH and colleagues. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007:369;657-666.</ref><ref>[[Robert C. Bailey|Bailey RC]] and colleagues. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007:369;643-656.</ref>, which investigated the effectiveness of circumcision as a means of reducing the spread of HIV from infected women to heterosexual men in African high risk areas, have been repeatedly subjected to strong criticism. Both studies were ended prematurely, which distorted the results. The men who had been circumcised for the study had to stay sexually inactive during the wound healing, which gave the intact control group more relative opportunity to become infected. The fact that the USA has both the highest rate of circumcised males in the western world, as well as the highest HIV infection rate, makes the studies look dubious. Besides that, several other studies concluded that circumcision does not have a significant impact on the risk of infection with HIV.<ref>Grosskurth H, Mosha F, Todd J, et al. A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results. AIDS 1995;9(8):927-34.</ref><ref>Barongo LR, Borgdorff MW, Mosha FF, et al. The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania. AIDS 1992;6(12):1521-8.</ref><ref>Changedia SM, Gilada IS. Role of male circumcision in HIV transmission insignificant in conjugal relationship (abstract no. ThPeC7420). Presented at the Fourteenth International AIDS Conference, Barcelona, Spain, July 7-12, 2002.</ref><ref>Connolly CA, Shishana O, Simbayi L, Colvin M. HIV and circumcision in South Africa (Abstract No. MoPeC3491). Presented at the 15th International AIDS Conference, Bangkok, Thailand, July 11-16, 2004.</ref><ref>Thomas AG, Bakhireva LN, Brodine SK, Shaffer RA. Prevalence of male circumcision and its association with HIV and sexually transmitted infections in a U.S. navy population (Abstract no. TuPeC4861). Presented at the 15th International AIDS Conference, Bangkok, Thailand, July 11-16, 2004.</ref>
-* Urinary tract infections (UTI): a UTI can be effectively treated with antibiotics, this was also proven by studies<ref>McCracken G. Options in antimicrobial management of urinary tract infections in infants and children. Pediatr Infect Dis J 1989;8(8):552–55.</ref><ref>Larcombe J. Urinary tract infection in children. BMJ 1999;319:1173–5.</ref>. A Swedish study <ref>Mårild S, Jodal U. Incidence rate of first–time symptomatic urinary tract infection in children under 6 years of age. Acta Paediatr 1998;87(5):549–52.</ref> found that, during the first 6 years of life, the incidence of UTIs in boys was 1.8%, but in girls was 6.6%. UTIs are less common in boys after the first year of life. Mueller et.al. <ref>Mueller ER, Steinhardt, G., Naseer S. The incidence of genitourinary abnormalities in circumcised and uncircumcised boys presenting with an initial urinary tract infection by 6 months of age. Pediatrics 1997;100 (Supplement): 580.</ref> did not find a significant difference in UTI rates between circumcised and intact boys with normal urinary tract anatomy.
-* Other studies suggest that circumcision is more likely to raise than to lower the generally low risk of acquiring UTI: multiple studies from Israel showed a strong correlation between ritual circumcision on the 8th day of life and postoperative UTI.<ref>Menahem S. Complications arising from ritual circumcision: pathogenesis and possible prevention. Isr J Med Sci 1981;17(1):45–8.</ref><ref>Cohen HA, Drucker MM, Vainer S, et al. Postcircumcision urinary tract infection. Clin Pediatr 1992;31(6):322–4.</ref><ref>Goldman M, Barr J, Bistritzer T, Aladjem M. Urinary tract infection following ritual Jewish circumcision Isr J Med Sci 1996;32:1098–102.</ref>
-* It can be concluded that circumcision is ineffective as a preventive measure against UTIs.
-* Penile and cervical cancer / HPV: first studies on those diseases and their assumed prevention by circumcision date back to 1932, a time when the cause for those illnesses was not yet fully understood
-<ref>Wolbarst A. Circumcision and penile cancer. Lancet 1932;1(5655):150–53.</ref>. Today, it is known that sexually transmitted human papillomavirus (HPV) is a major risk factor<ref>McCance DJ, Kalache A, Ashdown K, et al. Human papillomavirus types 16 and 18 in carcinomas of the penis from Brazil. Int J Cancer 1986;37(1):55–9.</ref>, as well as smoking<ref>Harish K, Ravi R. The role of tobacco in penile carcinoma. Brit J Urol 1995;75(3):375–7.</ref>. Studies have shown that there is no significant difference in the risk of getting penile cancer between circumcised and intact men. To prevent a single case of penile cancer, it would statistically take 600 to 900 circumcisions<ref>American Academy of Family Physicians. Position Paper on Neonatal Circumcision. Leawood, Kansas, (February 14, 2002).</ref>. The influence of circumcision on the infection risk of the female partner with cervical cancer has been refuted several times as well. HPV vaccination is an effective measure against carcinoma of the cervix.
-In conclusion, circumcision does not provide any proven benefits in preventive medicine.
+The [[United States]] and [[Israel]] are the only industrialized countries in the world to have a high incidence of non-therapeutic infant male circumcision. The vast majority of infant circumcisions performed in the United States are for non-religious, non-medical reasons. See [[History of circumcision]].
-== Circumcision in detail: Styles, techniques and instruments ==
+===Religious===
+The circumcision of newborn boys is seen as a [[Abrahamic covenant| divine commandment]] in the [[Judaism| Jewish faith]]. Though absent in the Koran, male circumcision is considered a religious requirement in [[Islam]], and it is performed on male children of varying ages. Converts to these faiths may also choose to undergo [[Adolescent and adult circumcision| circumcision]], but it is not always required.
-During circumcision, the [[foreskin]] of the [[penis]] is partly or completely removed. The exact amount and type of skin removed depends on the style and technique used, and therefore also on the tools being used.
+=== Medical indication ===
+There are no [[medical indication| medical indications]] for circumcision of the newborn. The [[circumcision industry]] offers circumcision of the newborn to the public because of the [[financial incentive]].
-=== First, a look on the common styles: ===
+The form of circumcision adopted by the medical community essentially was equivalent to the Jewish form with ''[[periah]]'', so it inflicts the maximum injury and physical [[trauma]].
-==== High & Tight<ref>de.Wikipedia user Tinoel</ref> ====
+In a few cases  with older patients, circumcision is legitimately indicated; a patient may be suffering recurring [[infection]], and other methods of treatment have failed. In other cases, a patient may be suffering from a severe case of [[phimosis]]. Overall, the actual medical necessity for circumcision is extremely rare since many conditions respond to conservative treatment. All circumcisions injure the patient by amputating the [[foreskin]] its with many protective, immunological, sensory, and sexual [[Foreskin#Physiological_functions| functions]].
-[[Image:Penis_unlabeled.jpg|200px|center]]
-This style is the most common in the USA. In this style, the outer [[foreskin]], parts of the inner [[foreskin]] and parts of the shaft skin are removed.
-The remaining part of the inner [[foreskin]] is folded back and sewed to the shaft skin. The scar is located closer to the body, hence the term "high".
+# '''Deformed or malformed foreskin'''. A foreskin so deformed or malformed that it does not function properly may be removed by circumcision.
-The inner [[foreskin]], which originally faced inwards lying on the [[Glans penis|glans]], now faces outward; this causes the differently coloured section between [[Glans penis|glans]] and shaft skin which is characteristic for this style.
+# '''Traumatically injured foreskin'''. A foreskin so traumatically damaged foreskin that it cannot be surgically repaired is a valid medical reason for circumcision.
-Of all styles, the tight ones remove the most skin. They already limit the mobility of the penile skin to a great extent when the [[penis]] is flaccid, and during an erection the skin is fully stretched and immobile. An insufficient amount of reserve skin can hamper a complete erection and lead to painful tension. Also, a skewed [[penis]] can occur due to an uneven distribution of the remaining skin, often caused by an inaccurately placed cut or a uneven growth during wound healing. Due to the extensive shortening of the inner [[foreskin]], this style also means the loss of large amounts of sensitive tissue.
+# '''Diseased foreskin.''' A foreskin that is diseased is a valid indication for circumcision. Some diseases that qualify are malignancy, lichen sclerosis, [[Balanitis#Diabetic_males| yeast infection in men with diabetes]], and recurrent [[balanoposthitis]].
-==== Low & Tight<ref>David-matthias http://commons.wikimedia.org/wiki/File:Beschneidungsstile,_Styles_of_Circumcision.jpg</ref> ====
+In such cases, the benefit of removing the problem foreskin may exceed the maleficial harms of tissue and function destruction.
-[[Image:Low_and_tight.jpg|200px|center]]
-In this style, both the inner and outer [[foreskin]] are completely removed. The shaft skin is sewed just below the rim of the [[Glans penis|glans]]. The scar is located close the [[Glans penis|glans]], hence the term "low".
-This style is the most radical, as it removes the entire sensitive tissue of the [[foreskin]]. As in the high & tight style, large amounts of skin are removed. In a flaccid state, the skin is barely movable, and in an erect state it is totally immobile.
+====Arguments of prophylaxia====
+Though the practice of ritual circumcision of males, both consenting and non-consenting, has existed for millenia, the search for "potential medical benefits" began relatively recently. {''Potential'' means to exist in possibility, but not in actuality, so a "''potential'' benefit" is not a genuine proven benefit.)  The discussion of circumcision in the Ninth Edition of the ''Encyclopǽdia Britannica'' (1876) made no mention of any prophylactic, medical, or therapeutic value or function.<ref>{{REFweb
+ |url=https://www.cirp.org/library/history/encyclopaediabritannica1876/
+ |title=Circumcision
+ |last=Cheyne
+ |first=T. K.
+ |author-link=
+ |publisher=Encyclopǽdia Brittanica
+ |website=Circumcision Reference Library
+ |date=1876
+ |accessdate=2019-11-10
+ |format=
+ |quote=
+}}</ref>
-An insufficient amount of reserve skin can hamper an erection and lead to painful tension and a skewed [[penis]] in this style as well.
+Initially, circumcision was adopted in the 19th century as a way to stop boys and men from masturbating, when [[masturbation]] was claimed to be the cause for many diseases. As the myth that circumcision prevented masturbation became debunked, advocates of circumcision began the great search to find the "medical benefits" of circumcision.
-==== High & Loose<ref>David-matthias http://commons.wikimedia.org/wiki/File:Beschneidungsstile,_Styles_of_Circumcision.jpg</ref> ====
+Male and female circumcision involves the removal and disruption of normal anatomical structures that are primary areas of sexual sensation.<ref name="taylor1996"/> In the past, some advocates of mass circumcision have considered the [[prepuce]] to be a "mistake of nature,"<!--{{Cold and Wiswell (1995)}} | [[Template:Cold and Wiswell (1995)|see more]]--> but this notion has no validity because the prepuce is ubiquitous in primates and because it provides functional advantages.<ref name="cold-mcgrath1995">{{REFbook
-[[image:High_and_loose.jpg|200px|center]]
+ |last=Cold
-The outer foreskin is completely removed, as well as parts of the shaft skin. The inner foreskin is folded back and sewed to the shaft skin. The scar is located towards the body, hence the term "high". Unlike the high & tight style, the inner [[foreskin]] is less reduced, and lies in folds behind the [[Glans penis|glans]].
+ |first=Christopher
+ |init=C
+ |last2=McGrath
+ |first2=Kenneth
+ |init2=K
+ |author2-link=Ken McGrath
+ |year=1999
+ |title=Male and female circumcision: medical, legal, and ethical considerations in pediatric practice
+ |url=https://www.cirp.org/library/anatomy/cold-mcgrath/
+ |work=
+ |editor=
+ |edition=
+ |volume=
+ |chapter=Anatomy and histology of the penile and clitoral prepuce in primates
+ |pages=
+ |location=New York
+ |publisher=
+ |isbn=0306461315
+ |quote=
+ |accessdate=2019-10-12
+ |note=
+}}</ref>
-There is enough remaining reserve skin to ensure a complete and unhindered erection. Of all variants, this one removes the smallest amount of sensitive tissue.
+All claims that circumcision prevents future disease are false.<ref>{{REFweb
+ |url=https://www.doctorsopposingcircumcision.org/for-professionals/alleged-medical-benefits/conclusions-and-references/
+ |title=Conclusions
+ |last=Anonymous
+ |first=
+ |init=
+ |publisher=Doctors Opposing Circumcision
+ |date=2016
+ |accessdate=2023-10-22
+}}</ref> They are made to enable a physician to perform circumcision and collect a fee.
+<!--
+===Search for prophylactic reasons===
-==== Low & Loose<ref>David-matthias http://commons.wikimedia.org/wiki/File:Beschneidungsstile,_Styles_of_Circumcision.jpg</ref> ====
+The practice of finding prophylactic reasons for infant circumcision started in Germany in the nineteenth century, when non-Jewish Germans criticized the Jewish practice of infant circumcision as being barbaric, Jewish doctors sprang to the defense of the religious practice by claiming health benefits.<ref name="ephron2001">{{REFbook
-[[image:Low_and_loose.jpg|200px|center]]
+ |last=Ephron
-The inner [[foreskin]] is removed, the outer [[foreskin]] is sewed on below the [[Glans penis|glans]]. The scar is therefore located close to the [[Glans penis|glans]], hence the term "low". The outer [[foreskin]] lies in folds behind the [[Glans penis|glans]]. Enough skin is left in place to ensure a complete and unhindered erection.
+ |first=John M.
+ |init=JM
+ |author-link=
+ |year=2001
+ |title=Medicine and the German Jews
+ |url=https://www.cirp.org/library/history/ephron1/
+ |work=
+ |editor=
+ |edition=
+ |volume=
+ |chapter=6
+ |pages=222-33
+ |location=New Haven
+ |publisher={{UNI|Yale University|Yale}} Press
+ |isbn=0-300-08377-7
+ |quote=
+ |accessdate=2019-11-20
+ |note=
+}}</ref> And so started the long tradition of Jewish doctors inventing reasons for circumcision (and deceving gentile doctors).
-Since, in contrast to the high & loose style, the inner instead of the outer [[foreskin]] is removed, this style results in the loss of almost all of the sensitive tissue.
+Following the discovery of bacteria as a cause of many diseases – such as tuberculosis – the search began for other illnesses that could be prevented by circumcision.
-=== Techniques and instruments ===
+In 1870 the prominent Dr. [[Lewis Albert Sayre|Lewis A. Sayre]] of NYC’s famed Bellevue Hospital<ref>https://nypost.com/2016/12/03/bellevues-doctors-invented-the-procedures-you-take-for-granted/</ref> claimed to cure a boy’s paralyzed legs with circumcision. Sayre's wild advocacy of circumcision exemplified how some [https://intaction.org/circumcision-facts-and-myths/ circumcision facts and myths] originated. He also claimed to cure epilepsy, mental disorders, hip-joint pain, & hernias with circumcision. “Genital irritations” & masturbation were deemed to be the cause of these issues. Sayre was later elected as the President of the American Medical Association. <ref>American Medical Association. Transactions of the American Medical Association. 1870;21:205–11</ref>
-Over time, a vast variety of methods has been developed to remove the [[foreskin]]. A multitude of clamps and tools is available to ease the work of the circumciser, to improve the chance for visually symmetrical results and to prevent injuries to the [[Glans penis|glans]] from inexpert cuts. I will introduce some of the most widely spread variants.
+In the 1920s it was penile cancer. [[Abraham L. Wolbarst]] (1926) claims that circumcision can prevent penile cancer.<ref name="wolbarst1926">{{REFjournal
+ |last=Wolbarst
+ |first=Abraham L.
+ |init=AL
+ |author-link=Abraham L. Wolbarst
+ |title=Is circumcision a prophylactic against penis cancer?
+ |journal=Cancer
+ |date=Jul 1926
+ |volume=3
+ |issue=4
+ |pages=301-10
+}}</ref>
-==== Freehand-techniques ====
+In the 1940s, prostate and tongue cancer as well as STDs. [[Eugene H. Hand]] (1949) falsely explains that circumcision somehow protects against venereal diseases and tongue cancer.<ref name="hand1949">{{REFjournal
-[[File:Circumpendium-6-2-1.jpg||center|thumb]]
+ |last=Hand
-The oldest method of removing the [[foreskin]] uses just a few instruments. In the simplest case, the [[foreskin]] is pulled out with a cord, a knife is placed directly above the [[Glans penis|glans]], and the skin finally cut with a hit on the blunt edge of the knife. No stitches are placed and the skin is left to grow together naturally.
+ |first=Eugene H.
+ |init=EH
+ |author-link=Eugene H. Hand
+ |url=https://pubmed.ncbi.nlm.nih.gov/18135844/
+ |title=Circumcision and venereal disease
+ |journal=Archives of Dermatology and Syphilology
+ |date=1949-09
+ |volume=60
+ |issue=3
+ |pages341-6
+ |pubmedID=18135844
+ |DOI=10.1001/archderm.1949.01530030037004
+ |accessdate=2021-10-08
+}}</ref>
-[[File:Circumpendium-6-2-1-b.jpg||center|thumb]]
+In the 1950s it was cervical cancer. [[Abraham Ravich]] (1951) invents the myth that circumcision reduces the risk of women getting cervical cancer.<ref name="ravich1951">{{Ravich1951}}</ref>
-In modern operating theatres the [[foreskin]] is first grasped with forceps, pulled out and clamped above the [[Glans penis|glans]] for a while to reduce bleeding. Next, the skin is cut along the forceps with a scalpel. Following that, the remaining skin is manually trimmed according to the desired style and finally sutured.
-[[File:Circumpendium-6-2-1-c.jpg||center|thumb]]
+In the late 1960s it was neuroses. [[Morris Fishbein]] (1969) calls for circumcision to prevent nervousness and, of course, [[masturbation]].<ref>{{Fishbein1969}}</ref>
-Completely freehand techniques are also common. The penile skin is first cut in two places along the circumference, in the area of the shaft skin and [[foreskin]]. After that the skin area between the cuts is removed and the remaining skin sutured.
-Also among the freehand techniques are the shield variants.
+In the 1970s bladder- and rectal cancer. [[Abraham Ravich]] (1971) claims that circumcision would prevent bladder cancer and rectal cancer.<ref>{{Ravich1971}}</ref>
-[[File:Circumpendium-6-2-1-Jewish-clamp.jpg||center|thumb|Jewish clamp]]
+In the 1980s, UTIs. [[Thomas E. Wiswell]] (1985) claims that circumcision, using a methodologically flawed report, reduces the risk of urinary tract infections.<ref name="wiswell1985">{{REFjournal
-In ritual Jewish circumcision the [[foreskin]] in inserted into the slit of the shield (left) and then cut on the upper side of the shield.
+ |last=Wiswell
+ |first=Thomas E.
+ |init=TE
+ |author-link=Thomas E. Wiswell
+ |url=https://pediatrics.aappublications.org/content/75/5/901
+ |title=Decreased incidence of urinary tract infections in circumcised male infants
+ |journal=Pediatrics
+ |date=May 1985
+ |volume=75
+ |issue=5
+ |pages=901-3
+ |accessdate=2019-10-12
+}}</ref>
-[[File:Circumpendium-6-2-1-Mogen-clamp.jpg||center|thumb|Mogen-clamp]]
+[[Aaron J. Fink]] (1986), with no evidence whatsoever, claims that circumcision protects against [[AIDS]] followed.<ref name="fink1986">{{REFjournal
-The Mogen-Clamp works in a similar way (middle), with the difference that it is locked shut after the [[foreskin]] is inserted, thus clamping it. After a few minutes the [[foreskin]] is cut in the same fashion as with the simple shield. The clamping is meant to reduce or prevent bleeding from the wound.
+ |last=Fink
+ |first=Aaron J.
+ |init=AJ
+ |author-link=Aaron J. Fink
+ |title=A possible explanation for heterosexual male infection with AIDS
+ |journal=New England Journal of Medicine
+ |date=1986-10-30
+ |volume=31
+ |issue=18
+ |page=1167
+ |url=https://www.nejm.org/doi/full/10.1056/NEJM198610303151818
+ |DOI=10.1056/NEJM198610303151818
+ |accessdate=2019-11-20
+}}</ref>
-[[File:Circumpendium-6-2-1-Sheldon-clamp.jpg||center|thumb|Sheldon-Clamp]]
+Retrospectively, circumcision was always advertised as a cure for whatever disease was in the public spotlight at the time. [[Doctors Opposing Circumcision (D.O.C.)]] (2016) state:
-The Sheldon-Clamp (right) works in a similar way. The inner clamp grasps the tip of the [[foreskin]], pulling it into the outer clamp which is closed. The outer clamp then grips the skin. After a few minutes of pressure, the [[foreskin]] is cut between the two clamps.
+<blockquote>
+These claims date originally from before the advent of evidence-based medicine, when doctors relied on the opinions of other clinicians to inform their practice, rather than on scientifically collected evidence.<ref name="doc2016">{{REFweb
+ |url=https://www.doctorsopposingcircumcision.org/for-professionals/alleged-medical-benefits/
+ |title=Alleged Medical Benefits
+ |publisher=[[Doctors Opposing Circumcision (D.O.C.)]]
+ |website=
+ |date=2016-05
+ |accessdate=2019-11-20
+ |format=
+ |quote=
+}}</ref>
+</blockquote>
-The use of a shield, rather than forceps, is meant to provide a better protection of the [[Glans penis|glans]] from cutting injuries. However, if used improperly both the Mogen and the Sheldon clamp are subject to the risk of the tip of the [[Glans penis|glans]] being accidentally clamped and being cut into or severed.
+The sheer mass of studies and publications that were released during those almost 180 years on this topic are the reason that even arguments that have been disproved multiple times, especially regarding infant and child circumcision, tenaciously persist up until today.
-==== Complex clamps ====
+An ever-recurring element of initiation rites found in many different cultures is the fixation upon the genitalia.
-[[File:Circumpendium-6-2-2-Gomco-clamp.jpg|center|thumb|Gomco clamp]]
-One of the most widely used clamps in the USA is the Gomco clamp. First, a cut is placed into the [[foreskin]], then the metal bell is placed over the [[Glans penis|glans]]. After that, the bell, together with the [[foreskin]], is pulled through the opening in the base plate and hung into the lever. By fastening the screw the lever pulls the bell upwards, jamming the [[foreskin]] between bell and base plate. After several minutes of clamping, the skin is cut off with a scalpel along the upper side of the base plate and the clamp removed.
-[[File:Circumpendium-6-2-2-plastibell.jpg|center|thumb|plastibell method]]
+It reflects the fascination that emerges from the ability to create new life. In most cultures, fertility is seen as the most precious good, and the body parts involved frequently find themselves in the focus of ritual acts. In many parts of the world, those rites take place when the boy reaches puberty, and are meant to symbolize his transition from boy to man. The removal of the male [[foreskin]] is just one of many phenomena that developed in this context. They range from the removal of the frenulum in boys and men through partial or complete removal of the [[foreskin]] up to radical operations. Australian [[Aborigines]], as mentioned above, have their [[foreskin]]s removed. It is also usual that, a few weeks later, young men have their [[penis]]es sliced open in a [[subincision]], resulting in a partly or completely divided [[urethra]].
-In the plastibell method, the skin is first cut lengthwise, then a plastic ring is placed over the [[Glans penis|glans]] and the [[foreskin]] pulled over it. A tightly tied string is used to fix the [[foreskin]] to a rim in the ring, thereby strangulating it.
-The tissue beyond the string is cut off and the bell's handle cracked off. The strangulated tissue dies off in the following days, and the ring falls off on its own. Since this form of circumcision means part of the process goes on without medical supervision, it may not be possible to intervene promptly in the event of swelling; also there is a risk of the ring being removed prematurely due to external influence. This may cause the healing wound to burst open, necessitating additional suturing.
+Another known, particularly massive, intervention is the stripping of the entire [[skin]] off the [[penis]]. In Indonesia, boys have metal or bamboo balls inserted into their [[penis]] shaft or [[Glans penis|glans]] at the beginning of puberty, which form little "humps".
-[[File:Circumpendium-6-2-2-Smartclamp.jpg|center|thumb|Smartclamp]]
+For many cultures it is also common to perform similar rituals on girls. This can range from relatively small interventions such as piercing or cutting the clitoral hood, to its complete removal and up to radical removal of clitoral hood, [[clitoris]], inner and outer labia followed by sewing up the vagina.
-The Smartclamp and a couple of similar designs are one way clamps, representing a mixture of the Gomco and Plastibell methods. The [[Glans penis|glans]] is inserted into the plastic tube, the [[foreskin]] pulled over it. The base plate of the outer clamping mechanism is pushed over the [[foreskin]] and cocked shut, jamming the [[foreskin]] between the bulging lower rim of the tube and the lower base plate. The [[foreskin]] is now cut off along the upper side of the base plate. The entire clamping mechanism remains on the [[penis]], until it - like the plastibell - falls off by itself after the clamped skin dies off in the following days.
-All of these methods have in common that the [[foreskin]] has to be separated from the [[Glans penis|glans]] first. In case of the circumcision of a child, it is in most cases (see chart above) necessary to forcibly tear apart the balanopreputial membrane, which fuses the [[foreskin]] to the [[Glans penis|glans]], either by violently retracting the [[foreskin]] or separating it by pushing a blunt instrument underneath the [[foreskin]], both of which can result in injuries and inflammations of the [[Glans penis|glans]].
+''The following text is taken from the [[Circumpendium]].''
+-->
-== Risks and late effects ==
+=== Prophylactic reasons ===
-Just like tonsil or appendix surgery, circumcision is a surgical intervention and brings the usual risks related to surgical operations, alongside several specific risks of complications and late effects.
+Some people claim that circumcision has prophylactic benefits. Especially in the [[USA]] those arguments have persisted for more then a 100 years, with ever changing diseases circumcision is said to protect against. At first, these were diseases where [[masturbation]] was believed to be the cause. After bacteria and viruses had been discovered, arguments changed, and one after another miscellaneous diseases were cited.
-=== Possible operative and postoperative complications ===
+* [[Phimosis]]: as mentioned earlier, true [[phimosis]] is rare and can be treated effectively without surgery. According to a study by Blalock et al. (2003)<ref name="blalock2003">{{REFjournal
+ |last=Blalock
+ |init=HJ
+ |last2=Vemulakonda
+ |init2=V
+ |last3=Ritchey
+ |init3=ML
+ |last4=Ribbeck
+ |init4=M
+ |title=Outpatient management of [[phimosis]] Following newborn circumcision
+ |journal=J Urol
+ |date=2003
+ |volume=169
+ |issue=6
+ |pages=2332-4
+ |url=https://www.cirp.org/library/complications/blalock1/
+ |accessdate=2019-11-07
+}}</ref>, 2.9% of those circumcised develop a post-operative [[phimosis]], in which the circumcision scar constricts. In [[intact]] patients, the rate of [[phimosis]] is only 1% (see also the study by [[Jakob Øster]]). Therefore, circumcision is not a preventive measure for [[phimosis]].
+* Sexually Transmitted Diseases (STDs): a vast number of studies has been conducted on the subject of transmission of STDs.
+* First, it has to be noted that any form of protection against these diseases only affects people who are sexually active. Circumcision in childhood cannot be justified on these grounds, since any assumed protective effect will not occur before the boy is already old enough to decide about circumcision for himself.
+* As mentioned above, the [[foreskin]] keeps the [[Glans penis|glans]] moist. This subpreputial moisture contains, among other substances, the enzyme lysozyme, which breaks up the cell wall of bacteria, thereby providing a natural antibacterial screen. This explains the results of several studies, such as Laumann et al.<ref>{{REFjournal
+ |last=Laumann
+ |init=EO
+ |last2=Masi
+ |init2=CM
+ |last3=Zuckerman
+ |init3=EW
+ |title=Circumcision in the United States: prevalence, prophylactic effects, and sexual practice
+ |journal=JAMA
+ |date=1997
+ |volume=277
+ |issue=
+ |pages=1052-7
+ |url=https://www.cirp.org/library/general/laumann/
+ |accessdate=2019-11-06
+}}</ref>, which found a higher rate of infection with bacterial venereal diseases in [[circumcised]] than in [[intact]] men.
+* The studies by Fleiss et al. (1998) support this.<ref name="fleiss-hodges-vanhowe1998">{{FleissP HodgesF VanHoweRS 1998}}</ref> According to the [[AAP]], the general sexual behaviour of the male — such as frequent change in partners and the use of condoms — has a much higher impact on sexually transmitted diseases then the circumcision status.<ref>{{REFjournal
+ |last=Task Force on Circumcision
+ |first=
+ |title=Circumcision policy statement
+ |journal=Pediatrics
+ |date=1999
+ |volume=103
+ |issue=3
+ |pages=686-93
+ |url=https://www.cirp.org/library/statements/aap1999/
+ |accessdate=2019-11-15
+}}</ref>
+* [[HIV]] / [[AIDS]]: in the recent past, the argument that circumcision could help to contain the spread of [[HIV]] has been stated numerous times.
+*:First, two notes: for one, the use of condoms is still by far the most effective protection against an infection. During intercourse with that preventive measure, circumcision status does not make a difference.
+*:Secondly, the assumed protection would only affect healthy men who have intercourse with an infected woman. An infected man can infect a women by transmission of his bodily fluids, so that his circumcision status is irrelevant. Therefore, the use of condoms remains vital in containing the spread of [[HIV]], which in return renders circumcision unnecessary
+* Due to the inevitable loss of sensitivity as a result of circumcision, there is also the temptation to go without condoms, in order not to lose even more sensitivity.<ref>{{REFjournal
+ |last=Hooykaas
+ |init=C
+ |last2=van der Velde
+ |init2=FW
+ |last3=van der Linden
+ |init3=MM
+ |etal=yes
+ |title=The importance of ethnicity as a risk factor for STDs and sexual behaviour among heterosexuals
+ |journal=Genitourin Med
+ |date=1991
+ |volume=67
+ |issue=5
+ |pages=378-83
+ |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1194736/pdf/genitmed00041-0022.pdf
+ |accessdate=2019-11-15
+}}</ref><ref>{{REFjournal
+ |last=Michael
+ |init=RT
+ |last2=Wadsworth
+ |init2=J
+ |last3=Feinleib
+ |init3=J
+ |etal=yes
+ |title=Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison
+ |journal=Am J Public Health
+ |date=1998
+ |volume=88
+ |issue=5
+ |pages=749-54
+ |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1508929/pdf/amjph00017-0039.pdf
+ |accessdate=2019-11-15
+}}</ref><ref>{{REFjournal
+ |last=Laumann
+ |init=EO
+ |last2=Masi
+ |init2=CM
+ |last3=Zuckerman
+ |init3=EW
+ |title=Circumcision in the United States: prevalence, prophylactic effects, and sexual practice
+ |journal=JAMA
+ |date=1997
+ |volume=277
+ |issue=
+ |pages=1052-7
+ |url=https://www.cirp.org/library/general/laumann/
+ |accessdate=2019-11-06
+}}</ref>
+* Two studies that have been published in early 2007<ref>{{RCT Gray et al 2007}}</ref><ref>{{RCT Bailey et al 2007}}</ref>, which investigated the effectiveness of circumcision as a means of reducing the spread of [[HIV]] from infected women to heterosexual men in African high risk areas, have been repeatedly subjected to strong criticism. Both studies were ended prematurely, which distorted the results. The men who had been [[circumcised]] for the study had to stay sexually inactive during the wound healing, which gave the intact control group more relative opportunity to become infected. These African randomized clinical trials have been demonstrated to have very serious methodological and statistical errors that distort the results in favor of circumcision.<ref name="boyle-hill2011">{{BoyleGJ HillG 2011}}</ref>
-* Intolerance or allergic reactions to the narcotics used.
+The fact that the [[USA]] has both the highest percentage of [[circumcised]] males in the western world, as well as the highest [[HIV]] infection rate, makes the studies look dubious. Besides that, several other studies concluded that circumcision does not have a significant impact on the risk of infection with [[HIV]].<ref>{{REFjournal
-* Especially in newborns, where the bodily pain reduction mechanisms are not yet fully developed, local anaesthesia is often insufficient for the operation. Even in conjunction with regional anaesthesia of the dorsal nerve of the [[penis]], the rate of failure to provide sufficient anaesthetic even for experienced anaesthetists is still 5-10%. The general anaesthesia that would be needed for newborns, however, poses significant risks for the child, and, therefore, is only likely to be used in emergencies. A surgical operation without proper pain control can lead to the development of a specific pain memory<ref>Prof. Dr. med. Boris Zernikow http://www.spiegel.de/spiegel/vorab/experte-warnt-rituelle-beschneidung-veraendert-das-gehirn-der-kinder-a-849534.html</ref>. In unsedated and partially sedated infants increased secretion of the stress hormone cortisol could be observed for months after the operation. Overall, their pain threshold was lower and the risk of chronic pain increased. Regardless of these findings, infant circumcisions with insufficient or no anaesthetic are still common practice<ref>Garry T. Circumcision: a survey of fees and practices. OBG Management 1994. (October): 34-6.</ref><ref>Howard CR, Howard FM, Garfunkel LC, de Blieck EA, Weitzman M. Neonatal circumcision and pain relief: current training practices. Pediatrics 1998; 101:423-428.</ref><ref>Stang HJ, Snellman LW. Circumcision practice patterns in the United States. Pediatrics 1998; 101: e5. Link to [[AAP]] website</ref>. During procedures which take several minutes, babies tend to fall into a state of stupor, which in the past was falsely interpreted as peaceful sleep, nurturing the belief that babies felt no pain. Measurements taken in those cases revealed a typically 3- to 4-fold increase in cortisol levels, which equals a state of severe shock.<ref>Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981; 6(3):269-75.</ref>
+ |last=Grosskurth
-* Postoperative wound pain, in the case of children's circumcisions conceivably worsened by the forceful breaking of the preputial adhesions.
+ |init=H
-* Postoperative bleeding of the wound. This can have severe consequences especially for very young infants, if they are not treated promptly. Their blood volume is only about 85 ml per kilogram of body weight, and even moderate blood loss can lead to hypovolaemia, hypovolaemic shock and even death.<ref>Smart J, Nolan T. (Editors). Paediatric Handbook, Sixth Edition. Victoria, Australia: Blackwell Science Asia, 2000: p. 82</ref><ref>Wetli CV. Case 93-1711. Autopsy of Demetrius Manker. Miami: Dade County Medical Examiner Department, June 23, 1993.</ref><ref>Hiss J, Horowitz A, Kahana T. Fatal haemorrhage following male ritual circumcision. J Clin Forensic Med 2000;7:32-4.</ref><ref>Newell TEC. Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan. Burnaby, B.C.: B.C. Coroner's Service, Monday, 19 January 2004</ref>
+ |last2=Mosha
-* Postoperative infections. This includes both local infections, which can be treated with local therapy, and systemic infections, requiring systemic antibiotic treatment.<ref>Dr.med Wolfram Hartmann, Stellungnahme zur Anhörung am 26. November 2012 im Rechtsausschuss des Bundestages</ref>
+ |init2=F
-* Wound dehiscence, meaning the separation of the edges of the wound or the tissue after suturing.
+ |last3=Todd
-* Adhesion between the surface or rim of the [[Glans penis|glans]] with the neighbouring penile skin, causing skin pockets and bridges, as well as visually unpleasant results like uneven scars, which make a re-circumcision necessary.
+ |init3=J
-* Postoperative [[phimosis]]: a phimotic ring can develop during scarring, which makes a re-circumcision necessary. According to a study by Blalock et.al.<ref>Blalock HJ, Vemulakonda V, Ritchey ML, Ribbeck M. Outpatient management of [[phimosis]] Following newborn circumcision. J Urol 2003;169(6):2332-4.</ref>, the prevalence is 2.9%, according to Leitch<ref>Leitch IOW. Circumcision - a continuing enigma. Aust Paediatr J 1970;6:59-65</ref> 5.5%.
+ |etal=yes
-* Meatal stenosis, a pathological narrowing of the opening of the urethra, which mostly occurs in infancy and early childhood. It is one of the most common complications of infant circumcision. A study from 2006 found meatal stenosis exclusively in previously circumcised boys. The incidence rate after a circumcision is at approximately 10%.<ref>Van Howe RS. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr (Phila). Jan-Feb 2006;45(1):49-54.</ref><ref>Stenram, A., Malmfors, G., & Okmian, L. (1986): Circumcision for [[phimosis]]: a follow-up study. Scandinavian journal of urology and nephrology, 20(2), 89 PMID 3749823.</ref><ref>http://emedicine.medscape.com/article/1016016-overview</ref>
+ |title=A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results
-* Knot formation of the veins. If the dorsal vein, which originates in the tip of the [[foreskin]], is cut during circumcision without being clamped and sutured at its origin separately, it starts to develop new branches over time, which can lead to the development of knots.
+ |journal=AIDS
-* Possible deformities due to circumcision include hypoplasia of the [[penis]] (micro-penis) and induratio [[penis]] plastica (skewed penis).
+ |date=1995
-* Medical malpractice can also not be ruled out. Injuries, partly or entirely severing the [[Glans penis|glans]] or the [[penis]] can occur.
+ |volume=9
-* In rare cases, necrosis, gangrene, ischaemia, keloid formation and circulatory problems may also occur.
+ |issue=8
-* When the circumcision is followed by the ultra-orthodox Jewish ritual of Metzitzah B'Peh (which consists of sucking blood from the wound with the mouth), there is a risk of infection with herpes simplex type 1, which can lead to brain damage or death.<ref>http://www.nytimes.com/2012/03/08/nyregion/infants-death-renews-debate-over-a-circumcision-ritual.html?_r=0</ref>
+ |pages=927-34
+ |url=https://insights.ovid.com/aids/aids/1995/08/000/community-trial-impact-improved-sexually/15/00002030
+ |accessdate=2019-11-15
+}}</ref><ref>{{REFjournal
+ |last=Barongo
+ |init=LR
+ |last2=Borgdorff
+ |init2=MW
+ |last3=Mosha
+ |init3=FF
+ |etal=yes
+ |title=The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania
+ |journal=AIDS
+ |date=1992
+ |volume=6
+ |issue=12
+ |pages=1521-8
+ |url=
+ |accessdate=
+}}</ref><ref>{{REFconference
+ |last=Changedia SM, Gilada IS
+ |first=
+ |title=Role of male circumcision in HIV transmission insignificant in conjugal relationship (abstract no. ThPeC7420)
+ |url=
+ |place=Barcelona, Spain
+ |source=Presented at the Fourteenth International AIDS Conference
+ |datefrom=2002-07-07
+ |dateto=2002-07-12
+ |accessdate=
+}}</ref><ref>{{REFconference
+ |last=Connolly CA, Shishana O, Simbayi L, Colvin M
+ |first=
+ |title=HIV and circumcision in South Africa (Abstract No. MoPeC3491)
+ |url=
+ |place=Bangkok, Thailand
+ |source=Presented at the 15th International AIDS Conference
+ |datefrom=2004-07-11
+ |dateto=2004-07-16
+ |accessdate=
+}}</ref><ref>{{REFconference
+ |last=Thomas AG, Bakhireva LN, Brodine SK, Shaffer RA
+ |first=
+ |title=Prevalence of male circumcision and its association with HIV and sexually transmitted infections in a U.S. navy population (Abstract no. TuPeC4861)
+ |url=https://apps.dtic.mil/dtic/tr/fulltext/u2/a458066.pdf
+ |place=Bangkok, Thailand
+ |source=Presented at the 15th International AIDS Conference
+ |datefrom=2004-07-11
+ |dateto=2004-07-16
+ |accessdate=2019-11-15
+}}</ref>
+* Urinary tract infections (UTI): a [[UTI]] can be effectively treated with antibiotics, this was also proven by studies.<ref>{{REFjournal
+ |last=McCracken
+ |init=G
+ |title=Options in antimicrobial management of urinary tract infections in infants and children
+ |journal=Pediatr Infect Dis J
+ |date=1989
+ |volume=8
+ |issue=8
+ |pages=552-5
+ |url=https://www.cirp.org/library/disease/UTI/mccracken/
+ |accessdate=2019-11-19
+}}</ref><ref>{{REFjournal
+ |last=Larcombe
+ |init=J
+ |title=Urinary tract infection in children
+ |journal=BMJ
+ |date=1999
+ |volume=319
+ |issue=
+ |pages=1173-5
+ |url=
+ |accessdate=
+}}</ref> A Swedish study<ref>{{REFjournal
+ |last=Mårild
+ |init=S
+ |last2=Jodal
+ |init2=U
+ |title=Incidence rate of first–time symptomatic urinary tract infection in children under 6 years of age
+ |journal=Acta Paediatr
+ |date=1998
+ |volume=87
+ |issue=5
+ |pages=549-52
+ |url=
+ |accessdate=
+}}</ref> found that, during the first 6 years of life, the incidence of [[UTI]]s in boys was 1.8%, but in girls was 6.6%. UTIs are less common in boys after the first year of life. Mueller et al. <ref>{{REFjournal
+ |last=Mueller
+ |init=ER
+ |last2=Steinhardt
+ |init2=G
+ |last3=Naseer
+ |init3=S
+ |title=The incidence of genitourinary abnormalities in [[circumcised]] and [[uncircumcised]] boys presenting with an initial urinary tract infection by 6 months of age
+ |journal=Pediatrics
+ |date=1997
+ |volume=100 (Supplement)
+ |issue=
+ |page=580
+ |url=
+ |accessdate=
+}}</ref> did not find a significant difference in UTI rates between [[circumcised]] and [[intact]] boys with normal urinary tract anatomy.
+* Other studies suggest that circumcision is more likely to raise than to lower the generally low risk of acquiring UTI: multiple studies from [[Israel]] showed a strong correlation between ritual circumcision on the 8th day of life and postoperative UTI.<ref>{{REFjournal
+ |last=Menahem
+ |init=S
+ |title=Complications arising from ritual circumcision: pathogenesis and possible prevention
+ |journal=Isr J Med Sci
+ |date=1981
+ |volume=17
+ |issue=1
+ |pages=45-8
+ |url=
+ |accessdate=
+}}</ref><ref>{{REFjournal
+ |last=Cohen
+ |init=HA
+ |last2=Drucker
+ |init2=MM
+ |last3=Vainer
+ |init3=S
+ |etal=yes
+ |title=Postcircumcision urinary tract infection
+ |journal=Clin Pediatr
+ |date=1992
+ |volume=31
+ |issue=6
+ |pages=322-4
+ |url=
+ |accessdate=
+}}</ref><ref>{{REFjournal
+ |last=Goldman
+ |init=M
+ |last2=Barr
+ |init2=J
+ |last3=Bistritzer
+ |init3=T
+ |last4=Aladjem
+ |init4=M
+ |title=Urinary tract infection following ritual Jewish circumcision
+ |journal=Isr J Med Sci
+ |date=1996
+ |volume=32
+ |issue=
+ |pages=1098-1102
+ |url=
+ |accessdate=
+}}</ref>
+* It can be concluded that circumcision is ineffective as a preventive measure against [[UTI]].
+* Penile and cervical cancer / HPV: first studies on those diseases and their assumed prevention by circumcision date back to 1932, a time when the cause for those illnesses was not yet fully understood.<ref>{{Wolbarst1932}}</ref> Today, it is known that sexually transmitted human papillomavirus (HPV) is a major risk factor<ref>{{REFjournal
+ |last=McCance
+ |init=DJ
+ |last2=Kalache
+ |init2=A
+ |last3=Ashdown
+ |init3=K
+ |etal=yes
+ |title=Human papillomavirus types 16 and 18 in carcinomas of the penis from Brazil
+ |journal=Int J Cancer
+ |date=1986
+ |volume=37
+ |issue=1
+ |pages=55-9
+ |url=
+ |accessdate=
+}}</ref>, as well as smoking<ref>{{REFjournal
+ |last=Harish
+ |init=K
+ |last2=Ravi
+ |init2=R
+ |title=The role of tobacco in penile carcinoma
+ |journal=Brit J Urol
+ |date=1995
+ |volume=75
+ |issue=3
+ |pages=375-7
+ |url=
+ |accessdate=
+}}</ref>. Studies have shown that there is no significant difference in the risk of getting penile cancer between [[circumcised]] and [[intact]] men. To prevent a single case of penile cancer, it would statistically take 600 to 900 circumcisions<ref>{{REFdocument
+ |title=Position Paper on Neonatal Circumcision
+ |url=
+ |contribution=
+ |last=
+ |first=
+ |publisher=American Academy of Family Physicians (Leawood, Kansas)
+ |format=
+ |date=2002-02-14
+ |accessdate=
+}}</ref>. The influence of circumcision on the infection risk of the female partner with cervical cancer has been refuted several times as well. HPV vaccination is an effective measure against carcinoma of the cervix.
-=== Physical late effects ===
+In conclusion, circumcision does not provide any proven benefits in preventive medicine.
-* An unavoidable late effect of any circumcision is the permanent loss of sexual sensitivity. This is partly due to the removal of sensory tissue. The [[foreskin]] contains very many nerve endings and touch receptors, which account for the major part of male sexual sensation. If the [[foreskin]] is removed, they can no longer provide sexual stimulation. It is also partly due to the fact that the surface of the [[Glans penis|glans]] reacts to the missing protection from friction and drying out by developing a callus layer. This reduces the sensitivity of the remaining nerves in the [[Glans penis|glans]] gradually over the years. The study conducted by Sorrells et.al.<ref>Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult [[penis]]. BJU Int 2007;99:864-9.</ref>  found a significant reduction of sensitivity to touch for circumcised compared to intact [[penis]]es in adult males. Other studies revealed that circumcised men use condoms significantly less often than intact men, since they further limit the sexual sensitivity (see above).
+== Non-medical indications for circumcision ==
-* Painful tension can occur when there is too little reserve skin left to support a full erection<ref>Taylor, J.R., Lockwood, A.P., & Taylor, A.J. (1996). The prepuce: „Specialized mucosa of the [[penis]] and its loss to circumcision.“ British Journal of Urology, 77, 291-295.</ref>. This risk is partly dependent on the anatomy of the [[penis]]. While some [[penis]]es already have the majority of their full size when flaccid ([[Flesh Penis]], or "[[shower]]"), others are rather short when flaccid and double or more their size during an erection ([[Blood Penis]], or "[[grower]]"). Especially in children's circumcision, where the [[penis]] is not yet fully developed, the amount of reserve skin needed in adulthood cannot be estimated.
-* Erectile dysfunction: Both the damage inflicted to the blood vessels in the [[foreskin]] and the reduced sexual sensitivity can be causes for reduced erectile function with advancing age.<ref>Money, J., & Davison, J. (1983): Adult penile circumcision: Erotosexual and cosmetic sequelae. Journal of Sex Research, 19, 289-292</ref>
-* Orgasm problems: In the wake of reduced sexual sensitivity, due to the loss of sensory tissue and gradual keratinization of the surface of the [[Glans penis|glans]], orgasm problems may develop with increasing age. In this case, the sexual arousal created by intercourse or masturbation is not enough to achieve orgasm. A preliminary stage of this late effect is the prolonged time circumcised men need to reach an orgasm. This is often fielded as the "cut men have more endurance" argument for circumcision.
-* Vaginal dryness: Due to the loss of the natural gliding action, which comes from the mobility of the fore- and shaft skin, a much increased friction between [[penis]] and vagina occurs during intercourse. This can make intercourse painful for both partners and lead to abrasions<ref>[[Morten Frisch]], Morten Lindholm, Morten Grønbæk: Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark. In: International Journal of Epidemiology Oktober 2011, 40(5), S. 1367-1381, doi:10.1093/ije/dyr104, PMID 21672947.</ref><ref>Cortés-González, J., Arratia-Maqueo, J., & Gómez-Guerra, L. (2008): Does circumcision has an effect on female's perception of sexual satisfaction? Rev Invest Clin, 60(3), 227 PMID 18807735.</ref> The prolonged time it takes circumcised men to reach orgasm, as well as the often longer and more vigorous thrusting movements - compared to intact men - play a part in this.<ref>Cold CJ, Taylor JR. The prepuce BJU Int 1999;83 Suppl. 1:34-44.</ref><ref>Fink KS, Carson CC, DeVellis RF. Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction. J Urol 2002;167(5):2113-2116.</ref>
-=== Psychological late effects ===
+Apart from the [[medical indication]] of pathological phimosis, there also are other reasons for circumcision.
-Psychological late effects are also possible after a circumcision, especially if the operation was carried out in childhood. On this occasion a variety of trauma may occur, which depend, among others, on age and circumstances of the circumcision. For example, whether the circumcision took place with or without sufficient anaesthesia, if the individual has been informed about the operation beforehand, if he was circumcised against his will or without his consent, and also, in the case of infant circumcision, if he was told about it during childhood or had to find it out coincidentally on his own.
+=== Aesthetic reasons ===
-The psychological late effects of circumcision are not yet fully researched, and many studies took place on rather a small scale. This situation needs to be rectified, because the available studies, as well as the histories of negatively affected men, suggest that these late effects may have more impact than previously assumed.
+The visual appearance of the [[penis]] is changed radically after circumcision. In this case, personal taste is decisive whether an [[intact]] or a [[circumcised]] [[penis]] is more appealing. Since a circumcision cannot be undone, it is essential to be fully informed about the risks and possible later complications before embarking on an aesthetically motivated circumcision, to decide whether the appearance will justify such bodily modification.
-* It was observed that infants, following circumcision without pain control, had a disturbed bond with their mother<ref>Marshall RE, Porter FL, Rogers AG, et al. Circumcision: II effects upon mother-infant interaction. Early Hum Dev 1982; 7(4):367-74.</ref>, as well as problems with nurturing, up to the point of refusal to be fed. The sleeping habits of these babies were also disturbed, with prolonged non-REM sleep and increased waking.
+It should be noted that every circumcision operation leaves a life-long [[circumcision scar]] that encircles the shaft of the [[penis]]. In addition, there frequently a a color change at the circumcision scar which results in a two-tone appearance.
-* In boys circumcised in childhood, post traumatic stress disorder (PTSD) could be diagnosed. In a study on Philippine boys, in whom no PTSD was found prior to the operation, 69% of the boys circumcised in the traditional ritual and 51% of those circumcised by standard medical procedures (including anaesthesia) fulfilled the DSM-IV criteria for PTSD following the operation.<ref>Ramos S, Boyle GJ. Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder. In: Denniston GC, Hodges FM, Milos MF (eds) Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem. New York: Kluwer Academic/Plenum Publishers, 2001: pp. 253-70.</ref>
-* Circumcisions, especially those that happen without consent, can spark feelings of helplessness and alienation, which can persist as trauma. These feeling can also be triggered later, when someone circumcised as an infant becomes aware of his circumcision. In an online study, interviewed men stated they felt betrayed - 55% by the mother, 50% by the father, and 58% by the doctor, and 73% felt that their human rights had been violated.<ref>http://www.circumcisionharm.org/</ref>
-* It can frequently be found that the loss is denied, much as happens with the loss of other body parts. This denial can lead to fathers having their sons circumcised in order not to be reminded of their own loss. In this process, their own body is defined as "normal" and the [[foreskin]] redefined as a foreign object. Their own parents are seen as "good", so that this image is projected onto the circumcision their parents carried out as well, in order to keep the positive emotion intact. The father wants to be a "good" father later in life as well, and so, following an idealised image of his own parents, circumcision, which has been redefined as a "good thing", is passed on to his son by having him circumcised as well.<ref>van der Kolk BA. The compulsion to repeat the trauma: re-enactment, revictimization, and masochism. Psychiatr Clin North Am 1989;12(2):389-411.</ref><ref>Goldman R. The psychological impact of circumcision. BJU Int 1999;83 Suppl. 1:93-103.</ref>
-* If the circumcised male feels incomplete, or due to the missing [[foreskin]] disadvantaged compared to intact males, an inferiority complex and depression may occur. This can be accompanied by conscious recognition of his own incompleteness, or the deficiency may remain completely subconscious<ref>Rhinehart J. Neonatal circumcision reconsidered. Transactional Analysis J 1999;29(3):215-21.</ref>. In an online study, 75% of those interviewed stated that they felt incomplete, and 66% said they felt inferior compared with intact males.<ref>http://www.circumcisionharm.org/</ref>
-* Cases in which children felt ill treated or punished have been documented as well. G. Cansever found in her study on 12 boys aged between 4 and 7 years, who had previously been prepared for their impending circumcision, that the children experienced the operation as an aggressive assault on their bodies.<ref>Cansever, G. (1965). Psychological effects of circumcision. Brit. J. Med. Psychol. 38: 321-331.</ref>
-* Fear of being alone or darkness.<ref>David M. Levy, Psychic trauma of operations in children; and a note on combat neurosis, American Journal of Diseases of Children, Vol. 69, 1945, 7-25</ref>
-* Fear of doctors, clinics and also closed rooms.<ref>David M. Levy, Psychic trauma of operations in children; and a note on combat neurosis, American Journal of Diseases of Children, Vol. 69, 1945, 7-25</ref>
-* Relapse into the state of bed-wetting, even if the child was already dry before.<ref>David M. Levy, Psychic trauma of operations in children; and a note on combat neurosis, American Journal of Diseases of Children, Vol. 69, 1945, 7-25</ref>
-== Historical background ==
+Since this modification and its possible late effects will be the lifelong burden of the person who undertakes an aesthetically motivated circumcision to suit his personal preferences, a valid decision to proceed can only be made by the person to be [[circumcised]] himself, once he has reached the necessary age and level of maturity to make that decision. This should normally be the case when adulthood is reached.
-The amputation of the [[foreskin]] is a very old ritual, whose exact origin cannot be verified beyond doubt. Medical historians assume that circumcision already served in ancient history as a way to control the sexuality of slaves and members of the lower classes without compromising their ability to reproduce. In religious history circumcision may be seen as a substitute for human sacrifice. In prehistoric times it was not uncommon to placate the gods with human sacrifice. Castration of slaves or conquered enemies was common as well. Following religious changes this sacrifice was altered, and only a part of the very organ responsible for the creation of new life was sacrificed.
+===Financial reasons===
-[[Image:Circumcision Sakkara 3.jpg|200px|right]] For the Aborigines, the Australian natives, the tradition of circumcision is said to go back to 10,000 BC. On the African continent, the first circumcisions are assumed to have emerged around 6000 BC. From ancient Egypt hints of various forms of circumcision date back to the time around 3000-2000 BC. The oldest known depiction<ref>http://commons.wikimedia.org/wiki/File:Circumcision Sakkara 3.jpg</ref> is an Egyptian tomb relief from the 6th dynasty, approximately 2300-2000 BC. It is not known precisely who was circumcised and why in those times.
+In the United States, payment for non-therapeutic circumcision is made by most [[third-party payment| third-party payers]] without question of necessity. Doctors frequently perform medically-unnecessary, non-therapeutic circumcision of infants and children simply to collect a fee for the surgical operation. The only beneficiary of such surgery is the [[Financial Incentive| bank account of the medical doctor]].
-In many cultures circumcision during puberty serves as a rite of passage, bringing adolescents into the community. As with other painful or humiliating initiation rites, proof of courage and mastering of critical situations are the key motivations. From some African tribes it is also known that the amputation of the [[foreskin]] is seen as the removal of an inborn piece of femininity from the boys, thus making them men.
+=== Moral reasons ===
-In the Jewish religion, the tradition of circumcision goes back to a passage in the Book of Genesis (17, 10-14). It is seen as a covenant between God and man, dating back to the patriarch Abraham.
+With the [[foreskin]], circumcision removes approximately 70% of the sensitive tissue of the [[penis]], lowering the potential for sexual stimulation accordingly. Due to the loss of around 50% of the entire [[penile skin]], the [[penis]] loses the reserve skin that provides cutaneous mobility in the erect [[penis]] and the [[gliding action]].
-{{Citation
-| Text=10 This is my covenant with you and your descendants after you, the covenant you are to keep: Every male among you shall be circumcised. 11 You are to undergo circumcision, and it will be the sign of the covenant between me and you. 12 For the generations to come every male among you who is eight days old must be circumcised, including those born in your household or bought with money from a foreigner—those who are not your offspring. 13 Whether born in your household or bought with your money, they must be circumcised. My covenant in your flesh is to be an everlasting covenant. 14 Any uncircumcised male, who has not been circumcised in the flesh, will be cut off from his people; he has broken my covenant.”
-| Author=Bible
-| Source=Gen 17, 10-14, NIV
-}}
-According to the anthropologist and sociologist Nissan Rubin, the Jewish form of circumcision, called brit mila, during the first two millennia did not include the later customary periah, namely the complete scraping of the inner [[foreskin]] from the [[Glans penis|glans]]. This was only added around 135 AD, to make it impossible to restore the [[foreskin]] by stretching, which became popular in the wake of Hellenic influence. While originally only the tip of the [[foreskin]] was cut off, periah removes the entire [[foreskin]]. In the Greek society of the day, a denuded [[Glans penis|glans]] was considered obscene and risible. In ultra-orthodox communities, circumcision is followed by the [[mohel]], the ritual circumciser, sucking blood from the wound with his mouth. This practice is highly controversial, as it can result in an infection with herpes simplex type 1. In New York City, between 2000 and 2011 eleven children were infected with herpes, 10 of whom had to be treated in hospital. Two of them suffered permanent brain damage, two others died. In the 12th century, the Jewish philosopher and doctor Maimonides pointed out that circumcision was necessary, as it diminished sexual desires and reduced the pleasure to a degree just sufficient for mere reproduction.
-In Islam, circumcision is also religiously founded, even though there is no mention of it in the Koran itself. According to tradition, the Prophet Mohammed was born without a [[foreskin]]. It is seen as a sign of prophets that they are born without a [[foreskin]] already. It is considered an honour to "resemble the example of the Prophet", meaning to be circumcised. In Islam, unlike Judaism, there is no specific age at which the circumcision should be performed. Most circumcisions take place at ages between 6 and 10 years, but the range goes from birth to adulthood.
+In the past, this circumstance was used to make it harder for boys to masturbate and [[masturbation]] less fun, as [[masturbation]] was viewed as immoral and was assumed to cause a variety of mental diseases, caused by the thinking of immoral thoughts! More on that can be found in the chapter "[[Circumcision#Historical_background|Historical background]]". Today, it is known that [[masturbation]] has no negative health effects, but can contribute positively to the child's sexual development. Sexuality is no longer a taboo nowadays, while [[masturbation]] is considered to be a natural part of human sexuality and is no longer seen as immoral. Therefore, circumcision for moral reasons — which would only affect boys too young to give [[informed consent]] — is no longer justifiable nowadays.
-In Christianity, circumcision is only common in a few orthodox churches. Nevertheless, Christian moral notions had decisive influence on the spread of this practice. In the puritan influenced USA, circumcision of children was popular in the 19th century as a means to prevent masturbation. In those days, this so-called ‘self-abuse‘ was not only considered immoral, but was supposedly responsible for a variety of diseases. Even the mere existence of a [[foreskin]] was linked to many illnesses. Among them one could find syphilis, epilepsy, paralysis of the spine, bed wetting, scoliosis (spinal deformity), paralysis of the bladder, club foot, nerve pain in the lower abdomen, tuberculosis and lazy eye. One of the best known advocates of child circumcision was [[John Harvey Kellogg]], co-inventor of the Corn Flakes bearing his name. In 1888, he wrote:
+=== Hygiene reasons ===
-{{Citation
-| Text=A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of [[phimosis]]. The operation should be performed by a surgeon without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement, and preventing the recurrence of the practice in those whose will-power has become so weakened that the patient is unable to exercise entire self-control.
-| Author=John Harvey Kellogg
-| Source=
-| ref=<ref>Treatment for Self-abuse and Its Effects, Plain Facts for Old and Young, Burlington, Iowa, F. Segner & Co. (1888) p. 107</ref>
-}}
-Following the discovery of bacteria as a cause of many diseases – such as tuberculosis – the search began for other illnesses that could be prevented by circumcision.
-In the 1920s it was penile cancer<ref>Abraham L. Wolbarst behauptet, die Beschneidung könne dem Peniskrebs vorbeugen. [Is circumcision a prophylactic against penis cancer? Cancer 1926 Jul;3(4):301-10]</ref>, in the 1940 prostate- and tongue cancer as well as STDs<ref>Eugene H. Hand erklärt, dass die Beschneidung irgendwie gegen Geschlechtskrankheiten und Zungenkrebs
+''Hygiene'' refers to health and only secondarily to cleanliness.
-schütze. [Circumcision and venereal disease. Archives of Dermatology and Syphilology 1949 Sep;60(3):341-6]</ref>, in the 1950s it was cervical cancer<ref>Abraham Ravich erfindet den Mythos, die Beschneidung verringere das Risiko von Frauen an Gebärmutterhalskrebs zu erkranken. [Prophylaxis of cancer of the prostate, penis, and cervix by circumcision. New York State Journal of Medicine 1951 Jun;51(12):1519-20</ref>, in the late 1960s it was neuroses<ref>Morris Fishbein fordert die Beschneidung zur Prävention von Nervosität und natürlich auch Masturbation. [Sex hygiene. Modern Home Medical Adviser. Garden City, New York: Doubleday & Co: 1969 pp 90, 119]</ref>, in the 1970s bladder- and rectal cancer<ref>Abraham Ravich behauptet, dass die Beschneidung Blasenkrebs und Rektumskrebs vorbeugen würde. [Viral carcinogenesis in venereally susceptible organs. Cancer 1971 Jun;27(6)1493-6]</ref>, nd in the 1980s UTIs<ref>Thomas E. Wiswell behauptet, eine Beschneidung verringere das Risiko für Harntraktinfektionen. [Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics 1985 May;75(5):901-3]</ref> and AIDS<ref>Aaron J. Fink behauptet, dass die Beschneidung gegen AIDS schütze. [A possible explanation for heterosexual male infection with AIDS. New England Journal of Medicine 1986 Oct 30;31(18):1167]</ref> followed. Retrospectively, circumcision was always advertised as a cure for whatever disease was in the public spotlight at the time.
-The sheer mass of studies and publications that were released during those almost 180 years on this topic are the reason that even arguments that have been disproved multiple times, especially regarding infant and child circumcision, tenaciously persist up until today.
+One should note that the human [[foreskin]] is endowed by nature with [[Foreskin#Immunological_functions| immunological functions]] that serve to protect the human body from disease.<ref name="fleiss-hodges-vanhowe1998"/> The [[glans penis]] receives blood through the frenular artery.<ref>{{REFjournal
+ |last=Persad
+ |init=R
+ |author-link=
+ |last2=Sharma
+ |init2=S
+ |author2-link=
+ |last3=McTavish
+ |init3=J
+ |author3-link=
+ |etal=yes
+ |title=Clinical presentation and pathophysiology of meatal stenosis following circumcision
+ |journal=Brit J Urol
+ |date=1995
+ |volume=75
+ |issue=1
+ |pages=91-3
+ |url=https://www.onlinelibrary.wiley.com/doi/abs/10.1111/j.1464-410X.1995.tb07242.x
+ |quote=
+ |pubmedID=7850308
+ |pubmedCID=
+ |DOI=10.1111/j.1464-410x.1995.tb07242.x
+ |accessdate=2019-11-26
+}}</ref> These facts are generally overlooked in arguments for alleged hygienic benefits of circumcision.
-An ever-recurring element of initiation rites found in many different cultures is the fixation upon the genitalia.
+A common reason stated for circumcision is the assumption of hygienic benefits. This argument has to be viewed in the context of the environment the person in question grows up in. It is commonly known that bad hygienic circumstances, especially insufficient access to clean drinking water, pose a serious problem. The situation in disaster areas or refugee camps in the so-called third world keep reminding us of that.
-It reflects the fascination that emerges from the ability to create new life. In most cultures, fertility is seen as the most precious good, and the body parts involved frequently find themselves in the focus of ritual acts. In many parts of the world, those rites take place when the boy reaches puberty, and are meant to symbolize his transition from boy to man. The removal of the male [[foreskin]] is just one of many phenomena that developed in this context. They range from the removal of the frenulum in boys and men through partial or complete removal of the [[foreskin]] up to radical operations. Australian Aborigines, as mentioned above, have their [[foreskin]]s removed. It is also usual that, a few weeks later, young men have their [[penis]]es sliced open, resulting in a partly or completely divided urethra.
+In western industrial nations, however, this problem does not exist, in view of the availability of clean water for daily personal hygiene. If the cleaning of the genitals is performed on a daily basis — and that may be assumed — no pathogens can accumulate under the [[foreskin]]. Cleaning of the [[Glans penis|glans]] and the [[preputial sac]] underneath the [[foreskin]] is easy — they are simply [[Preputial_sac#Washing| washed with warm water along with the rest of the body]], just like the areas between the toes.
-Another known, particularly massive, intervention is the stripping of the entire skin off the [[penis]]. In Indonesia, boys have metal or bamboo balls inserted into their [[penis]] shaft or [[Glans penis|glans]] at the beginning of puberty, which form little "humps".
+In small boys, where the [[foreskin]] cannot be retracted yet, cleaning is not necessary, since the [[Synechia| membrane]] that fuses the [[foreskin]] to the [[Glans penis|glans]] prevents the accumulation of micro-organisms. The so-called "[[Ballooning of the foreskin| ballooning]]", where the [[foreskin]] inflates during urination, is not a concern.
-For many cultures it is also common to perform similar rituals on girls. This can range from relatively small interventions such as piercing or cutting the clitoral hood, to its complete removal and up to radical removal of clitoral hood, clitoris, inner and outer labia followed by sewing up the vagina.
+The opening of the [[foreskin]] in small boys is often quite narrow and serves as a one-way valve, allowing the [[urine]] to flow out, but preventing entry of microbes, for example from a dirty diaper. As long as the child is able to pass water, everything works as nature intended.
-== Rights and Ethics ==
+But even in areas where there are poorer hygienic conditions and an insufficient access to medical care, the benefits of easier cleaning of a [[circumcised]] [[penis]] are to be viewed with a critical eye. Although even longer periods without personal hygiene will not result in an accumulation of germs under the [[foreskin]], circumcision itself is not without risk of complications. If the operation is carried out without proper sterility, there is a high risk of an [[infection]] of the wound. This also applies to the treatment of common complications like post-operative [[bleeding]].
-The [[/Rights situation/]] is discussed in a subpage of this article.
+The benefit of easier cleaning must be balanced against the risk of promoting serious infections — among others [[HIV]] — during the operation. In parts of Africa, several dozen of one tribe's boys die each year as a result of their circumcision.
-=== Legal and ethical issues ===
+== Circumcision methods ==
-Considering the severity of the intrusion into the body of the affected person, the question arises, whether it is both legally and morally acceptable to leave the decision about a non-therapeutic operation on a child too young to understand or give valid consent, to the parents alone. In Germany, several basic rights are concerned:
+The [[Circumcision methods]] are discussed in a separate article.
+== Pain ==
+It is too dangerous to administer general anesthesia to newborn infants, so infant boys experience severe pain during circumcision.<ref name="garrett2024-01-09">{{REFweb
+ |url=https://intactamerica.org/disadvantages-of-circumcision/
+ |title=10 Disadvantages of Circumcision & Horrifying Facts
+ |last=Garrett
+ |first=Connor
+ |init=
+ |author-link=Connor Judson Garrett
+ |publisher=Intact America
+ |date=2024-01-09
+ |accessdate=3034-06-04
+}}</ref>
+In the past, advocates of circumcision claimed that a newborn child's nerve system was not yet fully developed, and that as a result, the child felt no [[pain]] during the circumcision procedure. [[Kanwaljeet J. Singh Anand| Anand]] & Hickey (1987) have shown that newborn children do in fact feel [[pain]], and more acutely than adults.<ref name="anand-hickey1987">{{REFjournal
+ |last=Anand
+ |first=KJS
+ |author-link=Kanwaljeet J. Singh Anand
+ |last2=Hickey
+ |first2=PR
+ |author2-link=
+ |etal=no
+ |title=Pain and its effects in the human neonate and fetus
+ |trans-title=
+ |language=
+ |journal=New Engl J Med
+ |location=
+ |date=1987-11-19
+ |volume=317
+ |issue=21
+ |pages=1321-9
+ |url=https://www.cirp.org/library/pain/anand/
+ |quote=However, in decisions about the use of these techniques, current knowledge suggests that humane considerations should apply as forcefully to the care of neonates and young, nonverbal infants as they do to children and adults in similar painful and stressful situations.
+ |pubmedID=3317037
+ |pubmedCID=
+ |DOI=10.1056/NEJM198711193172105
+ |accessdate=2019-11-08
+}}</ref> This has led American health associations to recommend doctors take measures to reduce the [[pain]] of circumcision in infants.
-* the right to bodily integrity
+The [https://www.cirp.org/library/statements/aap1999/|AAP Circumcision Policy Statement] (1999) states quite clearly that ''"There is considerable evidence that newborns who are [[circumcised]] without analgesia experience pain and physiologic stress"''. Furthermore, the pain is quite severe, and requires injections for proper pain management. Sucrose and Acetaminophen ''"cannot be recommended as the sole method of analgesia"''. Topical cream is no longer thought sufficient as ''"the analgesic effect is limited during the phases associated with extensive tissue trauma such as...tightening of the clamp"''.<ref>{{REFjournal
-* the right to sexual self-determination
+ |last=
-* the right to equal treatment of genders (circumcision/FGM of females is illegal)
+ |first=
-* the right to religious freedom (where the circumcision has a religious motive)
+ |title=American Academy of Pediatrics: Circumcision Policy Statement; Task Force on Circumcision
+ |journal=Pediatrics
-These four basic rights are relevant from the legal as well as the ethical point of view.
+ |date=1999-03
+ |volume=103
-Let us begin with the most obvious intrusion - the one into the bodily integrity. Under German law, children enjoy far-reaching protection, that limits the parental rights and the powers delegated to third persons overseeing the upbringing (such as kindergarten staff or teachers). Methods of upbringing that may cause physical or mental harm are prohibited. This is not only corporal punishment, which was common in families, schools and vocational training for ages, which may cause direct (and sometimes severe) bodily harm - it also covers spanking, which is included under degrading treatment. It is assumed that not only does the immediate injury harm the child, but also the feeling of helplessness and of being at someone's mercy at the time of punishment by an authority figure. This also applies to other treatment that harms the dignity of a child - for example being forced to publicly change clothes in front of the kindergarten group after wetting his pants.
+ |issue=3
+ |pages=686-93
+ |url=https://pediatrics.aappublications.org/content/103/3/686#sec-9
+ |accessdate=2019-11-26
+ |note=Statement Reaffirmed Sept. 1, 2005
+}}</ref>
-If you take a look at the list of possible bodily and mental harms and late-effects listed in [[Circumcision#Risks_and_late_effects|"Risks and late effects"]], the imbalance becomes apparent. Spanking is already unlawful, but the irreversible amputation of an important, healthy part of the genital organ is not. The inevitable and possible consequences of this operation are ignored to a degree that is in harsh contrast to the established protection of children. Legalization, therefore, represents a considerable limitation of the male child's right to bodily integrity and protection from potentially harmful methods of upbringing.
+The [[AAFP]] (2002) states quite simply in their [https://www.cirp.org/library/statements/aafp2002/| position paper], ''"Newborns experience pain during circumcision".''<ref>{{REFweb
+ |title=Circumcision: Position Paper on Neonatal Circumcision. Board Approved: August 2007 Reaffirmed
+ |website=Official American Academy of Family Physicians Website
+ |url=http://www.aafp.org/online/en/home/clinical/clinicalrecs/children/circumcision.html
+ |accessdate=2011-05-02
+}}</ref> This is not a debatable fact, and yet, it is not widely accepted, even by some doctors. It might be hard for some doctors to accept, as they may have been taught that the infant does not feel [[pain]], and may have performed countless circumcisions with this idea. Usage of anesthesia for infant circumcision is still by no means the rule.
-There are also ethical problems. Can a child be denied the right to determine the visible appearance and degree of functionality of his body? Should a circumcised boy later in life decide that he would prefer to have an intact [[penis]], he has no means of reversing the decision his parents made. Other people's ideas about his body‘s appearance and functionality are imposed upon him irreversibly. He is denied the possibility of deciding upon that according to his own preferences, which can lead to inferiority complexes and depression - regardless of the parents‘ reasons or their idea of what would be best for their child. So great a level of paternalism regarding such a severe intrusion, especially in the most intimate area of the child, cannot be justified by the parents‘ will.
+Penile injections of local anesthetic are now recommended by all of the major medical institutions if a circumcision is to be performed. In their [http://www.ama-assn.org/ama/no-index/about-ama/13585.shtml Report 10 of the Council on Scientific Affairs], the AMA states ''"When the decision is made to proceed with circumcision, local anesthesia should be provided for the procedure. [[Ring block]] or [[dorsal penile nerve block]] [injections] are most effective. [[EMLA]] cream has limited utility"''. Alarmingly, ''"Despite the clear evidence that newborn males generate brisk pain responses during circumcision, a recent survey of residency training programs found that 26% of programs that taught circumcision provided no instruction on the use of local anesthesia". The AMA reports that "Of physicians performing circumcision, 45% use anesthesia, 71% of pediatricians, 56% of family practitioners, and 25% of obstetricians"''.<ref>{{REFweb
+ |title=Report 10 of the Council on Scientific Affairs (I-99): Neonatal Circumcision
+ |website=American Medical Association Official Website
+ |url=http://www.ama-assn.org/ama/no-index/about-ama/13585.shtml
+ |accessdate=2011-05-04
+}}</ref>
-It is not much different with the right to sexual self-determination. Here, the consequences that circumcision has and can have for the body, play a significant role. Normally, a man has free choice as to how he wants to experience his sexuality. It is solely up to him to decide in which way he wants to be stimulated, and he can - if he so desires - limit his sexual experience without a problem. A circumcised man does not have these options. The full range of his sexual experience and sensation is not available to him due the to bodily modification.
+The AAP's [http://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/pages/Where-We-Stand-Circumcision.aspx Heatlhy Children website] suggests ''"Your pediatrician (or your obstetrician) should discuss the forms of analgesia that are available"''.<ref>{{REFweb
+ |title=Where We Stand: Circumcision
+ |publisher=[[AAP]]
+ |date=2011-03-23
+ |url=http://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/pages/Where-We-Stand-Circumcision.aspx
+ |accessdate=2019-10-12
+}}</ref> Be that as it may, few forms of analgesia are recommended. There are basically two types of injections to choose from, and the website does not go into the difference between a 'dorsal nerve block' and a 'ring block' injection.
-An intact [[penis]] enables many men to reach orgasm just by manipulation of the [[foreskin]]. During masturbation, the man can choose whether he wants to stimulate the [[Glans penis|glans]] directly or indirectly through the movement of the [[foreskin]]. Since he has the full, naturally given potential of sensitivity at his disposal, he can use it to according to his own preferences. The circumcised man, however, does not have that freedom of choice. He has neither the opportunity to include the [[foreskin]] into the stimulation, nor can he utilize its nerves and touch receptors. He also only has access to 15-50% of the potential sensitivity of an intact man, depending on the amount and kind of tissue that was removed, and the degree of keratinization of the [[Glans penis|glans]]. In some cases, the limitation can be even more severe. On a heavily desensitized [[penis]], condoms can limit the sexual stimulation to the point where not enough arousal can be built up to reach an orgasm - which means that fulfilling safer sex is not possible.
+Given what is known from aforementioned official documents, the AAP website may be more informative and effective if it would say ''"Make sure your doctor knows of the ineffectiveness of anything short of local anesthesia, and make sure your baby is given an injection. This is your responsibility, because your doctor may or may not be up to date on the latest understandings of infant sensitivity to [[pain]] during circumcision."'' The AAP may be holding back, however, perhaps because this would upset the doctor/parent power relationship, and may cause too much questioning of doctors in general. One may not expect to find this kind of advice on such a website, and yet, anything less than this is a dangerously weak statement.
-In particular, the tight styles of circumcision bear the risk, that the loss of the friction-reducing gliding effect leads to unpleasant feelings or even pain for both partners during intercourse. The ability to masturbate without aid - for example, from lubricants - can be significantly reduced or even be lost in such a case. In a study<ref>DaiSik Kim, Myung-Geol Pang: The effect of male circumcision on sexuality. In: BJU international, Volume 99, Issue 3, März 2007, S. 619-622. doi:10.1111/j.1464-410X.2006.06646.x, PMID 17155977</ref>, 63% of the men interviewed reported problems with masturbation after being circumcised. If a boy or man is circumcised, without him making that decision for himself after thorough consideration and in full knowledge and understanding of all possible consequences, he is denied his constitutionally guaranteed freedom to experience his sexuality according to his own preferences. This is much like parental interference to promote a prohibition of masturbation, or to inhibit a homosexual relationship - with the key difference that the parental intervention in form of a circumcision, unlike prohibitions during childhood, will have an irreversible, lifelong effect. Both do not comply with modern views of children's well-being and accepting the child as an autonomous individual, and are, therefore, not ethically justifiable.
+To control [[pain]], some physicians that circumcise use Tylenol, sugar,<ref>{{REFweb
+ |quote=To calm the baby during the procedure, a sugar filled gauze pacifier soaked with sweet juice is used, and soothing music is played in the room.
+ |url=http://www.pollockclinics.com/circumcision/circumcision-guide.html
+ |title=Parents' Guide to Circumcision
+ |last=
+ |first=
+ |publisher=
+ |date=
+ |accessdate=2011-04-08
+}}</ref><ref>{{REFweb
+ |quote=During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions.
+ |url=http://www.pollockclinics.com/circumcision/circumcision-before.html
+ |title=Before the Circumcision
+ |last=
+ |first=
+ |publisher=
+ |date=2011-04-08
+ |accessdate=2011-04-08
+}}</ref> a topical cream,<ref>{{REFweb
+ |quote=Then in our office, he will have topical anesthetic applied to his penis.
+ |url=http://www.pollockclinics.com/circumcision/circumcision-before.html
+ |title=Before the Circumcision
+ |last=
+ |first=
+ |publisher=
+ |date=2011-04-08
+ |accessdate=2011-04-08
+}}</ref> and/or a local anaesthetic injection called a dorsal penile ring block.<ref>{{REFweb
+ |quote=We use extensive pain control methods including Tylenol, a sugar solution (to reduce pain perceptions), a topical freezing cream, and a local anesthetic injection.
+ |url=http://www.pollockclinics.com/circumcision/circumcision-guide.html
+ |title=Parents' Guide to Circumcision
+ |last=
+ |first=
+ |publisher=
+ |date=
+ |accessdate=2011-04-08
+}}</ref> Topical anaesthetic only serves to numb the area to lessen the pain of the injection, but studies have shown that a [[dorsal penile nerve block]] is only partially effective in stopping the [[Pain| pain of circumcision]].<ref name="Journal of Perinatology April/May 2002">{{REFjournal
+ |last=Taeusch
+ |first=H. William
+ |init=HW
+ |last2=Martinez
+ |first2=Alma M.
+ |init2=AM
+ |last3=Partridge
+ |first3=J. Colin
+ |init3=JC
+ |last4=Sniderman
+ |first4=Susan
+ |init4=S
+ |last5=Armstrong-Wells
+ |first5=Jennifer
+ |init5=J
+ |last6=Fuentes-Afflick
+ |first6=Elena
+ |init6=E
+ |title=Pain During Mogen or Plastibell Circumcision
+ |journal=Journal of Perinatology
+ |volume=22
+ |issue=3
+ |pages=214-8
+ |url=http://www.nature.com/jp/journal/v22/n3/full/7210653a.html
+ |quote=...more than half of the study group had what we considered excessive pain/discomfort over the course of the entire procedure.
+ |pubmedID=
+ |pubmedCID=
+ |DOI=
+ |note=April/May 2002
+ |date=2002-04
+ |accessdate=2011-04-08
+}}</ref><ref name="Clinical Pediatrics August 1986">{{REFjournal
+ |last=Williamson
+ |first=Paul S.
+ |init=PS
+ |last2=Evans
+ |first2=Nolan Donovan
+ |init2=ND
+ |title=Neonatal Cortisol Response to Circumcision with Anesthesia
+ |journal=Clinical Pediatrics
+ |volume=25
+ |issue=8
+ |pages=412-6
+ |url=http://cpj.sagepub.com/content/25/8/412.abstract
+ |quote=The adrenal cortisol response to surgery was not significantly reduced by the administration of lidocaine.
+ |pubmedID=
+ |pubmedCID=
+ |DOI=
+ |date=1986-08
+ |accessdate=2011-04-08
+}}</ref> During circumcision, somp physicians give children sugar pacifiers to "reduce the perception of pain",<ref>{{REFweb
+ |quote=During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions.
+ |url=http://www.pollockclinics.com/circumcision/circumcision-before.html
+ |title=Before the Circumcision
+ |last=
+ |first=
+ |publisher=
+ |date=2011-04-08
+ |accessdate=2011-04-08
+}}</ref> but in at least one study, data shows that giving sugar to a child doesn't help to reduce the perception of pain in the child.<ref name="Lancet, The 2010-10-09">{{REFjournal
+ |last=Slater
+ |first=Rebeccah
+ |init=R
+ |first2=Laura
+ |init2=L
+ |last2=Cornelissen
+ |first3=Lorenzo
+ |init3=L
+ |last3=Fabrizi
+ |first4=Debbie
+ |init4=D
+ |last4=Patten
+ |first5=Jan
+ |init5=J
+ |last5=Yoxen
+ |first6=Alan
+ |init6=A
+ |last6=Worley
+ |first7=Stewart
+ |init7=S
+ |last7=Boyd
+ |first8=Judith
+ |init8=J
+ |last8=Meek
+ |first9=Maria
+ |init9=M
+ |last9=Prof. Fitzgerald
+ |title=Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial
+ |journal=The Lancet
+ |volume=376
+ |issue=9748
+ |pages=1225-32
+ |url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961303-7/fulltext
+ |quote=Our data suggest that oral sucrose does not significantly affect activity in neonatal brain or spinal cord nociceptive circuits, and therefore might not be an effective analgesic drug. The ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief.
+ |pubmedID=
+ |pubmedCID=
+ |DOI=
+ |date=2010-10-09
+ |accessdate=2011-04-08
+}}</ref> Post-operative pain and the pain the child must endure during recovery is hardly, if ever, addressed by professionals.
-The basic right to equal treatment of the sexes is also breached, since girls are legally protected from violations of their genital integrity, while boys are not. This not only contradicts the constitution, but also is contrary to all efforts of equal treatment. Because in this case, decisions are made during childhood that will affect the entire later life, it equals the attempt to have certain educational grades open to one gender unconditionally, while giving parents the right to deny them to the other gender for life. That such an unequal treatment of genders is not justifiable, neither legally nor morally, is obvious.
+It has been shown that an infant's response to [[pain]] can be altered for years as a consequence of circumcision.<ref>{{TaddioA etal 1995}}</ref><ref>{{TaddioA KatzJ IlersichAL KorenG 1997}}</ref>
-Last not least, religious freedom is impaired. If a boy is circumcised for religious reasons as a child before he reaches the age of competence, he will carry the sign of that religion on his body for his entire life - even if he decides to abjure that religion in the course of his life.
+{{Box|Boxtext=<big><b>However, none of the above three procedures totally eliminate pain. A baby boy will still experience some pain despite any of those analgesic procedures. Prevention of [[pain]] requires protecting a boy from elective neonatal non-therapeutic circumcision. Only boys who are protected from the medically unnecessary circumcision surgery experience no [[pain]] or [[trauma]].</b></big>}}
-While his condition will not keep him from changing his religion, or to renounce it entirely, he has no way to discard the symbol of his old religion. This could be compared to a tattoo in the form of a religious symbol, with the difference that such a tattoo could still be removed by laser or covered with a new tattoo, if need be.
+== Risks and effects ==
+Just like tonsil or appendix surgery, circumcision is a surgical intervention and brings the usual risks related to surgical operations, alongside several specific risks of complications and late effects.<ref name="garrett2024-01-09" /> Uberoi et al. (2022) report "some men are experiencing a complex negative constellation of psychological, physical, and sexual associations that lead to significant emotional distress directed both internally and externally. The posts also reveal a discovery phenomenon wherein men discover the physical and psychological manifestations of the decisions made by others to modify their genitals."<ref name ="uberoi2022">{{REFjournal
+ |last=Uberoi
+ |first=
+ |init=M
+ |author-link=
+ |last2=Abdulcadir
+ |first2=
+ |init2=J
+ |author2-link=
+ |last3=Ohi
+ |first3=
+ |init3=DA
+ |author3-link=
+ |last4=Santiago
+ |first4=
+ |init4=JE
+ |author4-link=
+ |last5=
+ |first5=
+ |init5=
+ |author5-link=
+ |last6=
+ |first6=
+ |init6=
+ |author6-link=
+ |last7=
+ |first7=
+ |init7=
+ |author7-link=
+ |last8=
+ |first8=
+ |init8=
+ |author8-link=
+ |last9=
+ |first9=
+ |init9=
+ |author9-link=
+ |etal=yes
+ |title=Potentially under-recognized late-stage physical and psychosexual complications of non-therapeutic neonatal penile circumcision: a qualitative and quantitative analysis of self-reports from an online community forum
+ |trans-title=
+ |language=
+ |journal=Int J Impot Res
+ |location=
+ |date=2022-10-23
+ |volume=
+ |issue=
+ |article=
+ |page=
+ |pages=
+ |url=https://www.nature.com/articles/s41443-022-00619-8
+ |archived=
+ |quote=
+ |pubmedID=36274189
+ |pubmedCID=
+ |DOI=10.1038/s41443-022-00619-8
+ |accessdate=2023-01-08
+}}</ref>
-Therefore a circumcision does not impair the ability to change religion, but it makes it impossible to discard one's old religion entirely. This is not only a violation of the basic law, it is also ethically unjustifiable to force someone to carry a religious symbol for his entire life - especially in his most private body area.
+=== Physical effects ===
+* [[Bodily harm]]
+* [[Circumcision scar]] is an invariable effect.
+* [https://intactamerica.org/ask-marilyn-is-it-normal-to-have-hair-on-your-penis/ Hair on the penis] is a common effect.
+* An unavoidable effect of any circumcision is the permanent loss of sexual sensitivity.<ref name="garrett2024-01-09" /> This is partly due to the removal of sensory tissue. The [[foreskin]] contains very many nerve endings and touch receptors, which account for the major part of male sexual sensation. If the [[foreskin]] is removed, they can no longer provide sexual stimulation. It is also partly due to the fact that the surface of the [[Glans penis|glans]] reacts to the missing protection from friction and drying out by developing a callus layer. This reduces the sensitivity of the remaining nerves in the [[Glans penis|glans]] gradually over the years. The study conducted by Sorrells et al.<ref>{{Sorrells etal 2007}}</ref> found a significant reduction of sensitivity to touch for [[circumcised]] compared to [[intact]] [[penis]]es in adult males. Other studies revealed that [[circumcised]] men use condoms significantly less often than [[intact]] men, since they further limit the sexual sensitivity (see above).
-So why is circumcision tolerated as a means of upbringing, and even explicitly legalized? In Germany, this stems from - although it is not stated in the law for legal reasons - the belief that a ban would impair the religious freedom of the parents. Even though it is stated in Art.140 GG (German basic law):
+* Painful tension can occur when there is too little reserve [[skin]] left to support a full [[erection]]<ref name="taylor1996"/>. This risk is partly dependent on the anatomy of the [[penis]]. While some [[penis]]es already have the majority of their full size when flaccid ([[Flesh Penis]], or "[[shower]]"), others are rather short when flaccid and double or more their size during an [[erection]] ([[Blood Penis]], or "[[grower]]"). Especially in children's circumcision, where the [[penis]] is not yet fully developed, the amount of reserve [[skin]] needed in adulthood cannot be estimated.
-<blockquote>
+* Erectile dysfunction: Both the damage inflicted to the blood vessels in the [[foreskin]] and the reduced sexual sensitivity can be causes for reduced erectile function with advancing age.<ref>{{REFjournal
-''(1) Civic rights and duties are neither dependant on, nor impaired by, the exercise of religious freedom.''
+ |last=Money
+ |init=J
+ |last2=Davison
+ |init2=J
+ |title=Adult penile circumcision: Erotosexual and cosmetic sequelae
+ |journal=Journal of Sex Research
+ |date=1983
+ |volume=19
+ |issue=
+ |pages=289-92
+ |url=
+ |accessdate=
+}}</ref>
-''[...]''
+* Orgasm problems: In the wake of reduced sexual sensitivity, due to the loss of sensory tissue and gradual [[keratinization]] of the surface of the [[Glans penis|glans]], orgasm problems may develop with increasing age. In this case, the sexual arousal created by intercourse or [[masturbation]] is not enough to achieve orgasm. A preliminary stage of this late effect is the prolonged time [[circumcised]]] men need to reach an orgasm. This is often fielded as the "cut men have more endurance" argument for circumcision.
+* Vaginal dryness: Due to the loss of the natural [[gliding action]], which comes from the mobility of the [[foreskin]] and [[shaft skin]], a much increased friction between [[penis]] and [[vagina]] occurs during intercourse. This can make intercourse painful for both partners and lead to abrasions<ref>{{FrischM LindholmM GroenbaekM 2011}}</ref><ref>{{REFjournal
+ |last=Cortés-González
+ |init=J
+ |last2=Arratia-Maqueo
+ |init2=J
+ |last3=Gómez-Guerra
+ |init3=L
+ |title=Does circumcision has an effect on female's perception of sexual satisfaction?
+ |journal=Rev Invest Clin
+ |date=2008
+ |volume=60
+ |issue=3
+ |page=227
+ |url=
+ |pubmedID=18807735
+ |accessdate=
+}}</ref> The prolonged time it takes [[circumcised]] men to reach orgasm, as well as the often longer and more vigorous thrusting movements - compared to [[intact]] men - play a part in this.<ref name="ColdCJ TaylorJR 1999">{{ColdCJ TaylorJR 1999}}</ref><ref>{{REFjournal
+ |last=Fink
+ |init=KS
+ |last2=Carson
+ |init2=CC
+ |last3=DeVellis
+ |init3=RF
+ |title=Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction
+ |journal=J Urol
+ |date=2002
+ |volume=167
+ |issue=5
+ |pages=2113-6
+ |url=
+ |accessdate=
+}}</ref>
-''(4) No one may be forced to take part in a religious act or ceremony, or to participation in religious rites or to the use of a religious oath.''
+* [[Lymphoedema]] of the penis is a normal and expected complication of male circumcision.
-</blockquote>
-Still, it was considered intolerable for the parents to be unable to perform a religious rite that involved interference with the body of another person - in the case of that person being their son. While normally the religious freedom ends "at someone else‘s nose", an exemption was legalized to enable parents to comply with their own, personal, religious duties, even if that means that several of their son's basic rights are impaired. This does, however, not apply for other religious traditions, so that a ritual beating - no matter how religiously important it may be to the parents - is still considered child abuse and would likely result in the loss of child custody here.
+* [[Meatal stenosis]], a pathological narrowing of the opening of the [[urethra]], which mostly occurs in infancy and early childhood. It is one of the most common complications of infant circumcision. A study from 2006 found meatal stenosis exclusively in previously [[circumcised]] boys. The incidence rate after a circumcision is approximately 10 to 20 percent.<ref name="vanhowe2006">{{REFjournal
+ |last=Van Howe
+ |init=RS
+ |author-link=Robert S. Van Howe
+ |title=Incidence of meatal stenosis following neonatal circumcision in a primary care setting
+ |journal=Clin Pediatr (Phila)
+ |note=Jan-Feb 2006
+ |date=2006-01
+ |volume=45
+ |issue=1
+ |pages=49-54
+ |url=https://www.academia.edu/6992015/Incidence_of_Meatal_Stenosis_following_Neonatal_Circumcision_in_a_Primary_Care_Setting
+ |accessdate=2019-12-15
+}}</ref><ref>{{REFjournal
+ |last=Stenram
+ |init=A
+ |last2=Malmfors
+ |init2=G
+ |last3=Okmian
+ |init3=L
+ |title=Circumcision for [[phimosis]]: a follow-up study
+ |journal=Scandinavian journal of urology and nephrology
+ |date=1986
+ |volume=20
+ |issue=2
+ |page=89
+ |url=
+ |pubmedID=3749823
+ |accessdate=
+}}</ref><ref>{{REFweb
+ |url=http://emedicine.medscape.com/article/1016016-overview
+ |title=Meatal Stenosis
+ |publisher=Medscape
+ |accessdate=2019-10-11
+}}</ref>
-=== Business Interests ===
+* Shorter adult penile length was reported by Park et al. (2016) as a result of NMC (newborn male circumcision).
+{{Citation
-Only very few will supposedly know that circumcision has become a lucrative business. Not only the operation itself, but also the potentially needed aftercare, bring profits. But while this is still obvious, there are also other trades that make money from it.
+ |Title=
+ |Text=In conclusion, second to fourth digit ratio, flaccid penile length, and age of circumcision were significant predictive factors for erectile penile length. Furthermore, the penile lengths of the NMC group were shorter than those of the non-NMC group.
-Baby [[foreskin]]s are a coveted resource. Under the name "Apligraf" an artificial skin product is marketed worldwide, which is used - among other uses - as an alternative to skin grafts using the patient’s own skin. It is grown from the [[foreskin]]s of children as young as possible. Since they are also mostly free of pathogenic organisms, they are also used as the basis for collagen, which is, among other purposes, used for anti wrinkle therapy and for lip augmentation. The manufacturer of the british product "Vavelta" advertised with the use of "freshly harvested (!) [[foreskin]]s". It is ''inter alia'' used as a replacement for animal experiments testing the compatibility of cosmetic products. In the face of the falling numbers of routine infant circumcisions in the USA, manufacturers have already expressed concerns that they might not "bring in enough harvest" more than 10 years ago. The parents of the circumcised boys, however, very rarely know of the "secondary use" of their son's "donated" body parts. While preimplantation genetic diagnosis, stem cell research and genetic engineering are time and again critically questioned and discussed, the lifelong, significant modification of infant bodies for the good of the cosmetic industry is still common practice - supposedly partly because many women do not know what their augmented lips and wrinkle-free cheeks are made of - baby [[foreskin]]. An ethical justification cannot be valid here.
+ |Author=Park et al.
+ |Source=
+ |ref=<ref>{{REFjournal
+ |last=Park
------
+ |first=
+ |init=JK
+ |author-link=
-{{FromIntactWiki
+ |last2=Doo
-  | URL=http://intactwiki.org/wiki/Circumcision
+ |first2=
-  | Title=Circumcision
+ |init2=AR
+ |author2-link=
+ |last3=Kim
+ |first3=
+ |init3=JH
+ |author3-link=
+ |last4=Park
+ |first4=
+ |init4=HS
+ |author4-link=
+ |etal=yes
+ |title=Prospective investigation of penile length with newborn male circumcision and second to fourth digit ratio.
+ |trans-title=
+ |language=
+ |journal=Can Urol Assoc J
+ |location=
+ |date=2016-09
+ |season=
+ |volume=10
+ |issue=9-10
+ |article=
+ |page=
+ |pages=
+  |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028213/
+  |archived=
+ |quote=
+ |pubmedID=27695583
+ |pubmedCID=5028213
+ |DOI=10.5489/cuaj.3590
+ |accessdate=2022-09-04
+}}</ref>
 }}
-[[Image:Intact vs circumcised.JPG |thumbnail|right|300px| The intact and circumcised human penis, side by side.]]
+=== Sexual effects ===
+Cepeda-Emiliani et al (2023) cited six reports in the literature of detrimental effects of circumcision, including erectile function, sensation, masturbatory pleasure, orgasm, and sexual satisfaction. The authors also cited three studies of severe distress in [[circumcised]] men, due to their infant circumcision, with complaints of [[glans]] insensitivity, delayed [[ejaculation]], and unpleasant sensation.<ref name="cepeda2023">{{REFjournal
+ |last=Cepe da-Emiliani
+ |first=
+ |init=A
+ |author-link=Alfonso Cepeda-Emiliani
+ |last2=Gándara-Cortés
+ |first2=
+ |init2=M
+ |author2-link=
+ |last3=Otero-Alén
+ |first3=
+ |init3=M
+ |author3-link=
+ |last4=García
+ |first4=
+ |init4=H
+ |author4-link=
+ |last5=Suárez-Quintanilla
+ |first5=
+ |init5=J
+ |author5-link=
+ |last6=García-Caballero
+ |first6=
+ |init6=T
+ |author6-link=
+ |last7=Gallego
+ |first7=
+ |init7=R
+ |author7-link=
+ |last8=García-Caballero
+ |first8=
+ |init8=R
+ |author8-link=
+ |etal=no
+ |title=Immunohistological study of the density and distribution of human penile neural tissue: gradient hypothesis
+ |trans-title=
+ |language=
+ |journal= Int J Impot Res
+ |location=
+ |date=2023-05-02
+ |volume=35
+ |issue=3
+ |article=
+ |page=
+ |pages=286-305
+ |url=https://www.nature.com/articles/s41443-022-00561-9
+ |archived=
+ |quote=
+ |pubmedID=35501394
+ |pubmedCID=
+ |DOI=10.1038/s41443-022-00561-9
+ |accessdate=2023-11-26
+}}</ref>
-The term "circumcision" without a gender qualifier refers specifically to male circumcision. It means "to cut around," and it refers to the excision of the [[foreskin]] from the penis. Circumcision is most often performed in healthy males for [[Religion and Culture|religious or cultural]] reasons. The procedure may be performed on consenting adults, but it is most often performed on non-consenting minors, particularly newborn children, which is why the ritual is so controversial. Opponents of circumcision consider the circumcision of non-consenting minors to be unethical and a human rights violation, unless there is concrete medical indication. Proponents of circumcision consider the circumcision of non-consenting minors to be a "religious freedom" and a "parental right."
+Circumcision and frenectomy remove tissues with heightened erogenous sensitivity.<ref name="garrett2024-01-09" /><ref name="cepeda2023" /> <ref name="winkleman1959">{{WinkelmannRK 1959}}</ref>  They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."
-== Rationale ==
+The [[amputation]] of the prepuce results in the loss of the majority of fine-touch neuroreceptors found in the [[penis]], leaving only the uninhibited protopathic sensibility of the artificially externalized [[glans penis]]. The imbalance caused by not having the input from the now ablated fine-touch receptors may be a leading cause of the changes in sexual behavior noted in [[circumcised]] human males.<ref>{{REFjournal
+ |last=Van Howe
+ |init=RS
+ |author-link=Robert S. Van Howe
+ |last2=Cold
+ |init2=CJ
+ |title=Advantages and Disadvantages of Neonatal Circumcision
+ |journal=The Journal of the American Medical Association
+ |volume=277
+ |issue=13
+ |pages=1052-7
+ |url=http://www.ncbi.nlm.nih.gov/pubmed/9218663
+ |quote=
+ |pubmedID=9218663
+ |pubmedCID=
+ |DOI=
+ |date=1997-04-02
+ |accessdate=
+}}</ref>
-Reasons for performing circumcision range widely by culture, religion, location, and age.
+Histology of the male circumcision scar shows [[amputation]] neuromas, Schwann cell proliferation and the bulbous collection of variably sized neurites. [[Amputation]] neuromas do not mediate normal sensation and are notorious for generating pain.<ref name="ColdCJ TaylorJR 1999"/> Cepeda-Emiliani et al. (2023) commented:
+<blockquote>
+Taking the sleve technique as an example of surgical flexibility during circumcision, to the extent that this technique is of such versatility that it allows highly variable quantities of cutaneous and subcutaneous tissue to be excised directly from the penile body, and to the extent that the prepuce is still conceived by segments of the medical community as "just a small piece of skin", we are concerned that aggressive circumcisions are intentionally or unintentionally being performed in pediatric and adult patients in the belief that "redundant" or " extra" tissue is being excised, or in the belief that "excesive sensitivity" is being reduced to augment ejaculatory latency time.<ref name="cepeda2023" />
+</blockquote>
+The un-anesthetized and un-sedated newborn infant is restrained by being strapped to a special plastic board called the [[circumstraint]]. The procedure is most often an elective, non-therapeutic surgery without [[medical indication]] performed on neonates and children for religious and cultural reasons in violation of the child's [[human rights]] to [[physical integrity]], but in older patients may be rarely indicated for therapeutic reasons.  It is a radical treatment option for pathological [[phimosis]], refractory [[balanoposthitis]] and chronic [[urinary tract infection]]s (UTIs); it is contraindicated in cases of certain genital structure abnormalities or poor general health.
-===Cultural===
+See [[Sexual effects of circumcision]] for more information.
-Many cultures perform circumcision as a rite of passage into manhood. This is common in the Middle East and amongst some indigenous African and Southeast Asian peoples.
+=== Psychological effects ===
+[[Psychological_issues_of_male_circumcision#Circumcision_trauma_in_adults| Psychological late effects]] are also possible after a circumcision, especially if the operation was carried out in childhood.<ref name="garrett2024-01-09" /> On this occasion a variety of [[trauma]] may occur, which depend, among others, on age and circumstances of the circumcision. For example, whether the circumcision took place with or without sufficient anaesthesia, if the individual has been informed about the operation beforehand, if he was [[circumcised]] against his will or without his consent, and also, in the case of infant circumcision, if he was told about it during childhood or had to find it out coincidentally on his own.
-The United States and Israel are the only industrialized countries in the world to have a high incidence of routine infant male circumcision. The vast majority of infant circumcisions performed in the United States are for non-religious, non-medical reasons. See [[History of Circumcision]].
+The psychological late effects of circumcision are not yet fully researched, and many studies took place on rather a small scale. This situation needs to be rectified, because the available studies, as well as the histories of negatively affected men, suggest that these late effects may have more impact than previously assumed.
-===Religious===
+* It was observed that infants, following circumcision without [[pain]] control, had a disturbed bond with their mother<ref>{{REFjournal
-The circumcision of newborn boys is seen as a divine commandment in the Jewish faith. Though absent in the Koran, male circumcision is considered a religious requirement in Islam, and it is performed on male children of varying ages. Converts to these faiths may also choose to undergo circumcision, but it is not always required.
+ |last=Marshall
+ |init=RE
+ |last2=Porter
+ |init2=FL
+ |last3=Rogers
+ |init3=AG
+ |etal=yes
+ |title=Circumcision: II effects upon mother-infant interaction
+ |journal=Early Hum Dev
+ |date=1982
+ |volume=7
+ |issue=4
+ |pages=367-74
+ |url=https://www.cirp.org/library/birth/marshall2/
+ |accessdate=2020-02-01
+}}</ref>, as well as problems with nurturing, up to the point of refusal to be fed. The sleeping habits of these babies were also disturbed, with prolonged non-REM sleep and increased waking.
-===Medical Indication===
+* In boys [[circumcised]] in childhood, [[post-traumatic stress disorder]] ([[PTSD]]) could be diagnosed. In a study on Philippine boys, in whom no [[PTSD]] was found prior to the operation, 69% of the boys [[circumcised]] in the traditional ritual and 51% of those [[circumcised]] by standard medical procedures (including anaesthesia) fulfilled the DSM-IV criteria for PTSD following the operation.<ref>{{REFbook
-In some cases, circumcision is legitimately indicated; a patient may be suffering recurring infections, and other methods of treatment have failed. In other cases, a patient may be suffering from a severe case of [[phimosis]]. Overall, the actual medical necessity for circumcision is extremely rare.
+  |last=Ramos
+  |init=S
-====Arguments of Prophylaxia====
+  |last2=Boyle
-Though the practice of ritual circumcision of males, both consenting and non-consenting, has existed for millenia, the search for "potential medical benefits" began relatively recently. Initially, circumcision was adopted as a way to stop boys and men from masturbating, where mastubration was seen as the cause for many diseases. As the myth that circumcision prevented masturbation became debunked, advocates of circumcision began the great search to find the "medical benefits" of circumcision.
+  |init2=GJ
+  |year=2001
-Male and female circumcision involves the removal and disruption of normal anatomical structures that are primary areas of sexual sensation.<ref>{{REFjournal
+  |title=Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem
- | last=Taylor
+  |url=https://link.springer.com/chapter/10.1007/978-1-4757-3351-8_14
- | first=J.R.
- | coauthors=A.P. Lockwood and A.J. Taylor
- | title=The prepuce: Specialized mucosa of the penis and its loss to circumcision
- | journal=British Journal of Urology International
- | volume=77
- | issue=
- | pages=291-95
- | url=http://www.cirp.org/library/anatomy/taylor/
- | quote=
- | pubmedID=8800902
- | pubmedCID=
- | DOI=
- | date=1996-2
- | accessdate=
-}}</ref> In the past, some advocates of mass circumcision have considered the prepuce to be a "mistake of nature,"<ref>
-<nowiki>{{Cold and Wiswell (1995)}} | [[Template:Cold and Wiswell (1995)|see more]]</nowiki></p>
-</ref> but this notion has no validity because the prepuce is ubiquitous in primates and because it provides functional advantages.<ref>{{REFbook
-  |last=Cold
-  |first=Christopher
-  |last2=McGrath
- |first2=Kenneth
-  |author2-link=Ken McGrath
-  |year=1999
-  |title=Male and female circumcision: medical, legal, and ethical considerations in pediatric practice
-  |url=http://www.cirp.org/library/anatomy/cold-mcgrath/
   |work=
-  |editor=
+  |editors=[[George C. Denniston]], [[Frederick M. Hodges]], [[Marilyn Fayre Milos]]
   |edition=
   |volume=
-  |chapter=Anatomy and histology of the penile and clitoral prepuce in primates
+  |chapter=Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder
-  |pages=
+  |pages=253-70
   |location=New York
-  |publisher=
+  |publisher=Kluwer Academic/Plenum Publishers
-  |isbn=0306461315
+  |isbn=
   |quote=
   |accessdate=
   |note=
 }}</ref>
+* Circumcisions, especially those that happen without consent, can spark feelings of helplessness and alienation, which can persist as [[trauma]]. These feeling can also be triggered later, when someone [[circumcised]] as an infant becomes aware of his circumcision. In an online study, interviewed men stated they felt betrayed - 55% by the mother, 50% by the father, and 58% by the doctor, and 73% felt that their [[human rights]] had been violated.<ref name="GSoCH">{{REFweb
+ |url=http://www.circumcisionharm.org/
+ |title=Global Survey of Circumcision Harm
+ |accessdate=2019-10-12
+}}</ref>
+* It can frequently be found that the loss is denied, much as happens with the loss of other body parts. This denial can lead to fathers having their sons [[circumcised]] in order not to be reminded of their own loss. In this process, their own body is defined as "normal" and the [[foreskin]] redefined as a foreign object. Their own parents are seen as "good", so that this image is projected onto the circumcision their parents carried out as well, in order to keep the positive emotion intact. The father wants to be a "good" father later in life as well, and so, following an idealised image of his own parents, circumcision, which has been redefined as a "good thing", is passed on to his son by having him [[circumcised]] as well.<ref>{{VanderKolkBA 1989}}</ref><ref>{{REFjournal
+ |last=Goldman
+ |init=R
+ |author-link=Ronald Goldman
+ |url=https://www.cirp.org/library/psych/goldman1/
+ |title=The psychological impact of circumcision
+ |journal=BJU Int
+ |date=1999
+ |volume=83
+ |issue=Suppl. 1
+ |pages=93-103
+ |accessdate=2019-10-12
+}}</ref>
+* If the [[circumcised]] male feels incomplete, or due to the missing [[foreskin]] disadvantaged compared to [[intact]] males, an inferiority complex and [[depression]] may occur. This can be accompanied by conscious recognition of his own incompleteness, or the deficiency may remain completely subconscious<ref>{{REFjournal
+ |last=Rhinehart
+ |init=J
+ |url=https://www.cirp.org/library/psych/rhinehart1/
+ |title=Neonatal circumcision reconsidered
+ |journal=Transactional Analysis J
+ |date=1999
+ |volume=29
+ |issue=3
+ |pages=215-21
+ |accessdate=2019-10-12
+}}</ref>. In an online study, 75% of those interviewed stated that they felt incomplete, and 66% said they felt inferior compared with [[intact]] males.<ref name="GSoCH"/>
+* Cases in which children felt ill treated or punished have been documented as well. G. Cansever found in her study on 12 boys aged between 4 and 7 years, who had previously been prepared for their impending circumcision, that the children experienced the operation as an aggressive assault on their bodies.<ref>{{REFjournal
+ |last=Cansever
+ |init=G
+ |date=1965
+ |url=https://www.cirp.org/library/psych/cansever/
+ |title=Psychological effects of circumcision
+ |journal=Brit. J. Med. Psychol
+ |volume=38
+ |pages=321-31
+ |accessdate=2019-10-12
+}}</ref>
+* Fear of being alone or darkness.<ref name="Levy1945">{{REFjournal
+ |last=Levy
+ |first=David M.
+ |init=DM
+ |url=https://www.cirp.org/library/psych/levy1/
+ |title=Psychic trauma of operations in children; and a note on combat neurosis
+ |journal=American Journal of Diseases of Children
+ |volume=69
+ |date=1945
+ |pages=7-25
+ |accessdate=2019-10-12
+}}</ref>
+* Fear of doctors, clinics and also closed rooms.<ref name="Levy1945"/>
+* Relapse into the state of bed-wetting, even if the child was already dry before.<ref name="Levy1945"/>
+* [[Circumcised]] males who become fathers frequently manifest [[adamant father syndrome]].
-==Circumcision methods==
+[[Intact America]] (2019) called circumcision an [[Adverse Childhood Experiences (ACEs)| adverse childhood experience]],<ref name-"bollinger2019">{{REFdocument
+ |title=Child genital cutting as an adverse childhood experience
-Circumcision is performed in many ways which vary by culture, the person performing it, and the age of the subject. It may be performed by a specialized ritual circumciser in a non-medical setting, or a medical practitioner at a hospital or clinic. In some cultures, only the protruding end of the foreskin is cut off, and in others, the entire foreskin which covers the glans is removed. Some circumcisers take more skin than others, resulting in a "loose" or "tight" circumcision.
+ |url=http://adversechildhoodexperiences.net/CGC_as_an_ACE.pdf
+ |last=Bollinger
-Generally, the foreskin is pulled forward and enough of it is removed to permanently expose the glans of the penis. Sometimes a protective device is used to avoid hurting the glans, and sometimes the circumciser simply performs the procedure freehand. In adults, stitches are used to stop the bleeding and help close the wound. In infants, circumcisers often use a clamp that crushes the foreskin and seals the wound, eliminating the need for stitches.
+ |first=Dan
+ |author-link=Dan Bollinger
+ |last2=Chapin
+ |first2=Georganne
+ |author2-link=Georganne Chapin
+ |publisher=Intact America
+ |location=Tarrytown
+ |format=PDF
+ |date=2019-08
+ |accessdate=2021-11-02
+}}</ref>
 == Complications ==
-=== Pain ===
+=== Possible operative and postoperative complications ===
-In the past, advocates of circumcision claimed that a newborn child's nerve system was not yet fully developed, and that as a result, the child felt no pain during the circumcision procedure. Research has shown that newborn children do in fact feel pain, and more acutely than adults. This has led American health associations to recommend doctors take measures to reduce the pain of circumcision in infants.
+Circumcision is surgery.  Surgical complications of circumcision generally may be classified as [[Bleeding| hemorrhage]], [[infection]], or surgical misadventure up to and including loss of the penis and [[death]].<ref name="deacon2022" /><ref name="williams-kapilla1993">{{REFjournal
+ |last=Williams
+ |init=N
+ |author-link=
+ |last2=Kapilla
+ |init2=L
+ |author2-link=
+ |etal=no
+ |title=Complications of circumcision
+ |trans-title=
+ |language=
+ |journal=Brit J Surg
+ |location=
+ |date=1993-10
+ |volume=80
+ |issue=10
+ |pages=1231-6
+ |url=https://www.cirp.org/library/complications/williams-kapila/
+ |quote=
+ |pubmedID=8242285
+ |pubmedCID=
+ |DOI=10.1002/bjs.1800801005
+ |accessdate=2019-11-27
+}}</ref>
-The [[Position Statements on Infant Circumcision|AAP Circumcision Policy Statement]] states quite clearly that ''"There is considerable evidence that newborns who are circumcised without analgesia experience pain and physiologic stress"''. Furthermore, the pain is quite severe, and requires injections for proper pain management. Sucrose and Acetaminophen ''"cannot be recommend as the sole method of analgesia"''. Topical cream is no longer thought sufficient as ''"the analgesic effect is limited during the phases associated with extensive tissue trauma such as...tightening of the clamp"''.<ref>American Academy of Pediatrics: Circumcision Policy Statement; Task Force on Circumcision" Pediatrics Vol 103 No.3 March 1999, pp.686-693. (Statement Reaffirmed Sept. 1, 2005)."</ref>
+* Intolerance or allergic reactions to the narcotics used.
+* Especially in newborns, where the bodily pain reduction mechanisms are not yet fully developed, local anaesthesia is often insufficient for the operation. Even in conjunction with regional anaesthesia of the dorsal nerve of the [[penis]], the rate of failure to provide sufficient anaesthetic even for experienced anaesthetists is still 5-10%. The general anaesthesia that would be needed for newborns, however, poses significant risks for the child, and, therefore, is only likely to be used in emergencies. A surgical operation without proper [[pain]] control can lead to the development of a specific pain memory<ref>{{REFweb
-The AAFP states quite simply in their [[Position Statements on Infant Circumcision|position paper]], ''"Newborns experience pain during circumcision".''<ref>"Circumcision: Position Paper on Neonatal Circumcision. Board Approved: August 2007 Reaffirmed". Official American Academy of Family Physicians Website. http://www.aafp.org/online/en/home/clinical/clinicalrecs/children/circumcision.html. Accessed 5/2/2011.</ref> This is not a debatable fact, and yet, it is not widely accepted, even by some doctors. It might be hard for some doctors to accept, as they may have been taught that the infant does not feel pain, and may have performed countless circumcisions with this idea. Usage of anesthesia for infant circumcision is still by no means the rule.
+  |url=http://www.spiegel.de/spiegel/vorab/experte-warnt-rituelle-beschneidung-veraendert-das-gehirn-der-kinder-a-849534.html
+  |title=Kinderschmerz-Experte warnt: Rituelle Beschneidung verändert das Gehirn der Kinder
-Penile injections of anesthetic are now recommended by all of the major medical institutions. In their [http://www.ama-assn.org/ama/no-index/about-ama/13585.shtml Report 10 of the Council on Scientific Affairs], the AMA states ''"When the decision is made to proceed with circumcision, local anesthesia should be provided for the procedure. Ring block or dorsal penile blocks [injections] are most effective. EMLA cream has limited utility"''. Alarmingly, ''"Despite the clear evidence that newborn males generate brisk pain responses during circumcision, a recent survey of residency training programs found that 26% of programs that taught circumcision provided no instruction on the use of local anesthesia". The AMA reports that "Of physicians performing circumcision, 45% use anesthesia, 71% of pediatricians, 56% of family practitioners, and 25% of obstetricians"''.<ref>"Report 10 of the Council on Scientific Affairs (I-99): Neonatal Circumcision". American Medical Association Official Website. http://www.ama-assn.org/ama/no-index/about-ama/13585.shtml. Accessed May 4, 2011.</ref>
+  |trans-title=Children's pain expert warns: Ritual circumcision changes the brain of children
+  |language=German
-The AAP's [http://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/pages/Where-We-Stand-Circumcision.aspx Heatlhy Children website] suggests ''"Your pediatrician (or your obstetrician) should discuss the forms of analgesia that are available"''.<ref>Where We Stand: Circumcision". AAP Official Website. 03/23/2011. http://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/pages/Where-We-Stand-Circumcision.aspx</ref> Be that as it may, few forms of analgesia are recommended. There are basically two types of injections to choose from, and the website does not go into the difference between a 'dorsal nerve block' and a 'ring block' injection.
+  |last=Prof. Dr. med. Boris Zernikow
+  |first=
-Given what is known from aforementioned official documents, the AAP website may be more informative and effective if it would say ''"Make sure your doctor knows of the ineffectiveness of anything short of local anesthesia, and make sure your baby is given an injection. This is your responsibility, because your doctor may or may not be up to date on the latest understandings of infant sensitivity to pain during circumcision."'' The AAP may be holding back, however, perhaps because this would upset the doctor/parent power relationship, and may cause too much questioning of doctors in general. One may not expect to find this kind of advice on such a website, and yet, anything less than this is a dangerously weak statement.
+  |publisher=Spiegel Online
+  |website=
-To control pain, some physicians that circumcise use Tylenol, sugar,<ref>{{REFweb
+  |date=2012-08-12
- | quote=To calm the baby during the procedure, a sugar filled gauze pacifier soaked with sweet juice is used, and soothing music is played in the room.
+  |accessdate=2019-10-11
-  | url=http://www.pollockclinics.com/circumcision/circumcision-guide.html
+  |format=
-  | title=Parents' Guide to Circumcision
+  |quote=
- | last=
+}}</ref>. In unsedated and partially sedated infants increased secretion of the stress hormone cortisol could be observed for months after the operation. Overall, their pain threshold was lower and the risk of chronic pain increased. Regardless of these findings, infant circumcisions with insufficient or no anaesthetic are still common practice<ref>{{REFjournal
- | first=
+  |last=Garry
- | publisher=
+  |init=T
- | work=
+  |title=Circumcision: a survey of fees and practices
- | date=
+  |journal=OBG Management
-  | accessdate=2011-04-08
+  |date=1994
-}}</ref><ref>{{REFweb
+  |volume=October
- | quote=During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions.
+  |issue=
- | url=http://www.pollockclinics.com/circumcision/circumcision-before.html
+  |pages=34-6
-  | title=Before the Circumcision
+  |url=
-  | last=
+  |accessdate=
-  | first=
+}}</ref><ref>{{REFjournal
-  | publisher=
+  |last=Howard
-  | work=
+  |init=CR
-  | date=2011-04-08
+  |last2=Howard
-  | accessdate=2011-04-08
+  |init2=FM
-}}</ref> a topical cream,<ref>{{REFweb
+  |last3=Garfunkel
-  | quote=Then in our office, he will have topical anesthetic applied to his penis.
+  |init3=LC
-  | url=http://www.pollockclinics.com/circumcision/circumcision-before.html
+  |last4=de Blieck
- | title=Before the Circumcision
+  |init4=EA
- | last=
+  |last5=Weitzman
- | first=
+  |init5=M
- | publisher=
+  |title=Neonatal circumcision and pain relief: current training practices
- | work=
+  |journal=Pediatrics
- | date=2011-04-08
+  |date=1998
- | accessdate=2011-04-08
+  |volume=101
-}}</ref> and/or a local anaesthetic injection called a dorsal penile ring block.<ref>{{REFweb
+  |issue=
- | quote=We use extensive pain control methods including Tylenol, a sugar solution (to reduce pain perceptions), a topical freezing cream, and a local anesthetic injection.
+  |pages=423-8
- | url=http://www.pollockclinics.com/circumcision/circumcision-guide.html
+  |url=
- | title=Parents' Guide to Circumcision
+  |accessdate=
- | last=
- | first=
- | publisher=
- | work=
- | date=
- | accessdate=2011-04-08
-}}</ref> Topical anaesthetic only serves to numb the area to lessen the pain of the injection, but studies have shown that a dorsal penile ring block is not always effective in stopping the pain of circumcision.<ref name='Journal of Perinatology April/May 2002'>{{REFjournal
-  | last=Taeusch
- | first=H William
-  | coauthors=Alma M Martinez, J Colin Partridge, Susan Sniderman, Jennifer Armstrong-Wells, Elena Fuentes-Afflick
-  | title=Pain During Mogen or PlastiBell Circumcision
- | journal=Journal of Perinatology
-  | volume=22
- | issue=3
- | pages=214-218
- | url=http://www.nature.com/jp/journal/v22/n3/full/7210653a.html
- | quote=...more than half of the study group had what we considered excessive pain/discomfort over the course of the entire procedure.
- | pubmedID=
- | pubmedCID=
- | DOI=
-  | date=April/May 2002
- | accessdate=2011-04-08
-}}</ref><ref name='Clinical Pediatrics August 1986'>{{REFjournal
- | last=Williamson
- | first=Paul S.
- | coauthors=Nolan Donovan Evans
- | title=Neonatal Cortisol Response to Circumcision with Anesthesia
- | journal=Clinical Pediatrics
-  | volume=25
-  | issue=8
-  | pages=412-416
-  | url=http://cpj.sagepub.com/content/25/8/412.abstract
- | quote=The adrenal cortisol response to surgery was not significantly reduced by the administration of lidocaine.
- | pubmedID=
- | pubmedCID=
- | DOI=
- | date=August 1986
-  | accessdate=2011-04-08
-}}</ref> During circumcision, somp physicians give children sugar pacifiers to "reduce the perception of pain",<ref>{{REFweb
-  | quote=During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions.
-  | url=http://www.pollockclinics.com/circumcision/circumcision-before.html
-  | title=Before the Circumcision
-  | last=
-  | first=
-  | publisher=
-  | work=
-  | date=2011-04-08
-  | accessdate=2011-04-08
-}}</ref> but in at least one study, data shows that giving sugar to a child doesn't help to reduce the perception of pain in the child.<ref name='Lancet, The 2010-10-09'>{{REFjournal
-  | last=Slater
- | first=Rebeccah
- | coauthors=Laura Cornelissen, Lorenzo Fabrizi, Debbie Patten, Jan Yoxen, Alan Worley, Stewart Boyd, Judith Meek, Prof Maria Fitzgerald
-  | title=Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial
-  | journal=The Lancet
- | volume=376
- | issue=9748
- | pages=1225-1232
- | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961303-7/fulltext
- | quote=Our data suggest that oral sucrose does not significantly affect activity in neonatal brain or spinal cord nociceptive circuits, and therefore might not be an effective analgesic drug. The ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief.
- | pubmedID=
- | pubmedCID=
- | DOI=
-  | date=2010-10-09
- | accessdate=2011-04-08
-}}</ref> Post-operative pain and the pain the child must endure during recovery is hardly, if ever, addressed by professionals.
-It has been shown that an infant's response to pain can be altered for years as a consequence of circumcision.<ref>{{REFjournal
- | last=Taddio
- | first=Anna
- | coauthors=Morton Goldbach, Moshe Ipp, Bonnie Stevens, Gideon Koren
- | title=Effect of neonatal circumcision on pain responses during vaccination in boys
- | journal=The Lancet
-  | volume=345
-  | issue=8945
-  | pages=291-2
-  | url=http://www.cirp.org/library/pain/taddio/
- | quote=
- | pubmedID=7837863
- | pubmedCID=
- | DOI=
- | date=1995
-  | accessdate=
 }}</ref><ref>{{REFjournal
-  | last=Taddio
+  |last=Stang
-  | first=Anna
+  |init=HJ
-  | coauthors=Katz J, Ilersich AL, Koren G.
+ |last2=Snellman
-  | title=Effects of neonatal circumcision on pain response during subsequent routine vaccination
+ |init2=LW
-  | journal=The Lancet
+ |title=Circumcision practice patterns in the United States
-  | volume=349
+ |journal=Pediatrics
-  | issue=9052
+ |date=1998
-  | pages=599-603
+ |volume=101
-  | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)10316-0/fulltext
+ |issue=e5
-  | quote=
+ |pages=
-  | pubmedID=9057731
+ |url=
-  | pubmedCID=
+ |accessdate=
-  | DOI=10.1016/S0140-6736(96)10316-0
+  |note=Link to [[AAP]] website
-  | date=March 1997
+}}</ref>. During procedures which take several minutes, babies tend to fall into a state of stupor, which in the past was falsely interpreted as peaceful sleep, nurturing the belief that babies felt no pain. Measurements taken in those cases revealed a typically 3- to 4-fold increase in cortisol levels, which equals a state of severe [[shock]].<ref>{{REFjournal
-  | accessdate=
+ |last=Gunnar
+ |init=MR
+ |last2=Fisch
+ |init2=RO
+ |last3=Korsvik
+ |init3=S
+ |last4=Donhowe
+ |init4=JM
+  |title=The effects of circumcision on serum cortisol and behavior
+  |journal=Psychoneuroendocrinology
+ |date=1981
+  |volume=6
+  |issue=3
+  |pages=269-75
+  |url=https://www.cirp.org/library/pain/gunnar/
+ |accessdate=2019-11-26
+}}</ref>
+* Postoperative wound pain, in the case of children's circumcisions conceivably worsened by the forceful breaking of the preputial adhesions.
+* Postoperative pain from the exposure of the sensitive glans penis to clothing. This pain will endure for several weeks or even longer in some cases.
+* Postoperative [[bleeding]] of the wound. This can have severe consequences especially for very young infants, if they are not treated promptly. Their blood volume is only about 85 ml per kilogram of body weight, and even moderate blood loss can lead to hypovolaemia, hypovolaemic [[shock]] and even death.<ref>{{REFbook
+ |last=
+ |first=
+ |year=2000
+ |title=Paediatric Handbook
+ |url=
+ |work=
+ |editors=Smart J, Nolan T.
+ |edition=6
+ |volume=
+ |chapter=
+ |page=82
+ |location={{AUSC|VIC}}, Australia
+ |publisher=Blackwell Science Asia
+ |isbn=
+  |quote=
+  |accessdate=
+ |note=
+}}</ref><ref>{{REFdocument
+ |title=Autopsy of Demetrius Manker
+ |url=
+ |contribution=Case 93-1711
+ |last=Wetli
+ |first=CV
+ |publisher=Miami: Dade County Medical Examiner Department
+ |format=
+ |date=1993-06-23
+ |accessdate=
+}}</ref> <ref>{{REFjournal
+ |last=Hiss
+ |init=J
+ |last2=Horowitz
+ |init2=A
+ |last3=Kahana
+ |init3=T
+ |title=Fatal haemorrhage following male ritual circumcision
+ |journal=J Clin Forensic Med
+ |date=2000
+ |volume=7
+ |issue=
+  |pages=32-4
+  |url=https://www.cirp.org/library/death/hiss1/
+ |accessdate=2019-11-06
+}}</ref><ref>{{REFdocument
+ |title=Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan
+ |url=http://www.circumstitions.com/death-exsang.html
+ |contribution=
+ |last=Newell
+ |first=TEC
+ |publisher=Burnaby, B.C.: B.C. Coroner's Service
+ |format=
+  |date=2004-01-19
+  |accessdate=2019-11-26
 }}</ref>
+* Post operative [[lymphoedema]].
-=== Sexual effects ===
+* Postoperative [[Infection| infections]]. This includes both local infections, which can be treated with local therapy, and systemic infections, requiring systemic antibiotic treatment.<ref>{{REFconference
+  |last=Dr. med. Hartmann
-Circumcision and frenectomy remove tissues with heightened erogenous sensitivity. Boyle ''et al.'' (2002) wrote, "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings&mdash;many of which are lost to circumcision."<ref>{{REFjournal
+  |first=Wolfgang
- | last=Boyle
+  |url=
- | first=Gregory J.
+  |place=Rechtsausschuss des Bundestages [Legal Committee of the Bundestag] (German)
- | coauthors=Gillian A. Bensley
+  |title=Stellungnahme zur Anhörung am 26. November 2012 [Opinion on the hearing on 26 November 2012] (German)
- | title=Adverse Sexual and Psychological Effects of Male Infant Circumcision
+  |date=2012-11-26
- | journal=Psychological reports
+  |accessdate=
- | volume=88
- | issue=3, Part 2
- | pages=1105–1106
- | url=http://www.cirp.org/library/psych/boyle5/
- | quote=
- | pubmedID=11597060
- | pubmedCID=
- | DOI=10.1046/j.1464-410x.1999.0830s1085.x
- | date=July 2001
- | accessdate=
-}}</ref> They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."
-The amputation of the prepuce results in the loss of the majority of fine-touch neuroreceptors found in the penis, leaving only the uninhibited protopathic sensibility of the artificially externalized glans penis. The imbalance caused by not having the input from the now ablated fine-touch receptors may be a leading cause of the changes in sexual behavior noted in circumcised human males.<ref>{{REFjournal
-  | last=Van Howe
-  | first=RS
-  | coauthors=Cold CJ
-  | title=Advantages and Disadvantages of Neonatal Circumcision
- | journal=The Journal of the American Medical Association
-  | volume=277
- | issue=13
- | pages=1052-7
- | url=http://www.ncbi.nlm.nih.gov/pubmed/9218663
- | quote=
- | pubmedID=9218663
- | pubmedCID=
- | DOI=
-  | date=1997-04-02
-  | accessdate=
 }}</ref>
+* [[Wound dehiscence]], meaning the separation of the edges of the wound or the tissue after suturing.
-Histology of the male circumcision scar shows amputation neuromas, Schwann cell proliferation and the bulbous collection of variably sized neurites. Amputation neuromas do not mediate normal sensation and are notorious for generating pain.<ref>{{REFjournal
+* Adhesion between the surface or rim of the [[Glans penis|glans]] with the neighbouring [[penile skin]], causing [[skin]] pockets and bridges, as well as visually unpleasant results like uneven scars, which make a re-circumcision necessary.
-  | last=Cold
+* Postoperative [[phimosis]]: a phimotic ring can develop during scarring, which makes a re-circumcision necessary. According to a study by Blalock et al.<ref>{{REFjournal
-  | first=C.J.
+  |last=Blalock
-  | coauthors=J.R. Taylor
+ |init=HJ
-  | title=The prepuce
+ |last2=Vemulakonda
-  | journal=British Journal of Urology International
+ |init2=V
-  | volume=83
+ |last3=Ritchey
-  | issue=
+ |init3=ML
-  | pages=34-44
+ |last4=Ribbeck
-  | url=http://www.cirp.org/library/anatomy/cold-taylor/
+ |init4=M
-  | quote=
+ |title=Outpatient management of [[phimosis]] Following newborn circumcision
-  | pubmedID=10349413
+ |journal=J Urol
-  | pubmedCID=
+ |date=2003
-  | DOI=
+ |volume=169
-  | date=1999-1
+  |issue=6
-  | accessdate=
+ |pages=2332-4
+ |url=https://www.cirp.org/library/complications/blalock1/
+  |accessdate=2019-11-26
+}}</ref>, the prevalence is 2.9%, according to Leitch<ref>{{REFjournal
+ |last=Leitch
+ |init=IOW
+  |title=Circumcision - a continuing enigma
+  |journal=Aust Paediatr J
+ |date=1970
+  |volume=6
+  |issue=
+  |pages=59-65
+  |url=https://www.cirp.org/library/general/leitch1/
+ |accessdate=2019-12-15
+}}</ref> 5.5%.
+* [[Sudden Infant Death Syndrome]] (SIDS).
+* Knot formation of the veins. If the dorsal vein, which originates in the tip of the [[foreskin]], is cut during circumcision without being clamped and sutured at its origin separately, it starts to develop new branches over time, which can lead to the development of knots.
+* Possible deformities due to circumcision include hypoplasia of the [[penis]] (micro-penis) and induratio [[penis]] plastica (skewed penis).
+* Medical malpractice can also not be ruled out. Injuries, partly or entirely severing the [[Glans penis|glans]] or the [[penis]] can occur.
+* In rare cases, [[necrosis]], gangrene, ischaemia, keloid formation, and circulatory problems may also occur.
+* When the circumcision is followed by the ultra-orthodox Jewish ritual of Metzitzah B'Peh (which consists of sucking blood from the wound with the mouth), there is a risk of infection with [[herpes]] simplex type 1, which can lead to brain damage or [[death]].<ref>{{REFweb
+  |url=http://www.nytimes.com/2012/03/08/nyregion/infants-death-renews-debate-over-a-circumcision-ritual.html?_r=0
+  |title=Baby’s Death Renews Debate Over a Circumcision Ritual
+  |last=Robbins
+  |first=Liz
+  |date=2012-03-07
+  |accessdate=2019-10-11
 }}</ref>
 === Death ===
-A study in 2010 estimated approximately 117 neonatal circumcision-related deaths occur annually in the United States, about one out of every 77 male neonatal deaths, more than suffocation, auto accidents, or even SIDS.<ref>{{REFjournal
+There is indeed a risk of [[death]] from non-therapeutic neonatal circumcision,<ref name="garrett2024-01-09" /> although the [[circumcision industry]] takes care to not reveal it.
-  | last=Bollinger
+A study in 2010 estimated approximately 117 neonatal circumcision-related [[Death| deaths]] occur annually in the [[United States]], about one out of every 77 male neonatal deaths, more than suffocation, auto accidents, or even [[SIDS]].<ref name="Bollinger 2010">{{REFjournal
-  | first=Dan
+  |last=Bollinger
-  | coauthors=Boy's Health Advisory
+  |first=Dan
-  | title=Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths
+  |init=D
-  | journal=Thymos: Journal of Boyhood Studies
+ |author-link=Dan Bollinger
-  | volume=4
+ |last2=Boy's Health Advisory
-  | issue=1
+  |title=Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths
-  | pages=78-90
+  |journal=Thymos: Journal of Boyhood Studies
-  | url=http://www.mensstudies.com/content/b64n267w47m333x0/?p=7ebbd6b446d940cbbd4274c095754b12π=5
+  |volume=4
-  | quote=
+  |issue=1
-  | pubmedID=
+  |pages=78-90
-  | pubmedCID=
+  |url=http://www.mensstudies.com/content/b64n267w47m333x0/?p=7ebbd6b446d940cbbd4274c095754b12π=5
-  | DOI=10.3149/thy.0401.78
+  |quote=
-  | date=2010-04-26
+  |pubmedID=
-  | accessdate=
+  |pubmedCID=
+  |DOI=10.3149/thy.0401.78
+  |date=2010-04-26
+  |accessdate=2019-10-12
 }}</ref><ref>{{REFweb
- | quote=
+  |url=http://www.icgi.org/2010/04/infant-circumcision-causes-100-deaths-each-year-in-us
-  | url=http://www.icgi.org/2010/04/infant-circumcision-causes-100-deaths-each-year-in-us
+  |title=Infant circumcision causes 100 deaths each year in US
-  | title=Infant circumcision causes 100 deaths each year in US
+  |last=
-  | last=
+  |first=
-  | first=
+  |publisher=ICGI
-  | publisher=ICGI
+  |website=[[International Coalition for Genital Integrity]]
-  | website=International Coalition for Genital Integrity
+  |date=2010-04-26
-  | date=2010-04-26
+  |accessdate=
-  | accessdate=
+}}</ref> See also the list of [[fatalities]].
-}}</ref>
 == Forced circumcision ==
+<!--=== United States military ===
-=== United States Military ===
+American soldiers serving in World War II were subjected to regular inspections of their genitals. If intact, the soldiers risked being ordered to undergo immediate circumcision.<ref>{{REFbook
-American soldiers serving in World War II were subjected to regular inspections of their genitals. If uncircumcised, the soldiers risked being ordered to undergo immediate circumcision.<ref>{{REFbook
   |last=Schoen
   |first=Ed
+ |init=E
   |author-link=Edgar J. Schoen
   |year=2005
@@ Line 606: / Line 1,615: @@
   |volume=
   |chapter=
-  |pages=72-73
+  |pages=72-3
   |location=Georgetown, Canada
   |publisher=RDR Books
@@ Line 613: / Line 1,622: @@
   |accessdate=
   |note=
-}}</ref> This practice was discontinued decades ago.
+}}</ref> This practice was discontinued at least six decades ago.-->
+=== Non-therapeutic circumcision of male children ===
-=== Non-therapeutic circumcision of male children ===
+Human babies, because they are not yet in possession of language, are incapable of giving or refusing consent to be [[circumcised]]. The element of force has led some scholars to view the circumcision of baby boys as a category of forced circumcision.<ref>For example, Frederick M. Hodges, a medical historian, writes: "In the late 1970s, as the Americans were growing increasingly aware of the abuses of power rampant throughout the nation's social institutions, influential grass-roots movements protesting the forced circumcision of American children sprang up nationwide." F. Hodges, "A Short History," p. 31; see also [[Leonard B. Glick|Glick]], ''Marked in Your Flesh'', pp. 273-281.</ref> There are, however, physicians in the United States who argue strongly for non-therapeutic circumcision of newborn babies; and circumcision is widely accepted as a postnatal procedure in American hospitals.<ref>{{REFbook
+ |last=Fletcher
+ |first=Christopher R.
+ |init=CR
+ |year=1999
+ |title=Circumcision in America in 1998: Attitudes, Beliefs, and Charges of American Physicians
+ |url=http://www.springerlink.com/content/h2150v731233m177/
+ |work=Male and Female Circumcision
+ |editors=[[George C. Denniston]], [[Frederick M. Hodges]], [[Marilyn Fayre Milos]]
+ |edition=
+ |volume=
+ |chapter=Section 5
+ |pages=259-71
+ |location=New York
+ |publisher=Kluwer Academic/Plenum Publishers
+ |isbn=
+ |quote=
+ |accessdate=2019-10-12
+ |note=ID 10.1007/978-0-585-39937-9_19
+}}</ref> Parental consent is required.<ref>See, e.g., Shephard and Shephard, ''The Complete Guide'', p. 125.</ref> A statement published by the [[American Academy of Pediatrics]] in 1999 claimed that "parents should determine what is in the best interest of the child... It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in additions to the medical factors, when making a decision."<ref>Lannon and Bailey, "Circumcision Policy Statement," p. 691.</ref> however surrogate consent for non-therapeutic circumcision is now viewed as unethical.
+In the [[United Kingdom]], where non-therapeutic circumcision has now become far less prevalent than in the [[United States]], the written consent of both parents is required, if a physician is to perform a non-therapeutic circumcision of a child.<ref>{{REFjournal
+ |last=
+ |first=
+ |title=Re J (child's religious upbringing and circumcision)
+ |journal=Family Court Reports
+ |date=2000
+ |volume=1
+ |issue=
+ |pages=307-14
+ |url=https://www.cirp.org/library/legal/Re_J/2000.html
+ |accessdate=2019-10-12
+}}</ref> (The National Health Service does not provide non-therapeutic circumcision.)
+In recent years, legal writers in several English-speaking countries have been questioning the practice of acceding to parental wishes.<ref>See, e.g., [[Margaret A. Somerville|Somerville]], "Therapeutic and Non-Therapeutic Medical Procedures"; Poulter, ''English Criminal Law''; [[Abbie Chessler|Chessler]], "Justifying the Unjustifiable"; Smith, "Male Circumcision."</ref> For example, critics have pointed out that, in the [[United States]], more than 1.3% of male neonatal deaths are attributable to the complications of non-therapeutic circumcision surgery.<ref name="Bollinger 2010"/>
+==Recommendations of medical authorities==
+* [[George Hill| Hill]] (2007) said:
+<blockquote>
+Male circumcision is harmful because it excises healthy tissue and permanently impairs beneﬁcial physiological functions. Male circumcision also causes psychological problems that tend to perpetuate the cycle of abuse. Male circumcision is a costly diversion of medical resources away from beneﬁcial services. Male circumcision violates legal rights, [[human rights]], and ethical standards. Finally, we must remember that males are the more vulnerable and sensitive of the two genders and, therefore, deserve the greater degree of protection from traumatic, invasive, injurious,and unnecessary surgery. For all of these reasons the non-therapeutic circumcision of boys should not be performed and the [[genital integrity]] of all children should be respected and protected.<ref name="hill2007">{{REFjournal
+ |last=Hill
+ |first=George
+ |init=G
+ |author-link=George Hill
+ |title=The case against circumcision
+ |journal=Journal of Men's Health and Gender
+ |date=2007
+ |volume=4
+ |issue=3
+ |pages=318-23
+ |url=https://www.academia.edu/8367383/The_Case_Against_Circumcision
+ |quote=
+ |pubmedID=
+ |pubmedCID=
+ |DOI=
+ |accessdate=2021-05-30
+}}</ref>
+</blockquote>
+* Andrew E. MacNeiiy, Head, Division of Pediatric Urology, Department of Urological Sciences, {{UNI|University of British Columbia|UBC}}, Vancouver, BC, (2008) said:
+<blockquote>
+Newborn circumcision remains an area of controversy. Social, cultural, aesthetic and religious pressures form the most common reasons for non-therapeutic circumcision. Although penile cancer and UTIs are reduced compared with uncircumcised males, the incidence of such illness is so low that circumcision cannot be justified as prophylaxis. The role of the foreskin in [[HIV]] transmission in developed countries is unclear, and safe sexual practice remains the cornerstone of prevention. There remains a lack of knowledge regarding what constitutes the normal foreskin both among parents and among primary care providers. This lack of knowledge results in a burden of costs to our health care system in the form of unnecessary urological referrals, expansion of wait times and circumcisions. Routine circumcision of all infants is not justified from a health or cost-benefit perspective.<ref>{{REFjournal
+ |last=MacNeily
+ |first=Andrew
+ |init=
+ |author-link=
+ |etal=no
+ |title=Routine circumcision: the opposing view
+ |trans-title=
+ |language=
+ |journal=Can Urol Assoc J
+ |location=
+ |date=2007-11
+ |volume=1
+ |issue=4
+ |article=
+ |page=
+ |pages=395-7
+ |url=http://europepmc.org/article/PMC/2422979
+ |pubmedID=18542825
+ |pubmedCID=
+ |DOI=10.5489/cuaj.455
+ |accessdate=2021-11-08
+}}</ref>
+</blockquote>
+* The [[Royal Dutch Medical Association]] (KNMG) (2010) said:
+<blockquote>
+The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity. Contrary to popular belief, circumcision can cause complications – [[bleeding]], infection, [[urethra]]l stricture and panic attacks are particularly common. KNMG is therefore urging a strong policy of deterrence. KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications.<ref>{{REFdocument
+ |title=Non-therapeutic circumcision of male minors
+ |url=https://www.doctorsopposingcircumcision.org/wp-content/uploads/2016/09/knmg-non-therapeutic-circumcision-of-male-minors-27-05-2010.pdf
+ |contribution=
+ |last=
+ |first=
+ |publisher=Royal Dutch Medical Association
+ |format=PDF
+ |date=2010
+ |accessdate=2021-11-08
+}}</ref>
+</blockquote>
+* The [[Royal Australasian College of Physicians]] (2010) said:
+<blockquote>
+Ethical and [[human rights]] concerns have been raised regarding elective infant male
+circumcision because it is recognised that the foreskin has a functional role, the operation
+is non-therapeutic and the infant is unable to consent.
+After reviewing the currently available evidence, the RACP believes that the frequency of
+diseases modifiable by circumcision, the level of protection offered by circumcision and the
+complication rates of circumcision do not warrant routine infant circumcision in Australia
+and New Zealand. However it is reasonable for parents to weigh the benefits and risks of
+circumcision and to make the decision whether or not to circumcise their sons.<ref name="racp2010">{{REFdocument
+ |title=Circumcision of Infant Males
+ |url=https://www.racp.edu.au//docs/default-source/advocacy-library/circumcision-of-infant-males.pdf
+ |contribution=
+ |last=
+ |first=
+ |publisher=The Royal Australasian College of Physicians
+ |format=PDF
+ |date=2010-09-01
+ |accessdate=2021-11-08
+}}</ref>
+</blockquote>
+* The [[American Academy of Pediatrics]] (AAP) has not re-affirmed its disastrous, failed 2012 Circumcision Policy Statement, which expired in 2017, so currently has no position on child circumcision.
+* Medical historian [[Robert Darby]] (2014) wrote simply:
+<blockquote>
+"To avoid circumcision complications, avoid circumcision."<ref>{{REFjournal
+ |last=Darby
+ |first=
+ |init=R
+ |author-link=Robert Darby
+ |etal=no
+ |title=To avoid circumcision complications, avoid circumcision
+ |trans-title=
+ |language=
+ |journal=Can Urol Assoc J
+ |location=
+ |date=2014-08-14
+ |volume=8
+ |issue=7-8
+ |article=
+ |page=231
+ |pages=
+ |url=https://cuaj.ca/index.php/journal/article/view/1709/1823
+ |archived=
+ |quote=
+ |pubmedID=
+ |pubmedCID=
+ |DOI=10.5489/cuaj.1709
+ |accessdate=2022-12-16
+}}</ref>
+</blockquote>
+* The [[Canadian Paediatric Society]] (CPS) (2015) said:
+<blockquote>In most jurisdictions, authority is limited only to interventions deemed to be medically necessary. In cases in which medical necessity is not established or a proposed treatment is based on personal preference, interventions should be deferred until the individual concerned is able to make their own choices.<ref name="CPS2015">{{REFjournal
+ |last=Sorokin
+ |first=S. Todd
+ |init=ST
+ |author-link=
+ |last2=Finlay
+ |first2=JC
+ |author2-link=
+ |last3=Jeffries
+ |first3=AL
+ |author3-link=
+ |etal=yes
+ |title=Newborn male circumcision
+ |journal=Paediatr Child Health
+ |location=
+ |date=2015-08
+ |volume=20
+ |issue=6
+ |pages=311-20
+ |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578472/
+ |quote=
+ |pubmedID=26435672
+ |pubmedCID=4578472
+ |DOI=10.1093/pch/20.6.311
+ |accessdate=2019-10-27
+}}
+</ref></blockquote>
+* The [[Canadian Urological Association]] (CUA) considered the matter of circumcision and issued a statement in February 2018. The CUA concluded:
+<blockquote>"Given the socioeconomic, educational status, and health demographics of our population, universal neonatal circumcision cannot be justified based on the current evidence available.<ref name="cua2018">{{REFjournal
+ |last=Dave
+ |first=Sumit
+ |init=S
+ |author-link=
+ |etal=yes
+ |title=Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (abridged version)
+ |journal=Can Urol Assoc J
+ |location=
+ |date=2018-02
+ |volume=12
+ |issue=2
+ |pages=18-28
+ |url=https://cuaj.ca/index.php/journal/article/view/5034/3470
+ |quote=
+ |pubmedID=
+ |pubmedCID=
+ |DOI=
+ |accessdate=2021-11-09
+}}</ref></blockquote>
+==British family court opinion==
+The issue of non-therapeutic circumcision of male children came before the court in the case of ''[[Re B and G (children) (No 2) EWFC 3]] (2015)'' . In that case, Judge Sir James Munby ruled that circumcision of male children caused ''significant harm''.
+== Rights and ethics ==
+The [[Rights situation on circumcision|rights situation]] is discussed in a separate article.
+[[Image:Intact vs circumcised.JPG |thumbnail|right|300px| The intact and circumcised human penis, side by side.]]
+The term "circumcision" without a gender qualifier refers specifically to male circumcision. It means "to cut around," and it refers to the [[excision]] of the [[foreskin]] from the penis. The term is inaccurate and a euphemism because the operation actually cuts off or [[amputation| amputates]] the [[foreskin]], which in adults comprises about fifteen square inches of highly functional erogenous tissue.
+Circumcision is most often performed in healthy males for [[Religion and Culture|religious or cultural]] reasons. The procedure may be performed on consenting adults, but it is most often performed on non-consenting minors, particularly newborn children, which is why the ritual is so controversial. Opponents of circumcision consider the circumcision of non-consenting minors to be unethical and a [[human rights]] violation, unless there is concrete [[medical indication]].
+=== Consent by surrogates ===
+Medical ethics has long recognized limitations on the power of consent by surrogates.<ref>{{REFjournal
+ |last=Committee on Bioethics, American Academy of Pediatrics
+ |etal=no
+ |title= Informed consent, parental permission, and assent in pediatric practice
+ |trans-title=
+ |language=
+ |journal=Pediatrics
+ |location=
+ |date=1995
+ |volume=95
+ |issue=2
+ |article=
+ |page=
+ |pages=314-17
+ |url=https://www.cirp.org/library/ethics/AAP/
+ |archived=
+ |quote=
+ |pubmedID=7478854
+ |pubmedCID=
+ |DOI=
+ |accessdate=2023-05-21
+}}</ref> <ref>{{REFjournal
+ |last=Committee on Bioethics
+ |etal=no
+ |title=Informed Consent in Decision-Making in Pediatric Practice
+ |trans-title=
+ |language=
+ |journal=Pediatrics
+ |location=
+ |date=2016-08
+ |volume=138
+ |issue=2
+ |article=
+ |page=e20161485
+ |pages=
+ |url=https://watermark.silverchair.com/peds_20161485.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAApwwggKYBgkqhkiG9w0BBwagggKJMIIChQIBADCCAn4GCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQM8zYHFd0Ylu9Annq_AgEQgIICT24ikc839aJMYOiypqC2G9f7_yKGAGkAekzzbCtck5TElALWVCGNoVSOaA6rDA_dOkQ_LyJnxYlZ88J9-uk15tvlIBbE82_aNyYfq5e9xmEfqD2vh374q3Naz57dxZaUbgxUkKX4PqsiLmYHLvVrr7bQK2MZuuUOKiQU8JZy7lLjkp-PjJO1U9cyIplTAgs_EdvgK8MWWoIsj-X-ZUDImAG63-rlj_qLsy5dYwytmxfCuVa47RdZseLSr2_bdDpwKAKGhq_Ly9rlHZeW_f7fYktVfF_sFTgcJziAlvEQmdyWIw0qf-hlO31Qb3sH6kDdcvHAbm7llY5xa34XLYIt8QR0YFIimgDGFliN4-ce2vjvvrwS85WeeNFhpn-Ywn4Qjpy06hPuLDL-MtI2Z3BZbBsKq4dp8qGu1q9GlXaKw193riTFG9G5bF5GCKmxmt0nCQTthrb_CcK2UhKjZwPekC9zkIUHPZ9BXJt0SM03F_g-GgqbE0hTYKMqNdJ3sHDQu2luFrJ9JEiMzxtP28gJoYh20d2APA0xrRbXBYsFdAlr50gb1BSAbNJhTyx-Kh3geoSHsAYMjPaG7cIbh0jd42pWCUx30vjlAGK8zXTuf7-31oi81CLbHTAJLuzK3NT4Whi17jVq1SbXsIXlWpKc_d-HujCvlb74rkZQ6RG9wkxW7gAKaDqtKv5zTOTMBD9vLVxgp8lDmVA8PFB59Bqd6w-fi86tW132oWQM-mTfwdIBXFbUFXkeTUC5RYyqJQIXAEwLJSRm1RX-LRbKRzgaRQ
+ |archived=
+ |quote=
+ |pubmedID=27456510
+ |pubmedCID=
+ |DOI=10.1542/peds.2016-1485
+ |format=PDF
+ |accessdate=2023-05-21
+}}</ref> <ref>{{REFjournal
+ |last=Committee on Bioethics
+ ||etal=no
+ |title=Informed Consent in Decision-Making in Pediatric Practice
+ |trans-title=
+ |language=
+ |journal=Pediatrics
+ |location=
+ |date=2016-08
+ |volume=138
+ |issue=2
+ |article=
+ |page=e20161484
+ |pages=
+ |url=https://watermark.silverchair.com/peds_20161484.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAApwwggKYBgkqhkiG9w0BBwagggKJMIIChQIBADCCAn4GCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMYv3coRY-UCYMgTaqAgEQgIICT4di03qn2Hbho3i8Li_78lod0lNMunch25nx1rKvaM_aeFerz5eN6_k8VVeNv-DLocZp28whQr1x4WYDVwSs4uF73vZpYZYuDphYQkwxV1HHgMbZAbHBFuE8QyCHyDvSY-fhQcUl-JrYxa3TbhYgd4bKiU9zfIyXUsCnItroCc9iNrMicPg0v_A0AJJlhxioOlAU-im6OPI06OcCBj78yqkPO0J4nMTN1FLochsOyvZZdtFQQzLhrnM_Gey8K75lFYIBJHA7uzMmP2o5KZ-FTGUkEA_eSpEIpwv2WI4SbtrA8WYk3cQqXOmLIWjkSs9CTELD7CQP29xarr1ANrF_id4CiCX7zIomC2Ciz9lHBEgz8EH2i9Woke_YuZeLax52_6JpdhH1qdMQyF1bByjP8mU98V5_B4BPPiBpKt4pVA_UgtaABRHL8oPv6SwOUQZ2Bc-0_E2tod0VIF1FJBwZRZJm2ZkJPgBSKUo8VBe5Pz_6Vpt2DqLzwqVUYscPsIJMvxl09mMtvJrsBa8yVoTRWj4Rd0OBTMV7zhZskDnYYyrAZ6sHMk0MzvbHilPNbNgU5o7mXmcbFGDgGgWbqrIdT6sVSSfPJm4TnR0HSWbc_EnHhhyye7tVlFGjAsR0R46_DSwEMz8M5DkSln8xfKtX_so9rjCvYeq45wqn09g8DqtV-WHEA9PIrcw5kTcz5I0JkNuW4-vKVU1Xz9XHiYi4Zqbq0vx9NWLdNSYHQSOGMZ1MCAxT152evQdipQB5wokR8Q4rICoJYII5bsmRMYd7JQ
+ |archived=
+ |quote=
+ |pubmedID=27456514
+ |pubmedCID=
+ |DOI=10.1542/peds.2016-1484
+ |format=PDF
+ |accessdate=2023-05-21
+}}</ref>
+Two ethicists, Myers & Earp (2020), have conducted a detailed review and analysis of the claimed medical benefits of ''non-therapeutic'' [[circumcision]]. They have determined than the alleged benefits are not material, so they do not support granting of consent by a surrogate. In other words, ''Non-therapeutic'' circumcision is not truly healthcare. Moreover, they comment that even the most perfectly executed surgery produces [[trauma]] and harm to the patient. Circumcision also produces tissue loss and loss of function, therefore, circumcision should be performed only after the individual reaches the age of consent. <u>Consent by a surrogate for a ''non-therapeutic'' circumcision of a minor child is an unethical practice.</u><ref name="myers2020">{{REFjournal
+ |last=Myers
+ |first=
+ |init=A
+ |author-link=
+ |last2=Earp
+ |first2=
+ |init2=BD
+ |author2-link=Brian D. Earp
+ |etal=no
+ |title=What is the best age to circumcise? A medical and ethical analysis
+ |trans-title=
+ |language=
+ |journal=J Biosoc Sci
+ |location=
+ |date=2020-09
+ |volume=34
+ |issue=7
+ |pages=560-72
+ |url=https://onlinelibrary.wiley.com/doi/abs/10.1111/bioe.12714
+ |archived=
+ |quote=
+ |pubmedID=32068898
+ |pubmedCID=
+ |DOI=10.1111/bioe.12714
+ |accessdate=2023-05-18
+}}</ref>
+== Tipping point ==
+[[Intact America]] (2024) argues that public opinion regarding non-therapeutic [[circumcision]] of children is approaching or at a "tipping point" at which [[intact]] genitals would be preferred over the [[circumcised]] variety.<ref>{{REFweb
+ |url=https://intactamerica.org/public-opinion-on-circumcision/
+ |title=Public Opinion on Circumcision: Can Intactivists Hit A Tipping Point?
+ |last=Anonymous
+ |first=
+ |init=
+ |publisher=Intact America
+ |date=2024-03-23
+ |accessdate=2024-04-09
+}}</ref>
-Human babies, because they are not yet in possession of language, are incapable of giving or refusing consent for being circumcised. The element of force has led some scholars to view the circumcision of baby boys as a category of forced circumcision.<ref>For example, Frederick M. Hodges, a medical historian, writes: "In the late 1970s, as the Americans were growing increasingly aware of the abuses of power rampant throughout the nation's social institutions, influential grass-roots movements protesting the forced circumcision of American children sprang up nationwide." F. Hodges, "A Short History," p. 31; see also [[Leonard B. Glick|Glick]], ''Marked in Your Flesh'', pp. 273-281.</ref> There are, however, physicians in the United States who argue strongly for routine circumcision of newborn babies; and circumcision is widely accepted as a postnatal procedure in American hospitals.<ref>{{REFbook
+[[Intact America]] (2024) points out the need for reform in the American media false portrayal of infant circumcision as a benign procedure.<ref>{{REFweb
- | last=Fletcher
+  |url=https://intactamerica.org/truth-about-circumcision-media/
- | first=Christopher R.
+  |title=The Dark Side of Circumcision: Why the Media Needs to Speak Up
- | year=1999
+  |last=Alissa
- | title=Circumcision in America in 1998: Attitudes, Beliefs, and Charges of American Physicians
+  |first=Kristel
-  | url=http://www.springerlink.com/content/h2150v731233m177/
+  |init=
-  | work=
+  |author-link=
-  | editor=
+  |publisher=Intact America
-  | edition=
+  |date=2024-09-12
- | volume=
+  |accessdate=2024-09-13
-  | chapter=Section 5
+}}</ref>
-  | pages=259-271
- | location=New York
-  | publisher=Kluwer Academic/Plenum Publishers
-  | isbn=
- | quote=
-  | accessdate=
- | note=ID 10.1007/978-0-585-39937-9_19
-}}</ref> Parental consent is required.<ref>See, e.g., Shephard and Shephard, ''The Complete Guide'', p. 125.</ref> A statement published by the American Academy of Pediatrics in 1999 declares that "parents should determine what is in the best interest of the child... It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in additions to the medical factors, when making a decision."<ref>Lannon and Bailey, "Circumcision Policy Statement," p. 691.</ref> In the United Kingdom, where routine circumcision has now become far less prevalent than in the United States, a written consent of both parents is required, if a physician is to perform a non-therapeutic circumcision of a child.<ref>[http://www.cirp.org/library/legal/Re_J/2000.html Re J (child's religious upbringing and circumcision)], ''Family Court Reports'', vol. 1 (2000), pp. 307-314.</ref>
-In recent years, legal writers in several English-speaking countries have been questioning the practice of acceding to parental wishes.<ref>See, e.g., Somerville, "Therapeutic and Non-Therapeutic Medical Procedures"; Poulter, ''English Criminal Law''; Chessler, "Justifying the Unjustifiable"; Smith, "Male Circumcision."</ref> For example, critics have pointed out that, in the United States, more than 1.3% of male neonatal deaths are attributable to the complications of non-therapeutic circumcision surgery.<ref>{{REFjournal
+==Financial and other costs==
- | last=Bollinger
+Infant male circumcision is an extra-cost option after birth. There are no medical indications for it. It is a medically-unnecessary, non-therapeutic, non-beneficial irreversible amputation of a functional body part, so medical insurance may or may not pay for it. There are several financial costs associated with infant circumcision. There is a hospital fee, a set-up fee, pharmaceutical fees, a separate fee for the medical doctor who performs the amputation, and various possible additional costs for the treatment of complications.<ref name="garrett2023-12-21">{{REFweb
- | first=Dan
+  |url=https://intactamerica.org/economics-of-circumcision/
- | coauthors=Boy's Health Advisory
+  |title=The Economics of Circumcision: A Full Breakdown of This Penis Business
- | title=Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths
+  |last=Garrett
- | journal=Thymos: Journal of Boyhood Studies
+  |first=Connor
- | volume=4
+ |init=
- | issue=1
+  |author-link=Connor Judson Garrett
- | pages=78-90
+  |publisher=Intact America
- | url=http://www.mensstudies.com/content/b64n267w47m333x0/?p=7ebbd6b446d940cbbd4274c095754b12π=5
+  |date=2023-12-21
- | quote=
+  |accessdate=2024-05-15
- | pubmedID=
- | pubmedCID=
- | DOI=10.3149/thy.0401.78
- | date=2010-04-26
- | accessdate=
-}}</ref><ref>{{REFweb
- | quote=
-  | url=http://www.icgi.org/2010/04/infant-circumcision-causes-100-deaths-each-year-in-us
-  | title=Infant circumcision causes 100 deaths each year in US
-  | last=ICGI
-  | first=
-  | publisher=
-  | Special:CreateMassMessageList=International Coalition for Genital Integrity
-  | date=2010-04-26
-  | accessdate=
 }}</ref>
+Bollinger estimated the total cost of [[circumcision]] in 2012 for Americans, when all costs are included, to be $3.6 billion annually.<ref>{{REFweb
+ |url=https://www.academia.edu/6442587/High_Cost_of_Circumcision_3.6_Billion_Annually
+ |title=High Cost of Circumcision: $3.6 Billion Annually
+ |last=Bollinger
+ |first=Dan
+ |author-link=Dan Bollinger
+ |publisher=Academia
+ |website=https://www.academia.edu
+ |date=2012
+ |accessdate=2024-06-21
+ |format=
+ |quote=As the saying goes, follow the money. Now you know why neither the [[American Academy of Pediatrics]], American Medical Association, [[American Academy of Family Physicians]], or the [[American College of Obstetricians and Gynecologists]] haven’t condemned this unnecessary surgery, and why their physician members are quick to recommend the procedure to expectant parents.
+}}</ref> He has since updated his estimate of total annual cost in 2020 to be $5,685,000,000 or nearly six billion dollars per year.<ref>{{REFbook
+ |last=Anonymous
+ |first=
+ |init=
+ |year=2024
+ |title=Skin in the Game
+ |url=
+ |scope=
+ |location=
+ |page=28
+ |publisher=Intact America
+ |ISBN=
+ |quote=
+ |accessdate=2024-08-28
+ }}</ref>
+There also are additional non-financial costs, which include sexual and sensory losses that adversely impact on the sexual experience in adult life, and psychological losses such as [[PTSD]], and grieving of losses.
+==Video==
+===Is circumcision healthy?===
+The video ''Is Circumcision Healthy'' is recommended for parental viewing.
+<br><br>
+ <youtube>D_3LQjZgdbQ</youtube>
+===Dr. Christopher Guest discusses circumcision===
+<br>
+<youtube>v=TQIp9f4krVQ</youtube>
+=== Dr. Eric discusses circumcision ===
+<br>
+<youtube>v=iZ64pqWZRW8</youtube>
+Dr. Eric understates the numerous functions of the foreskin.
+===Plastibel circumcision===
+{{UNI|Stanford University|SU}} has published a video of an actual non-therapeutic plastibell circumcision. The infant has received two injections of local anesthesia to deaden the dorsal nerves. The ventral nerves were not deadened so the infant still feels pain. One can his cries on the soundtrack.
+* [https://med.stanford.edu/newborns/professional-education/circumcision/plastibell-technique.html Plastibell Technique]
+===Gomco clamp circumcision===
+'''Not for the squeamish:'''
+This is a video of an actual circumcision with a Gomco clamp. The infant boy received two dorsal penile nerve block (DPNB) analgesic injections but they did not seem to work.
+* [https://www.reddit.com/r/Intactivism/comments/qbpzqr/trained_medical_professionals_restrain_infant_to/ Circumcision video]
 {{SEEALSO}}
+* [[Adolescent and adult circumcision]]
+* [[Bodily harm]]
+* [[Breastfeeding]]
+* [[Case Histories]]
+* [[Circumcision bullet-points for parents]]
+* [[Circumcision maps]]
+* [[Circumcision methods]]
+* [[Circumcision scar]]
+* [[Circumpendium]]
+* [[Circumstraint]]
+* [[Documented severe complications of circumcision]]
+* [[Ethics of non-therapeutic child circumcision]]
 * [[FGM]]
+* [[Human rights]]
+* [[Lymphoedema]]
 * [[MGM]]
-* [[Circumpendium]]
+* [[Pain]]
+* [[Psychological issues of male circumcision]]
+* [[Rights situation on circumcision]]
+* [[Risks and complications]]
+* [[Sexual effects of circumcision]]
+* [[Sudden Infant Death Syndrome]] (SIDS)
+* [[Trauma]]
+{{LINKS}}
+* {{REFweb
+ |url=https://www.cirp.org/library/anatomy/garcia/
+ |title=What exactly is circumcision and what is it not?
+ |last=Garcia
+ |first=Francisco
+ |date=1995-12-11
+ |accessdate=2020-09-08
+}}
+* {{REFjournal
+ |last=Fleiss
+ |first=Paul
+ |init=P
+ |author-link=Paul M. Fleiss
+ |title=The foreskin is necessary
+ |journal=Mothering
+ |date=1997-01
+ |volume=
+ |issue=
+ |pages=36-45
+ |url=http://www.noharmm.org/mothering.htm
+ |accessdate=2020-06-29
+}}
+*{{REFweb
+ |url=https://15square.org.uk/losses-from-circumcision/
+ |title=Losses from Circumcision
+ |last=Ball
+ |first=Peter
+ |publisher=15 Square
+ |date=2003-08-09
+ |accessdate=2023-02-23
+}}
+* {{REFweb
+ |url=http://members.tranquility.net/~rwinkel/MGM/primer.html
+ |title=Male Circumcision in the USA: A Human Rights Primer
+ |last=Winkel
+ |first=Rich
+ |author-link=Rich Winkel
+ |date=2005-05-12
+ |accessdate=2021-01-27
+}}
+* {{REFnews
+ |title=Circumcision circumspection: Weigh the facts before making the call
+ |url=https://www.cirp.org/news/2007/2007-01-09_chicagotribune.php
+ |last=Peres
+ |first=Judy
+ |init=
+ |author-link=
+ |publisher=Chicago Tribune
+ |website=
+ |date=2007-01-09
+ |accessdate=2014-07-28
+ |format=
+ |quote=Ethan, a Chicagoan who asked that his last name not be used, said he and his wife decided not to circumcise their two sons, now ages 5 and 1. "We didn't think it was a good idea to impose an operation on a baby that was not medically necessary," he said.
+}}
+* {{REFnews
+ |title=Circumcision losing favor with U.S. parents
+ |url=https://www.cirp.org/news/2007/2007-06-21_SFChronicle.php
+ |last=Guthmann
+ |first=Edward
+ |publisher=San Francisco Chronicle
+ |website=
+ |date=2007-06-21
+ |accessdate=2024-07-28
+ |format=
+ |quote=According to the Centers for Disease Control and Prevention, the circumcision rate in the United States dropped to 55.9 percent in 2003 — an all-time postwar low.
+}}
+* {{REFnews
+ |title=In Last Four Decades, Circumcision Has Lost Popularity in United States
+ |url=https://www.cirp.org/news/2007/2007-07-08_theledger.php
+ |last=White
+ |first=Garry
+ |author-link=
+ |publisher=Lakeland Ledger
+ |website=
+ |date=2007-07-08
+ |accessdate=2024-07-28
+ |quote=Opponents of circumcision say the procedure is doubly harmful, inflicting pain at the time of surgery and reducing sexual pleasure later through the removal of the nerve-rich foreskin.
+}}
+* {{REFnews
+ |title=Making the Cut
+ |url=https://www.cirp.org/news/2007/2007-11-02_time.php
+ |last=Lee-St. John
+ |first=Jeninne
+ |init=
+ |author-link=
+ |publisher=Time Magazine
+ |website=
+ |date=2007-11-02
+ |accessdate=2024-07-28
+ |format=
+ |quote=But [[intactivism]] is also gaining traction among educated, middle-class whites. As University of Virginia sociologist Brad Wilcox observes, "It's these new parents that are unwilling to let kids suffer."
+}}
+* {{REFnews
+ |title=Parents reconsider routine circumcision
+ |url=https://www.cirp.org/news/2007/2007-11-30_theenquirer.php
+ |last=Facciolo
+ |first=Christine
+ |init=
+ |author-link=
+ |publisher=Cincinnati Enquirer
+ |date=2007-11-30
+ |season=
+ |accessdate=
+ |format=
+ |quote=But foes of removing the penis foreskin argue that the procedure provides minimal benefits, causes extreme pain and produces long-term psychological and sexual trauma.
+}}
+* {{REFjournal
+ |last=Testa
+ |first=Patrick
+ |init=
+ |author-link=
+ |last2=Block
+ |first2=Walter E.
+ |init2=
+ |author2-link=
+ |etal=no
+ |title=Libertarianism and circumcision
+ |trans-title=
+ |language=
+ |journal=Int J Health Poiicy Manag
+ |location=
+ |date=2014-05-26
+ |volume=3
+ |issue=
+ |article=
+ |page=
+ |pages=33-40
+ |url=https://www.academia.edu/7587653/Libertarianism_and_Circumcision?email_work_card=view-paper
+ |pubmedID=24987720
+ |pubmedCID=4075101
+ |DOI=10.15171/ijhpm.2014.51
+ |accessdate=
+}}
+* {{REFweb
+ |url=https://intaction.org/what-is-circumcision/
+ |title=What is circumcision?
+ |last=Simone
+ |first=Judy
+ |author-link=
+ |publisher=Intaction
+ |website=https://intaction.org/
+ |date=2020-07-26
+ |accessdate=2020-10-04
+ |format=
+ |quote=
+}}
+* {{REFjournal
+ |last=Deacon
+ |first=
+ |init=M
+ |author-link=
+ |last2=Muir
+ |first2=
+ |init2=G
+ |author2-link=
+ |etal=no
+ |title=What is the medical evidence on non-therapeutic child circumcision?
+ |trans-title=
+ |language=
+ |journal= Int J Impot Res
+ |location=
+ |date=2022-01-08
+ |volume=
+ |issue=
+ |article=
+ |page=
+ |pages=
+ |url=https://www.nature.com/articles/s41443-021-00502-y
+ |archived=
+ |quote=
+ |pubmedID=34997197
+ |pubmedCID=
+ |DOI=10.1038/s41443-021-00502-y
+ |accessdate=2023-04-30
+}}
+* {{REFweb
+ |url=https://intactamerica.org/pros-and-cons-of-circumcision/
+ |title=Pros and Cons of Circumcision (Spoiler: You’ve Been Lied to)
+ |last=Garrett
+ |first=
+ |init=CJ
+ |publisher=Intact America
+ |date=2023-11-10
+ |accessdate=2024-03-22
+}}
+* {{REFweb
+ |url=https://intactamerica.org/groups-who-pressure-you-to-circumcise/
+ |title=The 4 Authority Figures and Groups Who Will Pressure You to Circumcise (and What You Can Do)
+ |last=Garrett
+ |first=Connor
+ |init=
+ |publisher=Intact America
+ |date=2024-01-24
+ |accessdate=2024-01-27
+}}
+* {{REFweb
+ |url=https://intactamerica.org/keeping-your-sons-penis-intact/
+ |title=Keeping Your Son’s Penis Intact: A Guide for Parents
+ |last=Garrett
+ |first=Connor
+ |init=
+ |publisher=Intact America
+ |date=2024-01-24
+ |accessdate=2024-01-29
+}}
+* {{REFweb
+ |url=https://intactamerica.org/timeline-of-circumcision-suffering/
+ |title=A Timeline of Circumcision Suffering: A Detailed Look
+ |last=Garrett
+ |first=Connor
+ |init=
+ |publisher=Intact America
+ |date=2024-02-02
+ |accessdate=2024-02-09
+}}
+* {{REFweb
+ |url=https://intactamerica.org/circumcision-anger-and-resentment/
+ |title=The Circumcision Decision: Unpackaging Anger and Resentment
+ |last=Garner
+ |first=Bryan
+ |init=
+ |author-link=
+ |publisher=Intact America
+ |date=2024-08-26
+ |accessdate=2024-09-05
+}}
 {{REF}}
+[[Category:Circumcision]]
+[[Category:Genital mutilation]]
+[[Category:Body modification]]
+[[Category:Genital surgery]]
+[[Category:Islam]]
+[[Category:Judaism]]
+[[Category:Male circumcision]]
+[[Category:Parental information]]
+[[Category:Penile surgery]]
+[[Category:Medical term]]
+[[Category:Male genital mutilation]]
 [[Category:From Intactipedia]]
 [[Category:From IntactWiki]]
-[[Category:Genital Surgery]]
-[[Category:Terms]]
 [[de:Zirkumzision]]