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Circumcision

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"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 The un |url=https://intactamerica.org/pros-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, noncons-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. -circumcision/ It is a radical treatment option for pathological [[phimosis]], refractory [[balanoposthitis]] |title=Pros and chronic [[urinary tract infection]]s Cons of Circumcision (UTIsSpoiler: You’ve Been Lied to); it is contraindicated in cases of certain genital structure abnormalities or poor general health. |last=Garrett |first=Connor |init= |author-link=Connor Judson Garrett |publisher=Intact America |date=2023-11-10'''Posthectomy''' is a 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. |accessdate=2024-06-02}}</ref>
'''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
}}</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]].
== Historical background ==
===Judaism===
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 is 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.
{{Citation
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 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.
===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
}}</ref>
In Christianity, circumcision is practiced only in the Coptic churchesdenomination. 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
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:
{{Citation
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===
=== 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]].
The form of circumcision adopted by the medical community essentially was equivalent to the Jewish form with ''[[periah]]'', so it inflicted the maximum injury.
|accessdate=2023-10-22
}}</ref> They are made to enable a physician to perform circumcision and collect a fee.
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===Search for prophylactic reasons===
''The following text is taken from the [[Circumpendium]].''
-->
=== 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)<ref name="blalock2003">{{REFjournal
|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=
* 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>
The fact that the [[USA ]] has both the highest rate 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
|last=Grosskurth
|init=H
|url=
|accessdate=
}}</ref> found that, during the first 6 years of life, the incidence of UTIs [[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
|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
|accessdate=
}}</ref>
* It can be concluded that circumcision is ineffective as a preventive measure against UTIs[[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
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 "[[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.
=== Hygiene reasons ===
''Hygiene'' refers to health and only secondarily to cleanliness.
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
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 penis|glans]] and the area [[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.
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 serious problemconcern.
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.<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= Risks and late effects Intact America |date=2024-01-09 |accessdate=3034-06-04}}</ref>Just like tonsil or appendix surgeryIn the past, advocates of circumcision is claimed that a surgical intervention newborn child's nerve system was not yet fully developed, and brings that as a result, the usual risks related to surgical operations, alongside several specific risks of complications and late effectschild felt no [[pain]] during the circumcision procedure. Uberoi et al[[Kanwaljeet J. Singh Anand| Anand]] & Hickey (20221987) report "some men are experiencing a complex negative constellation of psychological, physicalhave shown that newborn children do in fact feel [[pain]], and sexual associations that lead to significant emotional distress directed both internally and externallymore acutely than adults. 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 ="uberoi2022anand-hickey1987">{{REFjournal |last=UberoiAnand |first= |init=MKJS |author-link=Kanwaljeet J. Singh Anand |last2=AbdulcadirHickey |first2= |init2=JPR
|author2-link=
|last3etal=Ohino |first3title=Pain and its effects in the human neonate and fetus |init3trans-title=DA |author3-linklanguage= |last4journal=SantiagoNew Engl J Med |first4location= |init4date=JE1987-11-19 |author4-linkvolume=317 |last5issue=21 |first5pages=1321-9 |init5url=https://www.cirp.org/library/pain/anand/ |author5-linkquote=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. |last6pubmedID=3317037 |first6pubmedCID= |init6DOI=10.1056/NEJM198711193172105 |author6accessdate=2019-11-link=08}}</ref> This has led American health associations to recommend doctors take measures to reduce the [[pain]] of circumcision in infants. |last7= The [https://www.cirp.org/library/statements/aap1999/|first7=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 |init7last= |author7-linkfirst= |last8title=American Academy of Pediatrics: Circumcision Policy Statement; Task Force on Circumcision |first8journal=Pediatrics |init8date= |author81999-link=03 |last9volume=103 |first9issue=3 |init9pages= |author9686-link=93 |etalurl=yeshttps://pediatrics.aappublications.org/content/103/3/686#sec-9 |titleaccessdate=Potentially under-recognized late-stage physical and psychosexual complications of non2019-therapeutic neonatal penile circumcision: a qualitative and quantitative analysis of self11-reports from an online community forum26 |trans-titlenote=Statement Reaffirmed Sept. 1, 2005 |language=}}</ref> |journal=Int J Impot Res The [[AAFP]] (2002) states quite simply in their [https://www.cirp.org/library/statements/aafp2002/|location=position paper], ''"Newborns experience pain during circumcision".''<ref>{{REFweb |datetitle=2022-10-23Circumcision: Position Paper on Neonatal Circumcision. Board Approved: August 2007 Reaffirmed |volumewebsite=Official American Academy of Family Physicians Website |issueurl=http://www.aafp.org/online/en/home/clinical/clinicalrecs/children/circumcision.html |articleaccessdate=2011-05-02 |page=}}</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. |pages= |url=httpsPenile 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.natureama-assn.comorg/articlesama/s41443no-022index/about-00619-8ama/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 |archivedtitle=Report 10 of the Council on Scientific Affairs (I-99): Neonatal Circumcision |quotewebsite=American Medical Association Official Website |pubmedIDurl=36274189 |pubmedCID= |DOI=10http://www.ama-assn.1038org/ama/s41443no-022index/about-00619-8ama/13585.shtml |accessdate=20232011-0105-0804
}}</ref>
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= Possible operative and postoperative complications =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. 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.
Circumcision is surgery. Surgical complications of circumcision generally may be classified as To control [[Bleeding| hemorrhagepain]], [[infection]]some physicians that circumcise use Tylenol, sugar, or surgical misadventure up to and including loss of the penis and [[death]].<ref name="deacon2022" /><ref name="williams-kapilla1993">{{REFjournalREFweb |lastquote=WilliamsTo 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. |initurl=N |authorhttp://www.pollockclinics.com/circumcision/circumcision-link= |last2=Kapilla |init2=L |author2-link= |etal=noguide.html |title=Complications of circumcisionParents' Guide to Circumcision |trans-titlelast= |languagefirst= |journalpublisher=Brit J Surg |locationdate= |dateaccessdate=19932011-04-1008 |volume=80}}</ref><ref>{{REFweb |issuequote=10 |pages=1231-6During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions. |url=httpshttp://www.cirppollockclinics.orgcom/librarycircumcision/complications/williamscircumcision-kapila/before.html |title=Before the Circumcision |quotelast= |pubmedIDfirst=8242285 |pubmedCIDpublisher= |DOIdate=10.1002/bjs.18008010052011-04-08 |accessdate=20192011-1104-2708}}</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]]a topical cream, 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 |quote=Then in our office, he will have topical anesthetic applied to his penis. |url=http://www.spiegelpollockclinics.decom/spiegelcircumcision/vorab/expertecircumcision-warnt-rituelle-beschneidung-veraendert-das-gehirn-der-kinder-a-849534before.html |title=Kinderschmerz-Experte warnt: Rituelle Beschneidung verändert das Gehirn der Kinder |trans-title=Children's pain expert warns: Ritual circumcision changes Before the brain of children |language=GermanCircumcision |last=Prof. Dr. med. Boris Zernikow
|first=
|publisher=Spiegel Online |website= |date=20122011-04-08-12 |accessdate=20192011-1004-11 |format= |quote=08}}</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 a local anaesthetic are still common practiceinjection called a dorsal penile ring block.<ref>{{REFjournalREFweb |lastquote=GarryWe use extensive pain control methods including Tylenol, a sugar solution (to reduce pain perceptions), a topical freezing cream, and a local anesthetic injection. |initurl=Thttp://www.pollockclinics.com/circumcision/circumcision-guide.html |title=Parents' Guide to Circumcision: a survey of fees and practices |journallast=OBG Management |datefirst=1994 |volumepublisher=October |issuedate= |pagesaccessdate=342011-6 |url= |accessdate=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]].<refname="Journal of Perinatology April/May 2002">{{REFjournal |last=HowardTaeusch |initfirst=CRH. William |last2init=HowardHW |init2last2=FMMartinez |last3first2=GarfunkelAlma M. |init3init2=LCAM |last4last3=de BlieckPartridge |init4first3=EAJ. Colin |last5init3=WeitzmanJC |init5last4=MSniderman |titlefirst4=Neonatal circumcision and pain relief: current training practicesSusan |journalinit4=PediatricsS |datelast5=1998Armstrong-Wells |volumefirst5=101Jennifer |issueinit5=J |pageslast6=423Fuentes-8Afflick |urlfirst6=Elena |accessdateinit6=}}</ref><ref>{{REFjournalE |lasttitle=StangPain During Mogen or Plastibell Circumcision |initjournal=HJJournal of Perinatology |last2volume=Snellman22 |init2issue=LW3 |titlepages=Circumcision practice patterns in the United States214-8 |url=http://www.nature.com/jp/journal=Pediatrics/v22/n3/full/7210653a.html |datequote=1998...more than half of the study group had what we considered excessive pain/discomfort over the course of the entire procedure. |volumepubmedID=101 |issuepubmedCID=e5 |pagesDOI= |urlnote=April/May 2002 |accessdatedate=2002-04 |noteaccessdate=Link to [[AAP]] website2011-04-08}}</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]].<refname="Clinical Pediatrics August 1986">{{REFjournal |last=GunnarWilliamson |initfirst=MRPaul S. |last2init=FischPS |init2last2=ROEvans |last3first2=KorsvikNolan Donovan |init3=S |last4init2=Donhowe |init4=JMND |title=The effects of circumcision on serum cortisol and behaviorNeonatal Cortisol Response to Circumcision with Anesthesia |journal=Psychoneuroendocrinology |date=1981Clinical Pediatrics |volume=625 |issue=38 |pages=269412-756 |url=httpshttp://wwwcpj.cirpsagepub.orgcom/librarycontent/pain25/gunnar8/412.abstract |quote=The adrenal cortisol response to surgery was not significantly reduced by the administration of lidocaine. |pubmedID= |pubmedCID= |DOI= |date=1986-08 |accessdate=20192011-1104-2608}}</ref>* Postoperative wound painDuring circumcision, in the case of somp physicians give children's circumcisions conceivably worsened by sugar pacifiers to "reduce the forceful breaking perception of the preputial adhesions.pain",<ref>{{REFweb* Postoperative pain from |quote=During the exposure of the sensitive glans penis circumcision, your son will receive sugar pacifiers to clothing. This suck on which reduce his pain will endure for several weeks or even longer in some casesperceptions.* Postoperative [[bleeding]] of the wound |url=http://www. This can have severe consequences especially for very young infants, if they are not treated promptlypollockclinics. 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 deathcom/circumcision/circumcision-before.<ref>{{REFbookhtml |title=Before the Circumcision
|last=
|first=
|yearpublisher=2000 |titledate=Paediatric Handbook2011-04-08 |urlaccessdate=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 |worklast=Slater |editorsfirst=Smart J, Nolan T.Rebeccah |editioninit=6R |volumefirst2=Laura |chapterinit2=L |pagelast2=82Cornelissen |locationfirst3={{AUSC|VIC}}, AustraliaLorenzo |publisherinit3=Blackwell Science AsiaL |isbnlast3=Fabrizi |quotefirst4=Debbie |accessdateinit4=D |notelast4=}}</ref><ref>{{REFdocumentPatten |titlefirst5=Autopsy of Demetrius MankerJan |urlinit5=J |contributionlast5=Case 93-1711Yoxen |lastfirst6=WetliAlan |firstinit6=CVA |publisherlast6=Miami: Dade County Medical Examiner DepartmentWorley |formatfirst7=Stewart |dateinit7=1993-06-23S |accessdatelast7=}}</ref> <ref>{{REFjournalBoyd |lastfirst8=HissJudith |initinit8=J |last2last8=HorowitzMeek |init2first9=AMaria |last3init9=KahanaM |init3last9=TProf. Fitzgerald |title=Fatal haemorrhage following male ritual circumcisionOral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial |journal=J Clin Forensic Med |date=2000The Lancet |volume=7376 |issue=9748 |pages=1225-32-4 |url=httpshttp://www.cirpthelancet.orgcom/libraryjournals/deathlancet/hiss1article/ |accessdate=2019PIIS0140-116736%2810%2961303-06}}<7/ref><ref>{{REFdocumentfulltext |titlequote=Judgement of inquiry into the death of McWillisOur data suggest that oral sucrose does not significantly affect activity in neonatal brain or spinal cord nociceptive circuits, Ryleigh Roman Bryan |url=http://wwwand therefore might not be an effective analgesic drug.circumstitions.com/death-exsangThe ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief.html |contributionpubmedID= |lastpubmedCID=Newell |first=TEC |publisher=Burnaby, B.C.: B.C. Coroner's Service |formatDOI= |date=20042010-0110-1909 |accessdate=20192011-1104-2608}}</ref>* Post -operative [[lymphoedema]]pain and the pain the child must endure during recovery is hardly, if ever, addressed by professionals.* Postoperative It has been shown that an infant's response to [[Infection| infectionspain]]. This includes both local infections, which can be treated with local therapy, and systemic infections, requiring systemic antibiotic treatmentaltered for years as a consequence of circumcision.<ref>{{REFconference |last=Dr. med. Hartmann |first=Wolfgang |url= |place=Rechtsausschuss des Bundestages [Legal Committee of the Bundestag] (German) |title=Stellungnahme zur Anhörung am 26. November 2012 [Opinion on the hearing on 26 November 2012] (German) |date=2012-11-26 |accessdate=TaddioA etal 1995}}</ref><ref>{{TaddioA KatzJ IlersichAL KorenG 1997}}</ref>* [[Wound dehiscence]]{{Box|Boxtext=<big><b>However, meaning the separation none of the edges above three procedures totally eliminate pain. A baby boy will still experience some pain despite any of the wound or the tissue after suturingthose analgesic procedures.* Adhesion between the surface or rim Prevention of the [[Glans penis|glanspain]] with requires protecting a boy from elective neonatal non-therapeutic circumcision. Only boys who are protected from the neighbouring medically unnecessary circumcision surgery experience no [[penile skinpain]], causing or [[skintrauma]] pockets .</b></big>}} == Risks and bridges, as well as visually unpleasant results effects ==Just like uneven scarstonsil or appendix surgery, which make circumcision is a resurgical intervention and brings the usual risks related to surgical operations, alongside several specific risks of complications and late effects.<ref name="garrett2024-01-circumcision necessary09" /> Uberoi et al.* Postoperative [[phimosis]]: (2022) report "some men are experiencing a phimotic ring can develop during scarringcomplex negative constellation of psychological, physical, which makes a re-circumcision necessaryand sexual associations that lead to significant emotional distress directed both internally and externally. According to The posts also reveal a study discovery phenomenon wherein men discover the physical and psychological manifestations of the decisions made by Blalock et alothers to modify their genitals."<refname ="uberoi2022">{{REFjournal |last=BlalockUberoi |first= |init=HJM |author-link= |last2=VemulakondaAbdulcadir |first2= |init2=VJ |author2-link= |last3=RitcheyOhi |first3= |init3=MLDA |author3-link= |last4=RibbeckSantiago |first4= |init4=MJE |author4-link= |last5= |titlefirst5=Outpatient management of [[phimosis]] Following newborn circumcision |journalinit5=J Urol |dateauthor5-link=2003 |volumelast6=169 |issuefirst6=6 |pagesinit6=2332 |author6-4link= |urllast7= |first7=https://www.cirp.org/library/complications/blalock1/ |accessdateinit7=2019 |author7-11link= |last8= |first8= |init8= |author8-26link=}}</ref>, the prevalence is 2.9%, according to Leitch<ref>{{REFjournal |last9= |first9= |init9= |lastauthor9-link=Leitch |initetal=IOWyes |title=Circumcision Potentially under- recognized late-stage physical and psychosexual complications of non-therapeutic neonatal penile circumcision: a continuing enigmaqualitative and quantitative analysis of self-reports from an online community forum |trans-title= |language= |journal=Aust Paediatr Int JImpot Res |location= |date=19702022-10-23 |volume=6
|issue=
|pagesarticle=59-65 |urlpage=https://www.cirp.org/library/general/leitch1/ |accessdatepages=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=httphttps://www.nytimesnature.com/2012articles/03/08/nyregion/infantss41443-death022-renews00619-debate-over-a-circumcision-ritual.html?_r8 |archived=0 |titlequote=Baby’s Death Renews Debate Over a Circumcision Ritual |lastpubmedID=Robbins36274189 |firstpubmedCID=Liz |dateDOI=201210.1038/s41443-03022-0700619-8 |accessdate=20192023-1001-1108
}}</ref>
=== Physical late effects ===* [[Bodily harm]]* [[Circumcision scar]] is an invariable effect.* An unavoidable late 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).
* 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.
}}
=== Psychological late Sexual effects === [[Psychological_issues_of_male_circumcision#Circumcision_trauma_in_adults| Psychological late Cepeda-Emiliani et al (2023) cited six reports in the literature of detrimental effects]] are also possible after a of circumcision, especially if the operation was carried out in childhood. On this occasion a variety of [[trauma]] may occurincluding erectile function, sensation, which dependmasturbatory pleasure, among othersorgasm, on age and circumstances sexual satisfaction. The authors also cited three studies 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 severe distress in [[circumcised]] against his will or without his consentmen, and also, in the case of due to their infant circumcision, if he was told about it during childhood or had to find it out coincidentally on his own. The psychological late effects with complaints of circumcision are not yet fully researched[[glans]] insensitivity, 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 delayed [[painejaculation]] control, had a disturbed bond with their motherand unpleasant sensation.<refname="cepeda2023">{{REFjournal |last=MarshallCepe da-Emiliani |first= |init=REA |author-link=Alfonso Cepeda-Emiliani |last2=PorterGándara-Cortés |first2= |init2=FLM |author2-link= |last3=RogersOtero-Alén |first3= |init3=AGM |author3-link= |last4=García |etalfirst4=yes |titleinit4=Circumcision: II effects upon motherH |author4-infant interactionlink= |journallast5=Early Hum DevSuárez-Quintanilla |datefirst5=1982 |volumeinit5=7J |issueauthor5-link=4 |pageslast6=367García-74Caballero |urlfirst6=https://www.cirp.org/library/birth/marshall2/ |accessdateinit6=2020T |author6-02-01link= |last7=Gallego}}</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. |first7= |init7=R* In boys [[circumcised]] in childhood, [[post |author7-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>{{REFbooklink= |lastlast8=RamosGarcía-Caballero |initfirst8=S |last2init8=BoyleR |init2author8-link=GJ |yearetal=2001no |title=Understanding circumcisionImmunohistological study of the density and distribution of human penile neural tissue: A Multigradient hypothesis |trans-Disciplinary Approach to a Multi-Dimensional Problemtitle= |language= |journal= Int J Impot Res |location= |urldate=https://link.springer.com/chapter/10.1007/9782023-105-4757-3351-8_1402 |workvolume=35 |editorsissue=[[George C. Denniston]], [[Frederick M. Hodges]], [[Marilyn Fayre Milos]]3 |editionarticle= |volumepage= |chapterpages=Ritual and medical circumcision among Filipino boys: evidence of post286-traumatic stress disorder305 |pagesurl=253https://www.nature.com/articles/s41443-70022-00561-9 |locationarchived=New York |publisherquote=Kluwer Academic/Plenum Publishers |isbnpubmedID=35501394 |quotepubmedCID= |accessdateDOI=10.1038/s41443-022-00561-9 |noteaccessdate=2023-11-26
}}</ref>
* Circumcisions, especially those that happen without consent, can spark feelings of helplessness Circumcision and alienation, which can persist as [[trauma]]frenectomy remove tissues with heightened erogenous sensitivity. 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 <ref name="garrett2024-01- 55% by the mother, 50% by the father, and 58% by the doctor, and 73% felt that their [[human rights]] had been violated.09" /><ref name="cepeda2023" /> <ref name="GSoCHwinkleman1959">{{REFweb |url=http://www.circumcisionharm.org/ |title=Global Survey of Circumcision Harm |accessdate=2019-10-12WinkelmannRK 1959}}</ref>* It can frequently be found They concluded, "Evidence has also started to accumulate that the loss is deniedmale circumcision may result in lifelong physical, sexual, much and sometimes psychological harm as happens with the loss of other body partswell. This denial can lead to fathers having their sons " The [[circumcisedamputation]] of the prepuce results in order not to be reminded the loss of the majority of their own loss. In this process, their own body is defined as "normal" and fine-touch neuroreceptors found in the [[foreskinpenis]] redefined as a foreign object. Their own parents are seen as "good", so that this image is projected onto leaving only the circumcision their parents carried out as well, in order to keep uninhibited protopathic sensibility of the positive emotion intactartificially externalized [[glans penis]]. The father wants to imbalance caused by not having the input from the now ablated fine-touch receptors may be a "good" father later leading cause of the changes in sexual behavior noted 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 wellhuman males.<ref>{{VanderKolkBA 1989}}</ref><ref>{{REFjournal |last=GoldmanVan Howe |init=RRS |author-link=Ronald GoldmanRobert 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=httpshttp://www.cirpncbi.nlm.nih.org/library/psychgov/goldman1pubmed/9218663 |title=The psychological impact of circumcision |journalquote=BJU Int |datepubmedID=19999218663 |volumepubmedCID=83 |issueDOI=Suppl. 1 |pagesdate=931997-04-10302 |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]].
Histology of the male circumcision scar shows [[amputation]] neuromas, Schwann cell proliferation and the bulbous collection of variably sized neurites. [[Intact AmericaAmputation]] neuromas do not mediate normal sensation and are notorious for generating pain.<ref name="ColdCJ TaylorJR 1999"/> Cepeda-Emiliani et al. (20192023) 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 circumcision the [[circumstraint]]. The procedure is most often an elective, non-therapeutic surgery without [[Adverse Childhood Experiences 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 (ACEsUTIs); 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_issues_of_male_circumcision#Circumcision_trauma_in_adults| adverse childhood experiencePsychological late effects]]are also possible after a circumcision,especially if the operation was carried out in childhood.<ref name="garrett2024-01-09"bollinger2019"/> 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<ref>{{REFdocumentREFjournal |titlelast=Child genital cutting as an adverse childhood experienceMarshall |urlinit=http://adversechildhoodexperiences.net/CGC_as_an_ACE.pdfRE |lastlast2=BollingerPorter |firstinit2=DanFL |author-linklast3=Dan BollingerRogers |last2init3=ChapinAG |first2etal=Georganneyes |author2title=Circumcision: II effects upon mother-linkinfant interaction |journal=Georganne ChapinEarly Hum Dev |publisherdate=Intact America1982 |locationvolume=Tarrytown7 |formatissue=PDF4 |datepages=2019367-0874 |url=https://www.cirp.org/library/birth/marshall2/ |accessdate=20212020-1102-0201}}</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.
== Complications ===== Pain ===* In the pastboys [[circumcised]] in childhood, advocates of circumcision claimed that [[post-traumatic stress disorder]] ([[PTSD]]) could be diagnosed. In a newborn child's nerve system study on Philippine boys, in whom no [[PTSD]] was not yet fully developed, and that as a resultfound prior to the operation, 69% of the child felt no boys [[paincircumcised]] during in the circumcision procedure. Anand & Hickey (1987) have shown that newborn children do in fact feel traditional ritual and 51% of those [[paincircumcised]], and more acutely than adultsby standard medical procedures (including anaesthesia) fulfilled the DSM-IV criteria for PTSD following the operation.<ref name="anand-hickey1987">{{REFjournalREFbook |last=AnandRamos |first= |author-linkinit=S |last2=HickeyBoyle |first2init2=GJ |author2-linkyear=2001 |etaltitle=noUnderstanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem |titleurl=Pain and its effects in the human neonate and fetushttps://link.springer.com/chapter/10.1007/978-1-4757-3351-8_14 |trans-titlework= |languageeditors=[[George C. Denniston]], [[Frederick M. Hodges]], [[Marilyn Fayre Milos]] |journaledition=New Engl J Med |locationvolume= |datechapter=1987-11Ritual and medical circumcision among Filipino boys: evidence of post-19traumatic stress disorder |volumepages=317253-70 |issuelocation=21New York |pagespublisher=1321-9Kluwer Academic/Plenum Publishers |urlisbn=https://www.cirp.org/library/pain/anand/
|quote=
|pubmedID=3317037 |pubmedCID= |DOI= |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 [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 |last= |first= |title=American Academy of Pediatrics: Circumcision Policy Statement; Task Force on Circumcision |journal=Pediatrics |date=1999-03 |volume=103 |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>
 The [[AAFP]] (2002) states quite simply in their [https://www.cirp.org/library/statements/aafp2002/| position paper]* Circumcisions, especially those that happen without consent, ''"Newborns experience pain during circumcision".''<ref>{{REFweb |title=Circumcision: Position Paper on Neonatal Circumcision. Board Approved: August 2007 Reaffirmed |website=Official American Academy can spark feelings 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, helplessness and yet, it is not widely accepted, even by some doctors. It might be hard for some doctors to acceptalienation, which can persist as they may have been taught that the infant does not feel [[paintrauma]], 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 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 circumcisionThese feeling can also be triggered later, local anesthesia should be provided for the procedure. Ring block or dorsal penile blocks when someone [injections] are most effective. [[EMLAcircumcised]] cream has limited utility"''. Alarmingly, ''"Despite the clear evidence that newborn males generate brisk pain responses during circumcision, a recent survey as an infant becomes aware of residency training programs found that 26% of programs that taught his circumcision provided no instruction on the use of local anesthesia". The AMA reports that "Of physicians performing circumcisionIn an online study, 45interviewed men stated they felt betrayed - 55% use anesthesiaby the mother, 7150% of pediatriciansby the father, 56and 58% of family practitionersby the doctor, and 2573% of obstetricians"''felt that their [[human rights]] had been violated.<refname="GSoCH">{{REFweb |title=Report 10 of the Council on Scientific Affairs (I-99): Neonatal Circumcision |website=American Medical Association Official Website |url=http://www.ama-assncircumcisionharm.org/ama/no-index/about-ama/13585.shtml |title=Global Survey of Circumcision Harm |accessdate=20112019-0510-0412
}}</ref>
 The AAP's * 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 [[http://wwwcircumcised]] in order not to be reminded of their own loss.healthychildrenIn this process, their own body is defined as "normal" and the [[foreskin]] redefined as a foreign object.org/English/ages-stages/prenatal/decisions-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-make/pages/Where-We-Stand-Circumcisionkeep the positive emotion intact.aspx Heatlhy Children website] suggests ''The father wants to be a "good"Your pediatrician (or your obstetrician) should discuss the forms father later in life as well, and so, following an idealised image of analgesia that are availablehis own parents, circumcision, which has been redefined as a "good thing"'', is passed on to his son by having him [[circumcised]] as well.<ref>{{REFwebVanderKolkBA 1989}}</ref><ref>{{REFjournal |titlelast=Where We Stand: CircumcisionGoldman |publisherinit=[[AAP]]R |dateauthor-link=2011-03-23Ronald Goldman |url=httphttps://www.healthychildrencirp.org/Englishlibrary/ages-stagespsych/prenatal/decisions-to-makegoldman1/ |title=The psychological impact of circumcision |journal=BJU Int |date=1999 |volume=83 |issue=Suppl. 1 |pages/Where=93-We-Stand-Circumcision.aspx103
|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. Given what is known from aforementioned official documents, * If 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[[circumcised]] male feels incomplete, and make sure your baby is given an injection. This is your responsibility, because your doctor may or may not be up due to date on the latest understandings of infant sensitivity missing [[foreskin]] disadvantaged compared to pain during circumcision."'' The AAP may be holding back, however, perhaps because this would upset the doctor/parent power relationship[[intact]] males, an inferiority complex 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 [[paindepression]]may occur. This can be accompanied by conscious recognition of his own incompleteness, some physicians that circumcise use Tylenol, sugar,or the deficiency may remain completely subconscious<ref>{{REFwebREFjournal |quotelast=Rhinehart |init=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.J |url=httphttps://www.pollockclinicscirp.comorg/circumcisionlibrary/psych/rhinehart1/ |title=Neonatal circumcision-guide.htmlreconsidered |titlejournal=Parents' Guide to CircumcisionTransactional Analysis J |lastdate=1999 |firstvolume=29 |publisherissue=3 |datepages=215-21 |accessdate=20112019-0410-0812}}</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>{{REFwebREFjournal |quotelast=Cansever |init=G |date=During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions.1965 |url=httphttps://www.pollockclinicscirp.comorg/circumcisionlibrary/psych/cansever/circumcision-before.html |title=Before the CircumcisionPsychological effects of circumcision |lastjournal=Brit. J. Med. Psychol |firstvolume=38 |publisherpages= |date=2011321-04-0831 |accessdate=20112019-0410-0812}}</ref> a topical cream,* Fear of being alone or darkness.<refname="Levy1945">{{REFwebREFjournal |last=Levy |quotefirst=Then in our office, he will have topical anesthetic applied to his penisDavid M. |init=DM |url=httphttps://www.pollockclinicscirp.comorg/library/circumcisionpsych/levy1/circumcision-before.html |title=Before the CircumcisionPsychic trauma of operations in children; and a note on combat neurosis |lastjournal=American Journal of Diseases of Children |firstvolume=69 |publisherdate=1945 |datepages=2011-047-0825 |accessdate=20112019-0410-0812}}</ref> * Fear of doctors, clinics andalso closed rooms.<ref name="Levy1945"/or a local anaesthetic injection >* 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]]. [[Intact America]] (2019) called a dorsal penile ring block.circumcision an [[Adverse Childhood Experiences (ACEs)| adverse childhood experience]],<refname-"bollinger2019">{{REFwebREFdocument |quotetitle=We use extensive pain control methods including Tylenol, a sugar solution (to reduce pain perceptions), a topical freezing cream, and a local anesthetic injection.Child genital cutting as an adverse childhood experience |url=http://wwwadversechildhoodexperiences.pollockclinicsnet/CGC_as_an_ACE.com/circumcision/circumcisionpdf |last=Bollinger |first=Dan |author-guide.htmllink=Dan Bollinger |titlelast2=Parents' Guide to CircumcisionChapin |lastfirst2=Georganne |firstauthor2-link=Georganne Chapin |publisher=Intact America |location=Tarrytown |format=PDF |date=2019-08 |accessdate=20112021-0411-0802}}</ref> Topical anaesthetic only serves  == Complications ===== Possible operative and postoperative complications ===Circumcision is surgery. Surgical complications of circumcision generally may be classified as [[Bleeding| hemorrhage]], [[infection]], or surgical misadventure up to numb the area to lessen the pain and including loss of the injection, but studies have shown that a dorsal penile ring block is not always effective in stopping the pain of circumcisionpenis and [[death]].<ref name="Journal of Perinatology Aprildeacon2022" /May 2002><ref name="williams-kapilla1993">{{REFjournal |last=TaeuschWilliams |firstinit=H. WilliamN |initauthor-link=HW |last2=Martinez |first2=Alma M.Kapilla |init2=AML |last3author2-link=Partridge |first3etal=J. Colinno |init3title=JCComplications of circumcision |last4trans-title=Sniderman |first4language=Susan |init4journal=SBrit J Surg |last5location=Armstrong-Wells |first5date=Jennifer |init5=J |last6=Fuentes1993-Afflick |first6=Elena |init6=E |title=Pain During Mogen or Plastibell Circumcision |journal=Journal of Perinatology10 |volume=2280 |issue=310 |pages=2141231-86 |url=httphttps://www.naturecirp.comorg/jplibrary/journalcomplications/v22williams-kapila/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=8242285
|pubmedCID=
|DOI= |note=April10.1002/May 2002 |date=2002-04bjs.1800801005 |accessdate=20112019-0411-0827}}</ref><ref name="Clinical Pediatrics August 1986">{{REFjournal |last=Williamson |first=Paul S* Intolerance or allergic reactions to the narcotics used. |init=PS |last2=Evans |first2=Nolan Donovan |init2=ND |title=Neonatal Cortisol Response * 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 Circumcision with Anesthesia |journal=Clinical Pediatrics |volume=25 |issue=8 |pages=412provide sufficient anaesthetic even for experienced anaesthetists is still 5-6 |url=http://cpj.sagepub.com/content/25/8/41210%.abstract |quote=The adrenal cortisol response general anaesthesia that would be needed for newborns, however, poses significant risks for the child, and, therefore, is only likely to surgery was not significantly reduced by the administration of lidocainebe used in emergencies. |pubmedID= |pubmedCID= |DOI= |date=1986-08 |accessdate=2011-04-08}}</ref> During circumcision, somp physicians give children sugar pacifiers A surgical operation without proper [[pain]] control can lead to "reduce the perception development of a specific pain",memory<ref>{{REFweb |quote=During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions. |url=http://www.pollockclinicsspiegel.comde/spiegel/circumcisionvorab/circumcisionexperte-warnt-rituelle-beschneidung-veraendert-das-gehirn-der-kinder-a-before849534.html |title=Before Kinderschmerz-Experte warnt: Rituelle Beschneidung verändert das Gehirn der Kinder |trans-title=Children's pain expert warns: Ritual circumcision changes the Circumcisionbrain of children |language=German |last=Prof. Dr. med. Boris Zernikow
|first=
|publisher=Spiegel Online |website= |date=20112012-0408-0812 |accessdate=20112019-0410-0811 |format= |quote=}}</ref> but in at least one study. In unsedated and partially sedated infants increased secretion of the stress hormone cortisol could be observed for months after the operation. Overall, data shows that giving sugar to a child doesn't help to reduce their pain threshold was lower and the perception risk of chronic pain in the childincreased.Regardless of these findings, infant circumcisions with insufficient or no anaesthetic are still common practice<ref name="Lancet, The 2010-10-09">{{REFjournal |last=SlaterGarry |firstinit=RebeccahT |inittitle=RCircumcision: a survey of fees and practices |first2journal=LauraOBG Management |init2date=L1994 |last2volume=CornelissenOctober |first3issue=Lorenzo |init3pages=34-6 |url=L |last3accessdate=Fabrizi}}</ref><ref>{{REFjournal |first4last=DebbieHoward |init4init=DCR |last4last2=PattenHoward |first5init2=JanFM |init5last3=JGarfunkel |last5init3=YoxenLC |first6last4=Alande Blieck |init6init4=AEA |last6last5=WorleyWeitzman |first7init5=StewartM |init7title=SNeonatal circumcision and pain relief: current training practices |last7journal=BoydPediatrics |first8date=Judith1998 |init8volume=J101 |last8issue=Meek |first9pages=Maria423-8 |init9url=M |last9accessdate=Prof. Fitzgerald}}</ref><ref>{{REFjournal |titlelast=Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trialStang |journalinit=The LancetHJ |volumelast2=376Snellman |issueinit2=9748LW |pagestitle=1225-32Circumcision practice patterns in the United States |urljournal=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961303-7/fulltextPediatrics |quotedate=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.1998 |pubmedIDvolume=101 |pubmedCIDissue=e5 |DOIpages= |dateurl=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 |note=Link to [[painAAP]] can be altered for years as a consequence of circumcision.<ref>{{TaddioA etal 1995website}}</ref><ref>{{TaddioA KatzJ IlersichAL KorenG 1997}}</ref> {{Box|Boxtext=<big><b>However. During procedures which take several minutes, none babies tend to fall into a state of stupor, which in the above three procedures totally eliminate past was falsely interpreted as peaceful sleep, nurturing the belief that babies felt no pain. A baby boy will still experience some pain despite any of Measurements taken in those analgesic procedures. Prevention of [[pain]] requires protecting cases revealed a boy from elective neonatal nontypically 3- to 4-therapeutic circumcision. Only boys who are protected from the medically unnecessary circumcision surgery experience no fold increase in cortisol levels, which equals a state of severe [[pain]] or [[traumashock]].</b></big>}} === Sexual effects === Circumcision and frenectomy remove tissues with heightened erogenous sensitivity.<ref name="cepeda2023">{{REFjournal |last=Cepeda-Emiliani |first=Gunnar |init=A |author-link=Alfonso Cepeda-EmilianiMR |last2=Gándara-Cortés |first2=Fisch |init2=M |author2-link=RO |last3=Otero-Alén |first3=Korsvik |init3=M |author3-link=S |last4=García |first4=Donhowe |init4=HJM |author4-linktitle=The effects of circumcision on serum cortisol and behavior |last5journal=Suárez-QuintanillaPsychoneuroendocrinology |first5date=1981 |init5volume=J6 |author5-linkissue=3 |last6pages=García269-Caballero75 |first6url=https://www.cirp.org/library/pain/gunnar/ |init6accessdate=T |author62019-11-link=26 |last7=Gallego}}</ref> |first7=* Postoperative wound pain, in the case of children's circumcisions conceivably worsened by the forceful breaking of the preputial adhesions. |init7=R* 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. |author7-link=* 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 |last8last=García-Caballero |first8first= |init8year=R |author8-link= |etal=no2000 |title=Immunohistological study of the density and distribution of human penile neural tissue: gradient hypothesisPaediatric Handbook |trans-titleurl= |languagework= |journaleditors= Int Smart J Impot Res |location=, Nolan T. |dateedition=2023-05-026 |volume=35 |issuechapter=3 |articlepage=82 |pagelocation= {{AUSC|pages=286-305VIC}}, Australia |urlpublisher=https://www.nature.com/articles/s41443-022-00561-9Blackwell Science Asia |archivedisbn=
|quote=
|pubmedID=35501394
|pubmedCID=
|DOI=10.1038/s41443-022-00561-9
|accessdate=2023-11-21
}}</ref> 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
|last=Boyle
|first=Gregory J.
|init=GJ
|author-link=Gregory Boyle
|first2=Gillian A.
|init2=GA
|last2=Bensley
|title=Adverse Sexual and Psychological Effects of Male Infant Circumcision
|journal=Psychological reports
|volume=88
|issue=3, Part 2
|pages=1105–6
|url=https://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
|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=
|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>
 Histology of the male circumcision scar shows * Post operative [[amputationlymphoedema]] neuromas, Schwann cell proliferation and the bulbous collection of variably sized neurites. * Postoperative [[AmputationInfection| infections]] neuromas do not mediate normal sensation . This includes both local infections, which can be treated with local therapy, and are notorious for generating painsystemic infections, requiring systemic antibiotic treatment.<ref name="ColdCJ TaylorJR 1999"/>{{REFconference |last=Dr. med. Hartmann |first=Wolfgang |url= |place= Death Rechtsausschuss des Bundestages [Legal Committee of the Bundestag] (German) |title=Stellungnahme zur Anhörung am 26. November 2012 [Opinion on the hearing on 26 November 2012] (German) |date=2012-11-26 |accessdate=A study in 2010 estimated approximately 117 neonatal circumcision-related deaths occur annually in }}</ref>* [[Wound dehiscence]], meaning the separation of the edges of the wound or the tissue after suturing.* Adhesion between the United States, about one out surface or rim of every 77 male neonatal deathsthe [[Glans penis|glans]] with the neighbouring [[penile skin]], more than suffocationcausing [[skin]] pockets and bridges, auto accidentsas well as visually unpleasant results like uneven scars, or even which make a re-circumcision necessary.* Postoperative [[SIDSphimosis]]: a phimotic ring can develop during scarring, which makes a re-circumcision necessary. According to a study by Blalock et al.<ref name="Bollinger 2010">{{REFjournal |last=BollingerBlalock |firstinit=DanHJ |initlast2=DVemulakonda |author-linkinit2=Dan BollingerV |last2last3=Boy's Health AdvisoryRitchey |titleinit3=Lost Boys: An Estimate of U.S. Circumcision-Related Infant DeathsML |journallast4=Thymos: Journal of Boyhood StudiesRibbeck |volumeinit4=4M |issuetitle=1Outpatient management of [[phimosis]] Following newborn circumcision |pagesjournal=78-90J Urol |url=http://www.mensstudies.com/content/b64n267w47m333x0/?p=7ebbd6b446d940cbbd4274c095754b12πdate=52003 |quotevolume=169 |pubmedIDissue=6 |pubmedCIDpages=2332-4 |DOIurl=10.3149https://thywww.0401cirp.78 |date=2010-04-26org/library/complications/blalock1/ |accessdate=2019-1011-1226}}</ref>, the prevalence is 2.9%, according to Leitch<ref>{{REFwebREFjournal |last=Leitch |urlinit=http://www.icgi.org/2010/04/infant-circumcision-causes-100-deaths-each-year-in-usIOW |title=Infant circumcision causes 100 deaths each year in USCircumcision - a continuing enigma |lastjournal=Aust Paediatr J |firstdate=1970 |publishervolume=ICGI6 |websiteissue=[[International Coalition for Genital Integrity]] |datepages=201059-04-2665 |url=https://www.cirp.org/library/general/leitch1/ |accessdate=2019-12-15}}</ref> See also 5.5%.* [[Sudden Infant Death Syndrome]] (SIDS).* Knot formation of the veins. If the dorsal vein, which originates in the list tip of the [[fatalitiesforeskin]], 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).== Forced circumcision ==* 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--=== United States military === American soldiers serving in World War II were subjected to regular inspections orthodox Jewish ritual of Metzitzah B'Peh (which consists of sucking blood from the wound with the mouth), there is a risk of their genitals. If intactinfection with [[herpes]] simplex type 1, the soldiers risked being ordered which can lead to undergo immediate circumcisionbrain damage or [[death]].<ref>{{REFbook |last=Schoen |first=Ed |init=E |author-link=Edgar J. Schoen |year=2005 |title=On CircumcisionREFweb |url=httpshttp://bookswww.googlenytimes.decom/books2012/03/08/nyregion/infants-death-renews-debate-over-a-circumcision-ritual.html?id_r=-zUhdvSt7cgC0 |worktitle=Baby’s Death Renews Debate Over a Circumcision Ritual |editorlast=Dianne YeakeyRobbins |editionfirst=Liz |volumedate= |chapter= |pages=722012-03-307 |locationaccessdate=Georgetown, Canada |publisher=RDR Books |isbn=12019-157143-12310-3 |quote=For a critical view, see Sorrells, "The History of Circumcision," p. 333 |accessdate= |note=11}}</ref> This practice was discontinued at least six decades ago.--> === Non-therapeutic circumcision of male children Death === Human babies, because they are not yet in possession There is indeed a risk of language, are incapable of giving or refusing consent to be [[circumciseddeath]]. The element of force has led some scholars to view the from non-therapeutic neonatal circumcision of baby boys as a category of forced circumcision.,<ref>For example, Frederick M. Hodges, a medical historian, writes: name="In the late 1970s, as the Americans were growing increasingly aware of the abuses of power rampant throughout the nation's social institutions, influential grassgarrett2024-01-roots movements protesting 09" /> although the forced [[circumcision of American children sprang up nationwideindustry]] takes care to not reveal it." F. Hodges, "A Short History," p. 31; see also study in 2010 estimated approximately 117 neonatal circumcision-related [[Leonard B. GlickDeath|Glickdeaths]], ''Marked in Your Flesh'', pp. 273-281.</ref> There are, however, physicians occur annually in the [[United States who argue strongly for non-therapeutic circumcision ]], about one out of newborn babies; and circumcision is widely accepted as a postnatal procedure in American hospitalsevery 77 male neonatal deaths, more than suffocation, auto accidents, or even [[SIDS]].<refname="Bollinger 2010">{{REFbookREFjournal |last=FletcherBollinger |first=Christopher R.Dan |init=CRD |yearauthor-link=1999Dan Bollinger |titlelast2=Circumcision in America in 1998: Attitudes, Beliefs, and Charges of American PhysiciansBoy's Health Advisory |urltitle=httpLost Boys://wwwAn Estimate of U.springerlinkS.com/content/h2150v731233m177/ |work=Male and Female Circumcision-Related Infant Deaths |editors=[[George C. Denniston]], [[Frederick M. Hodges]], [[Marilyn Fayre Milos]] |editionjournal=Thymos: Journal of Boyhood Studies |volume=4 |chapterissue=Section 51 |pages=25978-7190 |locationurl=New York |publisherhttp://www.mensstudies.com/content/b64n267w47m333x0/?p=Kluwer Academic/Plenum Publishers |isbn7ebbd6b446d940cbbd4274c095754b12π=5
|quote=
|pubmedID=
|pubmedCID=
|DOI=10.3149/thy.0401.78
|date=2010-04-26
|accessdate=2019-10-12
|note=ID 10.1007/978-0-585-39937-9_19}}</ref> Parental consent is required.<ref>See, e{{REFweb |url=http://www.gicgi., Shephard and Shephard, ''The Complete Guide'', p. 125.<org/2010/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.<04/ref> however surrogate consent for noninfant-therapeutic circumcision is now viewed as unethical. In the [[United Kingdom]], where non-therapeutic circumcision has now become far less prevalent than causes-100-deaths-each-year-in the [[United States]], the written consent of both parents is required, if a physician is to perform a non-therapeutic us |title=Infant circumcision of a child.<ref>{{REFjournalcauses 100 deaths each year in US
|last=
|first=
|titlepublisher=Re J (child's religious upbringing and circumcision)ICGI |journalwebsite=Family Court Reports[[International Coalition for Genital Integrity]] |date=2000 |volume=1 |issue= |pages=3072010-04-14 |url=https://www.cirp.org/library/legal/Re_J/2000.html26 |accessdate=2019-10-12}}</ref> (The National Health Service does not provide non-therapeutic circumcisionSee also the list of [[fatalities]].)
In recent years== Forced circumcision ==<!--=== United States military ===American soldiers serving in World War II were subjected to regular inspections of their genitals. If intact, legal writers in several English-speaking countries have been questioning the practice of acceding soldiers risked being ordered to parental wishesundergo immediate circumcision.<ref>See, e{{REFbook |last=Schoen |first=Ed |init=E |author-link=Edgar J.g., [[Margaret A. SomervilleSchoen |Somerville]], "Therapeutic and Non-Therapeutic Medical Procedures"; Poulter, ''English Criminal Law''; [[Abbie Chessleryear=2005 |Chessler]], "Justifying the Unjustifiable"; Smith, "Male title=On Circumcision."< |url=https://ref> For example, critics have pointed out that, in the [[United States]], more than 1books.3% of male neonatal deaths are attributable to the complications of non-therapeutic circumcision surgerygoogle.<ref namede/books?id="Bollinger 2010"/>-zUhdvSt7cgC |work= |editor=Dianne Yeakey |edition=Video |volume= |chapter= |pages=72-3 |location=Georgetown, Canada |publisher=Is circumcision healthy?RDR Books |isbn=1-157143-123-3 |quote==For a critical view, see Sorrells, "The video ''Is History of Circumcision Healthy'' is recommended for parental viewing," p.333<br><br> |accessdate= |note=}}<youtube/ref>D_3LQjZgdbQ</youtubeThis practice was discontinued at least six decades ago.-->=== 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=Dr. Christopher Guest discusses circumcisionCR |year=1999 |title=Circumcision in America in 1998: Attitudes, Beliefs, and Charges of American Physicians |url=http://www.springerlink.com/content/h2150v731233m177/<br> |work=Male and Female Circumcision<youtube>v |editors=TQIp9f4krVQ</youtube>[[George C. Denniston]], [[Frederick M. Hodges]], [[Marilyn Fayre Milos]] |edition= |volume= |chapter=Section 5 |pages=Plastibel circumcision259-71 |location=New York |publisher=Kluwer Academic/Plenum Publishers |isbn= |quote={{UNI |Stanford Universityaccessdate=2019-10-12 |SUnote=ID 10.1007/978-0-585-39937-9_19}} has </ref> Parental consent is required.<ref>See, e.g., Shephard and Shephard, ''The Complete Guide'', p. 125.</ref> A statement published a video by the [[American Academy of an actual non-therapeutic plastibell circumcision. The infant has received two injections Pediatrics]] in 1999 claimed that "parents should determine what is in the best interest of local anesthesia to deaden the dorsal nerveschild.. The ventral nerves were not deadened so the infant still feels pain. One can his cries on It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in additions to the soundtrackmedical factors, when making a decision.* [https://med"<ref>Lannon and Bailey, "Circumcision Policy Statement," p.stanford691.edu</newborns/professionalref> however surrogate consent for non-education/therapeutic circumcision/plastibell-techniqueis now viewed as unethical.html Plastibell Technique]
===Gomco clamp In the [[United Kingdom]], where non-therapeutic circumcision=== '''Not for has now become far less prevalent than in the [[United States]], the squeamish:''' This written consent of both parents is required, if a physician is to perform a video non-therapeutic circumcision of an actual circumcision with a Gomco clampchild. The infant boy received two dorsal penile nerve block <ref>{{REFjournal |last= |first= |title=Re J (DPNBchild's religious upbringing and circumcision) analgesic injections but they did not seem to work. |journal=Family Court Reports |date=2000 |volume=1 |issue= |pages=307-14* [ |url=https://www.redditcirp.comorg/rlibrary/Intactivismlegal/commentsRe_J/qbpzqr2000.html |accessdate=2019-10-12}}</trained_medical_professionals_restrain_infant_to/ Circumcision video]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>
* 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
|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> ==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.<ref name="garrett2023-12-21">{{REFweb |url=https://intactamerica.org/economics-of-circumcision/ |title=The Economics of Circumcision: A Full Breakdown of This Penis Business |last=Garrett |first=Connor |init= |author-link=Connor Judson Garrett |publisher=Intact America |date=2023-12-21 |accessdate=2024-05-15}}</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 maps]]* [[Circumcision methods]]* [[Circumcision scar]]* [[Circumpendium]]* [[Circumstraint]]* [[Documented severe complications of circumcision]]* [[Ethics of non-therapeutic child circumcision]]* [[FGM]]* [[Human rights]]* [[Lymphoedema]]* [[MGM]]* [[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
|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=Anonymous |first= |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=Anonymous |first= |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=Anonymous |first= |init= |publisher=Intact America |date=2024-02-02 |accessdate=2024-02-09}}{{REF}}
* {{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
}}
{{REF}}
[[Category:Circumcision]]
[[Category:Male circumcision]]
[[Category:Parental information]]
[[Category:Penile surgery]]
[[Category:Medical term]]
[[Category:Male genital mutilation]]
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