Difference between revisions of "Circumcision risks"

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This article wants to offer a comprehensive overview of risks which can occur by undergoing a [[circumcision]]. This page is a landing page for those who want to find a quick overview about circumcision risks. Chances are that information given here is shown in more detail in other IntactiWiki articles.
+
This article wants to offer a comprehensive overview of risks which can occur by undergoing a [[circumcision]]. This page is a landing page for those who want to find a quick overview about [[circumcision]] risks. Chances are that information given here is shown in more detail in other IntactiWiki articles.
 +
 
 +
Please bear in mind that infants are not born with a diseased [[penis]] that requires surgery. There are no medical indications for infant circumcision and few in later life. Infant circumcision is a medically-unnecssary, non-therapeutic amputation of functional tissue that does not treat or prevent disease. It has risks and complications but no upside benefit.
  
 
== General risks ==
 
== General risks ==
−
* Loss of the [[foreskin]] (100% complication rate)
+
* Loss of the [[foreskin]] (100% [[complication]] rate)
 +
* [[Circumcision scar|Operation scar]] (100% [[complication]] rate)
 
* Loss of the [[frenulum]]
 
* Loss of the [[frenulum]]
 +
* Loss of protection of the [[glans]]
 
* Reduction of the [[penis]]
 
* Reduction of the [[penis]]
 
* [[Keratinization]] of the [[glans]]
 
* [[Keratinization]] of the [[glans]]
−
* Loss of sensation
+
* Loss of [[Foreskin sensitivity| sensation]]
 +
* [[Financial incentive| Loss of money for a medically not indicated surgery]]
 +
* [[Foreskin restoration|Restoration of the foreskin]] not 100% possible and very time-consuming (adults)
 +
* Risk of [[penile frostbite]]<ref>{{REFweb
 +
|url=https://pagesix.com/2023/01/05/prince-harry-reveals-whether-hes-circumcised-in-bombshell-spare-memoir/
 +
|title=Prince Harry reveals whether he’s circumcised in bombshell ‘Spare’ memoir
 +
|last=Gostin
 +
|first=Nick
 +
|date=2023-01-05
 +
|accessdate=2023-01-26
 +
}}</ref>
  
 
== Operative risks ==
 
== Operative risks ==
 +
 
* [[Death]]
 
* [[Death]]
−
* Amputation of the [[penis]]
+
* [[Amputation]] of the [[penis]]
−
* Amputation of the [[glans]]
+
* [[Amputation]] of the [[glans]]
−
* Shock or coma due to the extreme pain (newborn circumcision)
+
* [http://www.cirp.org/library/complications/wilson1/ Amputation of excess skin or denudation]
 +
* [http://www.cirp.org/library/complications/bradley/ Burn of the penis after usage of electrocautery]
 +
* [[Heart attack]]
 +
* [[Shock]] or coma due to the extreme [[pain]] (newborn circumcision)
  
−
* Because [[circumcision]] always is type of surgery, it also encompasses all the basic risks of surgery.
+
* Because [[circumcision]] is type of surgery always, it also encompasses all the basic risks of surgery.
−
:* Infection
+
:* [http://www.cirp.org/library/complications/woodside2/ Infection]
 
:* [[Bleeding]], excess bleeding
 
:* [[Bleeding]], excess bleeding
−
:* ...
+
:* Surgical mishap
  
−
== Post-operative risks ==
+
== Post-operative risks (A-Z) ==
−
* Formation of skin bridges between the shaft and the glans
+
* Abnormal healing
−
* Infection
+
* [http://www.circumstitions.com/Restric/Botched1sb.html Adhesions between the shaft and the glans]
−
* Urinary retention (this has caused deaths)
+
* Brain damage (permanent) after [[herpes]] infection (newborn circumcision with [[Metzitzah b'peh]])
−
* Meatal ulcer
+
* Chlamydiaceae infections
−
* [[Meatal stenosis]] (20% complication rate)
+
* Chordee
 +
* Deformation of the [[penis]]
 +
* Early ablactation (weaning) (newborn circumcision)
 +
* Epispadias
 +
* Excessive [[foreskin]] removed (leads to deformation)
 +
* [Fistulas]
 +
* Genital warts
 +
* Gonorrhea
 +
* [[Herpes]] infection (newborn circumcision with [[Metzitzah b'peh]])
 +
* [[Hypospadias]]
 
* Impetigo
 
* Impetigo
−
* Fistulas
+
* Impotence
 +
* Inclusion cysts
 +
* [http://www.cirp.org/library/death/sauer1/ Infection]
 +
* Insufficient foreskin removed (re-surgery often done)
 +
* [[Intraperitoneal rupture of the urinary bladder]]
 +
* Loss of penile sensitivity
 +
* Lubricants required for [[masturbation]] and intercourse
 +
* Lung tear due to extreme cries of pain (newborn circumcision)
 
* [[Lymphoedema]]
 
* [[Lymphoedema]]
−
* Loss of penile sensitivity
+
* [[Meatal stenosis]] (20% [[complication]] rate)
−
* Sexual dysfunction
+
* Meatal ulcer
 +
* [http://www.cirp.org/library/complications/brennemann1/ Meatitis]
 +
* [[Necrosis]] of the penis
 
* Oedema of the glans
 
* Oedema of the glans
 +
* [http://www.cirp.org/library/complications/blalock1/ Phimosis]
 +
* [[Erection| Pain in erected state of the penis]]
 
* Risk of required re-surgery
 
* Risk of required re-surgery
−
* Pain in erected state of the penis
+
* [http://www.cirp.org/library/complications/stinson/ Sexual dysfunction]
−
* Lung tear due to extreme cries of pain (newborn circumcision)
+
* [[Skin bridges]] between the shaft and the glans
 +
* [[Sudden Infant Death Syndrome]]<ref>{{REFweb
 +
|url=https://medicalxpress.com/news/2019-01-neonatal-circumcision-sudden-infant-death.html
 +
|title=Neonatal circumcision could increase the risk of sudden infant death syndrome in babies – new research
 +
|first=Eran
 +
|last=Elhaik
 +
|publisher=MedicalXpress
 +
|date=2019-01-11
 +
|accessdate=2020-07-02
 +
}}</ref>
 +
* Syphilis
 
* Tummy wall tear due to extreme cries of pain (newborn circumcision)
 
* Tummy wall tear due to extreme cries of pain (newborn circumcision)
−
* Early ablactation (weaning) (newborn circumcision)
+
* Urethritus
 +
* Urethrocutaneous fistula
 +
* Urinary retention (this has caused deaths)
 +
* ...
  
 
== Psychological risks ==
 
== Psychological risks ==
−
* [[PTSD]] due to newborn trauma
+
=== Immediate risks ===
−
* Brain damage due to the extreme pain (newborn circumcision without effective anesthesia)
+
* [[PTSD]] due to newborn [[trauma]]
−
* [[Circumcision coma]]
+
* [http://www.cirp.org/library/pain/fitzgerald2/ Brain damage due to the extreme pain] (newborn circumcision without effective anesthesia)
−
* Frustration due to sexual dysfunction
 
−
* Lowered pain sensitivity threshold (newborn circumcision)
 
 
* Loss of bonding and trust to parents
 
* Loss of bonding and trust to parents
 
* Nipple confusion (newborn circumcision)
 
* Nipple confusion (newborn circumcision)
−
* ...
+
* Frustration due to sexual dysfunction
 +
* [https://yorkspace.library.yorku.ca/xmlui/bitstream/handle/10315/7941/KAT036.pdf?sequence=1&origin=publication_detail Lowered pain sensitivity threshold](newborn circumcision)
 +
 
 +
=== Delayed risks ===
 +
* Feelings of being cheated, robbed, abandoned and unprotected by the own parents
 +
* [[Collective Cognitive Dissonance|Cognitive dissonance]]
 +
* [[Circumcision coma]]
 +
* [[Psychological_issues_of_male_circumcision#Circumcision_trauma_in_adults|Circumcision trauma in adults]]
 +
* Impotence due to psychological bad feelings of being inferior
 +
* Depression
 +
* [[Suicide]]
 +
* Altered adult socio-affective processing<ref>{{REFjournal
 +
|url=https://vbn.aau.dk/en/publications/neonatal-male-circumcision-is-associated-with-altered-adult-socio
 +
|title=Neonatal male circumcision is associated with altered adult socio-affective processing
 +
|first=Alessandro
 +
|init=A
 +
|last=Miani
 +
|first2=Gian Antonio
 +
|init2=GA
 +
|last2=Di Bernardo
 +
|first3=Astrid Ditte
 +
|init3=AD
 +
|last3=Højgaard
 +
|first4=Brian D.
 +
|init4=BD
 +
|last4=Earp
 +
|author4-link=Brian D. Earp
 +
|first5=Paul J.
 +
|init5=PJ
 +
|last5=Zak
 +
|first6=Anne M.
 +
|init6=AM
 +
|last6=Landau
 +
|first7=Jørgen
 +
|init7=J
 +
|last7=Hoppe
 +
|first8=Michael
 +
|init8=M
 +
|last8=Winterdahl
 +
|journal=J Heliyon
 +
|volume=6
 +
|issue=11
 +
|article=e05566
 +
|date=2020-11-20
 +
|DOI=10.1016/j.heliyon.2020.e05566
 +
|accessdate=2020-12-20
 +
}}</ref>
 +
 
 +
== Statistical risks ==
 +
Out of 100 circumcised boys:<ref name="DrMomma2010">{{REFweb
 +
|url=http://www.drmomma.org/2010/01/cut-vs-intact-outcome-statistics.html
 +
|title=Intact vs. Circumcised Outcome Statistics
 +
|website=Dr. Momma
 +
|date=2010-01
 +
|accessdate=2021-06-07
 +
}}</ref>
 +
* 75 will not readily breastfeed post-op.
 +
* 55 will have adverse reactions from the surgery.
 +
* 35 will have some degree of post-op hemorrhaging.
 +
* 31 will develop meatal ulcers.
 +
* 10 will need to have repeat circumcision surgery to fix surgical errors.
 +
* 8 will suffer infection at the surgical site.
 +
* 3 will develop post-operative [[phimosis]].
 +
* 2 will have more serious complications (seizure, [[heart attack]], stroke, loss of [[penis]], [[death]]).
 +
* 1 will require additional immediate surgery and sutures to stop hemorrhage.
 +
* 1 will develop fibrosis.
 +
* 1 will be treated with antibiotics for a [[UTI]] (urinary tract infection).
 +
 
 +
Of those who receive anesthesia before surgery, some will have adverse reactions to the pain medication.
 +
 
 +
Out of 100 intact boys:<ref name="DrMomma2010"/>
 +
* 2 will be treated with antibiotics for a [[UTI]] (fewer if the [[foreskin]] is never forcibly retracted).
 +
* 1 will be told to get [[circumcised]] later in life for one reason or another (fewer if the foreskin is never forcibly retracted).
 +
 
 +
== AAP confirms complications ==
 +
The [[AAP]] offers a coding newsletter for those who encode medical diagnoses in ICD codes. They offer a "[https://publications.aap.org/codingnews/article-abstract/12/9/3/27080/Subspecialty-Corner-Coding-for-Complications-of?redirectedFrom=fulltext Subspecialty Corner: Coding for Complications of Neonatal Circumcision]"<ref>{{REFjournal
 +
|url=https://coding.solutions.aap.org/article.aspx?articleid=2629478
 +
|title=Subspecialty Corner: Coding for Complications of Neonatal Circumcision
 +
|journal=AAP Pediatric Coding Newsletter
 +
|volume12
 +
|issue=9
 +
|date=2017
 +
|accessdate=2020-02-24
 +
}}</ref> which definitely confirms that even the [[AAP]] knows of a bunch of [[complication]]s.
 +
 
 +
== Complication rates ==
 +
In fact, of course, not all possible [[complication]] rates have the same frequency and therefore not the same relevance. It is necessary to collect statistics on which complications are serious. Basically, however, it should be noted that circumcision without a [[medical indication]] is the most unnecessary complication in itself, with a '''100% rate'''.
 +
 
 +
The German Academy of Children and Youth Medicine (DAKJ) (2012) conducted an internet survey of medical practices and determined a serious complication rate of '''approx. 6%''' based on the reported data.<ref>{{REFweb
 +
|url=https://www.dakj.de/stellungnahmen/beschneidung-von-minderjaehrigen-jungen/
 +
|title=Beschneidung von minderjährigen Jungen
 +
|trans-title=Circumcision of minor boys
 +
|language=German
 +
|date=2016-12-21
 +
|accessdate=2020-11-24
 +
}}</ref> Thorup et al. (2013) report that '''about 5.1%''' of the recorded complications were significant complications.<ref>{{REFjournal
 +
|last=Thorup
 +
|init=J
 +
|last2=Cortes-Thorup
 +
|init2=S
 +
|last3=Rasmussen-Ifaoui
 +
|init3=JB
 +
|date=2013
 +
|title=Complication rate after circumcision in a paediatric surgical setting should not be neglected
 +
|url=https://pubmed.ncbi.nlm.nih.gov/23905566/
 +
|journal=Dan Med J
 +
|volume=60
 +
|pages=1-3
 +
|pubmedID=23905566
 +
|accessdate=2020-11-24
 +
}}</ref> Zöller et al. (2014) analyzed patient data in a retrospective and find that '''the complication rate after male circumcision is relevant'''.<ref>{{REFjournal
 +
|last=Zöller
 +
|init=C
 +
|last2=Fernandez
 +
|init2=G
 +
|last3=Peteresen
 +
|init3=C
 +
|last4=Ure
 +
|init4=B
 +
|title=Stationäre Behandlung bei Komplikationen nach männlicher Beschneidung: Retrospektive Analyse eines deutschen Referenzzentrums
 +
|trans-title=Inpatient treatment for complications after male circumcision: Retrospective analysis of a German reference center
 +
|language=German
 +
|url=https://www.egms.de/static/de/meetings/dgch2014/14dgch256.shtml
 +
|publisher=Deutsche Gesellschaft für Chirurgie
 +
|date=2014-03-21
 +
|accessdate=2020-11-24
 +
}}</ref>
 +
 
 +
Patel (1966) reported a complication rate of '''55%''' in a series at [https://kingstonhsc.ca/ Kingston General Hospital] in Ontariɔ.<ref name="patel1966">
 +
{{REFjournal
 +
|last=Patel
 +
|first=Hawa
 +
|init=H
 +
|author-link=
 +
|etal=no
 +
|title=The problem of routine circumcision
 +
|trans-title=
 +
|language=English
 +
|journal=Canad Med Assoct J
 +
|location=
 +
|date=1966-09-10
 +
|volume=95
 +
|issue=11
 +
|pages=576-81
 +
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936659/pdf/canmedaj01181-0029.pdf
 +
|archived=
 +
|quote=
 +
|pubmedID=5947615
 +
|pubmedCID=1936659
 +
|DOI=
 +
|accessdate=2020-11-25
 +
}}</ref>
 +
 
 +
Williams & Kapila (1993) reviewed the complications of circumcision. They estimated a complication rate of '''2 to 10 percent'''<ref name="williams1993">{{REFjournal
 +
|last=Williams
 +
|first=Nigel
 +
|init=N
 +
|author-link=
 +
|last2=Kapila
 +
|first2=Leela
 +
|init2=L
 +
|author2-link
 +
|etal=no
 +
|title=Complications of circumcision.
 +
|trans-title=
 +
|language=English
 +
|journal= Brit J Surg
 +
|location=
 +
|date=1993
 +
|volume=80
 +
|issue=10
 +
|pages=1231-6
 +
|url=http://www.cirp.org/library/complications/williams-kapila/
 +
|archived=
 +
|quote=
 +
|pubmedID=8242285
 +
|pubmedCID=
 +
|DOI=10.1002/bjs.1800801005
 +
|accessdate=2020-11-26
 +
}}</ref>
 +
 
 +
Okeke et al. (2006) investigated the incidence of circumcision complications in Ibadan, Nigeria. They reported a complication rate of '''20.2 percent'''<ref ="okeke2006">{{REFjournal
 +
|last=Okeke
 +
|first=Linus
 +
|init=L
 +
|author-link=
 +
|last2=Asinnobi
 +
|first2=Adanze
 +
|init2=A
 +
|author2-link=
 +
|last3=Ikeurerowo
 +
|first3=Odunayo
 +
|init3=O
 +
|author3-link=
 +
|etal=no
 +
|title=Epidemiology of complications of male circumcision in Ibadan, Nigeria
 +
|trans-title=
 +
|language=English
 +
|journal=BMC Urol.
 +
|location=
 +
|date=2006
 +
|volume=6
 +
|issue=21
 +
|pages=
 +
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1560152/
 +
|archived=
 +
|quote=
 +
|pubmedID=16934157
 +
|pubmedCID=1560152
 +
|DOI=10.1186/1471-2490-6-21
 +
|accessdate=2020-11-26
 +
}}</ref>
 +
 
 +
Lau et al. (2018) used the Utah [http://stats.health.utah.gov/about-the-data/ All-Payer Claims Database] to determine the incidence of circumcision and the percentage of complications for the state of Utah. The authors reported an incidence of neonatal circumcision of in Utah of '''29 percent''' and an incidence of complications of '''11.5 percent'''.<ref name="lau2018">{{REFjournal
 +
|last=Lau
 +
|first=Glen
 +
|init=G
 +
|author-link=
 +
|last2=Kim
 +
|first2=Jaewhan
 +
|init2=J
 +
|author2-link=
 +
|last3=Shaeffer
 +
|first3=Anthony
 +
|init3=A
 +
|author3-link=
 +
|etal=no
 +
|title=Identification of circumcision complications using a regional claims database
 +
|trans-title=
 +
|language=English
 +
|journal=Societies for Pediatric Urology
 +
|location=
 +
|date=2018
 +
|volume=
 +
|issue=
 +
|pages=
 +
|url=https://spuonline.org/abstracts/2018/P21.cgi
 +
|archived=
 +
|quote=
 +
|pubmedID=
 +
|pubmedCID=
 +
|DOI=
 +
|accessdate=2020-11-26
 +
}}</ref>
  
 
{{SEEALSO}}
 
{{SEEALSO}}
 +
 +
* [[Complication]]
 
* [[Circumcision botches]]
 
* [[Circumcision botches]]
 
* [[Documented severe complications of circumcision]]
 
* [[Documented severe complications of circumcision]]
Line 56: Line 350:
 
* [[Sexual effects of circumcision]]
 
* [[Sexual effects of circumcision]]
  
−
[[Category:Circumcision risks]]
+
{{LINKS}}
 +
* {{REFweb
 +
|url=https://med.stanford.edu/newborns/professional-education/circumcision/complications.html
 +
|title=Complications of Circumcision
 +
|publisher={{UNI|Stanford University|SU}}
 +
|accessdate=2020-02-20
 +
}}
 +
* {{REFweb
 +
|url=http://circumstitions.com/all.html
 +
|title=More than 600 Circumstitions (Reasons Given for Circumcising a Male)
 +
|publisher=Circumstitions
 +
|accessdate=2020-03-19
 +
}}
 +
 
 +
{{REF}}
 +
 
 +
[[Category:Parental information]]
 +
[[Category:Circumcision risk]]
 +
[[Category:Complication]]
 +
 
 +
[[de:Beschneidungsrisiken]]

Latest revision as of 12:50, 27 July 2024

Work in progress: The following information does not claim to be complete. More content will be added gradually.

This article wants to offer a comprehensive overview of risks which can occur by undergoing a circumcision. This page is a landing page for those who want to find a quick overview about circumcision risks. Chances are that information given here is shown in more detail in other IntactiWiki articles.

Please bear in mind that infants are not born with a diseased penis that requires surgery. There are no medical indications for infant circumcision and few in later life. Infant circumcision is a medically-unnecssary, non-therapeutic amputation of functional tissue that does not treat or prevent disease. It has risks and complications but no upside benefit.

General risks

Operative risks

  • Because circumcision is type of surgery always, it also encompasses all the basic risks of surgery.

Post-operative risks (A-Z)

Psychological risks

Immediate risks

Delayed risks

Statistical risks

Out of 100 circumcised boys:[4]

  • 75 will not readily breastfeed post-op.
  • 55 will have adverse reactions from the surgery.
  • 35 will have some degree of post-op hemorrhaging.
  • 31 will develop meatal ulcers.
  • 10 will need to have repeat circumcision surgery to fix surgical errors.
  • 8 will suffer infection at the surgical site.
  • 3 will develop post-operative phimosis.
  • 2 will have more serious complications (seizure, heart attack, stroke, loss of penis, death).
  • 1 will require additional immediate surgery and sutures to stop hemorrhage.
  • 1 will develop fibrosis.
  • 1 will be treated with antibiotics for a UTI (urinary tract infection).

Of those who receive anesthesia before surgery, some will have adverse reactions to the pain medication.

Out of 100 intact boys:[4]

  • 2 will be treated with antibiotics for a UTI (fewer if the foreskin is never forcibly retracted).
  • 1 will be told to get circumcised later in life for one reason or another (fewer if the foreskin is never forcibly retracted).

AAP confirms complications

The AAP offers a coding newsletter for those who encode medical diagnoses in ICD codes. They offer a "Subspecialty Corner: Coding for Complications of Neonatal Circumcision"[5] which definitely confirms that even the AAP knows of a bunch of complications.

Complication rates

In fact, of course, not all possible complication rates have the same frequency and therefore not the same relevance. It is necessary to collect statistics on which complications are serious. Basically, however, it should be noted that circumcision without a medical indication is the most unnecessary complication in itself, with a 100% rate.

The German Academy of Children and Youth Medicine (DAKJ) (2012) conducted an internet survey of medical practices and determined a serious complication rate of approx. 6% based on the reported data.[6] Thorup et al. (2013) report that about 5.1% of the recorded complications were significant complications.[7] Zöller et al. (2014) analyzed patient data in a retrospective and find that the complication rate after male circumcision is relevant.[8]

Patel (1966) reported a complication rate of 55% in a series at Kingston General Hospital in Ontariɔ.[9]

Williams & Kapila (1993) reviewed the complications of circumcision. They estimated a complication rate of 2 to 10 percent[10]

Okeke et al. (2006) investigated the incidence of circumcision complications in Ibadan, Nigeria. They reported a complication rate of 20.2 percent[11]

Lau et al. (2018) used the Utah All-Payer Claims Database to determine the incidence of circumcision and the percentage of complications for the state of Utah. The authors reported an incidence of neonatal circumcision of in Utah of 29 percent and an incidence of complications of 11.5 percent.[12]

See also

External links

References

  1. ↑ REFweb Gostin, Nick (5 January 2023). Prince Harry reveals whether he’s circumcised in bombshell ‘Spare’ memoir. Retrieved 26 January 2023.
  2. ↑ REFweb Elhaik, Eran (11 January 2019). Neonatal circumcision could increase the risk of sudden infant death syndrome in babies – new research, MedicalXpress. Retrieved 2 July 2020.
  3. ↑ REFjournal Miani A, Di Bernardo GA, Højgaard AD, Earp BD, Zak PJ, Landau AM, Hoppe J, Winterdahl M. Neonatal male circumcision is associated with altered adult socio-affective processing. J Heliyon. 20 November 2020; 6(11): [e05566]. DOI. Retrieved 20 December 2020.
  4. ↑ a b REFweb (January 2010). Intact vs. Circumcised Outcome Statistics, Dr. Momma. Retrieved 7 June 2021.
  5. ↑ REFjournal Subspecialty Corner: Coding for Complications of Neonatal Circumcision. AAP Pediatric Coding Newsletter. 2017; (9) Retrieved 24 February 2020.
  6. ↑ REFweb (21 December 2016). Beschneidung von minderjährigen Jungen [Circumcision of minor boys] (German). Retrieved 24 November 2020.
  7. ↑ REFjournal Thorup J, Cortes-Thorup S, Rasmussen-Ifaoui JB. Complication rate after circumcision in a paediatric surgical setting should not be neglected. Dan Med J. 2013; 60: 1-3. PMID. Retrieved 24 November 2020.
  8. ↑ REFjournal Zöller C, Fernandez G, Peteresen C, Ure B. (Deutsche Gesellschaft für Chirurgie) Stationäre Behandlung bei Komplikationen nach männlicher Beschneidung: Retrospektive Analyse eines deutschen Referenzzentrums [Inpatient treatment for complications after male circumcision: Retrospective analysis of a German reference center] (German) 21 March 2014; Retrieved 24 November 2020.
  9. ↑ REFjournal Patel H. The problem of routine circumcision. Canad Med Assoct J. 10 September 1966; 95(11): 576-81. PMID. PMC. Retrieved 25 November 2020.
  10. ↑ REFjournal Williams N, Kapila L. Complications of circumcision.. Brit J Surg. 1993; 80(10): 1231-6. PMID. DOI. Retrieved 26 November 2020.
  11. ↑ REFjournal Okeke L, Asinnobi A, Ikeurerowo O. Epidemiology of complications of male circumcision in Ibadan, Nigeria. BMC Urol.. 2006; 6(21) PMID. PMC. DOI. Retrieved 26 November 2020.
  12. ↑ REFjournal Lau G, Kim J, Shaeffer A. Identification of circumcision complications using a regional claims database. Societies for Pediatric Urology. 2018; Retrieved 26 November 2020.
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