Difference between revisions of "Adolescent and adult circumcision"

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'''Adolescent and adult circumcision''' is rare when compared to the millions upon millions of medically-unnecessary, non-therapeutic circumcisions of boys that are carried out in Islamic nations, Israel, the United States, and elsewhere.
+
'''Adolescent and adult circumcision''' is rare when compared to the millions upon millions of medically-unnecessary, non-therapeutic [[Circumcision| circumcisions]] of boys that are carried out in [[Islam]]ic nations, [[Israel]], the [[United States]], and elsewhere, however they are promoted by a [[medical trade association]] and its members.
 +
 
 +
[[Rosemary Romberg]] commented on adult circumcision in the [[United States]]:
 +
<blockquote>
 +
<i>In the United States doctors tend to consider the [[foreskin]] as something "dispensible."
 +
…
 +
It is difficult to ascertain the true percentage of actual need for adult circumcision among [[intact]] males. In a circumcision-oriented society such as ours many doctors prescribe the operation for conditions which could be resolved, often easily, without resort to surgery.…</i><ref>{{REFbook
 +
|last=Romberg
 +
|first=Rosemary
 +
|init=
 +
|author-link=Rosemary Romberg
 +
|year=2021
 +
|title=Circumcision — The Painful Dilemma
 +
|url=https://circumcisionthepainfuldilemma.wordpress.com/
 +
|work=
 +
|editor=[[Ulf Dunkel]]
 +
|edition=Second Edition, Revised
 +
|volume=
 +
|chapter=The Circumcision of an Adult
 +
|scope=
 +
|page=247
 +
|pages=
 +
|location=
 +
|publisher=Kindle
 +
|ISBN=23: 979-8683021252
 +
|quote=
 +
|accessdate=2023-08-31
 +
|note=
 +
}}</ref>
 +
</blockquote>
 +
 
 +
==Consent==
 +
 
 +
Male [[circumcision]] is an ''elective'' surgical [[amputation]] of the [[foreskin]] part of the [[penis]]. Legally, the patient or his surrogate must grant [[Informed consent| ''informed'' consent]] before the surgery can be performed. A surrogate's powers are limited to granting consent for medically-indicated and necessary diagnosis and treatment of existing disease.<ref name="myers2020">{{REFjournal
 +
|last=Myers
 +
|first=
 +
|init=A
 +
|author-link=Alex Myers
 +
|last2=Earp
 +
|first2=
 +
|init2=BD
 +
|author2-link=Brian D. Earp
 +
|etal=no
 +
|title=What is the best age to circumcise? A medical and ethical analysis
 +
|trans-title=
 +
|language=
 +
|journal= Bioethics
 +
|location=
 +
|date=2020
 +
|volume=34
 +
|issue=7
 +
|pages=645-63
 +
|url=https://www.researchgate.net/profile/Brian-Earp-2/publication/337720859_What_Is_the_Best_Age_to_Circumcise_A_Medical_and_Ethical_Analysis/links/5f815f61a6fdccfd7b555395/What-Is-the-Best-Age-to-Circumcise-A-Medical-and-Ethical-Analysis.pdf
 +
|quote=Based on a careful consideration of the relevant evidence, arguments and counterarguments, we conclude that medically unnecessary penile circumcision-like other medically unnecessary genital procedures, such as 'cosmetic' labiaplasty-should not be performed on individuals who are too young (or otherwise unable) to provide meaningful consent to the procedure.
 +
|pubmedID=32068898
 +
|pubmedCID=
 +
|doi=10.1111/bioe.12714
 +
|format=PDF
 +
|accessdate=2020-06-30
 +
}}</ref>
 +
 
 +
The surgeon most provide all material information to the patient before [[informed consent]] can be granted. There is a strong tendency for the surgeon to omit telling the patient anything about the nature and [http://www.intactaus.org/information/functionsoftheforeskin/ functions of the foreskin],<ref name="masood2005">{{REFjournal
 +
|last=Masood
 +
|init=S
 +
|last2=Patel
 +
|first2=
 +
|init2=HRH
 +
|author2-link=
 +
|last3=Himpson
 +
|first3=
 +
|init3=RC
 +
|author3-link=
 +
|etal=yes
 +
|title=Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly?
 +
|journal=Urol Int
 +
|date=2005
 +
|volume=75
 +
|issue=1
 +
|pages=62-6
 +
|url=https://www.cirp.org/library/sex_function/masood1/
 +
|pubmedID=16037710
 +
|pubmedCID=
 +
|DOI=10.1159/000085930
 +
|accessdate=2023-04-08
 +
}}</ref> which would be lost through [[amputation]] if consent should be granted.
 +
 
 +
[[Issues_with_American_urologists_and_the_practice_of_male_circumcision| Urologic surgeons]] in the [[United States]] derive a substantial fee from the performance of a [[circumcision]], so some may have a [[bias]] in favor of circumcision and may inappropriately recommend adult circumcision to patients when a conservative treatment would be satisfactory or even when no treatment is necessary. Patients should be wary and do their own research before granting consent for an <u>irreversible</u> [[circumcision]].
 +
 
 +
Milos (2022) advises:
 +
<blockquote> 
 +
* A penis without a foreskin doesn’t work as nature intended for its owner or his sexual partner.
 +
* Amputating the foreskin eliminates the penis’ “command and control” nerve center, the normal skin system that allows for comfortable erections and the gliding mechanism necessary for sensory pleasure, foreplay, and normal intromission (entry during intercourse).
 +
* Circumcision amputates the tens of thousands of specialized, erogenous nerve endings that signal to the man where he is in relation to the orgasmic threshold.
 +
* It denudes and exposes the glans (head of the penis), causing it to become dry, calloused, and desensitized. Circumcised men talk about becoming impotent during their 50s or 60s while intact males tell me the urge doesn’t come around as often but their sensitivity hasn’t diminished.
 +
* Circumcision makes the penis smaller, too.<ref name="milos2022-05-02">{{REFweb
 +
|url=https://intactamerica.org/ask-marilyn-a-19-year-old-considers-circumcision/
 +
|title=Ask Marilyn – 19-year-old Considers Circumcision
 +
|last=Milos
 +
|first=
 +
|init=MF
 +
|author-link=Marilyn Fayre Milos
 +
|publisher=Intact America
 +
|date=2022-05-02
 +
|accessdate=2024-10-24
 +
}}</ref>
 +
</blockquote>
  
 
==Reasons for circumcision==
 
==Reasons for circumcision==
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All circumcisions are injurious because they amputate a [http://www.intactaus.org/information/functionsoftheforeskin/ multi-functional body part], but in rare cases the benefit obtained by removing a deformed, diseased, or damaged foreskin may be of more value than the amputated [[foreskin]].
 
All circumcisions are injurious because they amputate a [http://www.intactaus.org/information/functionsoftheforeskin/ multi-functional body part], but in rare cases the benefit obtained by removing a deformed, diseased, or damaged foreskin may be of more value than the amputated [[foreskin]].
  
−
* Deformed foreskins — The common type of deformed foreskin is the narrow non-retractable foreskin of [[phimosis]]. Circumcision is the traditional treatment for phimosis, however circumcision is less performed today because newer conservative treatments are now available that preserve the foreskin and its many useful functions.
+
* Deformed foreskins — The common type of deformed foreskin is the narrow non-retractable foreskin of [[phimosis]]. Circumcision was the traditional treatment for phimosis, however circumcision is less performed today because newer conservative treatments are now available that preserve the [[foreskin]] and its many useful functions.
  
−
* Diseased foreskins — Diseases for which circumcision may be indicated include [[Penile cancer| malignant tumor]],[[Balanitis xerotica obliterans| lichen sclerosis]], recurrent yeast infection in diabetic males,<ref name="verma2011">{{REFjournal
+
* Diseased foreskins — Diseases for which circumcision may be indicated include [[Penile cancer|malignant tumor]],[[Balanitis xerotica obliterans| lichen sclerosis]], recurrent yeast infection in diabetic males (after conservative treatment fails),<ref name="verma2011">{{REFjournal
 
  |last=Verma
 
  |last=Verma
 
  |first=Shyam B.
 
  |first=Shyam B.
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  |pages=511-3
 
  |pages=511-3
 
  |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150172/
 
  |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150172/
−
|archived=
 
−
|quote=
 
 
  |pubmedID=21845057
 
  |pubmedID=21845057
 
  |pubmedCID=3150172
 
  |pubmedCID=3150172
 
  |DOI=10.2147/IJGM.S17875
 
  |DOI=10.2147/IJGM.S17875
 
  |accessdate=2020-12-19
 
  |accessdate=2020-12-19
−
}}</ref> and recurrent [[balanitis| balanoposthitis]].
+
}}</ref> recurrent [[balanoposthitis]], and gangrene.
  
−
* Damaged foreskins — This is includes any type of physical trauma and injury which is beyond surgical repair. Zipper injury usually does not require circumcision.<ref name="flowerdew1977">{{REFjournal
+
* Damaged foreskins — This includes any type of physical [[trauma]] and injury that is beyond surgical repair. Zipper injury does not require circumcision.<ref name="flowerdew1977">{{REFjournal
 
  |last=Flowerdew
 
  |last=Flowerdew
−
|first=R
 
 
  |init=R
 
  |init=R
 
  |author-link=
 
  |author-link=
 
  |last2=Fishman
 
  |last2=Fishman
−
|first2=I J
 
 
  |init2=IJ
 
  |init2=IJ
 
  |author2-link=
 
  |author2-link=
 
  |last3=Churchill
 
  |last3=Churchill
−
|first3=B M
 
 
  |init3=BM
 
  |init3=BM
 
  |author3-link=
 
  |author3-link=
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  |pages=
 
  |pages=
 
  |url=http://www.cirp.org/library/treatment/zipper/flowerdew/
 
  |url=http://www.cirp.org/library/treatment/zipper/flowerdew/
−
|archived=
 
−
|quote=
 
 
  |pubmedID=859209
 
  |pubmedID=859209
 
  |pubmedCID=
 
  |pubmedCID=
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  |pages=05
 
  |pages=05
 
  |url=http://www.cirp.org/library/treatment/zipper/chalfin/
 
  |url=http://www.cirp.org/library/treatment/zipper/chalfin/
−
|archived=
 
−
|quote=
 
−
|pubmedID=
 
−
|pubmedCID=
 
−
|DOI=
 
 
  |accessdate=2020-12-20
 
  |accessdate=2020-12-20
 
}}</ref>
 
}}</ref>
  
−
Some adult males may seek non-therapeutic circumcision because of a conversion to Judaism or Islam. Others may simply want a circumcision because they like the physical appearance, to fit into a society where most men are circumcised, or for some personal whim.<ref name="holman1999">{{REFjournal
+
===Elective non-therapeutic circumcision===
 +
 
 +
Some adult males may seek non-therapeutic circumcision because of a conversion to [[Judaism]] or [[Islam]]. Others may simply want a circumcision because they like the physical appearance, or to fit into a society where most men are [[circumcised]], or for some personal whim.<ref name="holman1999">{{REFjournal
 
  |last=Holman
 
  |last=Holman
 
  |first=John R.
 
  |first=John R.
Line 108: Line 203:
 
  |pages=
 
  |pages=
 
  |url=https://www.aafp.org/afp/1999/0315/p1514.html
 
  |url=https://www.aafp.org/afp/1999/0315/p1514.html
−
|archived=
 
−
|quote=
 
 
  |pubmedID=10193593
 
  |pubmedID=10193593
 
  |pubmedCID=
 
  |pubmedCID=
 
  |DOI=
 
  |DOI=
 
  |accessed=2020-12-20}}</ref>
 
  |accessed=2020-12-20}}</ref>
 +
 
===A word to intact teens===
 
===A word to intact teens===
  
−
Boys are born with a [[foreskin]] that is non-retractable for reasons of protection. The inner surface is fused with the [[glans penis]] by a [[synechia]] (similar to a fingernail that is glued to the nail bed of the finger). Also the tip of the foreskin is too narrow to retract. As a boy gets older, the synechia disintegrates and releases the foreskin and the foreskin gets wider as a boy ages, so the foreskin gradually becomes [[Retraction of the foreskin| retractable]]. Some boys go through puberty but find that their [[foreskin]] is still too narrow to permit retraction. The traditional way of addressing this issue was to consult a urologist and get a [[circumcision]], however we now understand that in the vast majority of cases, manual [[stretching]] over a few months will widen the foreskin by [[tissue expansion]], make the foreskin retractable and eliminate the need for a destructive circumcision.
+
Boys are born with a [[foreskin]] that is non-retractable for reasons of protection. The inner surface is fused with the [[glans penis]] by a [[synechia]] (similar to a fingernail that is glued to the nail bed of the finger). Also the tip of the foreskin is too narrow to retract. As a boy gets older, the synechia disintegrates and releases the foreskin and the foreskin gets wider as a boy ages, so the foreskin gradually becomes [[Retraction of the foreskin| retractable]]. Some boys go through puberty but find that their [[foreskin]] is still too narrow to permit retraction.  
 +
 
 +
Beaugé (1997) reported that boys, who masturbate by pulling their [[foreskin]] away from the body, will not stretch the tight part of the foreskin so non-retractile foreskin will persist. He advised changing the method of [[masturbation]] to the more conventional method of pulling the foreskin toward the body so that the narrow orifice gets stretched.<ref name="beauge1997">{{REFjournal
 +
|last=Beaugé
 +
|init=Michel
 +
|author-link=Michel Beaugé
 +
|url=http://www.cirp.org/library/treatment/phimosis/beauge2/
 +
|title=The causes of adolescent phimosis
 +
|journal=Br J Sex Med
 +
|date=1997
 +
|volume=
 +
|issue=September/October
 +
|pages=26
 +
|accessdate=2021-04-21
 +
}}</ref>
 +
 
 +
The traditional way of addressing this issue was to consult a urologist and get a circumcision, however we now understand that in the vast majority of cases, manual [[stretching]] over a few months will widen the foreskin by [[tissue expansion]], make the foreskin retractable and eliminate the need for a destructive circumcision.
  
 
==Methods of adult circumcision==
 
==Methods of adult circumcision==
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===Dorsal slit===
 
===Dorsal slit===
  
−
[[Dorsal slit]] is a cut on the top of the foreskin to open it. This allows the foreskin to fall below the shaft of the penis. Dorsal slit does not cut around and does not remove tissue, so it is not a true circumcision. Dorsal slit is a first step in the circumcision of a phimotic foreskin by the sleeve technique.<ref name="holman1999" />
+
[[Dorsal slit]] is a cut on the top of the [[foreskin]] to widen the opening, allowing the foreskin to retract and fall below the shaft of the [[penis]]. Dorsal slit does not cut around and does not remove tissue, so it is not a true circumcision. Dorsal slit is a first step in the circumcision of a phimotic foreskin by the sleeve technique.<ref name="holman1999" />
  
 
===Sleeve technique===
 
===Sleeve technique===
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They reported the indications for adult circumcision are uncommon. The most common is [[phimosis]].
 
They reported the indications for adult circumcision are uncommon. The most common is [[phimosis]].
  
−
They recommended dorsal penile nerve block or ring block local anesthesia for the [[pain]] of circumcision surgery.
+
They recommended [[dorsal penile nerve block]] or [[ring block]] local anesthesia for the [[pain]] of circumcision surgery.
  
 
[[Informed consent]] must be obtained. They stated:
 
[[Informed consent]] must be obtained. They stated:
 
<blockquote>
 
<blockquote>
−
Specifically, the patient should be told about the risks of bleeding, hematoma formation, infection, inadvertent damage to the glans, removal of too much or too little skin, aesthetically unpleasing results and a change of sensation during intercourse. The patient should also be informed that, during the postoperative period, erections can cause pain and disruption of the suture line that may require replacement of the sutures. Full recovery following circumcision generally requires four to six weeks of abstinence from all genital stimulation and sexual activity.<ref name="holman1999" />
+
Specifically, the patient should be told about the risks of [[bleeding]], hematoma formation, [[infection]], inadvertent damage to the [[glans]], removal of too much or too little [[skin]], aesthetically unpleasing results, and a change of sensation during intercourse. The patient should also be informed that, during the postoperative period, [[erection]]s can cause pain and [[Wound dehiscence| disruption of the suture line]] that may require replacement of the sutures. Full recovery following circumcision generally requires four to six weeks of abstinence from all genital stimulation and sexual activity.<ref name="holman1999" />
 
</blockquote>
 
</blockquote>
  
 
In regard to complications, Holman & Stuessi reported:
 
In regard to complications, Holman & Stuessi reported:
 
<blockquote>
 
<blockquote>
−
As with any surgical procedure, bleeding and infection are probably the most common complications of circumcision in adult patients; however, accurate statistics are not available. Other complications include hematoma formation, diffuse swelling, pain from inadequate anesthesia, poor cosmesis, tearing of the sutures due to erection before healing is complete and anesthetic complications. Some patients may also note an unpleasant heightened sensitivity during intercourse. Infection can be treated with local or parenteral antibiotics, depending on the severity of the infection. Bleeding can be controlled with pressure, an absorbable gelatin sponge product (i.e., Gelfoam), electrocautery or ligatures. None of these techniques can be preferentially recommended based on differences in complication rate or severity.<ref name="holman1999" />
+
As with any surgical procedure, [[bleeding]] and [[infection]] are probably the most common complications of circumcision in adult patients; however, accurate statistics are not available. Other complications include hematoma formation, diffuse swelling, pain from inadequate anesthesia, poor cosmesis, tearing of the sutures due to [[erection]] before healing is complete and anesthetic complications. Some patients may also note an unpleasant heightened sensitivity during intercourse. Infection can be treated with local or parenteral antibiotics, depending on the severity of the infection. [[Bleeding]] can be controlled with pressure, an absorbable gelatin sponge product (i.e., Gelfoam), electrocautery or ligatures. None of these techniques can be preferentially recommended based on differences in complication rate or severity.<ref name="holman1999" />
 
</blockquote>
 
</blockquote>
  
 
===Circumcision with a plastic ring device===
 
===Circumcision with a plastic ring device===
  
−
Adolescent and adult circumcision may also be carried out with one of several plastic, one-use, disposable ring devices.  These devices work by clamping the foreskin tightly so that it is crushed and flow is cut off completely. Ischemic necrosis ensues and the foreskin dies. It may then be cut off or left to fall off. Ring devices include the [[Tara KLamp]], the [[PrePex]], [[AccuCirc]], and the [[Shang Ring]].
+
Adolescent and adult circumcision may also be carried out with one of several plastic, one-use, disposable ring devices.  These devices work by clamping the foreskin tightly so that it is crushed and flow is cut off completely. Ischemic [[necrosis]] ensues and the foreskin dies. It may then be cut off or left to fall off. Ring devices include the [[TARA KLamp]], the [[PrePex]], [[AccuCirc]], and the [[Shang Ring]].
 +
 
 +
==Pain during and after circumcision==
 +
Circumcision is a surgical [[amputation]] of part of the [[penis]].  It is normal to feel [[pain]] during the surgical [[amputation]], however this is usually eliminated by general or local anesthesia.
 +
 
 +
One may expect pain after surgery until the incision heals. Ask your doctor for a two-week supply of an opioid pain reliever.
 +
 
 +
One may also expect pain when the sensitive [[glans penis]] is exposed to friction from clothing, etc.  It is no longer protected by the [[foreskin]], so there is not much one can do about it.
 +
 
 +
One may also expect painful [[erection]]s, depending on how much [[skin]] was removed. 
 +
Depending on how much [[skin]] was removed, there may not be enough [[skin]] left to allow for shaft expansion during [[erection]] and this may cause painful [[erection]]s.
 +
 
 +
One may also experience phantom pain from neuromas that form at the incision where nerves were severed.<ref name="cold-taylor1999">{{REFjournal
 +
|last=Cold
 +
|init=CJ
 +
|author-link=Christopher J. Cold
 +
|last2=Taylor
 +
|init2=JR
 +
|author2-link=John R. Taylor
 +
|title=The prepuce
 +
|journal=BJU Int
 +
|date=1999-01-01
 +
|volume=83 Suppl 1
 +
|issue=
 +
|pages=34-44
 +
|url=https://www.i2researchhub.org/wp-content/uploads/storage/TQ63QSHD/Cold%20and%20Taylor%20-%201999%20-%20The%20prepuce.pdf
 +
|quote=
 +
|pubmedID=1034941
 +
|pubmedCID=
 +
|DOI=10.1046/j.1464-410x.1999.0830s1034.x
 +
|accessdate=2021-03-07
 +
}}</ref>
 +
 
 +
[[Masturbation]] after circumcision may be painful if one doesn’t use lubrication because of lack of [[gliding action]].
 +
==Recovery period==
 +
Recovery from an adult circumcision is frequently said to be six weeks.
 +
===Complications===
 +
Erections tend to be painful and may cause [[wound dehiscence]].<ref name="wang2023">{{REFjournal
 +
|last=Wang
 +
|first=
 +
|init=D
 +
|author-link=
 +
|last2=Li
 +
|first2=
 +
|init2=Z
 +
|author2-link=
 +
|last3=Chen
 +
|first3=
 +
|init3=X
 +
|author3-link=
 +
|last4=Wang
 +
|first4=
 +
|init4=H
 +
|author4-link=
 +
|etal=no
 +
|title=Wound healing rates and wound problems of conventional circumcision compared with ring circumcision: A meta-analysis
 +
|trans-title=
 +
|language=
 +
|journal=Int Wound J
 +
|location=
 +
|date=2023-06-11
 +
|volume=Online ahead of print
 +
|issue=
 +
|article=
 +
|page=
 +
|pages=
 +
|url=https://onlinelibrary.wiley.com/doi/10.1111/iwj.14262
 +
|archived=
 +
|quote=
 +
|pubmedID=37303303
 +
|pubmedCID=
 +
|DOI=
 +
|doi=10.1111/iwj.14262
 +
|accessdate=2023-07-16
 +
}}</ref>
 +
 
 +
There is danger of [[infection]] until the [[circumcision]] wound heals closed.<ref name="wang2023" />
 +
 
 +
===Lymphoedema===
 +
[[Lymphoedema]] of the [[penis]] is a normal and expected [[complication]] of male adult circumcision due to the adverse effect on blood circulation.  Ferhatoglu et al. (2019) reported edema in 108 of 198 patients or 54.5 percent.<ref>{{REFjournal
 +
|last=Ferhatoglu
 +
|first=
 +
|init=Mf
 +
|author-link=
 +
|last2=Kartal
 +
|first2=
 +
|init2=A
 +
|author2-link=
 +
|last3=Gurkan
 +
|first3=
 +
|init3=A
 +
|author3-link=
 +
|etal=no
 +
|title=Evaluation of Male Circumcision: Retrospective Analysis of One Hundred and Ninety-eight Patients
 +
|trans-title=
 +
|language=
 +
|journal=Cureus
 +
|location=
 +
|date=2019-04-27
 +
|volume=11
 +
|issue=4
 +
|article=
 +
|page=e4555
 +
|pages=
 +
|url=https://www.cureus.com/articles/19380-evaluation-of-male-circumcision-retrospective-analysis-of-one-hundred-and-ninety-eight-patients
 +
|archived=
 +
|quote=
 +
|pubmedID=31275779
 +
|pubmedCID=6592839
 +
|DOI=10.7759/cureus.4555
 +
|accessdate=2022-02-17
 +
}}</ref> It frequently lasts for months.
  
 
==Permanent adverse effects==
 
==Permanent adverse effects==
 +
===Loss of sensation===
 +
The human [[foreskin]] has long been noted for its high level of erogenous sensation. Winklemann (1959) early identified the foreskin as a ''specific erogenous zone''.<ref name="winklemann1959">{{WinkelmannRK 1959}}</ref> Falliers (1970) called attention to ''sensory pleasure'' induced by tactile stimulation of the foreskin, which is almost totally lost after its surgical removal.<ref>{{REFjournal
 +
|last=Falliers
 +
|first=CJ
 +
|init=
 +
|author-link=
 +
|etal=no
 +
|title=Circumcision
 +
|trans-title=
 +
|language=
 +
|journal=JAMA
 +
|location=
 +
|date=1970-12-21
 +
|volume=214
 +
|issue=12
 +
|article=
 +
|page=2194
 +
|accessdate=2021-06-04
 +
}}</ref>
 +
 +
Money & Davison (1983) reported "diminished penile sensitivity, less penile gratification, more penile pain, and cosmetic deformity" as the effect of circumcision, however they considered that a "prolongation of the period prior to ejaculation" was a possible benefit.<ref name="money1983">{{REFjournal
 +
|last=Money
 +
|first=John
 +
|init=
 +
|author-link=
 +
|last2=Davison
 +
|first2=Jackie
 +
|init2=
 +
|author2-link=
 +
|author9-link=
 +
|etal=no
 +
|title=Adult penile circumcision: erotosexual and cosmetic sequelae
 +
|trans-title=
 +
|language=
 +
|journal=J Sex Res|
 +
|location=
 +
|date=1983
 +
|volume=19
 +
|issue=3
 +
|article=
 +
|page=
 +
|pages=289-92
 +
|url=http://www.cirp.org/library/complications/money/
 +
|accessdate=2021-06-04
 +
}}</ref>
  
−
# Circumcision is a surgical amputation of functional tissue. The various functions cease to operate. If the patient does not like the results, it cannot be reversed or undone.
+
Money & Davison thought the loss of sensation is "secondary to diminished sensory input from stretch receptors in the less mobile [[shaft skin|skin of the shaft]] of the penis, as well as loss of foreskin stretch receptors".<ref name="money1983" />
−
# Recovery from adolescent or adult circumcision is slow and painful. Erections are painful because the skin is stretched and the sutures are stressed. [[Wound dehiscence]] may occur.
+
 
−
# The [[foreskin]] is protective of the [[glans penis]]. After the foreskin is amputated, the glans penis is exposed so that it touches clothing and other things. Some men report this causes extreme pain so that they cannot wear pants for an extended time. The pain subsides when the glans penis start to build a layer of keratin to protect itself. The [[keratinization]] of the glans penis causes loss of sensation in the glans.
+
Denniston (2004) carried out a survey of 38 adult males who were [[circumcised]] at least 2 years after they commenced sexual intercourse. Thirteen men felt that sexual intercourse was better after circumcision, but 22 felt that intercourse was worse and would not have the circumcision again, because of loss of sexual pleasure.<ref>{{REFjournal
−
# The foreskin has [[Immunological and protective function of the foreskin| immunological functions]] that protect from disease. Circumcised populations have a higher incidence of [[Circumcision and HIV| HIV]] than intact populations.
+
|last=Denniston
−
# The heavily innervated [[ridged band]] is located on the foreskin and is always amputated along with the foreskin. The most sensitive regions in the uncircumcised penis are those parts ablated by circumcision.<ref>{{REFjournal
+
|first=George C.
−
  |last=Sorrells
+
|init=
−
  |first=M.L.
+
|author-link=George C. Denniston
−
  |init=ML
+
|last2=Hill
−
  |author-link=Morris L. Sorrells
+
|first2=George
−
  |last2=Synder
+
|init2=
−
  |first2=J.L.
+
|author2-link=George Hill
−
  |init2=JL
+
|etal=no
−
  |author2-link=James L. Snyder
+
|title=Circumcision in adults: effect on sexual function
−
  |last3=Reiss
+
|trans-title=
−
  |first3=M.D.
+
|language=
−
  |init3=MD
+
|journal=Urology
−
  |author3-link=Mark D. Reiss
+
|location=
−
  |last4=Eden
+
|date=2004-12
−
  |first4=C.
+
|volume=54
−
  |init4=C
+
|issue=5
 +
|article=
 +
|page=1267
 +
|pages=
 +
|url=http://www.cirp.org/library/sex_function/denniston3/
 +
|pubmedID=15596221
 +
|DOI=10.1016/j.urology.2004.03.059
 +
|accessdate=2021-06-05
 +
}}</ref>
 +
 
 +
Masood et al. (2005) suggested "before circumcision, men should be warned of the long-term consequences (penile sensations and effect on erectile function) as well as be talked through the more traditional subjects (peri-operative complications)."<ref name="masood2005" />
 +
 
 +
Kim & Pang (2007) studied the effect of adult circumcision on 138 males in [[South Korea]]. They concluded:
 +
<blockquote>There were no significant differences in sexual drive, [[erection]], [[ejaculation]], and ejaculation latency time between [[circumcised]] and [[uncircumcised]] men. Masturbatory pleasure decreased after circumcision in 48% of the respondents, while 8% reported increased pleasure. Masturbatory difficulty increased after circumcision in 63% of the respondents but was easier in 37%. About 6% answered that their sex lives improved, while 20% reported a worse sex life after circumcision.<ref>{{KimDS PangMG 2007}}</ref>
 +
</blockquote>
 +
 
 +
García-Mesa et al. (2021) reported the [[foreskin]] has an abundance of [[Meissner's corpuscles]] which provide pleasant sexual sensation when mechanically stimulated by motion of the foreskin.<ref name="garcía-mesa2021">{{REFjournal
 +
  |last=García-Mesa
 +
  |first=Yolanda
 +
  |init=
 +
  |author-link=
 +
  |last2=García-Piqueras
 +
  |first2=Jorge
 +
  |init2=
 +
  |author2-link=
 +
  |last3=Cobo
 +
  |first3=Ramón
 +
  |init3=
 +
  |author3-link=
 +
  |last4=Martín-Cruces
 +
  |first4=José
 +
  |init4=
 
  |author4-link=
 
  |author4-link=
−
  |last5=Milos
+
  |last5=Suazo
−
  |first5=M.F.
+
  |first5=Iván
−
  |init5=MF
+
  |init5=
−
  |author5-link=Marilyn Fayre Milos
+
  |author5-link=
−
  |last6=Wilcox
+
  |last6=García-Suárez
−
  |first6=N.
+
  |first6=Olivia
−
  |init6=N
+
  |init6=
 
  |author6-link=
 
  |author6-link=
−
  |last7=Van Howe
+
  |last7=Feito
−
  |first7=R.S.
+
  |first7=Jorge
−
  |init7=RS
+
  |init7=
−
  |author7-link=Robert Van Howe
+
  |author7-link=
 +
|last8=
 +
|first8=Vega
 +
|init8=José A.
 +
|author8-link=
 
  |etal=no
 
  |etal=no
−
  |title=Fine-touch pressure thresholds in the adult penis
+
  |title=Sensory innervation of the human male prepuce: Meissner's corpuscles predominate
−
  |journal=BJU Int
+
|trans-title=
−
  |date=2007-04
+
|language=
−
  |volume=99
+
  |journal=Journal of Anatomy
 +
|location=
 +
  |date=2021-10
 +
  |volume=239
 
  |issue=4
 
  |issue=4
−
  |pages=864-9
+
|article=
−
  |url=https://www.arclaw.org/wp-content/uploads/Sorrells-Fine-touch-BJUI-2007.pdf
+
|page=
−
  |quote=
+
  |pages=892-902
−
  |pubmedID=17378847
+
  |url=https://onlinelibrary.wiley.com/doi/full/10.1111/joa.13481
−
  |pubmedCID=
+
|pubmedID=34120333
−
  |DOI=10.1111/j.1464-410X.2006.06685.x
+
|pubmedCID=8450466
−
  |accessdate=2020-12-22
+
|DOI=10.1111/joa.13481
−
}}</ref> There is great loss of sensation caused by the amputation of this structure. It appears that many intact males are unaware of the source of sensation and are shocked by the loss of sensation after circumcision.
+
|accessdate=2021-11-15
−
# The abundance of skin in the foreskin allows [[gliding action]]. Gliding action facilitates [[masturbation]] and [[vagina| intercourse]]. The shortening of penile skin reduces or eliminates gliding action. The loss of gliding action may cause [[dyspareunia]].
+
}}</ref>
−
# Painful erections may occur due to lack of sufficient skin to allow for expansion of the penis.
+
 
 +
===Other adverse effects===
 +
# Circumcision causes both physical and psychic [[trauma]].
 +
# Circumcision severs blood vessels and disrupts blood circulation in the [[penis]]. This frequently causes [[lymphoedema]] and [[erection]] difficulties.
 +
# Circumcision invariably excises the [[ridged band]].
 +
# Circumcision is a surgical [[amputation]] of functional tissue. The various [https://foreskinfunction.org/ functions] cease to operate. If the patient does not like the results, it cannot be reversed or undone.
 +
# Recovery from adolescent or adult circumcision is slow and painful. [[Erection]]s are painful because the [[skin]] is stretched and the sutures are stressed. [[Wound dehiscence]] may occur.
 +
# The [[foreskin]] is protective of the [[glans penis]]. After the foreskin is amputated, the [[glans penis]] is exposed so that it touches clothing and other things. Some men report this causes extreme pain so that they cannot wear pants for an extended time. Some circumcised men complain of discomfort due to the head being permanently exposed.
 +
# The foreskin provides moisture and oil to the glans penis. After circumcision, the glans penis will become desiccated. Many [[circumcised]] men complain of dryness.
 +
# The foreskin has [[Immunological and protective function of the foreskin| immunological functions]] that protect from disease. [[Circumcised]] populations have a higher incidence of [[HIV]] than [[intact]] populations.<ref name="denniston2020">{{REFdocument
 +
|title=World Health Organization, HIV, and male circumcision
 +
|url=https://pool.intactiwiki.org/images/2020-06-15b_LettertoPEPFAR.pdf
 +
|contribution=
 +
|last=Denniston
 +
|first=George C.
 +
|publisher=[[Doctors Opposing Circumcision (D.O.C.)]]
 +
|format=
 +
|date=2020-06-29
 +
|accessdate=2020-09-02
 +
}}</ref><ref name="fish2020">{{REFjournal
 +
|last=Fish
 +
|first=Max
 +
|init=M
 +
|author-link=
 +
|last2=Shavisi
 +
|first2=Arianne
 +
|init2=A
 +
|author2-link=
 +
|last3=Gwaambuka
 +
|first3=Tatenda
 +
|init3=T
 +
|author3-link=
 +
|last4=Tangwa
 +
|first4=Godfrey B.
 +
|init4=GB
 +
|author4-link=
 +
|last5=Ncayiyana
 +
|first5=Daniel
 +
|init5=D
 +
|author5-link=
 +
|last6=Earp
 +
|first6=Brian D.
 +
|init6=BD
 +
|author6-link=Brian D. Earp
 +
|etal=no
 +
|title=A new Tuskegee? Unethical human experimentation and Western neocolonialism in the mass circumcision of African men
 +
|journal=Developing World Bioeth
 +
  |date=2020-09-09
 +
  |volume=00
 +
  |pages=1-16
 +
  |url=https://doi.org/10.1111/dewb.12285
 +
|DOI=10.1111/dewb.12285
 +
  |accessdate=2021-02-13
 +
}}</ref>
 +
# The heavily innervated [[ridged band]] is located on the foreskin and is always amputated along with the foreskin. The [[Foreskin sensitivity| most sensitive regions in the intact penis]] are those parts ablated by circumcision.<ref>{{Sorrells etal 2007}}</ref> There is great loss of sensation caused by the [[amputation]] of this structure. It appears that many [[intact]] males are unaware of the source of sensation and are shocked by the loss of sensation after circumcision.
 +
# The abundance of [[skin]] in the foreskin allows [[gliding action]]. Gliding action facilitates [[masturbation]] and [[vagina| intercourse]]. The shortening of [[penile skin]] reduces or eliminates gliding action. The loss of gliding action may cause [[dyspareunia]].
 +
# Painful [[erection]]s may occur due to lack of sufficient [[skin]] to allow for expansion of the [[penis]].
 +
# The erect penis may be shorter due to lack of sufficient [[skin]] to allow full expansion.
 +
# There always will be a [[circumcision scar]] that encircles the shaft of the penis.
 +
# The exposed [[glans penis]] will protect itself from friction by developing a layer of [[keratin]] and become cracked and hardened. The [[keratinization]] of the [[glans penis]] will reduce its sensitivity.
 +
# There are possible [[Psychological issues of male circumcision| emotional issues]] secondary to a partial loss of the [[penis]] through circumcision.
 +
==Financial considerations==
 +
Medical insurance policies vary with the provider of insurance. Most will pay for circumcision only if it is done to treat a medical condition. When circumcision is carried out for cosmetic reasons or personal desire, it is very unlikely that medical insurance would pay. The cost of an adult circumcision would include a facility fee, a surgeon's fee, an anesthesiologist's fee, and pre-operative and post-operative care. Garrett (2024) says the cost may range from $1,650 to $6,450.<ref name="garrett2024-03-07">{{REFweb
 +
|url=https://intactamerica.org/adult-circumcision-cost/
 +
|title=Adult Circumcision Cost: The Profit Motives and Hidden Toll
 +
|last=Garrett
 +
|first=Connor
 +
|init=
 +
|author-link=Connor Judson Garrett
 +
|publisher=Intact America
 +
|date=2024-03-07
 +
|accessdate=2024-05-15
 +
}}</ref>
 +
 
 +
==Warning==
 +
It is quite common for some urologists to push circumcision on any [[foreskinned]] male although conservative treatment would have been sufficient, since there is a nice fee attached to a circumcision [[amputation]]. There are many reports of false statements being made. It is totally unethical and akin to fraud, but it happens frequently.
  
 
===Videos===
 
===Videos===
−
Here are three videos in which men who had an adult circumcision express regret.
+
Here are five videos in which [[regret men]] who had an adult circumcision express their regret.
 +
 
 +
==== Circumcised at 18 ====
 +
<youtube>v=NAHGFx95D80</youtube>
 +
====Circumcised at 46====
 +
<youtube>v=pZ3n8CtcmRY</youtube>
 +
 
 +
==== Why I Regret Getting Circumcised At 19 ====
 +
<youtube>v=7AaUb63NLLw</youtube>
  
−
<center>
+
==== Circumcised Man: "I feel such a sense of loss" ====
 
<youtube>v=gx_PoXm3XZ4</youtube>
 
<youtube>v=gx_PoXm3XZ4</youtube>
  
−
<youtube>v=NAHGFx95D80</youtube>
+
==== Circumcised at 30 ====
 +
<youtube>v=g2CwHbCDiAU</youtube>
  
−
<youtube>v=g2CwHbCDiAU</youtube>
+
==== Got Circumcised as an Adult (Just saw the Penn & Teller episode) ====
−
</center>
+
<youtube>v=QtN7JmMUfZE</youtube>
 +
==== Circumcision Care - After Circumcision - 5 Post Circumcision Surgery Recovery Tips!====
 +
<youtube>v=xdrvq_10vTM</youtube>
  
 
== Rite of passage ==
 
== Rite of passage ==
Line 213: Line 603:
  
 
=== Aborigines ===
 
=== Aborigines ===
−
The indigeous people of [[Australia]], the Aborigines, have variously practiced [[Religion and culture#Australia|subincision]] and [[circumcision]] on adolescents and adults since before the first contact with Europeans.
+
The indigeous people of [[Australia]], the [[Aborigines]], have variously practiced [[Religion and culture#Australia|subincision]] and [[circumcision]] on adolescents and adults since before the first contact with Europeans.
  
 
=== Ulwaluko ===
 
=== Ulwaluko ===
−
Traditional [[Circumcision]] and Initiation into Manhood (ulwaluko) is an ancient initiation ritual practiced by the amaXhosa of the Eastern Cape. The ritual is traditionally intended as a teaching institution to prepare boys for the responsibilities of manhood. The principles that lie at the very core of the ritual are respect for self (including self control and integrity), respect for family (not to bring shame to them), and respect for community (to protect them from harm).  
+
Traditional [[Circumcision]] and Initiation into Manhood (ulwaluko) is an ancient initiation ritual practiced by the amaXhosa of the Eastern Cape Province of [[South Africa]]. The ritual is traditionally intended as a teaching institution to prepare boys for the responsibilities of manhood. The principles that lie at the very core of the ritual are respect for self (including self control and integrity), respect for family (not to bring shame to them), and respect for community (to protect them from harm).  
  
−
Every single initiation season the media writes about complications accompanying the ritual of Traditional [[Circumcision]] and Initiation into Manhood ''(ulwaluko)''. The magnitude of these complications is horrific, from 1995 till 2014, 919 boys have lost their lives in the mountains and hills of the Eastern Cape. Many others were mutilated or even lost their manhood.
+
Every single initiation season the media writes about complications accompanying the ritual of Traditional [[Circumcision]] and Initiation into Manhood ''(ulwaluko)''. The magnitude of these complications is horrific: From 1995 till 2014, 919 boys have lost their lives in the mountains and hills of the Eastern Cape. Many others were mutilated or even lost their manhood. [[Ulwaluko|Many of these mutilations are documented (graphic content).]]
 +
 
 +
===Tuli===
 +
[[Tuli]] is a [[genital mutilation]] rite of boys and adolescents practiced in the Philippine Islands.
  
 
{{SEEALSO}}
 
{{SEEALSO}}
−
 
+
* [[Circumcision methods]]
 +
* [[Circumcision scar]]
 +
* [[Development of retractable foreskin]]
 +
* [[Doctors Cut Off Man’s Penis During Circumcision]]
 +
* [[Foreskin]]
 +
* [[Foreskin sensitivity]]
 +
* [[Frenectomy]]
 +
* [[Frenuloplasty]]
 +
* [[Ischemia of the glans penis]]
 +
* [[Issues with American urologists and the practice of male circumcision]]
 +
* [[Penis]]
 +
* [[Phimosis]]
 +
* [[Phimosis#Preputioplasty| Preputioplasty]]
 +
* [[The recovery after an adult circumcision]]
 +
* [[Regret men]]
 
* [[Risks and complications]]
 
* [[Risks and complications]]
 
* [[Sexual effects of circumcision]]
 
* [[Sexual effects of circumcision]]
−
* [[Tuli]]
+
* [[Stretching]]
−
 
+
* [[Trauma]]
 
{{LINKS}}
 
{{LINKS}}
−
 
+
====Medical circumcision====
 +
* {{REFjournal
 +
|last=Holman
 +
|first=
 +
|init=JR
 +
|author-link=
 +
|last2=Stuessi
 +
|first2=
 +
|init2=KA
 +
|author2-link=
 +
|etal=no
 +
|title=Adult circumcision
 +
|trans-title=
 +
|language=
 +
|journal=American Family Physician
 +
|location=
 +
|date=1999-03-15
 +
|season=
 +
|volume=59
 +
|issue=6
 +
|article=
 +
|page=
 +
|pages=1514-18
 +
|url=https://www.aafp.org/pubs/afp/issues/1999/0315/p1514.html
 +
|archived=
 +
|quote=
 +
|pubmedID=10193593
 +
|accessdate=2024-05-03
 +
}}
 +
* {{REFjournal
 +
|last=Hammond
 +
|first=
 +
|init=T
 +
|author-link=
 +
|etal=no
 +
|title=A preliminary poll of men circumcised in infancy or childhood
 +
|trans-title=
 +
|language=
 +
|journal=BJU Int
 +
|location=
 +
|date=1999-01
 +
|season=
 +
|volume=83 Supple 1
 +
|issue=
 +
|article=
 +
|page=
 +
|pages=85-92
 +
|url=http://www.noharmm.org/bju.htm
 +
|archived=
 +
|quote=
 +
|pubmedID=10349419
 +
|pubmedCID=
 +
|DOI=10.1046/j.1464-410x.1999.0830s1085.x
 +
|format=PDF
 +
|accessdate=2022-06-10
 +
}}
 +
* {{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=https://davidlouis77.wordpress.com/2010/05/08/adult-circumcision-my-experience-2-years-on/comment-page-4/#comment-24567
 +
|title=Adult Circumcision: My experience two years on.
 +
|last=Louis
 +
|first=David
 +
|author-link=
 +
|publisher=
 +
DavidLouis77's Blog
 +
|website=wordpress.com
 +
|date=2010-05-08
 +
|accessdate=2020-12-29
 +
|format=
 +
|quote=
 +
}}
 
* {{REFweb
 
* {{REFweb
 
  |url=http://www.circumstitions.com/Resent.html
 
  |url=http://www.circumstitions.com/Resent.html
−
|archived=
 
 
  |title=The tip of the iceberg: Men who resent being circumcised
 
  |title=The tip of the iceberg: Men who resent being circumcised
−
|trans-title=
 
−
|language=
 
 
  |last=Young
 
  |last=Young
 
  |first=Hugh
 
  |first=Hugh
Line 244: Line 726:
 
  |quote=
 
  |quote=
 
}}
 
}}
−
 
+
* {{REFweb
 +
|url=http://www.intactaus.org/information/functionsoftheforeskin/
 +
|title=Functions of the Foreskin
 +
|last=Helard
 +
|first=Lou
 +
|author-link=
 +
|publisher=Intact Australia
 +
|website=
 +
|date=2014-08-01
 +
|accessdate=2020-05-29
 +
|format=
 +
|quote=
 +
}}
 
* {{REFweb
 
* {{REFweb
 
  |url=http://www.intactaus.org/men-circumcised-as-adults/
 
  |url=http://www.intactaus.org/men-circumcised-as-adults/
Line 254: Line 748:
 
  |quote=
 
  |quote=
 
}}
 
}}
−
 
+
* {{REFweb
−
* NSFW {{REFweb
+
|url=https://ladagueetlefourreau.wordpress.com/2017/07/17/a-personal-account-of-adult-circumcision/
−
  |url=http://www.ulwaluko.co.za/Complications.html
+
|title=A Personal Account of Adult Circumcision
−
  |title=Ulwaluko: Complications
+
|last=
−
  |accessdate=2020-12-21
+
|first=
 +
|date=2017-07-17
 +
|accessdate=2021-02-14
 +
}}
 +
* {{REFdocument
 +
|title=Circumcision (Complete Removal of the Foreskin}
 +
|url=https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Circumcision.pdf
 +
|contribution=
 +
|last=
 +
|first=
 +
|publisher=British Association of Paediatric Surgeons
 +
|format=PDF
 +
|date=2020-12
 +
|accessdate=2024-02-12
 +
}}
 +
* {{REFweb
 +
  |url=https://www.cosmopolitan.com/sex-love/a28580739/circumcision-pros-and-cons/
 +
|title=I Had an Adult Circumcision, and I Totally Regret It
 +
|last=Hseih
 +
|first=Carina
 +
|date=2019-08-02
 +
|accessdate=2021-06-05
 +
}}
 +
* {{REFjournal
 +
|last=Remennick
 +
|first=Larissa
 +
|init=L
 +
|author-link=
 +
|etal=no
 +
|title=Joining the tribe: adult circumcision among immigrant men in Israel and its traumatic aftermath
 +
|trans-title=
 +
|language=
 +
|journal=Cult Health Sex
 +
|location=
 +
|date=2021-01-29
 +
|volume=24
 +
|issue=5
 +
|article=
 +
|page=
 +
|pages=702-16
 +
|url=https://www.tandfonline.com/doi/abs/10.1080/13691058.2021.1879272?journalCode=tchs20
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* {{REFweb
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|url=https://intactamerica.org/adult-circumcision-cost/
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  |title=Adult Circumcision Cost: The Profit Motives and Hidden Toll
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|last=Garrett
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|first=Connor
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|author-link=Connor Judson Garrett
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|publisher=Intact America
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|date=2024-03-07
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|url=https://wikionlymen.com/?s=circumcision
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|title=Disadvantages Of Circumcision In Man
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|publisher=Wiki Only Men
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|date=2021-11-05
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  |accessdate=2024-10-05
 
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* NSFW {{REFweb
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====Traditional circumcision====
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|url=http://www.ulwaluko.co.za/Photos.html
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* {{NSFW}} [[Ulwaluko]]
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|title=Ulwaluko: Photos
 
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|accessdate=2020-12-21
 
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[[Category:Body modification]]
 
[[Category:Circumcision]]
 
[[Category:Circumcision]]
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[[Category:Male circumcision]]
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[[Category:Male genital mutilation]]
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[[Category:Penile surgery]]
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[[de:Jugendlichen- und Erwachsenenbeschneidung]]

Latest revision as of 14:02, 25 October 2024

Adolescent and adult circumcision is rare when compared to the millions upon millions of medically-unnecessary, non-therapeutic circumcisions of boys that are carried out in Islamic nations, Israel, the United States, and elsewhere, however they are promoted by a medical trade association and its members.

Rosemary Romberg commented on adult circumcision in the United States:

In the United States doctors tend to consider the foreskin as something "dispensible." … It is difficult to ascertain the true percentage of actual need for adult circumcision among intact males. In a circumcision-oriented society such as ours many doctors prescribe the operation for conditions which could be resolved, often easily, without resort to surgery.…[1]

Consent

Male circumcision is an elective surgical amputation of the foreskin part of the penis. Legally, the patient or his surrogate must grant informed consent before the surgery can be performed. A surrogate's powers are limited to granting consent for medically-indicated and necessary diagnosis and treatment of existing disease.[2]

The surgeon most provide all material information to the patient before informed consent can be granted. There is a strong tendency for the surgeon to omit telling the patient anything about the nature and functions of the foreskin,[3] which would be lost through amputation if consent should be granted.

Urologic surgeons in the United States derive a substantial fee from the performance of a circumcision, so some may have a bias in favor of circumcision and may inappropriately recommend adult circumcision to patients when a conservative treatment would be satisfactory or even when no treatment is necessary. Patients should be wary and do their own research before granting consent for an irreversible circumcision.

Milos (2022) advises:

  • A penis without a foreskin doesn’t work as nature intended for its owner or his sexual partner.
  • Amputating the foreskin eliminates the penis’ “command and control” nerve center, the normal skin system that allows for comfortable erections and the gliding mechanism necessary for sensory pleasure, foreplay, and normal intromission (entry during intercourse).
  • Circumcision amputates the tens of thousands of specialized, erogenous nerve endings that signal to the man where he is in relation to the orgasmic threshold.
  • It denudes and exposes the glans (head of the penis), causing it to become dry, calloused, and desensitized. Circumcised men talk about becoming impotent during their 50s or 60s while intact males tell me the urge doesn’t come around as often but their sensitivity hasn’t diminished.
  • Circumcision makes the penis smaller, too.[4]

Reasons for circumcision

All circumcisions are injurious because they amputate a multi-functional body part, but in rare cases the benefit obtained by removing a deformed, diseased, or damaged foreskin may be of more value than the amputated foreskin.

  • Deformed foreskins — The common type of deformed foreskin is the narrow non-retractable foreskin of phimosis. Circumcision was the traditional treatment for phimosis, however circumcision is less performed today because newer conservative treatments are now available that preserve the foreskin and its many useful functions.
  • Damaged foreskins — This includes any type of physical trauma and injury that is beyond surgical repair. Zipper injury does not require circumcision.[6] [7]

Elective non-therapeutic circumcision

Some adult males may seek non-therapeutic circumcision because of a conversion to Judaism or Islam. Others may simply want a circumcision because they like the physical appearance, or to fit into a society where most men are circumcised, or for some personal whim.[8]

A word to intact teens

Boys are born with a foreskin that is non-retractable for reasons of protection. The inner surface is fused with the glans penis by a synechia (similar to a fingernail that is glued to the nail bed of the finger). Also the tip of the foreskin is too narrow to retract. As a boy gets older, the synechia disintegrates and releases the foreskin and the foreskin gets wider as a boy ages, so the foreskin gradually becomes retractable. Some boys go through puberty but find that their foreskin is still too narrow to permit retraction.

Beaugé (1997) reported that boys, who masturbate by pulling their foreskin away from the body, will not stretch the tight part of the foreskin so non-retractile foreskin will persist. He advised changing the method of masturbation to the more conventional method of pulling the foreskin toward the body so that the narrow orifice gets stretched.[9]

The traditional way of addressing this issue was to consult a urologist and get a circumcision, however we now understand that in the vast majority of cases, manual stretching over a few months will widen the foreskin by tissue expansion, make the foreskin retractable and eliminate the need for a destructive circumcision.

Methods of adult circumcision

Dorsal slit

Dorsal slit is a cut on the top of the foreskin to widen the opening, allowing the foreskin to retract and fall below the shaft of the penis. Dorsal slit does not cut around and does not remove tissue, so it is not a true circumcision. Dorsal slit is a first step in the circumcision of a phimotic foreskin by the sleeve technique.[8]

Sleeve technique

Holman & Stuessi (1999) said patients should be advised of alternatives to circumcision.

They reported the indications for adult circumcision are uncommon. The most common is phimosis.

They recommended dorsal penile nerve block or ring block local anesthesia for the pain of circumcision surgery.

Informed consent must be obtained. They stated:

Specifically, the patient should be told about the risks of bleeding, hematoma formation, infection, inadvertent damage to the glans, removal of too much or too little skin, aesthetically unpleasing results, and a change of sensation during intercourse. The patient should also be informed that, during the postoperative period, erections can cause pain and disruption of the suture line that may require replacement of the sutures. Full recovery following circumcision generally requires four to six weeks of abstinence from all genital stimulation and sexual activity.[8]

In regard to complications, Holman & Stuessi reported:

As with any surgical procedure, bleeding and infection are probably the most common complications of circumcision in adult patients; however, accurate statistics are not available. Other complications include hematoma formation, diffuse swelling, pain from inadequate anesthesia, poor cosmesis, tearing of the sutures due to erection before healing is complete and anesthetic complications. Some patients may also note an unpleasant heightened sensitivity during intercourse. Infection can be treated with local or parenteral antibiotics, depending on the severity of the infection. Bleeding can be controlled with pressure, an absorbable gelatin sponge product (i.e., Gelfoam), electrocautery or ligatures. None of these techniques can be preferentially recommended based on differences in complication rate or severity.[8]

Circumcision with a plastic ring device

Adolescent and adult circumcision may also be carried out with one of several plastic, one-use, disposable ring devices. These devices work by clamping the foreskin tightly so that it is crushed and flow is cut off completely. Ischemic necrosis ensues and the foreskin dies. It may then be cut off or left to fall off. Ring devices include the TARA KLamp, the PrePex, AccuCirc, and the Shang Ring.

Pain during and after circumcision

Circumcision is a surgical amputation of part of the penis. It is normal to feel pain during the surgical amputation, however this is usually eliminated by general or local anesthesia.

One may expect pain after surgery until the incision heals. Ask your doctor for a two-week supply of an opioid pain reliever.

One may also expect pain when the sensitive glans penis is exposed to friction from clothing, etc. It is no longer protected by the foreskin, so there is not much one can do about it.

One may also expect painful erections, depending on how much skin was removed. Depending on how much skin was removed, there may not be enough skin left to allow for shaft expansion during erection and this may cause painful erections.

One may also experience phantom pain from neuromas that form at the incision where nerves were severed.[10]

Masturbation after circumcision may be painful if one doesn’t use lubrication because of lack of gliding action.

Recovery period

Recovery from an adult circumcision is frequently said to be six weeks.

Complications

Erections tend to be painful and may cause wound dehiscence.[11]

There is danger of infection until the circumcision wound heals closed.[11]

Lymphoedema

Lymphoedema of the penis is a normal and expected complication of male adult circumcision due to the adverse effect on blood circulation. Ferhatoglu et al. (2019) reported edema in 108 of 198 patients or 54.5 percent.[12] It frequently lasts for months.

Permanent adverse effects

Loss of sensation

The human foreskin has long been noted for its high level of erogenous sensation. Winklemann (1959) early identified the foreskin as a specific erogenous zone.[13] Falliers (1970) called attention to sensory pleasure induced by tactile stimulation of the foreskin, which is almost totally lost after its surgical removal.[14]

Money & Davison (1983) reported "diminished penile sensitivity, less penile gratification, more penile pain, and cosmetic deformity" as the effect of circumcision, however they considered that a "prolongation of the period prior to ejaculation" was a possible benefit.[15]

Money & Davison thought the loss of sensation is "secondary to diminished sensory input from stretch receptors in the less mobile skin of the shaft of the penis, as well as loss of foreskin stretch receptors".[15]

Denniston (2004) carried out a survey of 38 adult males who were circumcised at least 2 years after they commenced sexual intercourse. Thirteen men felt that sexual intercourse was better after circumcision, but 22 felt that intercourse was worse and would not have the circumcision again, because of loss of sexual pleasure.[16]

Masood et al. (2005) suggested "before circumcision, men should be warned of the long-term consequences (penile sensations and effect on erectile function) as well as be talked through the more traditional subjects (peri-operative complications)."[3]

Kim & Pang (2007) studied the effect of adult circumcision on 138 males in South Korea. They concluded:

There were no significant differences in sexual drive, erection, ejaculation, and ejaculation latency time between circumcised and uncircumcised men. Masturbatory pleasure decreased after circumcision in 48% of the respondents, while 8% reported increased pleasure. Masturbatory difficulty increased after circumcision in 63% of the respondents but was easier in 37%. About 6% answered that their sex lives improved, while 20% reported a worse sex life after circumcision.[17]

García-Mesa et al. (2021) reported the foreskin has an abundance of Meissner's corpuscles which provide pleasant sexual sensation when mechanically stimulated by motion of the foreskin.[18]

Other adverse effects

  1. Circumcision causes both physical and psychic trauma.
  2. Circumcision severs blood vessels and disrupts blood circulation in the penis. This frequently causes lymphoedema and erection difficulties.
  3. Circumcision invariably excises the ridged band.
  4. Circumcision is a surgical amputation of functional tissue. The various functions cease to operate. If the patient does not like the results, it cannot be reversed or undone.
  5. Recovery from adolescent or adult circumcision is slow and painful. Erections are painful because the skin is stretched and the sutures are stressed. Wound dehiscence may occur.
  6. The foreskin is protective of the glans penis. After the foreskin is amputated, the glans penis is exposed so that it touches clothing and other things. Some men report this causes extreme pain so that they cannot wear pants for an extended time. Some circumcised men complain of discomfort due to the head being permanently exposed.
  7. The foreskin provides moisture and oil to the glans penis. After circumcision, the glans penis will become desiccated. Many circumcised men complain of dryness.
  8. The foreskin has immunological functions that protect from disease. Circumcised populations have a higher incidence of HIV than intact populations.[19][20]
  9. The heavily innervated ridged band is located on the foreskin and is always amputated along with the foreskin. The most sensitive regions in the intact penis are those parts ablated by circumcision.[21] There is great loss of sensation caused by the amputation of this structure. It appears that many intact males are unaware of the source of sensation and are shocked by the loss of sensation after circumcision.
  10. The abundance of skin in the foreskin allows gliding action. Gliding action facilitates masturbation and intercourse. The shortening of penile skin reduces or eliminates gliding action. The loss of gliding action may cause dyspareunia.
  11. Painful erections may occur due to lack of sufficient skin to allow for expansion of the penis.
  12. The erect penis may be shorter due to lack of sufficient skin to allow full expansion.
  13. There always will be a circumcision scar that encircles the shaft of the penis.
  14. The exposed glans penis will protect itself from friction by developing a layer of keratin and become cracked and hardened. The keratinization of the glans penis will reduce its sensitivity.
  15. There are possible emotional issues secondary to a partial loss of the penis through circumcision.

Financial considerations

Medical insurance policies vary with the provider of insurance. Most will pay for circumcision only if it is done to treat a medical condition. When circumcision is carried out for cosmetic reasons or personal desire, it is very unlikely that medical insurance would pay. The cost of an adult circumcision would include a facility fee, a surgeon's fee, an anesthesiologist's fee, and pre-operative and post-operative care. Garrett (2024) says the cost may range from $1,650 to $6,450.[22]

Warning

It is quite common for some urologists to push circumcision on any foreskinned male although conservative treatment would have been sufficient, since there is a nice fee attached to a circumcision amputation. There are many reports of false statements being made. It is totally unethical and akin to fraud, but it happens frequently.

Videos

Here are five videos in which regret men who had an adult circumcision express their regret.

Circumcised at 18

Circumcised at 46

Why I Regret Getting Circumcised At 19

Circumcised Man: "I feel such a sense of loss"

Circumcised at 30

Got Circumcised as an Adult (Just saw the Penn & Teller episode)

Circumcision Care - After Circumcision - 5 Post Circumcision Surgery Recovery Tips!

Rite of passage

In some cultures, circumcision is viewed as a rite of passage, and a male may not be considered a privileged adult until he has undergone circumcision.

Aborigines

The indigeous people of Australia, the Aborigines, have variously practiced subincision and circumcision on adolescents and adults since before the first contact with Europeans.

Ulwaluko

Traditional Circumcision and Initiation into Manhood (ulwaluko) is an ancient initiation ritual practiced by the amaXhosa of the Eastern Cape Province of South Africa. The ritual is traditionally intended as a teaching institution to prepare boys for the responsibilities of manhood. The principles that lie at the very core of the ritual are respect for self (including self control and integrity), respect for family (not to bring shame to them), and respect for community (to protect them from harm).

Every single initiation season the media writes about complications accompanying the ritual of Traditional Circumcision and Initiation into Manhood (ulwaluko). The magnitude of these complications is horrific: From 1995 till 2014, 919 boys have lost their lives in the mountains and hills of the Eastern Cape. Many others were mutilated or even lost their manhood. Many of these mutilations are documented (graphic content).

Tuli

Tuli is a genital mutilation rite of boys and adolescents practiced in the Philippine Islands.

See also

External links

Medical circumcision

Traditional circumcision

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