Child circumcision: Difference between revisions

"Male '''circumcision''' (from Latin ''circumcidere'', meaning "to cut around") is the surgical removal or [[amputation]] of the [[foreskin]] (prepuce) 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.

'''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.

The practice of non-therapeutic circumcision of boys has greatly declined in [[Australia]], [[Canada]], [[New Zealand]] and the [[United Kingdom]]. It has been gradually declining since 1985 in the [[United States]].

 

 

The [[amputation]] of the [[foreskin]] is a very old ritual, whose exact origin cannot be verified beyond doubt. Circumcision is believed to have originated in east Africa near the Red Sea well before the dawn of recorded history.<ref name="demeo1997">{{REFbook

  |last=DeMeo

  |year=1997

  |title=The geography of sexual mutilations

  |url=https://www.academia.edu/4212007/The_Geography_of_Male_and_Female_Genital_Mutilations

  |work=Sexual Mutilations: A Human Tragedy

  |editors=George C. Denniston, Marilyn Milos

  |edition=

  |volume=

  |chapter=

  |pages=

  |location=New York

  |publisher=Plenum

  |isbn=0-306-45589-7

  |quote=

  |accessdate=2021-11-13

  |note=

}}</ref> Medical historians assume that circumcision already served in ancient history as a way to control the sexuality of slaves and members of the lower classes without compromising their ability to reproduce. In religious history circumcision may be seen as a substitute for human sacrifice. In prehistoric times it was not uncommon to placate the gods with human sacrifice. Castration of slaves or conquered enemies was common as well. Following religious changes this sacrifice was altered, and only a part of the very organ responsible for the creation of new life was sacrificed.

[[Image:Circumcision Sakkara 3.jpg|200px|right]] For the [[Aborigines]], the [[Australia| Australian]] natives, the tradition of circumcision is said to go back to 10,000 BC. On the African continent, the first circumcisions are assumed to have emerged around 6000 BC. From ancient Egypt hints of various forms of circumcision date back to the time around 3000-2000 BC. The oldest known depiction<ref>{{REFweb

  |url=https://commons.wikimedia.org/wiki/File:Circumcision_Sakkara_3.jpg

  |title=File:Circumcision Sakkara 3.jpg

  |accessdate=2019-10-12

}}</ref> is an Egyptian tomb relief from the 6th dynasty, approximately 2300-2000 BC. It is not known precisely who was circumcised and why in those times.

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

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 seen as a covenant between God and man, dating back to the patriarch Abraham. The validity of this passage is increasingly being questioned.

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

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.

Jesus was born into a Jewish family in Israel, where [[Judaism]] was the prevailing religion, so He was [[circumcised]] on the eighth day.<ref>{{REFweb

  |url=https://www.biblegateway.com/passage/?search=Luke+2%3A21&version=NASB

  |title=Gospel of Luke

  |last=Luke

  |first=

  |publisher=NASB

  |website=Bible Gateway

  |date=

  |accessdate=2019-11-10

  |format=

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

  |url=https://www.biblegateway.com/passage/?search=Acts+15%3A1-30&version=NASB

  |accessdate=2019-11-10

In Christianity, circumcision is practiced only in the Coptic denomination. There is no general belief that circumcision is a requirement of Christianity.<ref name="hill2004">{{REFweb

|url=https://www.cirp.org/pages/cultural/christian.php

|title=The Holy Bible, Circumcision, False Prophets, and Christian Parents

|first=George

|publisher=Circumcision Reference Library

|accessdate=2019-11-10

|quote=The falseness of those who advocate circumcision is a recurrent theme in the New Testament.  

 

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 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:

 

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

|Author=[[John Harvey Kellogg]]

|url=https://archive.org/details/plainfaorold00kell/page/290

 

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

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

===Religious===

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

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.

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

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

 

# '''Diseased foreskin.''' A foreskin that is diseased is a valid indication for cirumcision. Some diseases that qualify are malignancy, lichen sclerosis, [[Balanitis#Diabetic_males| yeast infection in men with diabetes]], and recurrent [[balanoposthitis]].

It reflects the fascination that emerges from the ability to create new life. In most cultures, fertility is seen as the most precious good, and the body parts involved frequently find themselves in the focus of ritual acts. In many parts of the world, those rites take place when the boy reaches puberty, and are meant to symbolize his transition from boy to man. The removal of the male [[foreskin]] is just one of many phenomena that developed in this context. They range from the removal of the frenulum in boys and men through partial or complete removal of the [[foreskin]] up to radical operations. Australian [[Aborigines]], as mentioned above, have their [[foreskin]]s removed. It is also usual that, a few weeks later, young men have their [[penis]]es sliced open in a [[subincision]], resulting in a partly or completely divided [[urethra]].

Another known, particularly massive, intervention is the stripping of the entire [[skin]] off the [[penis]]. In Indonesia, boys have metal or bamboo balls inserted into their [[penis]] shaft or [[Glans penis|glans]] at the beginning of puberty, which form little "humps".

=== Prophylactic reasons ===

}}</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

  |url=

  |accessdate=

}}</ref><ref>{{REFconference

  |url=https://apps.dtic.mil/dtic/tr/fulltext/u2/a458066.pdf

* 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

  |url=

  |accessdate=

 

== Non-medical indications for circumcision ==

 

 

 

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

 

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

 

 

===Financial reasons===

 

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

 

=== Moral reasons ===

 

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

 

In the past, this circumstance was used to make it harder for boys to masturbate and [[masturbation]] less fun, as [[masturbation]] was viewed as immoral and was assumed to cause a variety of mental diseases, caused by the thinking of immoral thoughts! More on that can be found in the chapter "[[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.

 

 

 

One should note that the human foreskin is endowed by nature with [[Foreskin#Immunological_functions| immunological functions]] that serve to protect the human body from disease.<ref name="fleiss-hodges-vanhowe1998"/> The glans penis receives blood through the frenular artery.<ref>{{REFjournal

  |last=Persad

  |init=R

  |author-link=

  |last2=Sharma

  |init2=S

  |last3=McTavish

  |init3=J

  |author3-link=

  |etal=yes

  |title=Clinical presentation and pathophysiology of meatal stenosis following circumcision

  |journal=Brit J Urol

  |date=1995

  |volume=75

  |issue=1

  |pages=91-3

  |url=https://www.onlinelibrary.wiley.com/doi/abs/10.1111/j.1464-410X.1995.tb07242.x

  |quote=

  |pubmedID=7850308

  |DOI=10.1111/j.1464-410x.1995.tb07242.x

  |accessdate=2019-11-26

}}</ref> These facts are generally overlooked in arguments for alleged hygienic benefits of circumcision.

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 underneath the [[foreskin]] is easy - they are simply [[Preputial_sac#Washing| washed 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 problem.

 

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.

 

The [[Circumcision methods]] are discussed in a separate article.

In the past, advocates of circumcision claimed that a newborn child's nerve system was not yet fully developed, and that as a result, the child felt no [[pain]] during the circumcision procedure. Anand & Hickey (1987) have shown that newborn children do in fact feel [[pain]], and more acutely than adults.<ref name="anand-hickey1987">{{REFjournal

  |last=Anand

  |author-link=Kanwaljeet J. Singh Anand

|location=

  |date=1987-11-19

|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

  |title=American Academy of Pediatrics: Circumcision Policy Statement; Task Force on Circumcision

|journal=Pediatrics

  |date=1999-03

 

|accessdate=2011-05-02

 

  |accessdate=2011-05-04

 

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

}}</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.

 

 

To control [[pain]], some physicians that circumcise use Tylenol, sugar,<ref>{{REFweb

  |quote=To calm the baby during the procedure, a sugar filled gauze pacifier soaked with sweet juice is used, and soothing music is played in the room.

  |url=http://www.pollockclinics.com/circumcision/circumcision-guide.html

  |title=Parents' Guide to Circumcision

  |date=

}}</ref> and/or a local anaesthetic injection called a dorsal penile ring block.<ref>{{REFweb

}}</ref> During circumcision, somp physicians give children sugar pacifiers to "reduce the perception of pain",<ref>{{REFweb

}}</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

}}</ref> Post-operative pain and the pain the child must endure during recovery is hardly, if ever, addressed by professionals.

 

Just like tonsil or appendix surgery, circumcision is a surgical intervention and brings the usual risks related to surgical operations, alongside several specific risks of complications and late effects. Uberoi et al. (2022) report "some men are experiencing a complex negative constellation of psychological, physical, and sexual associations that lead to significant emotional distress directed both internally and externally. The posts also reveal a discovery phenomenon wherein men discover the physical and psychological manifestations of the decisions made by others to modify their genitals."<ref name ="uberoi2022">{{REFjournal

* An unavoidable effect of any circumcision is the permanent loss of sexual sensitivity. This is partly due to the removal of sensory tissue. The [[foreskin]] contains very many nerve endings and touch receptors, which account for the major part of male sexual sensation. If the [[foreskin]] is removed, they can no longer provide sexual stimulation. It is also partly due to the fact that the surface of the [[Glans penis|glans]] reacts to the missing protection from friction and drying out by developing a callus layer. This reduces the sensitivity of the remaining nerves in the [[Glans penis|glans]] gradually over the years. The study conducted by Sorrells et al.<ref>{{Sorrells 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).

* Orgasm problems: In the wake of reduced sexual sensitivity, due to the loss of sensory tissue and gradual [[keratinization]] of the surface of the [[Glans penis|glans]], orgasm problems may develop with increasing age. In this case, the sexual arousal created by intercourse or [[masturbation]] is not enough to achieve orgasm. A preliminary stage of this late effect is the prolonged time [[circumcised]]] men need to reach an orgasm. This is often fielded as the "cut men have more endurance" argument for circumcision.

}}</ref> The prolonged time it takes [[circumcised]] men to reach orgasm, as well as the often longer and more vigorous thrusting movements - compared to [[intact]] men - play a part in this.<ref name="ColdCJ TaylorJR 1999">{{ColdCJ TaylorJR 1999}}</ref><ref>{{REFjournal

Circumcision and frenectomy remove tissues with heightened erogenous sensitivity.<ref name="cepeda2023" /> <ref name="winkleman1959">{{WinkelmannRK 1959}}</ref>  They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."

Histology of the male circumcision scar shows [[amputation]] neuromas, Schwann cell proliferation and the bulbous collection of variably sized neurites. [[Amputation]] neuromas do not mediate normal sensation and are notorious for generating pain.<ref name="ColdCJ TaylorJR 1999"/>Cepeda-Emiliani et al. (2023) commented:

<blockquote>

Taking the sleve technique as an example of surgical flexibility during circumcision, to the extent that this technique is of such versatility that it allows highly variable quantities of cutaneous and subcutaneous tissue to be excised directly from the penile body, and to the extent that the prepuce is still conceived by segments of the medical community as "just a small piece of skin", we are concerned that aggressive circumcisions are intentionally or unintentionally being performed in pediatric and adult patients in the belief that "redundant" or " extra" tissue is being excised, or in the belief that "excesive sensitivity" is being reduced to augment ejaculatory latency time.<ref name="cepeda2023">{{REFjournal

  |last=Cepeda-Emiliani

|first=

|init=A

|author-link=Alfonso Cepeda-Emiliani

  |last2=Gándara-Cortés

  |first2=

  |init2=M

  |author2-link=

  |last3=Otero-Alén

  |first3=

  |init3=M

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|author5-link=

|last6=García-Caballero

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  |init6=T

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  |last7=Gallego

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  |init7=R

|author7-link=

  |last8=García-Caballero

  |first8=

  |init8=R

  |author8-link=

  |etal=no

  |title=Immunohistological study of the density and distribution of human penile neural tissue: gradient hypothesis

|trans-title=

  |journal= Int J Impot Res

|date=2023-05-02

  |volume=35

  |issue=3

|url=https://www.nature.com/articles/s41443-022-00561-9

  |archived=

  |pubmedID=35501394

  |pubmedCID=

  |DOI=10.1038/s41443-022-00561-9

  |accessdate=2023-11-23

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

 

 

[[Psychological_issues_of_male_circumcision#Circumcision_trauma_in_adults| Psychological late effects]] are also possible after a circumcision, especially if the operation was carried out in childhood. 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>{{REFjournal

  |last=Marshall

  |init=RE

  |last2=Porter

  |init2=FL

  |title=Circumcision: II effects upon mother-infant interaction

  |journal=Early Hum Dev

  |date=1982

  |volume=7

  |issue=4

  |pages=367-74

  |accessdate=2020-02-01

}}</ref>, as well as problems with nurturing, up to the point of refusal to be fed. The sleeping habits of these babies were also disturbed, with prolonged non-REM sleep and increased waking.

 

* In boys [[circumcised]] in childhood, [[post-traumatic stress disorder]] ([[PTSD]]) could be diagnosed. In a study on Philippine boys, in whom no [[PTSD]] was found prior to the operation, 69% of the boys [[circumcised]] in the traditional ritual and 51% of those [[circumcised]] by standard medical procedures (including anaesthesia) fulfilled the DSM-IV criteria for PTSD following the operation.<ref>{{REFbook

  |last=Ramos

  |init=S

  |last2=Boyle

  |init2=GJ

  |year=2001

  |title=Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem

  |url=https://link.springer.com/chapter/10.1007/978-1-4757-3351-8_14

  |work=

  |editors=[[George C. Denniston]], [[Frederick M. Hodges]], [[Marilyn Fayre Milos]]

  |edition=

  |volume=

  |chapter=Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder

  |pages=253-70

  |location=New York

  |publisher=Kluwer Academic/Plenum Publishers

  |isbn=

  |quote=

  |accessdate=

  |note=

* Circumcisions, especially those that happen without consent, can spark feelings of helplessness and alienation, which can persist as [[trauma]]. These feeling can also be triggered later, when someone [[circumcised]] as an infant becomes aware of his circumcision. In an online study, interviewed men stated they felt betrayed - 55% by the mother, 50% by the father, and 58% by the doctor, and 73% felt that their [[human rights]] had been violated.<ref name="GSoCH">{{REFweb

  |url=http://www.circumcisionharm.org/

  |title=Global Survey of Circumcision Harm

* It can frequently be found that the loss is denied, much as happens with the loss of other body parts. This denial can lead to fathers having their sons [[circumcised]] in order not to be reminded of their own loss. In this process, their own body is defined as "normal" and the [[foreskin]] redefined as a foreign object. Their own parents are seen as "good", so that this image is projected onto the circumcision their parents carried out as well, in order to keep the positive emotion intact. The father wants to be a "good" father later in life as well, and so, following an idealised image of his own parents, circumcision, which has been redefined as a "good thing", is passed on to his son by having him [[circumcised]] as well.<ref>{{VanderKolkBA 1989}}</ref><ref>{{REFjournal

  |last=Goldman

  |init=R

  |author-link=Ronald Goldman

  |url=https://www.cirp.org/library/psych/goldman1/

  |title=The psychological impact of circumcision

  |journal=BJU Int

  |date=1999

  |volume=83

  |issue=Suppl. 1

  |pages=93-103

  |accessdate=2019-10-12

* 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"/>

  |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

 

* Intolerance or allergic reactions to the narcotics used.

* Especially in newborns, where the bodily pain reduction mechanisms are not yet fully developed, local anaesthesia is often insufficient for the operation. Even in conjunction with regional anaesthesia of the dorsal nerve of the [[penis]], the rate of failure to provide sufficient anaesthetic even for experienced anaesthetists is still 5-10%. The general anaesthesia that would be needed for newborns, however, poses significant risks for the child, and, therefore, is only likely to be used in emergencies. A surgical operation without proper [[pain]] control can lead to the development of a specific pain memory<ref>{{REFweb

  |url=http://www.spiegel.de/spiegel/vorab/experte-warnt-rituelle-beschneidung-veraendert-das-gehirn-der-kinder-a-849534.html

  |title=Kinderschmerz-Experte warnt: Rituelle Beschneidung verändert das Gehirn der Kinder

  |trans-title=Children's pain expert warns: Ritual circumcision changes the brain of children

  |language=German

  |last=Prof. Dr. med. Boris Zernikow

  |first=

  |publisher=Spiegel Online

  |website=

  |date=2012-08-12

  |accessdate=2019-10-11

  |format=

  |quote=

}}</ref>. In unsedated and partially sedated infants increased secretion of the stress hormone cortisol could be observed for months after the operation. Overall, their pain threshold was lower and the risk of chronic pain increased. Regardless of these findings, infant circumcisions with insufficient or no anaesthetic are still common practice<ref>{{REFjournal

  |last=Garry

  |init=T

  |title=Circumcision: a survey of fees and practices

  |journal=OBG Management

  |date=1994

  |volume=October

  |issue=

  |pages=34-6

}}</ref><ref>{{REFjournal

  |last=Howard

  |init=CR

  |last2=Howard

  |init2=FM

  |last3=Garfunkel

  |init3=LC

  |last4=de Blieck

  |init4=EA

  |last5=Weitzman

  |init5=M

  |title=Neonatal circumcision and pain relief: current training practices

  |journal=Pediatrics

  |date=1998

  |volume=101

  |issue=

  |pages=423-8

}}</ref><ref>{{REFjournal

  |title=Circumcision practice patterns in the United States

}}</ref>. During procedures which take several minutes, babies tend to fall into a state of stupor, which in the past was falsely interpreted as peaceful sleep, nurturing the belief that babies felt no pain. Measurements taken in those cases revealed a typically 3- to 4-fold increase in cortisol levels, which equals a state of severe [[shock]].<ref>{{REFjournal

  |last=Gunnar