Child circumcision: Difference between revisions
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}}</ref> [...] The procedure is most often an elective surgery performed on neonates and children for religious and cultural reasons, but in other cases may be indicated for both therapeutic and prophylactic reasons. It is a treatment option for pathological phimosis, refractory balanoposthitis and chronic urinary tract infections (UTIs); it is contraindicated in cases of certain genital structure abnormalities or poor general health." (Source: [http://en.wikipedia.org/wiki/Circumcision Wikipedia]) | }}</ref> [...] The procedure is most often an elective surgery performed on neonates and children for religious and cultural reasons, but in other cases may be indicated for both therapeutic and prophylactic reasons. It is a treatment option for pathological phimosis, refractory balanoposthitis and chronic urinary tract infections (UTIs); it is contraindicated in cases of certain genital structure abnormalities or poor general health." (Source: [http://en.wikipedia.org/wiki/Circumcision Wikipedia]) | ||
'''Posthectomy''' is a more accurate medical term, but the Biblical euphemism, ''circumcision'', is more commonly used | |||
----- | ----- | ||
== Historical background == | |||
The amputation of the [[foreskin]] is a very old ritual, whose exact origin cannot be verified beyond doubt. Medical historians assume that circumcision already served in ancient history as a way to control the sexuality of slaves and members of the lower classes without compromising their ability to reproduce. In religious history circumcision may be seen as a substitute for human sacrifice. In prehistoric times it was not uncommon to placate the gods with human sacrifice. Castration of slaves or conquered enemies was common as well. Following religious changes this sacrifice was altered, and only a part of the very organ responsible for the creation of new life was sacrificed. | |||
== | [[Image:Circumcision Sakkara 3.jpg|200px|right]] For the Aborigines, the Australian natives, the tradition of circumcision is said to go back to 10,000 BC. On the African continent, the first circumcisions are assumed to have emerged around 6000 BC. From ancient Egypt hints of various forms of circumcision date back to the time around 3000-2000 BC. The oldest known depiction<ref>{{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 the Jewish religion, the tradition of circumcision goes back to a passage in the Book of Genesis (17, 10-14). It is seen as a covenant between God and man, dating back to the patriarch Abraham. | |||
{{Citation | |||
|Text=10 This is my covenant with you and your descendants after you, the covenant you are to keep: Every male among you shall be circumcised. 11 You are to undergo circumcision, and it will be the sign of the covenant between me and you. 12 For the generations to come every male among you who is eight days old must be circumcised, including those born in your household or bought with money from a foreigner—those who are not your offspring. 13 Whether born in your household or bought with your money, they must be circumcised. My covenant in your flesh is to be an everlasting covenant. 14 Any uncircumcised male, who has not been circumcised in the flesh, will be cut off from his people; he has broken my covenant.” | |||
|Author=Bible | |||
|Source=Gen 17, 10-14, NIV | |||
}} | |||
According to the anthropologist and sociologist Nissan Rubin, the Jewish form of circumcision, called brit mila, during the first two millennia did not include the later customary periah, namely the complete scraping of the inner [[foreskin]] from the [[Glans penis|glans]]. This was only added around 135 AD, to make it impossible to restore the [[foreskin]] by stretching, which became popular in the wake of Hellenic influence. While originally only the tip of the [[foreskin]] was cut off, periah removes the entire [[foreskin]]. In the Greek society of the day, a denuded [[Glans penis|glans]] was considered obscene and risible. In ultra-orthodox communities, circumcision is followed by the [[mohel]], the ritual circumciser, sucking blood from the wound with his mouth. This practice is highly controversial, as it can result in an infection with herpes simplex type 1. In New York City, between 2000 and 2011 eleven children were infected with herpes, 10 of whom had to be treated in hospital. Two of them suffered permanent brain damage, two others died. In the 12th century, the Jewish philosopher and doctor Maimonides pointed out that circumcision was necessary, as it diminished sexual desires and reduced the pleasure to a degree just sufficient for mere reproduction. | |||
It | In Islam, circumcision is also religiously founded, even though there is no mention of it in the Koran itself. According to tradition, the Prophet Mohammed was born without a [[foreskin]]. It is seen as a sign of prophets that they are born without a [[foreskin]] already. It is considered an honour to "resemble the example of the Prophet", meaning to be circumcised. In Islam, unlike Judaism, there is no specific age at which the circumcision should be performed. Most circumcisions take place at ages between 6 and 10 years, but the range goes from birth to adulthood. | ||
In Christianity, circumcision is only common in a few orthodox churches. Nevertheless, Christian moral notions had decisive influence on the spread of this practice. In the puritan influenced USA, circumcision of children was popular in the 19th century as a means to prevent [[masturbation]]. In those days, this so-called ‘self-abuse‘ was not only considered immoral, but was supposedly responsible for a variety of diseases. Even the mere existence of a [[foreskin]] was linked to many illnesses. Among them one could find syphilis, epilepsy, paralysis of the spine, bed wetting, scoliosis (spinal deformity), paralysis of the bladder, club foot, nerve pain in the lower abdomen, tuberculosis and lazy eye. One of the best known advocates of child circumcision was [[John Harvey Kellogg]], co-inventor of the Corn Flakes bearing his name. In 1888, he wrote: | |||
{{Citation | |||
|Text=A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of [[phimosis]]. The operation should be performed by a surgeon without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement, and preventing the recurrence of the practice in those whose will-power has become so weakened that the patient is unable to exercise entire self-control. | |||
|Author=[[John Harvey Kellogg]] | |||
|Source= | |||
|ref=<ref>{{REFbook | |||
|url=https://archive.org/details/plainfaorold00kell/page/290 | |||
|chapter=Treatment for Self-abuse and Its Effects | |||
|title=Plain Facts for Old and Young | |||
|location=Burlington, Iowa | |||
|publisher=F. Segner & Co. | |||
|year=1888 | |||
|pages=107 | |||
}}</ref> | |||
}} | |||
Following the discovery of bacteria as a cause of many diseases – such as tuberculosis – the search began for other illnesses that could be prevented by circumcision. | |||
In the 1920s it was penile cancer<ref>Abraham L. Wolbarst claims that circumcision can prevent penile cancer. {{REFjournal | |||
|last=Wolbarst | |||
|first=Abraham L. | |||
|author-link=Abraham L. Wolbarst | |||
In the | |title=Is circumcision a prophylactic against penis cancer? | ||
|journal=Cancer | |||
= | |date=Jul 1926 | ||
|volume=3 | |||
|issue=4 | |||
|pages=301-10 | |||
}}</ref>, in the 1940 prostate- and tongue cancer as well as STDs<ref>Eugene H. Hand explains that circumcision somehow protects against venereal diseases and tongue cancer. {{REFjournal | |||
|title=Circumcision and venereal disease. | |||
|last=Hand | |||
|first=Eugene H. | |||
|journal=Archives of Dermatology and Syphilology | |||
|date=Sep 1949 | |||
|volume=60 | |||
|issue=3 | |||
|pages=341-346 | |||
}}</ref>. In the 1950s it was cervical cancer<ref>Abraham Ravich invents the myth that circumcision reduces the risk of women getting cervical cancer. {{REFjournal | |||
|url=https://www.ncbi.nlm.nih.gov/pubmed/14853120 | |||
|title=Prophylaxis of cancer of the prostate, penis, and cervix by circumcision | |||
|last=Ravich | |||
|first=Abraham | |||
|last2=Ravich | |||
|last= | |first2=R.A. | ||
|first=H | |journal=New York State Journal of Medicine | ||
| | |date=Jun 1951 | ||
| | |volume=51 | ||
| | |issue=12 | ||
| | |pages=1519-1520 | ||
| | |pubmedID=14853120 | ||
| | |accessdate=2019-10-12 | ||
|title= | }}</ref>, in the late 1960s it was neuroses<ref>Morris Fishbein calls for circumcision to prevent nervousness and, of course, [[masturbation]]. {{REFbook | ||
|journal= | |last=Fishbein | ||
|date= | |first=Morris | ||
|volume= | |chapter=Sex hygiene | ||
|issue= | |title=Modern Home Medical Adviser | ||
|pages= | |location=Garden City, New York | ||
| | |publisher=Doubleday & Co | ||
|accessdate=2019- | |year=1969 | ||
}}</ref> | |pages=90, 119 | ||
|url=https://openlibrary.org/works/OL95362W/Modern_home_medical_adviser | |||
|accessdate=2019-10-12 | |||
}}</ref>, in the 1970s bladder- and rectal cancer<ref>Abraham Ravich claims that circumcision would prevent bladder cancer and rectal cancer. {{REFjournal | |||
|last= | |last=Ravich | ||
|first= | |first=Abraham | ||
| | |url=https://www.deepdyve.com/lp/wiley/viral-carcinogenesis-in-venereally-susceptible-organs-HCeWmTLmKl | ||
| | |title=Viral carcinogenesis in venereally susceptible organs | ||
|journal=Cancer | |||
| | |date=Jun 1971 | ||
|volume=27 | |||
| | |issue=6 | ||
| | |pages=1493-1496 | ||
|accessdate=2019-10-12 | |||
}}</ref>, and in the 1980s UTIs<ref>Thomas E. Wiswell claims that circumcision reduces the risk of urinary tract infections. {{REFjournal | |||
|pages= | |last=Wiswell | ||
|url= | |first=Thomas E. | ||
|accessdate=2019- | |author-link=Thomas E. Wiswell | ||
}}</ref>, | |url=https://pediatrics.aappublications.org/content/75/5/901 | ||
|title=Decreased incidence of urinary tract infections in circumcised male infants | |||
|last= | |||
|first= | |||
| | |||
|title= | |||
|journal= | |||
|date= | |||
|volume= | |||
|issue= | |||
|pages= | |||
|accessdate=2019- | |||
}}</ref> | |||
|last= | |||
|first= | |||
|title= | |||
|journal=Pediatrics | |journal=Pediatrics | ||
|date= | |date=May 1985 | ||
|volume= | |volume=75 | ||
|issue= | |issue=5 | ||
|pages= | |pages=901-903 | ||
|url= | |accessdate=2019-10-12 | ||
}}</ref> and AIDS<ref>Aaron J. Fink claims that circumcision protects against AIDS. {{REFjournal | |||
|last=Fink | |||
|first=Aaron J. | |||
|author-link=Aaron J. Fink | |||
|title=A possible explanation for heterosexual male infection with AIDS | |||
|journal=New England Journal of Medicine | |||
|date=1986-10-30 | |||
|volume=31 | |||
|issue=18 | |||
|pages=1167 | |||
|url=https://www.nejm.org/doi/full/10.1056/NEJM198610303151818 | |||
|DOI=10.1056/NEJM198610303151818 | |||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref> followed. Retrospectively, circumcision was always advertised as a cure for whatever disease was in the public spotlight at the time. | ||
The sheer mass of studies and publications that were released during those almost 180 years on this topic are the reason that even arguments that have been disproved multiple times, especially regarding infant and child circumcision, tenaciously persist up until today. | |||
An ever-recurring element of initiation rites found in many different cultures is the fixation upon the genitalia. | |||
It reflects the fascination that emerges from the ability to create new life. In most cultures, fertility is seen as the most precious good, and the body parts involved frequently find themselves in the focus of ritual acts. In many parts of the world, those rites take place when the boy reaches puberty, and are meant to symbolize his transition from boy to man. The removal of the male [[foreskin]] is just one of many phenomena that developed in this context. They range from the removal of the frenulum in boys and men through partial or complete removal of the [[foreskin]] up to radical operations. Australian Aborigines, as mentioned above, have their [[foreskin]]s removed. It is also usual that, a few weeks later, young men have their [[penis]]es sliced open, resulting in a partly or completely divided urethra. | |||
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". | |||
For many cultures it is also common to perform similar rituals on girls. This can range from relatively small interventions such as piercing or cutting the clitoral hood, to its complete removal and up to radical removal of clitoral hood, clitoris, inner and outer labia followed by sewing up the vagina. | |||
''The following text is taken from the [[Circumpendium]].'' | |||
=== Prophylactic reasons === | |||
Some people claim that circumcision has prophylactic benefits. Especially in the USA those arguments have persisted for more then a 100 years, with ever changing diseases circumcision is said to protect against. At first, these were diseases where [[masturbation]] was believed to be the cause. After bacteria and viruses had been discovered, arguments changed, and one after another miscellaneous diseases were cited. | |||
* [[Phimosis]]: as mentioned earlier, true [[phimosis]] is rare and can be treated effectively without surgery. According to a study by Blalock ''et al.'' (2003)<ref>{{REFjournal | |||
|last=Blalock | |||
|first=H.J. | |||
|last2=Vemulakonda | |||
|last= | |first2=V. | ||
|first= | |last3=Ritchey | ||
|last2= | |first3=M.L. | ||
|first2= | |last4=Ribbeck | ||
|last3= | |first4=M. | ||
|first3= | |title=Outpatient management of [[phimosis]] Following newborn circumcision | ||
| | |journal=J Urol | ||
|title= | |date=2003 | ||
|journal= | |volume=169 | ||
|date= | |issue=6 | ||
|volume= | |pages=2332-2334 | ||
|issue= | |url=http://www.cirp.org/library/complications/blalock1/ | ||
|pages= | |accessdate=2019-11-07 | ||
|url= | }}</ref>, 2.9% of those circumcised develop a post-operative [[phimosis]], in which the circumcision scar constricts. In intact patients, the rate of [[phimosis]] is only 1% (see also the study by [[Jakob Øster]]). Therefore, circumcision is not a preventive measure for [[phimosis]]. | ||
|accessdate= | * Sexually Transmitted Diseases (STDs): a vast number of studies has been conducted on the subject of transmission of STDs. | ||
}}</ref><ref>{{REFjournal | * First, it has to be noted that any form of protection against these diseases only affects people who are sexually active. Circumcision in childhood cannot be justified on these grounds, since any assumed protective effect will not occur before the boy is already old enough to decide about circumcision for himself. | ||
* As mentioned above, the [[foreskin]] keeps the [[Glans penis|glans]] moist. This subpreputial moisture contains, among other substances, the enzyme lysozyme, which breaks up the cell wall of bacteria, thereby providing a natural antibacterial screen. This explains the results of several studies, such as Laumann ''et al.''<ref>{{REFjournal | |||
|last=Laumann | |last=Laumann | ||
|first=E.O. | |first=E.O. | ||
| Line 182: | Line 201: | ||
|url=http://www.cirp.org/library/general/laumann/ | |url=http://www.cirp.org/library/general/laumann/ | ||
|accessdate=2019-11-06 | |accessdate=2019-11-06 | ||
}}</ref> | }}</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<ref>{{REFjournal | ||
|last= | |last=Fleiss | ||
|first=P.M. | |||
|last2=Hodges | |||
|first2=F.M. | |||
|last3=Van Howe | |||
|first3=R.S. | |||
|title=Immunological functions of the human prepuce | |||
|journal=Sex Transm Inf | |||
|date=1998 | |||
|volume=74 | |||
|issue= | |||
|pages=364-367 | |||
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1758142/pdf/v074p00364.pdf | |||
|accessdate=2019-11-06 | |||
}}</ref> support this. According to the [[AAP]], the general sexual behaviour of the male - such as frequent change in partners and the use of condoms - has a much higher impact on sexually transmitted diseases then the circumcision status.<ref>{{REFjournal | |||
|last=Task Force on Circumcision | |||
|first= | |first= | ||
|title= | |title=Circumcision policy statement | ||
|journal= | |journal=Pediatrics | ||
|date= | |date=1999 | ||
|volume= | |volume=103 | ||
|issue= | |issue=3 | ||
|pages= | |pages=686-693 | ||
|url= | |||
|accessdate= | |||
}}</ref> | |||
* HIV / AIDS: in the recent past, the argument that circumcision could help to contain the spread of HIV has been stated numerous times. | |||
*:First, two notes: for one, the use of condoms is still by far the most effective protection against an infection. During intercourse with that preventive measure, circumcision status does not make a difference. | |||
*:Secondly, the assumed protection would only affect healthy men who have intercourse with an infected woman. An infected man can infect a women by transmission of his bodily fluids, so that his circumcision status is irrelevant. Therefore, the use of condoms remains vital in containing the spread of HIV, which in return renders circumcision unnecessary | |||
* Due to the inevitable loss of sensitivity as a result of circumcision, there is also the temptation to go without condoms, in order not to lose even more sensitivity.<ref>{{REFjournal | |||
|last=Hooykaas | |||
|first=C. | |||
|last2=van der Velde | |||
|first2=F.W. | |||
|last3=van der Linden | |||
|first3=M.M. | |||
|etal=yes | |||
|title=The importance of ethnicity as a risk factor for STDs and sexual behaviour among heterosexuals | |||
|journal=Genitourin Med | |||
|date=1991 | |||
|volume=67 | |||
|issue=5 | |||
|pages=378-383 | |||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref><ref>{{REFjournal | }}</ref><ref>{{REFjournal | ||
|last= | |last=Michael | ||
|first= | |first=R.T. | ||
|last2=Wadsworth | |||
|first2=J. | |||
|last3=Feinleib | |||
|last2= | |||
|first2= | |||
|last3= | |||
|first3=J. | |first3=J. | ||
|etal=yes | |etal=yes | ||
|title= | |title=Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison | ||
|journal= | |journal=Am J Public Health | ||
|date= | |date=1998 | ||
|volume= | |volume=88 | ||
|issue= | |issue=5 | ||
|pages= | |pages=749-754 | ||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref><ref>{{REFjournal | }}</ref><ref>{{REFjournal | ||
|last= | |last=Laumann | ||
|first= | |first=E.O. | ||
|last2= | |last2=Masi | ||
|first2=M..W. | |first2=C.M. | ||
| | |last3=Zuckerman | ||
| | |first3=E.W. | ||
| | |title=Circumcision in the United States: prevalence, prophylactic effects, and sexual practice | ||
|title= | |journal=JAMA | ||
|journal= | |date=1997 | ||
|date= | |volume=277 | ||
|volume= | |issue= | ||
|issue= | |pages=1052-1057 | ||
|pages= | |url=http://www.cirp.org/library/general/laumann/ | ||
|accessdate=2019-11-06 | |||
}}</ref> | |||
* Two studies that have been published in early 2007<ref>{{REFjournal | |||
|last=Gray, R.H. and colleagues | |||
|first= | |||
|title=Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial | |||
|journal=Lancet | |||
|date=2007 | |||
|volume=369 | |||
|issue= | |||
|pages=657-666 | |||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref><ref>{{ | }}</ref><ref>{{REFjournal | ||
|last= | |last=[[Robert C. Bailey|Bailey, R.C.]] and colleagues | ||
|first= | |first= | ||
|title= | |title=Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial | ||
|journal=Lancet | |||
|date=2007 | |||
|volume=369 | |||
|issue= | |||
|pages=643-656 | |||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref><ref>{{ | }}</ref>, which investigated the effectiveness of circumcision as a means of reducing the spread of HIV from infected women to heterosexual men in African high risk areas, have been repeatedly subjected to strong criticism. Both studies were ended prematurely, which distorted the results. The men who had been circumcised for the study had to stay sexually inactive during the wound healing, which gave the intact control group more relative opportunity to become infected. These African randomized clinical trials have been demonstrated to have very serious methodological and statistical errors that distort the results in favor of circumcision.<ref name="boyle-hill2011">{{REFjournal | ||
|last= | |last=Boyle | ||
|first= | |first=Gregory J. | ||
| | |author-link= | ||
| | |last2=Hill | ||
| | |first2=George | ||
| | |author2-link=George Hill | ||
| | |title=Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns | ||
| | |journal=J Law Med | ||
| | |date=2011-12 | ||
|volume=19 | |||
| | |issue=2 | ||
| | |pages=316-34 | ||
| | |url=http://www.salem-news.com/fms/pdf/2011-12_JLM-Boyle-Hill.pdf | ||
| | |quote= | ||
| | |pubmedID=22320006 | ||
| | |pubmedCID= | ||
| | |DOI= | ||
| | |accessdate=2019-11-09 | ||
}}</ref> | |||
}}</ref> | |||
The fact that the USA has both the highest rate of circumcised males in the western world, as well as the highest HIV infection rate, makes the studies look dubious. Besides that, several other studies concluded that circumcision does not have a significant impact on the risk of infection with HIV.<ref>{{REFjournal | |||
|last= | |last=Grosskurth | ||
|first= | |first=H. | ||
|title= | |last2=Mosha | ||
|journal= | |first2=F. | ||
|date= | |last3=Todd | ||
|volume= | |first3=J. | ||
|etal=yes | |||
|title=A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results | |||
|journal=AIDS | |||
|date=1995 | |||
|volume=9 | |||
|issue=8 | |issue=8 | ||
|pages= | |pages=927-934 | ||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref><ref>{{REFjournal | }}</ref><ref>{{REFjournal | ||
|last= | |last=Barongo | ||
|first= | |first=L.R. | ||
|title= | |last2=Borgdorff | ||
|journal= | |first2=M..W. | ||
|date= | |last3=Mosha | ||
|volume= | |first3=F.F. | ||
|issue= | |etal=yes | ||
|pages= | |title=The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania | ||
|journal=AIDS | |||
|date=1992 | |||
|volume=6 | |||
|issue=12 | |||
|pages=1521-1528 | |||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref><ref>{{REFconference | ||
|last= | |last=Changedia SM, Gilada IS | ||
|first= | |first= | ||
|title=Role of male circumcision in HIV transmission insignificant in conjugal relationship (abstract no. ThPeC7420) | |||
|title= | |||
|url= | |url= | ||
|place=Barcelona, Spain | |||
|source=Presented at the Fourteenth International AIDS Conference | |||
|datefrom=2002-07-07 | |||
|dateto=2002-07-12 | |||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref><ref>{{REFconference | ||
|last= | |last=Connolly CA, Shishana O, Simbayi L, Colvin M | ||
|first= | |first= | ||
| | |title=HIV and circumcision in South Africa (Abstract No. MoPeC3491) | ||
| | |url= | ||
| | |place=Bangkok, Thailand | ||
| | |source=Presented at the 15th International AIDS Conference | ||
| | |datefrom=2004-07-11 | ||
| | |dateto=2004-07-16 | ||
| | |accessdate= | ||
| | }}</ref><ref>{{REFconference | ||
| | |last=Thomas AG, Bakhireva LN, Brodine SK, Shaffer RA | ||
| | |first= | ||
|title=Prevalence of male circumcision and its association with HIV and sexually transmitted infections in a U.S. navy population (Abstract no. TuPeC4861) | |||
|url= | |url= | ||
|place=Bangkok, Thailand | |||
|source=Presented at the 15th International AIDS Conference | |||
|datefrom=2004-07-11 | |||
|dateto=2004-07-16 | |||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref> | ||
* | * Urinary tract infections (UTI): a UTI can be effectively treated with antibiotics, this was also proven by studies<ref>{{REFjournal | ||
|last= | |last=McCracken | ||
|first= | |first=G. | ||
|title= | |title=Options in antimicrobial management of urinary tract infections in infants and children | ||
|journal= | |journal=Pediatr Infect Dis J | ||
|date= | |date=1989 | ||
|volume= | |volume=8 | ||
|issue= | |issue=8 | ||
|pages= | |pages=552-555 | ||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref><ref>{{REFjournal | }}</ref><ref>{{REFjournal | ||
|last= | |last=Larcombe | ||
|first= | |first=J. | ||
|title=Urinary tract infection in children | |||
|journal=BMJ | |||
|date=1999 | |||
|volume=319 | |||
|issue= | |||
|title= | |pages=1173-1175 | ||
|journal= | |||
|date= | |||
|volume= | |||
|issue= | |||
|pages= | |||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref><ref>{{REFjournal | }}</ref>. A Swedish study <ref>{{REFjournal | ||
|last= | |last=Mårild | ||
|first= | |first=S. | ||
|last2= | |last2=Jodal | ||
|first2= | |first2=U. | ||
| | |title=Incidence rate of first–time symptomatic urinary tract infection in children under 6 years of age | ||
| | |journal=Acta Paediatr | ||
| | |date=1998 | ||
| | |volume=87 | ||
|title= | |issue=5 | ||
|journal= | |pages=549-552 | ||
|date= | |url= | ||
|volume= | |accessdate= | ||
}}</ref> found that, during the first 6 years of life, the incidence of UTIs in boys was 1.8%, but in girls was 6.6%. UTIs are less common in boys after the first year of life. Mueller ''et al.'' <ref>{{REFjournal | |||
|last=Mueller | |||
|first=E.R. | |||
|last2=Steinhardt | |||
|first2=G. | |||
|last3=Naseer | |||
|first3=S. | |||
|title=The incidence of genitourinary abnormalities in circumcised and uncircumcised boys presenting with an initial urinary tract infection by 6 months of age | |||
|journal=Pediatrics | |||
|date=1997 | |||
|volume=100 (Supplement) | |||
|issue= | |issue= | ||
|pages= | |pages=580 | ||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref> did not find a significant difference in UTI rates between circumcised and intact boys with normal urinary tract anatomy. | ||
* | * Other studies suggest that circumcision is more likely to raise than to lower the generally low risk of acquiring UTI: multiple studies from Israel showed a strong correlation between ritual circumcision on the 8th day of life and postoperative UTI.<ref>{{REFjournal | ||
|last=Menahem | |||
<ref>{{REFjournal | |first=S. | ||
|last= | |title=Complications arising from ritual circumcision: pathogenesis and possible prevention | ||
|first= | |journal=Isr J Med Sci | ||
|title= | |date=1981 | ||
|journal= | |volume=17 | ||
|date= | |issue=1 | ||
|volume= | |pages=45-48 | ||
|issue= | |||
|pages= | |||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref><ref>{{REFjournal | ||
|last= | |last=Cohen | ||
|first= | |first=H.A. | ||
|last2= | |last2=Drucker | ||
|first2= | |first2=M.M. | ||
|last3= | |last3=Vainer | ||
|first3= | |first3=S. | ||
|etal=yes | |etal=yes | ||
|title= | |title=Postcircumcision urinary tract infection | ||
|journal= | |journal=Clin Pediatr | ||
|date= | |date=1992 | ||
|volume= | |volume=31 | ||
|issue= | |issue=6 | ||
|pages= | |pages=322-324 | ||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref><ref>{{REFjournal | ||
|last= | |last=Goldman | ||
|first= | |first=M. | ||
|last2= | |last2=Barr | ||
|first2= | |first2=J. | ||
|title= | |last3=Bistritzer | ||
|journal= | |first3=T. | ||
|date= | |last4=Aladjem | ||
|volume= | |first4=M. | ||
|issue= | |title=Urinary tract infection following ritual Jewish circumcision | ||
|pages= | |journal=Isr J Med Sci | ||
|date=1996 | |||
|volume=32 | |||
|issue= | |||
|pages=1098-1102 | |||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref> | ||
| | * It can be concluded that circumcision is ineffective as a preventive measure against UTIs. | ||
| | * Penile and cervical cancer / HPV: first studies on those diseases and their assumed prevention by circumcision date back to 1932, a time when the cause for those illnesses was not yet fully understood | ||
| | <ref>{{REFjournal | ||
| | |last=Wolbarst | ||
| | |first=A. | ||
| | |title=Circumcision and penile cancer | ||
| | |journal=Lancet | ||
| | |date=1932 | ||
|volume=1 | |||
|issue=5655 | |||
|pages=150-153 | |||
|url= | |||
|accessdate= | |accessdate= | ||
}}</ref>. | }}</ref>. Today, it is known that sexually transmitted human papillomavirus (HPV) is a major risk factor<ref>{{REFjournal | ||
|last=McCance | |||
|first=D.J. | |||
|last2=Kalache | |||
== | |first2=A. | ||
|last3=Ashdown | |||
|first3=K. | |||
== | |etal=yes | ||
|title=Human papillomavirus types 16 and 18 in carcinomas of the penis from Brazil | |||
|journal=Int J Cancer | |||
|date=1986 | |||
=== | |volume=37 | ||
|issue=1 | |||
|pages=55-59 | |||
|url= | |||
|accessdate= | |||
}}</ref>, as well as smoking<ref>{{REFjournal | |||
|last=Harish | |||
|title= | |first=K. | ||
| | |last2=Ravi | ||
| | |first2=R. | ||
|last= | |title=The role of tobacco in penile carcinoma | ||
|journal=Brit J Urol | |||
|date=1995 | |||
|volume=75 | |||
|issue=3 | |||
|pages=375-377 | |||
|url= | |||
|accessdate= | |||
}}</ref>. Studies have shown that there is no significant difference in the risk of getting penile cancer between circumcised and intact men. To prevent a single case of penile cancer, it would statistically take 600 to 900 circumcisions<ref>{{REFdocument | |||
|title=Position Paper on Neonatal Circumcision | |||
|url= | |||
|contribution= | |||
|last= | |||
|first= | |first= | ||
|publisher= | |publisher=American Academy of Family Physicians (Leawood, Kansas) | ||
|format= | |format= | ||
| | |date=2002-02-14 | ||
}}</ref>. | |accessdate= | ||
}}</ref>. The influence of circumcision on the infection risk of the female partner with cervical cancer has been refuted several times as well. HPV vaccination is an effective measure against carcinoma of the cervix. | |||
In conclusion, circumcision does not provide any proven benefits in preventive medicine. | |||
== Non-medical indications for circumcision == | |||
Apart from the medical indication of pathological phimosis, there also are other reasons for circumcision. | |||
=== Aesthetic reasons === | |||
The visual appearance of the [[penis]] is changed radically after circumcision. In this case, personal taste is decisive whether an intact or a cut [[penis]] is more appealing. Since a circumcision cannot be undone, it is essential to be fully informed about the risks and possible later complications before embarking on an aesthetically motivated circumcision, to decide whether the appearance will justify such bodily modification. | |||
Since this modification and its possible late effects will be the lifelong burden of the person who undertakes an aesthetically motivated circumcision to suit his personal preferences, a valid decision to proceed can only be made by the person to be circumcised himself, once he has reached the necessary age and level of maturity to make that decision. This should normally be the case when adulthood is reached. | |||
It should be noted that every circumcision operation leaves a life-long [[circumcision scar]] that encircles the shaft of the penis. | |||
===Financial reasons=== | |||
In the United States, payment for non-therapeutic circumcision is made by most [[third-party payment| third-party payers]] without question. 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 diseases. More on that can be found in the chapter "[[Circumcision#Historical_background|Historical background]]". Today, it is known that [[masturbation]] has no negative health effects, but can contribute positively to the child's sexual development. Sexuality is no longer a taboo nowadays, while [[masturbation]] is considered to be a natural part of human sexuality and is no longer seen as immoral. Therefore, circumcision for moral reasons - which would only affect boys too young to give informed consent - is no longer justifiable nowadays. | |||
=== Hygiene reasons === | |||
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 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", 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. | |||
== Circumcision methods == | |||
The [[Circumcision methods]] are discussed in a separate article. | |||
== Risks and late effects == | |||
Just like tonsil or appendix surgery, circumcision is a surgical intervention and brings the usual risks related to surgical operations, alongside several specific risks of complications and late effects. | |||
=== Possible operative and postoperative complications === | |||
Circumcision is surgery. Surgical complications of circumcision generally may be classified as hemorrhage, infection, or surgical misadventure up to and including loss of the penis and [[death]]. | |||
* 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 | |||
* | |||
|last= | |||
|first= | |first= | ||
| | |publisher=Spiegel Online | ||
|website= | |||
|date=2012-08-12 | |||
|accessdate=2019-10-11 | |||
|format= | |||
| | |||
| | |||
| | |||
| | |||
|quote= | |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 | |||
|first=T. | |||
|title=Circumcision: a survey of fees and practices | |||
|journal=OBG Management | |||
|date=1994 | |||
|volume=October | |||
|issue= | |||
|pages=34-36 | |||
|url= | |||
|accessdate= | |accessdate= | ||
}}</ref><ref>{{REFjournal | |||
}}</ref><ref>{{ | |last=Howard | ||
| | |first=C.R. | ||
| | |last2=Howard | ||
| | |first2=F.M. | ||
| | |last3=Garfunkel | ||
| | |first3=L.C. | ||
| | |last4=de Blieck | ||
| | |first4=E.A. | ||
|date= | |last5=Weitzman | ||
|first5=M. | |||
|title=Neonatal circumcision and pain relief: current training practices | |||
|journal=Pediatrics | |||
|date=1998 | |||
|volume=101 | |||
|issue= | |||
|pages=423-428 | |||
|url= | |||
|accessdate= | |accessdate= | ||
}}</ref><ref>{{REFjournal | }}</ref><ref>{{REFjournal | ||
|last= | |last=Stang | ||
|first=J. | |first=H.J. | ||
|last2= | |last2=Snellman | ||
|first2= | |first2=L.W. | ||
|title=Circumcision practice patterns in the United States | |||
|journal=Pediatrics | |||
|title= | |date=1998 | ||
|journal= | |volume=101 | ||
|date= | |issue=e5 | ||
|volume= | |pages= | ||
|issue= | |||
|pages= | |||
|url= | |url= | ||
| | |accessdate= | ||
|last= | |note=Link to [[AAP]] website | ||
|first= | }}</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 | ||
| | |first=M.R. | ||
|date= | |last2=Fisch | ||
| | |first2=R.O. | ||
|last3=Korsvik | |||
|first3=S. | |||
| | |last4=Donhowe | ||
| | |first4=J.M. | ||
|title=The effects of circumcision on serum cortisol and behavior | |||
|journal=Psychoneuroendocrinology | |||
|date=1981 | |||
|volume=6 | |||
|issue=3 | |||
|pages=269-275 | |||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref> | ||
* | * Postoperative wound pain, in the case of children's circumcisions conceivably worsened by the forceful breaking of the preputial adhesions. | ||
* | * Postoperative bleeding of the wound. This can have severe consequences especially for very young infants, if they are not treated promptly. Their blood volume is only about 85 ml per kilogram of body weight, and even moderate blood loss can lead to hypovolaemia, hypovolaemic shock and even death.<ref>{{REFbook | ||
|last=Smart J, Nolan T. (Editors) | |||
|last= | |first= | ||
|year=2000 | |||
| | |title=Paediatric Handbook | ||
| | |||
|title= | |||
|url= | |url= | ||
| | |work= | ||
|editor= | |||
| | |edition=6 | ||
| | |volume= | ||
| | |chapter= | ||
| | |pages=82 | ||
| | |location=Victoria, Australia | ||
| | |publisher=Blackwell Science Asia | ||
| | |isbn= | ||
| | |quote= | ||
| | |accessdate= | ||
| | |note= | ||
}}</ref> | }}</ref><ref>{{REFdocument | ||
|title=Autopsy of Demetrius Manker | |||
|title= | |||
|url= | |url= | ||
|contribution=Case 93-1711 | |||
|last=Wetli | |||
|first=CV | |||
|publisher=Miami: Dade County Medical Examiner Department | |||
|format= | |||
|date=1993-06-23 | |||
|accessdate= | |accessdate= | ||
}}</ref><ref>{{REFjournal | }}</ref><ref>{{REFjournal | ||
|last= | |last=Hiss | ||
|first= | |first=J. | ||
|last2= | |last2=Horowitz | ||
|first2= | |first2=A. | ||
|last3= | |last3=Kahana | ||
|first3= | |first3=T. | ||
|title= | |title=Fatal haemorrhage following male ritual circumcision | ||
|journal= | |journal=J Clin Forensic Med | ||
|date= | |date=2000 | ||
|volume= | |volume=7 | ||
|issue= | |issue= | ||
|pages= | |pages=32-34 | ||
|url=http://www.cirp.org/library/death/hiss1/ | |||
|accessdate=2019-11-06 | |||
}}</ref><ref>{{REFdocument | |||
|title=Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan | |||
|url= | |url= | ||
| | |contribution= | ||
|last=Newell | |||
|first=TEC | |||
|publisher=Burnaby, B.C.: B.C. Coroner's Service | |||
|format= | |||
|date=2004-01-19 | |||
|accessdate= | |||
}}</ref> | |||
* Postoperative infections. This includes both local infections, which can be treated with local therapy, and systemic infections, requiring systemic antibiotic treatment.<ref>{{REFconference | |||
|last=Dr. med. Hartmann | |||
|first=Wolfgang | |||
|url= | |||
|place=Rechtsausschuss des Bundestages [Legal Committee of the Bundestag] (German) | |||
|title=Stellungnahme zur Anhörung am 26. November 2012 [Opinion on the hearing on 26 November 2012] (German) | |||
|date=2012-11-26 | |||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref> | ||
* | * [http://www.circumstitions.com/Restric/Botched9wd.html Wound dehiscence], meaning the separation of the edges of the wound or the tissue after suturing. | ||
* | * Adhesion between the surface or rim of the [[Glans penis|glans]] with the neighbouring penile skin, causing skin pockets and bridges, as well as visually unpleasant results like uneven scars, which make a re-circumcision necessary. | ||
* Postoperative [[phimosis]]: a phimotic ring can develop during scarring, which makes a re-circumcision necessary. According to a study by Blalock ''et al.''<ref>{{REFjournal | |||
|last=Blalock | |||
* | |first=H.J. | ||
| | |last2=Vemulakonda | ||
| | |first2=V. | ||
| | |last3=Ritchey | ||
| | |first3=M.L. | ||
| | |last4=Ribbeck | ||
| | |first4=M. | ||
|title=Outpatient management of [[phimosis]] Following newborn circumcision | |||
|journal=J Urol | |||
|date=2003 | |||
|volume=169 | |||
|issue=6 | |||
| | |pages=2332-2334 | ||
| | |url= | ||
| | |accessdate= | ||
| | }}</ref>, the prevalence is 2.9%, according to Leitch<ref>{{REFjournal | ||
| | |last=Leitch | ||
| | |first=I.O.W. | ||
| | |title=Circumcision - a continuing enigma | ||
|title= | |journal=Aust Paediatr J | ||
|journal= | |date=1970 | ||
|date= | |volume=6 | ||
|volume= | |||
|issue= | |issue= | ||
|pages= | |pages=59-65 | ||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref> 5.5%. | ||
* Meatal stenosis, a pathological narrowing of the opening of the urethra, which mostly occurs in infancy and early childhood. It is one of the most common complications of infant circumcision. A study from 2006 found meatal stenosis exclusively in previously circumcised boys. The incidence rate after a circumcision is at approximately 10%.<ref>{{REFjournal | |||
|last= | |last=Van Howe | ||
|first= | |first=R.S. | ||
|title=Incidence of meatal stenosis following neonatal circumcision in a primary care setting | |||
|journal=Clin Pediatr (Phila) | |||
| | |note=Jan-Feb 2006 | ||
| | |date=2006-01 | ||
| | |volume=45 | ||
|issue=1 | |||
|date= | |pages=49-54 | ||
|volume= | |||
|issue= | |||
|pages= | |||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref><ref>{{REFjournal | ||
|last=Stenram | |||
|last= | |first=A. | ||
|first= | |last2=Malmfors | ||
|last2= | |first2=G. | ||
|first2= | |last3=Okmian | ||
|title= | |first3=L. | ||
|journal= | |title=Circumcision for [[phimosis]]: a follow-up study | ||
|date= | |journal=Scandinavian journal of urology and nephrology | ||
|volume= | |date=1986 | ||
|issue= | |volume=20 | ||
|pages= | |issue=2 | ||
|pages=89 | |||
|url= | |url= | ||
|pubmedID=3749823 | |||
|accessdate= | |accessdate= | ||
}} </ref><ref>{{REFweb | |||
|url=http://emedicine.medscape.com/article/1016016-overview | |||
|title=Meatal Stenosis | |||
|publisher=Medscape | |||
|accessdate=2019-10-11 | |||
}}</ref> | }}</ref> | ||
* | * Knot formation of the veins. If the dorsal vein, which originates in the tip of the [[foreskin]], is cut during circumcision without being clamped and sutured at its origin separately, it starts to develop new branches over time, which can lead to the development of knots. | ||
* Possible deformities due to circumcision include hypoplasia of the [[penis]] (micro-penis) and induratio [[penis]] plastica (skewed penis). | |||
|last= | * Medical malpractice can also not be ruled out. Injuries, partly or entirely severing the [[Glans penis|glans]] or the [[penis]] can occur. | ||
|first= | * In rare cases, necrosis, gangrene, ischaemia, keloid formation and circulatory problems may also occur. | ||
| | * When the circumcision is followed by the ultra-orthodox Jewish ritual of Metzitzah B'Peh (which consists of sucking blood from the wound with the mouth), there is a risk of infection with herpes simplex type 1, which can lead to brain damage or death.<ref>{{REFweb | ||
|first2= | |url=http://www.nytimes.com/2012/03/08/nyregion/infants-death-renews-debate-over-a-circumcision-ritual.html?_r=0 | ||
| | |title=Baby’s Death Renews Debate Over a Circumcision Ritual | ||
|first3= | |last=Robbins | ||
| | |first=Liz | ||
|title= | |date=2012-03-07 | ||
|journal= | |accessdate=2019-10-11 | ||
|date= | }}</ref> | ||
|volume= | |||
|issue= | === Physical late effects === | ||
|pages= | |||
|url= | * An unavoidable late effect of any circumcision is the permanent loss of sexual sensitivity. This is partly due to the removal of sensory tissue. The [[foreskin]] contains very many nerve endings and touch receptors, which account for the major part of male sexual sensation. If the [[foreskin]] is removed, they can no longer provide sexual stimulation. It is also partly due to the fact that the surface of the [[Glans penis|glans]] reacts to the missing protection from friction and drying out by developing a callus layer. This reduces the sensitivity of the remaining nerves in the [[Glans penis|glans]] gradually over the years. The study conducted by Sorrells ''et al.''<ref>{{REFjournal | ||
|last=Sorrells | |||
|first=M.L. | |||
|last2=Snyder | |||
|first2=J..L. | |||
|last3=Reiss | |||
|first3=M.D. | |||
|etal=yes | |||
|title=Fine-touch pressure thresholds in the adult [[penis]] | |||
|journal=BJU Int | |||
|date=2007 | |||
|volume=99 | |||
|issue= | |||
|pages=864-869 | |||
|url= | |||
|accessdate= | |accessdate= | ||
}}</ref><ref>{{REFjournal | }}</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). | ||
|last= | * Painful tension can occur when there is too little reserve skin left to support a full erection<ref>{{REFjournal | ||
|first=J. | |last=Taylor | ||
|last2= | |first=J.R. | ||
|first2= | |last2=Lockwood | ||
|last3= | |first2=A.P. | ||
|first3= | |last3=Taylor | ||
|title= | |first3=A.J. | ||
|journal= | |title=The prepuce: <q>Specialized mucosa of the [[penis]] and its loss to circumcision</q> | ||
|date= | |journal=British Journal of Urology | ||
|volume= | |date=1996 | ||
|issue= | |volume=77 | ||
|pages= | |issue= | ||
|pages=291-295 | |||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref>. This risk is partly dependent on the anatomy of the [[penis]]. While some [[penis]]es already have the majority of their full size when flaccid ([[Flesh Penis]], or "[[shower]]"), others are rather short when flaccid and double or more their size during an erection ([[Blood Penis]], or "[[grower]]"). Especially in children's circumcision, where the [[penis]] is not yet fully developed, the amount of reserve skin needed in adulthood cannot be estimated. | ||
|last= | * Erectile dysfunction: Both the damage inflicted to the blood vessels in the [[foreskin]] and the reduced sexual sensitivity can be causes for reduced erectile function with advancing age.<ref>{{REFjournal | ||
|first= | |last=Money | ||
|last2= | |first=J. | ||
|first2=J | |last2=Davison | ||
|title= | |first2=J. | ||
|journal= | |title=Adult penile circumcision: Erotosexual and cosmetic sequelae | ||
|date= | |journal=Journal of Sex Research | ||
|volume= | |date=1983 | ||
|issue= | |volume=19 | ||
|pages= | |issue= | ||
|pages=289-292 | |||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref><ref>{{REFjournal | }}</ref> | ||
|last= | * 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. | ||
|first= | * Vaginal dryness: Due to the loss of the natural gliding action, which comes from the mobility of the fore- and shaft skin, a much increased friction between [[penis]] and vagina occurs during intercourse. This can make intercourse painful for both partners and lead to abrasions<ref>{{REFjournal | ||
| | |last=Frisch | ||
|first2= | |first=Morten | ||
| | |author-link=Morten Frisch | ||
|first3= | |first2=Morten | ||
|title= | |last2=Lindholm | ||
|journal= | |first3=Morten | ||
|date= | |last3=Grønbæk | ||
|volume= | |title=Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark | ||
|journal=International Journal of Epidemiology | |||
|date=2011-10 | |||
|volume=40 | |||
|issue=5 | |issue=5 | ||
|pages= | |pages=1367-1381 | ||
|url= | |url= | ||
|pubmedID=21672947 | |||
|DOI=10.1093/ije/dyr104 | |||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref><ref>{{REFjournal | ||
|last=Cortés-González | |||
=== | |first=J. | ||
|last2=Arratia-Maqueo | |||
|first2=J. | |||
|last3=Gómez-Guerra | |||
The | |first3=L. | ||
|title=Does circumcision has an effect on female's perception of sexual satisfaction? | |||
|journal=Rev Invest Clin | |||
|last= | |date=2008 | ||
|first= | |volume=60 | ||
|last2= | |issue=3 | ||
|first2= | |pages=227 | ||
|url= | |||
|pubmedID=18807735 | |||
|accessdate= | |||
|title= | }}</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>{{REFjournal | ||
|journal= | |last=Cold | ||
|date= | |first=C.J. | ||
|volume= | |last2=Taylor | ||
|issue= | |first2=J.R. | ||
|pages= | |title=The prepuce | ||
|url= | |journal=BJU Int | ||
|date=1999 | |||
|volume=83 | |||
|issue=Suppl. 1 | |||
|pages=34-44 | |||
|url= | |||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref><ref>{{REFjournal | ||
|last=Fink | |||
|last= | |first=K.S. | ||
|first=S | |last2=Carson | ||
|last2= | |first2=C.C. | ||
|first2= | |last3=DeVellis | ||
|first3=R.F. | |||
| | |title=Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction | ||
| | |journal=J Urol | ||
| | |date=2002 | ||
| | |volume=167 | ||
| | |issue=5 | ||
|volume= | |pages=2113-2116 | ||
| | |url= | ||
|pages= | |||
| | |||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref> | ||
|url=http://www. | === Psychological late effects === | ||
|accessdate= | 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. | ||
}}</ref> | |||
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. | |||
|last= | |||
|first= | * It was observed that infants, following circumcision without pain control, had a disturbed bond with their mother<ref>{{REFjournal | ||
|url= | |last=Marshall | ||
| | |first=R.E. | ||
| | |last2=Porter | ||
| | |first2=F.L. | ||
|volume= | |last3=Rogers | ||
| | |first3=A.G. | ||
|pages= | |etal=yes | ||
| | |title=Circumcision: II effects upon mother-infant interaction | ||
|journal=Early Hum Dev | |||
| | |date=1982 | ||
| | |volume=7 | ||
| | |issue=4 | ||
|url=http://www. | |pages=367-374 | ||
|title= | |url=http://www.cirp.org/library/birth/marshall2/ | ||
|accessdate= | |||
}}</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 | |||
|first=S | |||
|last2=Boyle | |||
|first2=GJ | |||
|year=2001 | |||
|title=Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder | |||
|url=https://link.springer.com/chapter/10.1007/978-1-4757-3351-8_14 | |||
|work=Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem | |||
|editor=Denniston GC, Hodges FM, Milos MF | |||
|edition= | |||
|volume= | |||
|chapter= | |||
|pages=253-270 | |||
|location=New York | |||
|publisher=Kluwer Academic/Plenum Publishers | |||
|isbn= | |||
|quote= | |||
|accessdate= | |||
|note= | |||
}}</ref> | |||
* Circumcisions, especially those that happen without consent, can spark feelings of helplessness and alienation, which can persist as trauma. These feeling can also be triggered later, when someone circumcised as an infant becomes aware of his circumcision. In an online study, interviewed men stated they felt betrayed - 55% by the mother, 50% by the father, and 58% by the doctor, and 73% felt that their human rights had been violated.<ref name="GSoCH">{{REFweb | |||
|url=http://www.circumcisionharm.org/ | |||
|title=Global Survey of Circumcision Harm | |||
|accessdate=2019-10-12 | |accessdate=2019-10-12 | ||
}}</ref> | }}</ref> | ||
* If the circumcised male feels incomplete, or due to the missing [[foreskin]] disadvantaged compared to intact males, an inferiority complex and depression may occur. This can be accompanied by conscious recognition of his own incompleteness, or the deficiency may remain completely subconscious<ref>{{REFjournal | * 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>{{REFjournal | ||
|last=Rhinehart | |last=van der Kolk | ||
|first=J. | |first=B.A. | ||
|url=http://www.cirp.org/library/psych/vanderkolk/ | |||
|title=The compulsion to repeat the trauma: re-enactment, revictimization, and masochism | |||
|journal=Psychiatr Clin North Am | |||
|date=1989 | |||
|volume=12 | |||
|issue=2 | |||
|pages=389-411 | |||
|accessdate=2019-10-12 | |||
}}</ref><ref>{{REFjournal | |||
|last=Goldman | |||
|first=R. | |||
|author-link=Ronald Goldman | |||
|url=http://www.cirp.org/library/psych/goldman1/ | |||
|title=The psychological impact of circumcision | |||
|journal=BJU Int | |||
|date=1999 | |||
|volume=83 | |||
|issue=Suppl. 1 | |||
|pages=93-103 | |||
|accessdate=2019-10-12 | |||
}}</ref> | |||
* If the circumcised male feels incomplete, or due to the missing [[foreskin]] disadvantaged compared to intact males, an inferiority complex and depression may occur. This can be accompanied by conscious recognition of his own incompleteness, or the deficiency may remain completely subconscious<ref>{{REFjournal | |||
|last=Rhinehart | |||
|first=J. | |||
|url=http://www.cirp.org/library/psych/rhinehart1/ | |url=http://www.cirp.org/library/psych/rhinehart1/ | ||
|title=Neonatal circumcision reconsidered | |title=Neonatal circumcision reconsidered | ||
| Line 873: | Line 1,028: | ||
* Relapse into the state of bed-wetting, even if the child was already dry before.<ref name="Levy1945"/> | * Relapse into the state of bed-wetting, even if the child was already dry before.<ref name="Levy1945"/> | ||
== Rights and Ethics == | == Rights and Ethics == | ||
| Line 1,442: | Line 1,464: | ||
=== Non-therapeutic circumcision of male children === | === Non-therapeutic circumcision of male children === | ||
Human babies, because they are not yet in possession of language, are incapable of giving or refusing consent for being circumcised. The element of force has led some scholars to view the circumcision of baby boys as a category of forced circumcision.<ref>For example, Frederick M. Hodges, a medical historian, writes: "In the late 1970s, as the Americans were growing increasingly aware of the abuses of power rampant throughout the nation's social institutions, influential grass-roots movements protesting the forced circumcision of American children sprang up nationwide." F. Hodges, "A Short History," p. 31; see also [[Leonard B. Glick|Glick]], ''Marked in Your Flesh'', pp. 273-281.</ref> There are, however, physicians in the United States who argue strongly for | Human babies, because they are not yet in possession of language, are incapable of giving or refusing consent for being circumcised. The element of force has led some scholars to view the circumcision of baby boys as a category of forced circumcision.<ref>For example, Frederick M. Hodges, a medical historian, writes: "In the late 1970s, as the Americans were growing increasingly aware of the abuses of power rampant throughout the nation's social institutions, influential grass-roots movements protesting the forced circumcision of American children sprang up nationwide." F. Hodges, "A Short History," p. 31; see also [[Leonard B. Glick|Glick]], ''Marked in Your Flesh'', pp. 273-281.</ref> There are, however, physicians in the United States who argue strongly for non-therapeutic circumcision of newborn babies; and circumcision is widely accepted as a postnatal procedure in American hospitals.<ref>{{REFbook | ||
|last=Fletcher | |last=Fletcher | ||
|first=Christopher R. | |first=Christopher R. | ||