Child circumcision: Difference between revisions
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}}</ref> They are made to enable a physician to perform circumcision and collect a fee. | }}</ref> They are made to enable a physician to perform circumcision and collect a fee. | ||
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===Search for prophylactic reasons=== | ===Search for prophylactic reasons=== | ||
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''The following text is taken from the [[Circumpendium]].'' | ''The following text is taken from the [[Circumpendium]].'' | ||
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=== Prophylactic reasons === | === 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. | Some people claim that circumcision has prophylactic benefits. Especially in the [[USA]] those arguments have persisted for more then a 100 years, with ever changing diseases circumcision is said to protect against. At first, these were diseases where [[masturbation]] was believed to be the cause. After bacteria and viruses had been discovered, arguments changed, and one after another miscellaneous diseases were cited. | ||
* [[Phimosis]]: as mentioned earlier, true [[phimosis]] is rare and can be treated effectively without surgery. According to a study by Blalock et al. (2003)<ref name="blalock2003">{{REFjournal | * [[Phimosis]]: as mentioned earlier, true [[phimosis]] is rare and can be treated effectively without surgery. According to a study by Blalock et al. (2003)<ref name="blalock2003">{{REFjournal | ||
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* Two studies that have been published in early 2007<ref>{{RCT Gray et al 2007}}</ref><ref>{{RCT Bailey et al 2007}}</ref>, which investigated the effectiveness of circumcision as a means of reducing the spread of [[HIV]] from infected women to heterosexual men in African high risk areas, have been repeatedly subjected to strong criticism. Both studies were ended prematurely, which distorted the results. The men who had been [[circumcised]] for the study had to stay sexually inactive during the wound healing, which gave the intact control group more relative opportunity to become infected. These African randomized clinical trials have been demonstrated to have very serious methodological and statistical errors that distort the results in favor of circumcision.<ref name="boyle-hill2011">{{BoyleGJ HillG 2011}}</ref> | * Two studies that have been published in early 2007<ref>{{RCT Gray et al 2007}}</ref><ref>{{RCT Bailey et al 2007}}</ref>, which investigated the effectiveness of circumcision as a means of reducing the spread of [[HIV]] from infected women to heterosexual men in African high risk areas, have been repeatedly subjected to strong criticism. Both studies were ended prematurely, which distorted the results. The men who had been [[circumcised]] for the study had to stay sexually inactive during the wound healing, which gave the intact control group more relative opportunity to become infected. These African randomized clinical trials have been demonstrated to have very serious methodological and statistical errors that distort the results in favor of circumcision.<ref name="boyle-hill2011">{{BoyleGJ HillG 2011}}</ref> | ||
The fact that the USA has both the highest | The fact that the [[USA]] has both the highest percentage of [[circumcised]] males in the western world, as well as the highest [[HIV]] infection rate, makes the studies look dubious. Besides that, several other studies concluded that circumcision does not have a significant impact on the risk of infection with [[HIV]].<ref>{{REFjournal | ||
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}}</ref> found that, during the first 6 years of life, the incidence of | }}</ref> found that, during the first 6 years of life, the incidence of [[UTI]]s in boys was 1.8%, but in girls was 6.6%. UTIs are less common in boys after the first year of life. Mueller et al. <ref>{{REFjournal | ||
|last=Mueller | |last=Mueller | ||
|init=ER | |init=ER | ||
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}}</ref> | }}</ref> | ||
* It can be concluded that circumcision is ineffective as a preventive measure against | * It can be concluded that circumcision is ineffective as a preventive measure against [[UTI]]. | ||
* Penile and cervical cancer / HPV: first studies on those diseases and their assumed prevention by circumcision date back to 1932, a time when the cause for those illnesses was not yet fully understood.<ref>{{Wolbarst1932}}</ref> Today, it is known that sexually transmitted human papillomavirus (HPV) is a major risk factor<ref>{{REFjournal | * Penile and cervical cancer / HPV: first studies on those diseases and their assumed prevention by circumcision date back to 1932, a time when the cause for those illnesses was not yet fully understood.<ref>{{Wolbarst1932}}</ref> Today, it is known that sexually transmitted human papillomavirus (HPV) is a major risk factor<ref>{{REFjournal | ||
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The [[Circumcision methods]] are discussed in a separate article. | The [[Circumcision methods]] are discussed in a separate article. | ||
== Pain == | == Pain == | ||
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 | 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 | ||
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}}</ref> Topical anaesthetic only serves to numb the area to lessen the pain of the injection, but studies have shown that a dorsal penile ring block is not always effective in stopping the pain of circumcision.<ref name="Journal of Perinatology April/May 2002">{{REFjournal | }}</ref> Topical anaesthetic only serves to numb the area to lessen the pain of the injection, but studies have shown that a [[dorsal penile ring block]] is not always effective in stopping the [[Pain| pain of circumcision]].<ref name="Journal of Perinatology April/May 2002">{{REFjournal | ||
|last=Taeusch | |last=Taeusch | ||
|first=H. William | |first=H. William | ||
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{{Box|Boxtext=<big><b>However, none of the above three procedures totally eliminate pain. A baby boy will still experience some pain despite any of those analgesic procedures. Prevention of [[pain]] requires protecting a boy from elective neonatal non-therapeutic circumcision. Only boys who are protected from the medically unnecessary circumcision surgery experience no [[pain]] or [[trauma]].</b></big>}} | {{Box|Boxtext=<big><b>However, none of the above three procedures totally eliminate pain. A baby boy will still experience some pain despite any of those analgesic procedures. Prevention of [[pain]] requires protecting a boy from elective neonatal non-therapeutic circumcision. Only boys who are protected from the medically unnecessary circumcision surgery experience no [[pain]] or [[trauma]].</b></big>}} | ||
== Risks and effects == | == Risks and 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. 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 | 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 | ||
|last=Uberoi | |last=Uberoi | ||
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|accessdate=2023-01-08 | |accessdate=2023-01-08 | ||
}}</ref> | }}</ref> | ||
=== Physical effects === | |||
|last= | * 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). | ||
|init= | |||
* Painful tension can occur when there is too little reserve [[skin]] left to support a full [[erection]]<ref name="taylor1996"/>. This risk is partly dependent on the anatomy of the [[penis]]. While some [[penis]]es already have the majority of their full size when flaccid ([[Flesh Penis]], or "[[shower]]"), others are rather short when flaccid and double or more their size during an [[erection]] ([[Blood Penis]], or "[[grower]]"). Especially in children's circumcision, where the [[penis]] is not yet fully developed, the amount of reserve [[skin]] needed in adulthood cannot be estimated. | |||
|last2= | |||
|init2= | * 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 | ||
|last=Money | |||
|init=J | |||
|title= | |last2=Davison | ||
|init2=J | |||
|title=Adult penile circumcision: Erotosexual and cosmetic sequelae | |||
|journal= | |journal=Journal of Sex Research | ||
|date=1983 | |||
|date= | |volume=19 | ||
|volume= | |issue= | ||
|issue= | |pages=289-92 | ||
|pages= | |url= | ||
|url= | |accessdate= | ||
|accessdate= | |||
}}</ref> | }}</ref> | ||
* | * 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. | ||
* Vaginal dryness: Due to the loss of the natural [[gliding action]], which comes from the mobility of the [[foreskin]] 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>{{FrischM LindholmM GroenbaekM 2011}}</ref><ref>{{REFjournal | |||
| | |last=Cortés-González | ||
| | |init=J | ||
| | |last2=Arratia-Maqueo | ||
| | |init2=J | ||
| | |last3=Gómez-Guerra | ||
| | |init3=L | ||
| | |title=Does circumcision has an effect on female's perception of sexual satisfaction? | ||
| | |journal=Rev Invest Clin | ||
| | |date=2008 | ||
|volume=60 | |||
| | |issue=3 | ||
| | |page=227 | ||
}}</ref> | |url= | ||
|last= | |pubmedID=18807735 | ||
|init= | |accessdate= | ||
|title=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 | ||
|journal= | |last=Fink | ||
|date= | |init=KS | ||
|volume= | |last2=Carson | ||
|issue= | |init2=CC | ||
|pages= | |last3=DeVellis | ||
|init3=RF | |||
|title=Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction | |||
|journal=J Urol | |||
|date=2002 | |||
|volume=167 | |||
|issue=5 | |||
|pages=2113-6 | |||
|url= | |url= | ||
|accessdate= | |accessdate= | ||
}}</ref><ref>{{REFjournal | }}</ref> | ||
|last= | |||
|init= | * [[Lymphoedema]] of the penis is a normal and expected complication of male circumcision. | ||
| | |||
| | * [[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 approximately 10 to 20 percent.<ref name="vanhowe2006">{{REFjournal | ||
| | |last=Van Howe | ||
| | |init=RS | ||
| | |author-link=Robert S. Van Howe | ||
| | |title=Incidence of meatal stenosis following neonatal circumcision in a primary care setting | ||
| | |journal=Clin Pediatr (Phila) | ||
| | |note=Jan-Feb 2006 | ||
|title= | |date=2006-01 | ||
|journal= | |volume=45 | ||
|date= | |issue=1 | ||
|volume= | |pages=49-54 | ||
|issue= | |url=https://www.academia.edu/6992015/Incidence_of_Meatal_Stenosis_following_Neonatal_Circumcision_in_a_Primary_Care_Setting | ||
| | |accessdate=2019-12-15 | ||
}}</ref><ref>{{REFjournal | |||
|last=Stenram | |||
|init=A | |||
|last2=Malmfors | |||
|init2=G | |||
|last3=Okmian | |||
|init3=L | |||
|title=Circumcision for [[phimosis]]: a follow-up study | |||
|journal=Scandinavian journal of urology and nephrology | |||
|date=1986 | |||
|volume=20 | |||
|issue=2 | |||
|page=89 | |||
|url= | |url= | ||
|pubmedID=3749823 | |||
|accessdate= | |accessdate= | ||
}}</ref><ref>{{ | }}</ref><ref>{{REFweb | ||
|url=http://emedicine.medscape.com/article/1016016-overview | |||
|title=Meatal Stenosis | |||
|publisher=Medscape | |||
|accessdate=2019-10-11 | |||
|url= | |||
|title= | |||
| | |||
|accessdate=2019-11 | |||
}}</ref> | }}</ref> | ||
* | |||
* Shorter adult penile length was reported by Park et al. (2016) as a result of NMC (newborn male circumcision). | |||
{{Citation | |||
|last= | |Title= | ||
|Text=In conclusion, second to fourth digit ratio, flaccid penile length, and age of circumcision were significant predictive factors for erectile penile length. Furthermore, the penile lengths of the NMC group were shorter than those of the non-NMC group. | |||
|Author=Park et al. | |||
|Source= | |||
|ref=<ref>{{REFjournal | |||
|last=Park | |||
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| | |etal=yes | ||
|title=Prospective investigation of penile length with newborn male circumcision and second to fourth digit ratio. | |||
|title= | |trans-title= | ||
| | |language= | ||
|journal=Can Urol Assoc J | |||
|location= | |||
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}} | |||
=== Sexual effects === | |||
|last= | 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." | ||
| | |||
| | The [[amputation]] of the prepuce results in the loss of the majority of fine-touch neuroreceptors found in the [[penis]], leaving only the uninhibited protopathic sensibility of the artificially externalized [[glans penis]]. The imbalance caused by not having the input from the now ablated fine-touch receptors may be a leading cause of the changes in sexual behavior noted in [[circumcised]] human males.<ref>{{REFjournal | ||
| | |last=Van Howe | ||
| | |init=RS | ||
|date= | |author-link=Robert S. Van Howe | ||
|last2=Cold | |||
|init2=CJ | |||
|title=Advantages and Disadvantages of Neonatal Circumcision | |||
|journal=The Journal of the American Medical Association | |||
|volume=277 | |||
|issue=13 | |||
|pages=1052-7 | |||
|url=http://www.ncbi.nlm.nih.gov/pubmed/9218663 | |||
|quote= | |||
|pubmedID=9218663 | |||
|pubmedCID= | |||
|DOI= | |||
|date=1997-04-02 | |||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref> | ||
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> | |||
|last= | 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 | ||
|init= | |last=Cepeda-Emiliani | ||
|last2= | |first= | ||
|init2= | |init=A | ||
| | |author-link=Alfonso Cepeda-Emiliani | ||
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|last8=García-Caballero | |||
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|etal=no | |||
|url= | |title=Immunohistological study of the density and distribution of human penile neural tissue: gradient hypothesis | ||
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| | |journal= Int J Impot Res | ||
| | |date=2023-05-02 | ||
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|accessdate= | |issue=3 | ||
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|url=https://www.nature.com/articles/s41443-022-00561-9 | |||
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}}</ref> | }}</ref> | ||
</blockquote> | |||
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. | |||
See [[Sexual effects of circumcision]] for more information. | |||
=== Psychological effects === | |||
[[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= | |last=Marshall | ||
|init= | |init=RE | ||
|last2= | |last2=Porter | ||
|init2= | |init2=FL | ||
|title= | |last3=Rogers | ||
|journal= | |init3=AG | ||
|date= | |etal=yes | ||
|volume= | |title=Circumcision: II effects upon mother-infant interaction | ||
|issue= | |journal=Early Hum Dev | ||
|pages= | |date=1982 | ||
|url= | |volume=7 | ||
|accessdate= | |issue=4 | ||
}}</ref> | |pages=367-74 | ||
|url=https://www.cirp.org/library/birth/marshall2/ | |||
|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 | |||
|last= | |init=S | ||
|init= | |last2=Boyle | ||
|last2= | |init2=GJ | ||
|init2= | |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 | |||
|title= | |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 | |||
|url= | |location=New York | ||
| | |publisher=Kluwer Academic/Plenum Publishers | ||
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* 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 | |||
| | }}</ref> | ||
* 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 | |||
|title= | |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 | |||
}}</ref><ref>{{REFjournal | |accessdate=2019-10-12 | ||
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|accessdate=2019-10- | |||
}}</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 | |||
* | |last=Rhinehart | ||
|init=J | |||
|url=https://www.cirp.org/library/psych/rhinehart1/ | |||
|title=Neonatal circumcision reconsidered | |||
|journal=Transactional Analysis J | |||
|date=1999 | |||
|volume=29 | |||
|last= | |issue=3 | ||
|pages=215-21 | |||
|init= | |accessdate=2019-10-12 | ||
| | }}</ref>. In an online study, 75% of those interviewed stated that they felt incomplete, and 66% said they felt inferior compared with [[intact]] males.<ref name="GSoCH"/> | ||
| | * Cases in which children felt ill treated or punished have been documented as well. G. Cansever found in her study on 12 boys aged between 4 and 7 years, who had previously been prepared for their impending circumcision, that the children experienced the operation as an aggressive assault on their bodies.<ref>{{REFjournal | ||
| | |last=Cansever | ||
| | |init=G | ||
| | |date=1965 | ||
| | |url=https://www.cirp.org/library/psych/cansever/ | ||
| | |title=Psychological effects of circumcision | ||
| | |journal=Brit. J. Med. Psychol | ||
|volume=38 | |||
|pages=321-31 | |||
| | |accessdate=2019-10-12 | ||
| | }}</ref> | ||
| | * Fear of being alone or darkness.<ref name="Levy1945">{{REFjournal | ||
| | |last=Levy | ||
|title= | |first=David M. | ||
|init=DM | |||
|url=https://www.cirp.org/library/psych/levy1/ | |||
|journal= | |title=Psychic trauma of operations in children; and a note on combat neurosis | ||
| | |journal=American Journal of Diseases of Children | ||
| | |volume=69 | ||
| | |date=1945 | ||
|pages=7-25 | |||
|accessdate=2019-10-12 | |||
| | |||
| | |||
| | |||
|url=https://www. | |||
| | |||
| | |||
| | |||
| | |||
| | |||
|accessdate= | |||
}}</ref> | }}</ref> | ||
* Fear of doctors, clinics and also closed rooms.<ref name="Levy1945"/> | |||
= | * Relapse into the state of bed-wetting, even if the child was already dry before.<ref name="Levy1945"/> | ||
* Circumcised males who become fathers frequently manifest [[adamant father syndrome]]. | |||
[[Intact America]] (2019) called circumcision an [[Adverse Childhood Experiences (ACEs)| adverse childhood experience]],<ref name-"bollinger2019">{{REFdocument | |||
|title=Child genital cutting as an adverse childhood experience | |||
|url=http://adversechildhoodexperiences.net/CGC_as_an_ACE.pdf | |||
| | |last=Bollinger | ||
| | |first=Dan | ||
|author-link=Dan Bollinger | |||
| | |last2=Chapin | ||
| | |first2=Georganne | ||
| | |author2-link=Georganne Chapin | ||
| | |publisher=Intact America | ||
|location=Tarrytown | |||
| | |format=PDF | ||
| | |date=2019-08 | ||
|accessdate=2021-11-02 | |||
| | |||
| | |||
| | |||
|date= | |||
|accessdate= | |||
}}</ref> | }}</ref> | ||
== Complications == | |||
=== Possible operative and postoperative complications === | |||
Circumcision is surgery. Surgical complications of circumcision generally may be classified as [[Bleeding| hemorrhage]], [[infection]], or surgical misadventure up to and including loss of the penis and [[death]].<ref name="deacon2022" /><ref name="williams-kapilla1993">{{REFjournal | |||
|last=Williams | |||
|last= | |init=N | ||
|author-link= | |||
|init= | |last2=Kapilla | ||
|author-link= | |init2=L | ||
|last2= | |||
|init2= | |||
|author2-link= | |author2-link= | ||
|etal=no | |||
|title=Complications of circumcision | |||
|trans-title= | |||
|language= | |||
|journal=Brit J Surg | |||
|location= | |||
|date=1993-10 | |||
|volume=80 | |||
|issue=10 | |||
|pages=1231-6 | |||
|url=https://www.cirp.org/library/complications/williams-kapila/ | |||
|quote= | |||
|pubmedID=8242285 | |||
|pubmedCID= | |||
|DOI=10.1002/bjs.1800801005 | |||
|accessdate=2019-11-27 | |||
}}</ref> | |||
* Intolerance or allergic reactions to the narcotics used. | |||
* Especially in newborns, where the bodily pain reduction mechanisms are not yet fully developed, local anaesthesia is often insufficient for the operation. Even in conjunction with regional anaesthesia of the dorsal nerve of the [[penis]], 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 | |||
|etal=no | |last=Prof. Dr. med. Boris Zernikow | ||
|title= | |first= | ||
|trans-title= | |publisher=Spiegel Online | ||
| | |website= | ||
| | |date=2012-08-12 | ||
| | |accessdate=2019-10-11 | ||
| | |format= | ||
| | |||
| | |||
|pages= | |||
|url=https://www. | |||
|quote= | |||
|pubmedID= | |||
|pubmedCID= | |||
|DOI=10. | |||
|accessdate= | |||
}}</ref> | |||
The | |||
|url= | |||
|title= | |||
| | |||
| | |||
| | |||
| | |||
| | |||
| | |||
| | |||
| | |||
| | |||
|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 | |||
|init=T | |||
|title=Circumcision: a survey of fees and practices | |||
|journal=OBG Management | |||
|date=1994 | |||
|volume=October | |||
|issue= | |||
|pages=34-6 | |||
|url= | |||
|accessdate= | |||
}}</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 | |||
|url= | |||
|accessdate= | |accessdate= | ||
}}</ref><ref>{{REFjournal | |||
}}</ref> | |last=Stang | ||
|init=HJ | |||
| | |last2=Snellman | ||
|title= | |init2=LW | ||
|accessdate= | |title=Circumcision practice patterns in the United States | ||
}}</ref> | |journal=Pediatrics | ||
|date=1998 | |||
|last= | |volume=101 | ||
|init= | |issue=e5 | ||
| | |pages= | ||
| | |url= | ||
|title=The | |accessdate= | ||
|journal= | |note=Link to [[AAP]] website | ||
|date= | }}</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 | ||
|volume= | |last=Gunnar | ||
|issue= | |init=MR | ||
|pages= | |last2=Fisch | ||
|accessdate=2019- | |init2=RO | ||
|last3=Korsvik | |||
|init3=S | |||
|last4=Donhowe | |||
|init4=JM | |||
|title=The effects of circumcision on serum cortisol and behavior | |||
|journal=Psychoneuroendocrinology | |||
|date=1981 | |||
|volume=6 | |||
|issue=3 | |||
|pages=269-75 | |||
|url=https://www.cirp.org/library/pain/gunnar/ | |||
|accessdate=2019-11-26 | |||
}}</ref> | }}</ref> | ||
* | * Postoperative wound pain, in the case of children's circumcisions conceivably worsened by the forceful breaking of the preputial adhesions. | ||
|last= | * Postoperative pain from the exposure of the sensitive glans penis to clothing. This pain will endure for several weeks or even longer in some cases. | ||
| | * 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 | ||
|url= | |last= | ||
| | |first= | ||
| | |year=2000 | ||
| | |title=Paediatric Handbook | ||
|volume= | |url= | ||
| | |work= | ||
| | |editors=Smart J, Nolan T. | ||
|accessdate= | |edition=6 | ||
}}</ref> | |volume= | ||
|chapter= | |||
|last= | |page=82 | ||
|init= | |location={{AUSC|VIC}}, Australia | ||
|date= | |publisher=Blackwell Science Asia | ||
|url=https://www.cirp.org/library/ | |isbn= | ||
|title= | |quote= | ||
| | |accessdate= | ||
| | |note= | ||
| | }}</ref><ref>{{REFdocument | ||
|accessdate=2019- | |title=Autopsy of Demetrius Manker | ||
}}</ref> | |url= | ||
* | |contribution=Case 93-1711 | ||
|last= | |last=Wetli | ||
|first= | |first=CV | ||
| | |publisher=Miami: Dade County Medical Examiner Department | ||
| | |format= | ||
|title= | |date=1993-06-23 | ||
|accessdate= | |||
}}</ref> <ref>{{REFjournal | |||
|date= | |last=Hiss | ||
|init=J | |||
|accessdate= | |last2=Horowitz | ||
|init2=A | |||
|last3=Kahana | |||
|init3=T | |||
|title=Fatal haemorrhage following male ritual circumcision | |||
|journal=J Clin Forensic Med | |||
|date=2000 | |||
|volume=7 | |||
|issue= | |||
|pages=32-4 | |||
|url=https://www.cirp.org/library/death/hiss1/ | |||
|accessdate=2019-11-06 | |||
}}</ref><ref>{{REFdocument | |||
|title=Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan | |||
|url=http://www.circumstitions.com/death-exsang.html | |||
|contribution= | |||
|last=Newell | |||
|first=TEC | |||
|publisher=Burnaby, B.C.: B.C. Coroner's Service | |||
|format= | |||
|date=2004-01-19 | |||
|accessdate=2019-11-26 | |||
}}</ref> | |||
* Post operative [[lymphoedema]]. | |||
* Postoperative [[Infection| 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= | |||
}}</ref> | }}</ref> | ||
* | * [[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 | |||
[[ | |init=HJ | ||
|title= | |last2=Vemulakonda | ||
|url= | |init2=V | ||
|last= | |last3=Ritchey | ||
| | |init3=ML | ||
| | |last4=Ribbeck | ||
| | |init4=M | ||
| | |title=Outpatient management of [[phimosis]] Following newborn circumcision | ||
| | |journal=J Urol | ||
| | |date=2003 | ||
| | |volume=169 | ||
| | |issue=6 | ||
|date= | |pages=2332-4 | ||
|accessdate= | |url=https://www.cirp.org/library/complications/blalock1/ | ||
|accessdate=2019-11-26 | |||
}}</ref>, the prevalence is 2.9%, according to Leitch<ref>{{REFjournal | |||
|last=Leitch | |||
|init=IOW | |||
|title=Circumcision - a continuing enigma | |||
|journal=Aust Paediatr J | |||
|date=1970 | |||
|volume=6 | |||
|issue= | |||
|pages=59-65 | |||
|url=https://www.cirp.org/library/general/leitch1/ | |||
|accessdate=2019-12-15 | |||
}}</ref> 5.5%. | |||
* [[Sudden Infant Death Syndrome]] (SIDS). | |||
* Knot formation of the veins. If the dorsal vein, which originates in the tip of the [[foreskin]], is cut during circumcision without being clamped and sutured at its origin separately, it starts to develop new branches over time, which can lead to the development of knots. | |||
* Possible deformities due to circumcision include hypoplasia of the [[penis]] (micro-penis) and induratio [[penis]] plastica (skewed penis). | |||
* Medical malpractice can also not be ruled out. Injuries, partly or entirely severing the [[Glans penis|glans]] or the [[penis]] can occur. | |||
* In rare cases, [[necrosis]], gangrene, ischaemia, keloid formation, and circulatory problems may also occur. | |||
* When the circumcision is followed by the ultra-orthodox Jewish ritual of Metzitzah B'Peh (which consists of sucking blood from the wound with the mouth), there is a risk of infection with [[herpes]] simplex type 1, which can lead to brain damage or [[death]].<ref>{{REFweb | |||
|url=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 | |||
|last=Robbins | |||
|first=Liz | |||
|date=2012-03-07 | |||
|accessdate=2019-10-11 | |||
}}</ref> | }}</ref> | ||
=== Death === | === Death === | ||
A study in 2010 estimated approximately 117 neonatal circumcision-related deaths occur annually in the United States, about one out of every 77 male neonatal deaths, more than suffocation, auto accidents, or even [[SIDS]].<ref name="Bollinger 2010">{{REFjournal | A study in 2010 estimated approximately 117 neonatal circumcision-related deaths occur annually in the United States, about one out of every 77 male neonatal deaths, more than suffocation, auto accidents, or even [[SIDS]].<ref name="Bollinger 2010">{{REFjournal | ||
| Line 1,573: | Line 1,564: | ||
|accessdate= | |accessdate= | ||
}}</ref> See also the list of [[fatalities]]. | }}</ref> See also the list of [[fatalities]]. | ||
== Forced circumcision == | == Forced circumcision == | ||
<!--=== United States military === | <!--=== United States military === | ||
American soldiers serving in World War II were subjected to regular inspections of their genitals. If intact, the soldiers risked being ordered to undergo immediate circumcision.<ref>{{REFbook | American soldiers serving in World War II were subjected to regular inspections of their genitals. If intact, the soldiers risked being ordered to undergo immediate circumcision.<ref>{{REFbook | ||
|last=Schoen | |last=Schoen | ||
| Line 1,599: | Line 1,587: | ||
|note= | |note= | ||
}}</ref> This practice was discontinued at least six decades ago.--> | }}</ref> This practice was discontinued at least six decades ago.--> | ||
=== Non-therapeutic circumcision of male children === | === Non-therapeutic circumcision of male children === | ||
| Line 1,637: | Line 1,624: | ||
In recent years, legal writers in several English-speaking countries have been questioning the practice of acceding to parental wishes.<ref>See, e.g., [[Margaret A. Somerville|Somerville]], "Therapeutic and Non-Therapeutic Medical Procedures"; Poulter, ''English Criminal Law''; [[Abbie Chessler|Chessler]], "Justifying the Unjustifiable"; Smith, "Male Circumcision."</ref> For example, critics have pointed out that, in the [[United States]], more than 1.3% of male neonatal deaths are attributable to the complications of non-therapeutic circumcision surgery.<ref name="Bollinger 2010"/> | In recent years, legal writers in several English-speaking countries have been questioning the practice of acceding to parental wishes.<ref>See, e.g., [[Margaret A. Somerville|Somerville]], "Therapeutic and Non-Therapeutic Medical Procedures"; Poulter, ''English Criminal Law''; [[Abbie Chessler|Chessler]], "Justifying the Unjustifiable"; Smith, "Male Circumcision."</ref> For example, critics have pointed out that, in the [[United States]], more than 1.3% of male neonatal deaths are attributable to the complications of non-therapeutic circumcision surgery.<ref name="Bollinger 2010"/> | ||
==Video== | ==Video== | ||
===Is circumcision healthy?=== | ===Is circumcision healthy?=== | ||
| Line 1,684: | Line 1,670: | ||
</blockquote> | </blockquote> | ||
* Andrew E. MacNeiiy, Head, Division of Pediatric Urology, Department of Urological Sciences, {{UNI|University of British Columbia|UBC}}, Vancouver, BC, (2008) said: | * Andrew E. MacNeiiy, Head, Division of Pediatric Urology, Department of Urological Sciences, {{UNI|University of British Columbia|UBC}}, Vancouver, BC, (2008) said: | ||
<blockquote> | <blockquote> | ||
Newborn circumcision remains an area of controversy. Social, cultural, aesthetic and religious pressures form the most common reasons for non-therapeutic circumcision. Although penile cancer and UTIs are reduced compared with uncircumcised males, the incidence of such illness is so low that circumcision cannot be justified as prophylaxis. The role of the foreskin in [[HIV]] transmission in developed countries is unclear, and safe sexual practice remains the cornerstone of prevention. There remains a lack of knowledge regarding what constitutes the normal foreskin both among parents and among primary care providers. This lack of knowledge results in a burden of costs to our health care system in the form of unnecessary urological referrals, expansion of wait times and circumcisions. Routine circumcision of all infants is not justified from a health or cost-benefit perspective.<ref>{{REFjournal | Newborn circumcision remains an area of controversy. Social, cultural, aesthetic and religious pressures form the most common reasons for non-therapeutic circumcision. Although penile cancer and UTIs are reduced compared with uncircumcised males, the incidence of such illness is so low that circumcision cannot be justified as prophylaxis. The role of the foreskin in [[HIV]] transmission in developed countries is unclear, and safe sexual practice remains the cornerstone of prevention. There remains a lack of knowledge regarding what constitutes the normal foreskin both among parents and among primary care providers. This lack of knowledge results in a burden of costs to our health care system in the form of unnecessary urological referrals, expansion of wait times and circumcisions. Routine circumcision of all infants is not justified from a health or cost-benefit perspective.<ref>{{REFjournal | ||