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"Male '''circumcision''' (from Latin ''circumcidere'', meaning "to cut around") is the surgical removal or [[amputation]] of the [[foreskin]] (prepuce) , a major part of the human [[penis]]. The foreskin comprises ''more than fifty percent'' of the epithelium of the [[penis]].<ref name="taylor1996">{{TaylorJR LockwoodAP TaylorAJ 1996}}</ref> When the "cutting around" is performed, the foreskin falls off, so [[amputation]] and [[mutilation]] is the result. The amputation destroys the [[Foreskin#Physiological_functions| many protective, immunological, sexual, and sensory physiological functions]] of the foreskin, so it is a very harmful and [[Pain| painfdulpainful]] surgery. 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 [[Balanitis| balanoposthitis]] and chronic [[urinary tract infection]]s (UTIs); it is contraindicated in cases of certain genital structure abnormalities or poor general health.  '''Posthectomy''' is a more accurate medical term that more accurately reflects the injury and loss of functional body tissue, but the Biblical [[euphemism]], ''circumcision'', is more commonly used.

In [[Judaism]], the tradition of [[Brit Milah| circumcision ]] goes back to the [[Abrahamic covenant]] in a passage in the Book of Genesis (17, :10-14). It is was seen as a [[Abrahamic covenant| covenant between God and man]], dating back to the patriarch Abraham. The validity of this passage is increasingly being questioned.

According to the anthropologist and sociologist Rabbi Nissan Rubin, the [[Jewish circumcision| Jewish form of circumcision]], called ''[[Brit Milah| brit mila]]'', during the first two millennia did not include the later customary ''[[periah]]'', namely the complete scraping of the inner [[foreskin]] from the [[Glans penis|glans]]. This was only added around 135 AD, to make it almost impossible to restore the [[foreskin]] by [[stretching]], which became popular in the wake of Hellenic influence. While originally only the tip of the [[foreskin]] was cut off, ''[[periah]]'' removes the entire [[foreskin]].  In the Greek society of the day, a denuded [[Glans penis|glans]] was considered obscene and risible. In ultra-orthodox communities, circumcision is followed by the ''[[mohel]]'', the ritual circumciser, sucking blood from the wound with his mouth. This practice is highly controversial, as it can result in an [[infection ]] with [[herpes]] simplex type 1. In New York City, between 2000 and 2011 eleven children were infected with [[herpes]], 10 of whom had to be treated in hospital. Two of them suffered permanent brain damage, two others died. In the 12th century, the Jewish philosopher and doctor [[Moses Maimonides| Maimonides]] pointed out claimed that circumcision was necessary, as it diminished sexual desires and reduced the pleasure to a degree just sufficient for mere reproduction.

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

In Christianity, circumcision is practiced only in the Coptic churchesdenomination. There is no general belief that circumcision is a requirement of Christianity.<ref name="hill2004">{{REFweb |url=httphttps://www.cirp.org/pages/cultural/christian.htmlphp

Even the mere existence of a [[foreskin]] was falsoly 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:

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

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

=== [[Medical indication]] ===There are no [[medical indication| medical indications ]] for circumcision of the newborn. The [[circumcision industry]] offers circumcision of the newborn to the public because of the [[financial incentive]].

The form of circumcision adopted by the medical community essentially was equivalent to the Jewish form with ''[[periah]]'', so it inflicted the maximum injury.

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

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

|url=httphttps://www.cirp.org/library/history/encyclopaediabritannica1876/

Initially, circumcision was adopted in the 19th century as a way to stop boys and men from masturbating, where when [[masturbation]] was seen as claimed to be the cause for many diseases. As the myth that circumcision prevented masturbation became debunked, advocates of circumcision began the great search to find the "medical benefits" of circumcision.

|url=httphttps://www.cirp.org/library/anatomy/cold-mcgrath/

|url=httphttps://www.cirp.org/library/history/ephron1/

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.

|url=httphttps://www.cirp.org/library/complications/blalock1/

|url=httphttps://www.cirp.org/library/general/laumann/

}}</ref>, which found a higher rate of infection with bacterial venereal diseases in [[circumcised ]] than in [[intact ]] men.* The studies by Fleiss et al. (1998) support this.<ref name="fleiss-hodges-vanhowe1998">{{FleissP HodgesF VanHoweRS 1998}}</ref> According to the [[AAP]], the general sexual behaviour of the male - — such as frequent change in partners and the use of condoms - — has a much higher impact on sexually transmitted diseases then the circumcision status.<ref>{{REFjournal

|url=httphttps://www.cirp.org/library/statements/aap1999/

|url=httphttps://www.cirp.org/library/general/laumann/

The fact that the [[USA ]] has both the highest rate 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

|url=httphttps://www.cirp.org/library/disease/UTI/mccracken/

}}</ref> found that, during the first 6 years of life, the incidence of UTIs [[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

* 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

* It can be concluded that circumcision is ineffective as a preventive measure against UTIs[[UTI]].

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

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

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 [[preputial sac]] underneath the [[foreskin]] is easy - — they are simply [[Preputial_sac#Washing| washed with warm water along with the rest of the body]], just like the areas between the toes.

In small boys, where the [[foreskin]] cannot be retracted yet, cleaning is not necessary, since the [[Synechia| membrane]] that fuses the [[foreskin]] to the [[Glans penis|glans]] prevents the accumulation of micro-organisms. The so-called "[[Ballooning of the foreskin| ballooning]]", where the [[foreskin]] inflates during urination, is not a serious problemconcern.

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.

== 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 effectsThe [https://www. Uberoi et alcirp. org/library/statements/aap1999/|AAP Circumcision Policy Statement] (20221999) report states quite clearly that ''"some men There is considerable evidence that newborns who are experiencing a complex negative constellation of psychological[[circumcised]] without analgesia experience pain and physiologic stress"''. Furthermore, physicalthe pain is quite severe, and sexual associations that lead to significant emotional distress directed both internally requires injections for proper pain management. Sucrose and externallyAcetaminophen ''"cannot be recommended as the sole method of analgesia"''. The posts also reveal a discovery phenomenon wherein men discover Topical cream is no longer thought sufficient as ''"the analgesic effect is limited during the physical and psychological manifestations phases associated with extensive tissue trauma such as...tightening of the decisions made by others to modify their genitalsclamp"''."<ref name ="uberoi2022">{{REFjournal |last=Uberoi

|inittitle=MAmerican Academy of Pediatrics: Circumcision Policy Statement; Task Force on Circumcision |author-linkjournal=Pediatrics |last2=Abdulcadir |first2= |init2date=J |author21999-link=03 |last3volume=Ohi103 |first3issue=3 |init3pages=DA |author3686-link=93 |last4url=Santiagohttps://pediatrics.aappublications.org/content/103/3/686#sec-9 |first4accessdate= |init4=JE |author42019-11-link=26 |last5note=Statement Reaffirmed Sept. 1, 2005 |first5=}}</ref> |init5= The [[AAFP]] (2002) states quite simply in their [https://www.cirp.org/library/statements/aafp2002/|author5-link=position paper], ''"Newborns experience pain during circumcision".''<ref>{{REFweb |last6title=Circumcision: Position Paper on Neonatal Circumcision. Board Approved: August 2007 Reaffirmed |first6website=Official American Academy of Family Physicians Website |init6url=http://www.aafp.org/online/en/home/clinical/clinicalrecs/children/circumcision.html |author6-link= |last7= |first7= |init7accessdate= |author72011-link= |last8= |first8= |init8= |author805-link=02 |last9=}}</ref> This is not a debatable fact, and yet, it is not widely accepted, even by some doctors. It might be hard for some doctors to accept, as they may have been taught that the infant does not feel [[pain]], and may have performed countless circumcisions with this idea. Usage of anesthesia for infant circumcision is still by no means the rule. |first9= |init9= |author9Penile injections of local anesthetic are now recommended by all of the major medical institutions if a circumcision is to be performed. In their [http://www.ama-link= |etal=yes |title=Potentially underassn.org/ama/no-recognized lateindex/about-stage physical and psychosexual complications ama/13585.shtml Report 10 of non-therapeutic neonatal the Council on Scientific Affairs], the AMA states ''"When the decision is made to proceed with circumcision, local anesthesia should be provided for the procedure. [[Ring block]] or [[dorsal penile nerve block]] [injections] are most effective. [[EMLA]] cream has limited utility"''. Alarmingly, ''"Despite the clear evidence that newborn males generate brisk pain responses during circumcision: , a qualitative recent survey of residency training programs found that 26% of programs that taught circumcision provided no instruction on the use of local anesthesia". The AMA reports that "Of physicians performing circumcision, 45% use anesthesia, 71% of pediatricians, 56% of family practitioners, and quantitative analysis 25% of self-reports from an online community forumobstetricians"''.<ref>{{REFweb |trans-title=Report 10 of the Council on Scientific Affairs (I-99): Neonatal Circumcision |languagewebsite=American Medical Association Official Website |journalurl=Int J Impot Reshttp://www.ama-assn.org/ama/no-index/about-ama/13585.shtml |locationaccessdate= |date=20222011-1005-2304 |volume= |issue= |article=}}</ref> |page= |pages= |url=httpsThe AAP's [http://www.naturehealthychildren.comorg/articlesEnglish/s41443ages-022stages/prenatal/decisions-00619to-8make/pages/Where-We-Stand-Circumcision.aspx Heatlhy Children website] suggests ''"Your pediatrician (or your obstetrician) should discuss the forms of analgesia that are available"''.<ref>{{REFweb |archivedtitle=Where We Stand: Circumcision |quotepublisher=[[AAP]] |pubmedIDdate=362741892011-03-23 |pubmedCIDurl= |DOI=10http://www.healthychildren.1038org/s41443English/ages-022stages/prenatal/decisions-00619to-8make/pages/Where-We-Stand-Circumcision.aspx |accessdate=20232019-0110-0812}}</ref>Be that as it may, few forms of analgesia are recommended. There are basically two types of injections to choose from, and the website does not go into the difference between a 'dorsal nerve block' and a 'ring block' injection. Given what is known from aforementioned official documents, the AAP website may be more informative and effective if it would say ''"Make sure your doctor knows of the ineffectiveness of anything short of local anesthesia, and make sure your baby is given an injection. This is your responsibility, because your doctor may or may not be up to date on the latest understandings of infant sensitivity to [[pain]] during circumcision."'' The AAP may be holding back, however, perhaps because this would upset the doctor/parent power relationship, and may cause too much questioning of doctors in general. One may not expect to find this kind of advice on such a website, and yet, anything less than this is a dangerously weak statement.

=== Possible operative and postoperative complications === Circumcision is surgery. Surgical complications of circumcision generally may be classified as To control [[Bleeding| hemorrhagepain]], [[infection]]some physicians that circumcise use Tylenol, sugar, or surgical misadventure up to and including loss of the penis and [[death]].<ref name="deacon2022" /><ref name="williams-kapilla1993">{{REFjournalREFweb |lastquote=WilliamsTo calm the baby during the procedure, a sugar filled gauze pacifier soaked with sweet juice is used, and soothing music is played in the room. |initurl=N |authorhttp://www.pollockclinics.com/circumcision/circumcision-link= |last2=Kapilla |init2=L |author2-link= |etal=noguide.html |title=Complications of circumcisionParents' Guide to Circumcision |trans-titlelast= |languagefirst= |journalpublisher=Brit J Surg |locationdate= |dateaccessdate=19932011-1004-08 |volume=80}}</ref><ref>{{REFweb |issuequote=10 |pages=1231-6During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions. |url=http://www.cirppollockclinics.orgcom/librarycircumcision/complications/williamscircumcision-kapila/before.html |title=Before the Circumcision |quotelast= |pubmedIDfirst=8242285 |pubmedCIDpublisher= |DOIdate=10.1002/bjs.18008010052011-04-08 |accessdate=20192011-1104-2708}}</ref> * Intolerance or allergic reactions to the narcotics used.* Especially in newborns, where the bodily pain reduction mechanisms are not yet fully developeda topical cream, 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 |quote=Then in our office, he will have topical anesthetic applied to his penis. |url=http://www.spiegelpollockclinics.decom/spiegelcircumcision/vorab/expertecircumcision-warnt-rituelle-beschneidung-veraendert-das-gehirn-der-kinder-a-849534before.html |title=Kinderschmerz-Experte warnt: Rituelle Beschneidung verändert das Gehirn der Kinder |trans-title=Children's pain expert warns: Ritual circumcision changes Before the brain of children |language=GermanCircumcision |last=Prof. Dr. med. Boris Zernikow

|publisher=Spiegel Online |website= |date=20122011-04-08-12 |accessdate=20192011-1004-11 |format= |quote=08}}</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 a local anaesthetic are still common practiceinjection called a dorsal penile ring block.<ref>{{REFjournalREFweb |lastquote=GarryWe use extensive pain control methods including Tylenol, a sugar solution (to reduce pain perceptions), a topical freezing cream, and a local anesthetic injection. |initurl=Thttp://www.pollockclinics.com/circumcision/circumcision-guide.html |title=Parents' Guide to Circumcision: a survey of fees and practices |journallast=OBG Management |datefirst=1994 |volumepublisher=October |issuedate= |pagesaccessdate=342011-6 |url= |accessdate=04-08}}</ref>Topical anaesthetic only serves to numb the area to lessen the pain of the injection, but studies have shown that a [[dorsal penile nerve block]] is only partially effective in stopping the [[Pain| pain of circumcision]].<refname="Journal of Perinatology April/May 2002">{{REFjournal |last=HowardTaeusch |initfirst=CRH. William |last2init=HowardHW |init2last2=FMMartinez |last3first2=GarfunkelAlma M. |init3init2=LCAM |last4last3=de BlieckPartridge |init4first3=EAJ. Colin |last5init3=WeitzmanJC |init5last4=MSniderman |titlefirst4=Neonatal circumcision and pain relief: current training practicesSusan |journalinit4=PediatricsS |datelast5=1998Armstrong-Wells |volumefirst5=101Jennifer |issueinit5=J |pageslast6=423Fuentes-8Afflick |urlfirst6=Elena |accessdateinit6=}}</ref><ref>{{REFjournalE |lasttitle=StangPain During Mogen or Plastibell Circumcision |initjournal=HJJournal of Perinatology |last2volume=Snellman22 |init2issue=LW3 |titlepages=Circumcision practice patterns in the United States214-8 |url=http://www.nature.com/jp/journal=Pediatrics/v22/n3/full/7210653a.html |datequote=1998...more than half of the study group had what we considered excessive pain/discomfort over the course of the entire procedure. |volumepubmedID=101 |issuepubmedCID=e5 |pagesDOI= |urlnote=April/May 2002 |accessdatedate=2002-04 |noteaccessdate=Link to [[AAP]] website2011-04-08}}</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]].<refname="Clinical Pediatrics August 1986">{{REFjournal |last=GunnarWilliamson |initfirst=MRPaul S. |last2init=FischPS |init2last2=ROEvans |last3first2=KorsvikNolan Donovan |init3=S |last4init2=Donhowe |init4=JMND |title=The effects of circumcision on serum cortisol and behaviorNeonatal Cortisol Response to Circumcision with Anesthesia |journal=Psychoneuroendocrinology |date=1981Clinical Pediatrics |volume=625 |issue=38 |pages=269412-756 |url=http://wwwcpj.cirpsagepub.orgcom/librarycontent/pain25/gunnar8/412.abstract |quote=The adrenal cortisol response to surgery was not significantly reduced by the administration of lidocaine. |pubmedID= |pubmedCID= |DOI= |date=1986-08 |accessdate=20192011-1104-2608}}</ref>* Postoperative wound painDuring circumcision, in the case of somp physicians give children's circumcisions conceivably worsened by sugar pacifiers to "reduce the forceful breaking perception of the preputial adhesions.pain",<ref>{{REFweb* Postoperative pain from |quote=During the exposure of the sensitive glans penis circumcision, your son will receive sugar pacifiers to clothing. This suck on which reduce his pain will endure for several weeks or even longer in some casesperceptions.* Postoperative [[bleeding]] of the wound |url=http://www. This can have severe consequences especially for very young infants, if they are not treated promptlypollockclinics. 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 deathcom/circumcision/circumcision-before.<ref>{{REFbookhtml |title=Before the Circumcision

|yearpublisher=2000 |titledate=Paediatric Handbook2011-04-08 |urlaccessdate=2011-04-08}}</ref> but in at least one study, data shows that giving sugar to a child doesn't help to reduce the perception of pain in the child.<ref name="Lancet, The 2010-10-09">{{REFjournal |worklast=Slater |editorsfirst=Smart J, Nolan T.Rebeccah |editioninit=6R |volumefirst2=Laura |chapterinit2=L |pagelast2=82Cornelissen |locationfirst3={{AUSC|VIC}}, AustraliaLorenzo |publisherinit3=Blackwell Science AsiaL |isbnlast3=Fabrizi |quotefirst4=Debbie |accessdateinit4=D |notelast4=}}</ref><ref>{{REFdocumentPatten |titlefirst5=Autopsy of Demetrius MankerJan |urlinit5=J |contributionlast5=Case 93-1711Yoxen |lastfirst6=WetliAlan |firstinit6=CVA |publisherlast6=Miami: Dade County Medical Examiner DepartmentWorley |formatfirst7=Stewart |dateinit7=1993-06-23S |accessdatelast7=}}</ref> <ref>{{REFjournalBoyd |lastfirst8=HissJudith |initinit8=J |last2last8=HorowitzMeek |init2first9=AMaria |last3init9=KahanaM |init3last9=TProf. Fitzgerald |title=Fatal haemorrhage following male ritual circumcisionOral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial |journal=J Clin Forensic Med |date=2000The Lancet |volume=7376 |issue=9748 |pages=1225-32-4 |url=http://www.cirpthelancet.orgcom/libraryjournals/deathlancet/hiss1article/ |accessdate=2019PIIS0140-116736%2810%2961303-06}}<7/ref><ref>{{REFdocumentfulltext |titlequote=Judgement of inquiry into the death of McWillisOur data suggest that oral sucrose does not significantly affect activity in neonatal brain or spinal cord nociceptive circuits, Ryleigh Roman Bryan |url=http://wwwand therefore might not be an effective analgesic drug.circumstitionsThe ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief.com/death-exsang.html |contributionpubmedID= |lastpubmedCID=Newell |first=TEC |publisher=Burnaby, B.C.: B.C. Coroner's Service |formatDOI= |date=20042010-0110-1909 |accessdate=20192011-1104-2608}}</ref>* Post -operative [[lymphoedema]]pain and the pain the child must endure during recovery is hardly, if ever, addressed by professionals.* Postoperative It has been shown that an infant's response to [[Infection| infectionspain]]. This includes both local infections, which can be treated with local therapy, and systemic infections, requiring systemic antibiotic treatmentaltered for years as a consequence of circumcision.<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=TaddioA etal 1995}}</ref><ref>{{TaddioA KatzJ IlersichAL KorenG 1997}}</ref>* [[Wound dehiscence]]{{Box|Boxtext=<big><b>However, meaning the separation none of the edges above three procedures totally eliminate pain. A baby boy will still experience some pain despite any of the wound or the tissue after suturingthose analgesic procedures.* Adhesion between the surface or rim Prevention of the [[Glans penis|glanspain]] with requires protecting a boy from elective neonatal non-therapeutic circumcision. Only boys who are protected from the neighbouring medically unnecessary circumcision surgery experience no [[penile skinpain]], causing or [[skintrauma]] pockets .</b></big>}} == Risks and bridges, as well as visually unpleasant results effects ==Just like uneven scarstonsil or appendix surgery, which make circumcision is a re-circumcision necessarysurgical intervention and brings the usual risks related to surgical operations, alongside several specific risks of complications and late effects. Uberoi et al.* Postoperative [[phimosis]]: (2022) report "some men are experiencing a phimotic ring can develop during scarringcomplex negative constellation of psychological, physical, which makes a re-circumcision necessaryand sexual associations that lead to significant emotional distress directed both internally and externally. According to The posts also reveal a study discovery phenomenon wherein men discover the physical and psychological manifestations of the decisions made by Blalock et alothers to modify their genitals."<refname ="uberoi2022">{{REFjournal |last=BlalockUberoi |first= |init=HJM |author-link= |last2=VemulakondaAbdulcadir |first2= |init2=VJ |author2-link= |last3=RitcheyOhi |first3= |init3=MLDA |author3-link= |last4=RibbeckSantiago |first4= |init4=MJE |author4-link= |last5= |titlefirst5=Outpatient management of [[phimosis]] Following newborn circumcision |journalinit5=J Urol |dateauthor5-link=2003 |volumelast6=169 |issuefirst6=6 |pagesinit6=2332 |author6-4link= |urllast7=http://www.cirp.org/library/complications/blalock1/ |accessdatefirst7=2019-11-26}}</ref>, the prevalence is 2.9%, according to Leitch<ref>{{REFjournal |init7= |lastauthor7-link=Leitch |initlast8=IOW |titlefirst8=Circumcision - a continuing enigma |journalinit8=Aust Paediatr J |dateauthor8-link=1970 |volumelast9=6 |issuefirst9= |pagesinit9=59 |author9-65link= |urletal=http://www.cirp.org/library/general/leitch1/yes |accessdatetitle=2019Potentially under-12recognized late-15}}</ref> 5.5%.* [[Sudden Infant Death Syndrome]] (SIDS).* Knot formation stage physical and psychosexual complications of the veins. If the dorsal vein, which originates in the tip of the [[foreskin]], is cut during non-therapeutic neonatal penile circumcision without being clamped : a qualitative and sutured at its origin separately, it starts to develop new branches over time, which can lead to the development quantitative analysis of knots.self-reports from an online community forum* Possible deformities due to circumcision include hypoplasia of the [[penis]] (micro |trans-penis) and induratio [[penis]] plastica (skewed penis).title= |language=* Medical malpractice can also not be ruled out. Injuries, partly or entirely severing the [[Glans penis |glans]] or the [[penis]] can occur.journal=Int J Impot Res* In rare cases, [[necrosis]], gangrene, ischaemia, keloid formation, and circulatory problems may also occur. |location=* When the circumcision is followed by the ultra |date=2022-10-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>{{REFweb23 |volume= |issue= |article= |page= |pages= |url=httphttps://www.nytimesnature.com/2012articles/03/08/nyregion/infantss41443-death022-renews00619-debate-over-a-circumcision-ritual.html?_r8 |archived=0 |titlequote=Baby’s Death Renews Debate Over a Circumcision Ritual |lastpubmedID=Robbins36274189 |firstpubmedCID=Liz |dateDOI=201210.1038/s41443-03022-0700619-8 |accessdate=20192023-1001-1108

=== Physical late effects ===* [[Bodily harm]]* [[Circumcision scar]] is an invariable effect.* 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>{{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).

=== Psychological late Sexual effects === [[Psychological_issues_of_male_circumcision#Circumcision_trauma_in_adults| Psychological late Cepeda-Emiliani et al (2023) cited six reports in the literature of detrimental effects]] are also possible after a of circumcision, especially if the operation was carried out in childhoodincluding erectile function, sensation, masturbatory pleasure, orgasm, and sexual satisfaction. On this occasion a variety The authors also cited three studies of severe distress in [[traumacircumcised]] may occurmen, which depend, among others, on age and circumstances of the due to their infant circumcision. For example, whether the circumcision took place with or without sufficient anaesthesia, if the individual has been informed about the operation beforehandcomplaints of [[glans]] insensitivity, if he was delayed [[circumcisedejaculation]] 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 scaleunpleasant sensation. 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<refname="cepeda2023">{{REFjournal |last=MarshallCepe da-Emiliani |first= |init=REA |author-link=Alfonso Cepeda-Emiliani |last2=PorterGándara-Cortés |first2= |init2=FLM |author2-link= |last3=RogersOtero-Alén |first3= |init3=AGM |author3-link= |last4=García |first4= |init4=H |author4-link= |last5=Suárez-Quintanilla |first5= |init5=J |author5-link= |last6=García-Caballero |first6= |init6=T |author6-link= |last7=Gallego |first7= |init7=R |author7-link= |last8=García-Caballero |first8= |init8=R |author8-link= |etal=yesno |title=CircumcisionImmunohistological study of the density and distribution of human penile neural tissue: II effects upon mothergradient hypothesis |trans-infant interactiontitle= |language= |journal=Early Hum DevInt J Impot Res |location= |date=19822023-05-02 |volume=735 |issue=43 |article= |page= |pages=367286-74305 |url=httphttps://www.cirpnature.orgcom/libraryarticles/birth/marshall2s41443-022-00561-9 |archived= |quote= |pubmedID=35501394 |pubmedCID= |DOI=10.1038/s41443-022-00561-9 |accessdate=20202023-0211-0126}}</ref>, as well as problems  Circumcision and frenectomy remove tissues with nurturingheightened erogenous sensitivity.<ref name="cepeda2023" /> <ref name="winkleman1959">{{WinkelmannRK 1959}}</ref> They concluded, up "Evidence has also started to the point of refusal to be fed. The sleeping habits of these babies were also disturbedaccumulate that male circumcision may result in lifelong physical, sexual, with prolonged non-REM sleep and increased wakingsometimes psychological harm as well."

* In boys The [[circumcisedamputation]] of the prepuce results in the loss of the majority of fine-touch neuroreceptors found in childhood, [[posttraumatic stress disorder]] (the [[PTSDpenis]]) could be diagnosed. In a study on Philippine boys, in whom no [[PTSD]] was found prior to leaving only the operation, 69% uninhibited protopathic sensibility of the boys artificially externalized [[circumcisedglans penis]] in . The imbalance caused by not having the input from the traditional ritual and 51% now ablated fine-touch receptors may be a leading cause of those the changes in sexual behavior noted in [[circumcised]] by standard medical procedures (including anaesthesia) fulfilled the DSM-IV criteria for PTSD following the operationhuman males.<ref>{{REFbookREFjournal |last=RamosVan Howe |init=SRS |last2author-link=BoyleRobert S. Van Howe |init2last2=GJCold |yearinit2=2001CJ |title=Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional ProblemAdvantages and Disadvantages of Neonatal Circumcision |url=https://link.springer.com/chapter/10.1007/978-1-4757-3351-8_14 |work= |editors=[[George C. Denniston]], [[Frederick M. Hodges]], [[Marilyn Fayre Milos]] |editionjournal=The Journal of the American Medical Association |volume=277 |chapterissue=Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder13 |pages=2531052-707 |locationurl=New York |publisher=Kluwer Academichttp://www.ncbi.nlm.nih.gov/pubmed/Plenum Publishers |isbn=9218663

* Circumcisions, especially those that happen without consent, can spark feelings Histology of helplessness and alienation, which can persist as the male circumcision scar shows [[traumaamputation]]neuromas, Schwann cell proliferation and the bulbous collection of variably sized neurites. These feeling can also be triggered later, when someone [[circumcisedAmputation]] neuromas do not mediate normal sensation and are notorious for generating pain.<ref name="ColdCJ TaylorJR 1999"/> Cepeda-Emiliani et al. (2023) commented:<blockquote> Taking the sleve technique as an infant becomes aware example of his surgical flexibility during circumcision. In an online study, interviewed men stated they felt betrayed - 55% by 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 motherpenile body, 50% and to the extent that the prepuce is still conceived by segments of the fathermedical community as "just a small piece of skin", we are concerned that aggressive circumcisions are intentionally or unintentionally being performed in pediatric and 58% by adult patients in the doctorbelief that "redundant" or " extra" tissue is being excised, and 73% felt or in the belief that their [[human rights]] had been violated"excesive sensitivity" is being reduced to augment ejaculatory latency time.<ref name="GSoCHcepeda2023"/>{{REFweb |url=http://www.circumcisionharm.org</blockquote> |title=Global Survey of Circumcision Harm |accessdate=2019The un-10anesthetized and un-12}}</ref>* It can frequently be found that sedated newborn infant is restrained by being strapped to a special plastic board called the loss [[circumstraint]]. The procedure is deniedmost often an elective, much as happens with non-therapeutic surgery without [[medical indication]] performed on neonates and children for religious and cultural reasons in violation of the loss of other body parts. This denial can lead child's [[human rights]] to fathers having their sons [[circumcisedphysical integrity]] , but in order not to older patients may be reminded of their own lossrarely indicated for therapeutic reasons. In this process It is a radical treatment option for pathological [[phimosis]], their own body refractory [[balanoposthitis]] and chronic [[urinary tract infection]]s (UTIs); it is defined as "normal" and the contraindicated in cases of certain genital structure abnormalities or poor general health.  See [[foreskinSexual effects of circumcision]] redefined as a foreign objectfor more information. Their own parents  === Psychological effects ===[[Psychological_issues_of_male_circumcision#Circumcision_trauma_in_adults| Psychological late effects]] are seen as "good"also possible after a circumcision, so that this image is projected onto especially if the circumcision their parents operation was carried out as well, in order to keep the positive emotion intactchildhood. The father wants to be On this occasion a "good" father later in life as wellvariety of [[trauma]] may occur, which depend, among others, on age and so, following an idealised image circumstances of his own parentsthe circumcision. For example, whether the circumcisiontook place with or without sufficient anaesthesia, which if the individual has been redefined as a "good thing"informed about the operation beforehand, is passed on to his son by having him 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 wellas the histories of negatively affected men, suggest that these late effects may have more impact than previously assumed.<ref>{{VanderKolkBA 1989}}</ref> * It was observed that infants, following circumcision without [[pain]] control, had a disturbed bond with their mother<ref>{{REFjournal |last=GoldmanMarshall |init=RRE |last2=Porter |init2=FL |last3=Rogers |author-linkinit3=Ronald GoldmanAG |urletal=http://www.cirp.org/library/psych/goldman1/yes |title=The psychological impact of circumcisionCircumcision: II effects upon mother-infant interaction |journal=BJU IntEarly Hum Dev |date=19991982 |volume=837 |issue=Suppl. 14 |pages=93367-10374 |url=https://www.cirp.org/library/birth/marshall2/ |accessdate=20192020-1002-1201}}</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. * If the In boys [[circumcised]] male feels incompletein childhood, [[post-traumatic stress disorder]] ([[PTSD]]) could be diagnosed. In a study on Philippine boys, or due in whom no [[PTSD]] was found prior to the missing operation, 69% of the boys [[foreskincircumcised]] disadvantaged compared to in the traditional ritual and 51% of those [[intactcircumcised]] males, an inferiority complex and depression may occur. This can be accompanied by conscious recognition of his own incompleteness, or standard medical procedures (including anaesthesia) fulfilled the DSM-IV criteria for PTSD following the deficiency may remain completely subconsciousoperation.<ref>{{REFjournalREFbook |last=RhinehartRamos |init=JS |urllast2=http://www.cirp.org/library/psych/rhinehart1/Boyle |titleinit2=Neonatal circumcision reconsideredGJ |journalyear=Transactional Analysis J2001 |datetitle=1999Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem |volumeurl=29https://link.springer.com/chapter/10.1007/978-1-4757-3351-8_14 |issuework=3 |pageseditors=215-21 |accessdate=2019-10-12}}</ref>[[George C. In an online studyDenniston]], 75% of those interviewed stated that they felt incomplete[[Frederick M. Hodges]], and 66% said they felt inferior compared with [[intactMarilyn Fayre Milos]] males.<ref name |edition="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 |lastvolume=Cansever |initchapter=GRitual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder |datepages=1965253-70 |urllocation=http://www.cirp.org/library/psych/cansever/New York |titlepublisher=Psychological effects of circumcisionKluwer Academic/Plenum Publishers |journalisbn=Brit. J. Med. Psychol |volumequote=38 |pagesaccessdate=321-31 |accessdatenote=2019-10-12

* Fear Circumcisions, especially those that happen without consent, can spark feelings of being alone or darknesshelplessness 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="Levy1945GSoCH">{{REFjournal |last=Levy |first=David M. |init=DMREFweb |url=http://www.cirpcircumcisionharm.org/library/psych/levy1/ |title=Psychic trauma Global Survey of operations in children; and a note on combat neurosis |journal=American Journal of Diseases of Children |volume=69 |date=1945 |pages=7-25Circumcision Harm

* Fear It can frequently be found that the loss is denied, much as happens with the loss of doctorsother 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, clinics their own body is defined as "normal" and also closed roomsthe [[foreskin]] redefined as a foreign object.<ref name=Their own parents are seen as "Levy1945good"/>* Relapse into , so that this image is projected onto the state of bed-wettingcircumcision their parents carried out as well, even if in order to keep the child was already dry beforepositive emotion intact.<ref name=The father wants to be a "Levy1945good"/>* Circumcised males who become fathers frequently manifest [[adamant father syndrome]]. 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 [[Intact Americacircumcised]] (2019) called circumcision as an adverse childhood experience,well.<ref name-"bollinger2019">{{REFdocument |title=Child genital cutting as an adverse childhood experience |url=http:VanderKolkBA 1989}}<//adversechildhoodexperiences.net/CGC_as_an_ACE.pdfref><ref>{{REFjournal |last=BollingerGoldman |firstinit=DanR |author-link=Dan BollingerRonald Goldman |last2url=Chapinhttps://www.cirp.org/library/psych/goldman1/ |first2title=GeorganneThe psychological impact of circumcision |author2-linkjournal=Georganne ChapinBJU Int |publisherdate=Intact America1999 |locationvolume=Tarrytown83 |formatissue=PDFSuppl. 1 |datepages=201993-08103 |accessdate=20212019-1110-0212

 == Complications ===== Pain ===In * If the past, advocates of circumcision claimed that a newborn child's nerve system was not yet fully developed, and that as a result[[circumcised]] male feels incomplete, or due to the child felt no missing [[painforeskin]] during the circumcision procedure. Anand & Hickey (1987) have shown that newborn children do in fact feel disadvantaged compared to [[painintact]]males, an inferiority complex and more acutely than adults[[depression]] may occur.This can be accompanied by conscious recognition of his own incompleteness, or the deficiency may remain completely subconscious<ref name="anand-hickey1987">{{REFjournal |last=AnandRhinehart |firstinit= |author-link= |last2=Hickey |first2= |author2-link= |etal=no |title=Pain and its effects in the human neonate and fetus |trans-title= |language= |journal=New Engl J Med |location= |date=1987-11-19 |volume=317 |issue=21 |pages=1321-9 |url=httphttps://www.cirp.org/library/painpsych/anandrhinehart1/ |quotetitle= |pubmedID=3317037 |pubmedCID= |DOI= |accessdate=2019-11-08}}</ref> This has led American health associations to recommend doctors take measures to reduce the pain of Neonatal circumcision in infants. The [http://www.cirp.org/library/statements/aap1999/|AAP Circumcision Policy Statement] (1999) states quite clearly that ''"There is considerable evidence that newborns who are [[circumcised]] without analgesia experience pain and physiologic stress"''. Furthermore, the pain is quite severe, and requires injections for proper pain management. Sucrose and Acetaminophen ''"cannot be recommended as the sole method of analgesia"''. Topical cream is no longer thought sufficient as ''"the analgesic effect is limited during the phases associated with extensive tissue trauma such as...tightening of the clamp"''.<ref>{{REFjournal |last= |first= |title=American Academy of Pediatrics: Circumcision Policy Statement; Task Force on Circumcisionreconsidered |journal=PediatricsTransactional Analysis J |date=1999-03 |volume=10329

|pages=686215-9321 |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://pediatricswww.aappublicationscirp.org/contentlibrary/103psych/3cansever/686#sec |title=Psychological effects of circumcision |journal=Brit. J. Med. Psychol |volume=38 |pages=321-931 |accessdate=2019-1110-2612}}</ref>* Fear of being alone or darkness.<ref name="Levy1945">{{REFjournal |last=Levy |first=David M. |init=DM |url=https://www.cirp.org/library/psych/levy1/ |title=Psychic trauma of operations in children; and a noteon combat neurosis |journal=American Journal of Diseases of Children |volume=69 |date=1945 |pages=7-25 |accessdate=Statement Reaffirmed Sept. 1, 20052019-10-12

The [[AAFPIntact America]] (20022019) states quite simply in their called circumcision an [http://www.cirp.org/library/statements/aafp2002/[Adverse Childhood Experiences (ACEs)| position paperadverse childhood experience]], ''<ref name-"Newborns experience pain during circumcisionbollinger2019".''<ref>{{REFwebREFdocument |title=Circumcision: Position Paper on Neonatal Circumcision. Board Approved: August 2007 Reaffirmed |website=Official American Academy of Family Physicians WebsiteChild genital cutting as an adverse childhood experience |url=http://wwwadversechildhoodexperiences.aafp.orgnet/online/en/home/clinical/clinicalrecs/children/circumcisionCGC_as_an_ACE.htmlpdf |last=Bollinger |accessdatefirst=2011Dan |author-05-02link=Dan Bollinger}}</ref> This is not a debatable fact, and yet, it is not widely accepted, even by some doctors. It might be hard for some doctors to accept, as they may have been taught that the infant does not feel [[pain]], and may have performed countless circumcisions with this idea. Usage of anesthesia for infant circumcision is still by no means the rule. |last2=Chapin |first2=GeorgannePenile injections of anesthetic are now recommended by all of the major medical institutions. In their [http://www.ama |author2-assn.org/ama/no-index/about-ama/13585.shtml Report 10 of the Council on Scientific Affairs], the AMA states ''"When the decision is made to proceed with circumcision, local anesthesia should be provided for the procedure. Ring block or dorsal penile blocks [injections] are most effective. [[EMLA]] cream has limited utility"''. Alarmingly, ''"Despite the clear evidence that newborn males generate brisk pain responses during circumcision, a recent survey of residency training programs found that 26% of programs that taught circumcision provided no instruction on the use of local anesthesia". The AMA reports that "Of physicians performing circumcision, 45% use anesthesia, 71% of pediatricians, 56% of family practitioners, and 25% of obstetricians"''.<ref>{{REFweblink=Georganne Chapin |publisher=Intact America |titlelocation=Report 10 of the Council on Scientific Affairs (I-99): Neonatal CircumcisionTarrytown |websiteformat=American Medical Association Official WebsitePDF |urldate=http://www.ama2019-assn.org/ama/no-index/about-ama/13585.shtml08 |accessdate=20112021-0511-0402

The AAP's [http://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/pages/Where-We-Stand-== Complications ===== Possible operative and postoperative complications ===Circumcisionis surgery.aspx Heatlhy Children website Surgical complications of circumcision generally may be classified as [[Bleeding| hemorrhage] suggests ''"Your pediatrician (], [[infection]], or your obstetrician) should discuss surgical misadventure up to and including loss of the forms of analgesia that are availablepenis and [[death]].<ref name="deacon2022"''./><refname="williams-kapilla1993">{{REFwebREFjournal |last=Williams |init=N |author-link= |last2=Kapilla |init2=L |author2-link= |etal=no |title=Where We Stand: CircumcisionComplications of circumcision |trans-title= |language= |journal=Brit J Surg |publisherlocation=[[AAP]] |date=20111993-0310 |volume=80 |issue=10 |pages=1231-236 |url=httphttps://www.healthychildrencirp.org/English/ages-stageslibrary/prenatalcomplications/decisionswilliams-to-makekapila/pages |quote= |pubmedID=8242285 |pubmedCID= |DOI=10.1002/Where-We-Stand-Circumcisionbjs.aspx1800801005 |accessdate=2019-1011-1227}}</ref> Be that as it may, few forms of analgesia are recommended. There are basically two types of injections to choose from, and the website does not go into the difference between a 'dorsal nerve block' and a 'ring block' injection.

Given what * 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 known from aforementioned official documents, often insufficient for the AAP website may be more informative and effective if it would say ''"Make sure your doctor knows operation. Even in conjunction with regional anaesthesia of the ineffectiveness dorsal nerve of anything short of local anesthesia, and make sure your baby is given an injection. This is your responsibilitythe [[penis]], because your doctor may or may not be up to date on the latest understandings rate of infant sensitivity failure to pain during circumcisionprovide sufficient anaesthetic even for experienced anaesthetists is still 5-10%."'' The AAP may general anaesthesia that would be holding backneeded for newborns, however, perhaps because this would upset poses significant risks for the doctor/parent power relationshipchild, and may cause too much questioning of doctors , therefore, is only likely to be used in generalemergencies. One may not expect A surgical operation without proper [[pain]] control can lead to find this kind the development of advice on such a website, and yet, anything less than this is a dangerously weak statement. To control specific pain, some physicians that circumcise use Tylenol, sugar,memory<ref>{{REFweb |quote=To calm the baby during the procedure, a sugar filled gauze pacifier soaked with sweet juice is used, and soothing music is played in the room. |url=http://www.pollockclinicsspiegel.comde/circumcisionspiegel/vorab/circumcisionexperte-warnt-rituelle-beschneidung-veraendert-das-gehirn-der-kinder-a-guide849534.html |title=ParentsKinderschmerz-Experte warnt: Rituelle Beschneidung verändert das Gehirn der Kinder |trans-title=Children' Guide to Circumcisions pain expert warns: Ritual circumcision changes the brain of children |language=German |last=Prof. Dr. med. Boris Zernikow

|publisher=Spiegel Online |website= |date=2012-08-12 |accessdate=20112019-0410-0811 |format= |quote=}}</ref>. In unsedated and partially sedated infants increased secretion of the stress hormone cortisol could be observed for months after the operation. Overall, their pain threshold was lower and the risk of chronic pain increased. Regardless of these findings, infant circumcisions with insufficient or no anaesthetic are still common practice<ref>{{REFwebREFjournal |quotelast=During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions.Garry |urlinit=http://www.pollockclinics.com/circumcision/circumcision-before.htmlT |title=Before the Circumcision: a survey of fees and practices |lastjournal=OBG Management |date=1994 |firstvolume=October |publisherissue= |datepages=201134-04-086 |url= |accessdate=2011-04-08}}</ref> a topical cream,<ref>{{REFwebREFjournal |last=Howard |quoteinit=Then in our office, he will have topical anesthetic applied to his penis.CR |urllast2=http://www.pollockclinics.com/circumcision/circumcision-before.htmlHoward |titleinit2=Before the CircumcisionFM |lastlast3=Garfunkel |firstinit3=LC |publisherlast4=de Blieck |dateinit4=2011-04-08EA |accessdatelast5=2011-04-08Weitzman}}</ref> and/or a local anaesthetic injection called a dorsal penile ring block.<ref>{{REFweb |init5=M |quotetitle=We use extensive Neonatal circumcision and pain control methods including Tylenol, a sugar solution (to reduce pain perceptions), a topical freezing cream, and a local anesthetic injection.relief: current training practices |urljournal=http://www.pollockclinics.com/circumcision/circumcision-guide.htmlPediatrics |titledate=Parents' Guide to Circumcision1998 |lastvolume=101 |firstissue= |publisherpages=423-8 |dateurl= |accessdate=2011-04-08}}</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 |last=TaeuschStang |firstinit=H. WilliamHJ |initlast2=HWSnellman |last2init2=MartinezLW |first2title=Alma M.Circumcision practice patterns in the United States |init2journal=AMPediatrics |last3date=Partridge1998 |first3volume=J. Colin101 |init3issue=JCe5 |last4pages=Sniderman |first4url=Susan |init4accessdate=S |last5note=ArmstrongLink to [[AAP]] website}}</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-Wellsto 4-fold increase in cortisol levels, which equals a state of severe [[shock]].<ref>{{REFjournal |last=Gunnar |init=MR |last2=Fisch |first5init2=JenniferRO |init5last3=JKorsvik |last6init3=Fuentes-AfflickS |first6last4=ElenaDonhowe |init6init4=EJM |title=Pain During Mogen or Plastibell CircumcisionThe effects of circumcision on serum cortisol and behavior |journal=Journal of PerinatologyPsychoneuroendocrinology |date=1981 |volume=226

|pages=214269-875 |url=httphttps://www.naturecirp.comorg/jp/journal/v22/n3/fulllibrary/7210653a.html |quote=...more than half of the study group had what we considered excessive pain/discomfort over the course of the entire procedure. |pubmedID= |pubmedCID= |DOI= |note=Aprilgunnar/May 2002 |date=2002-04 |accessdate=20112019-0411-0826}}</ref>* Postoperative wound pain, in the case of children's circumcisions conceivably worsened by the forceful breaking of the preputial adhesions.* 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 name="Clinical Pediatrics August 1986">{{REFjournalREFbook |last=Williamson |first=Paul S. |inityear=PS2000 |last2title=EvansPaediatric Handbook |first2url=Nolan Donovan |init2work=ND |titleeditors=Neonatal Cortisol Response to Circumcision with AnesthesiaSmart J, Nolan T. |journaledition=Clinical Pediatrics6 |volume=25 |issuechapter=8 |pagespage=412-682 |urllocation=http://cpj.sagepub.com/content/25/8/412.abstract {{AUSC|quote=The adrenal cortisol response to surgery was not significantly reduced by the administration of lidocaine.VIC}}, Australia |pubmedIDpublisher=Blackwell Science Asia |pubmedCIDisbn= |DOIquote= |dateaccessdate=1986-08 |accessdatenote=2011-04-08}}</ref> During circumcision, somp physicians give children sugar pacifiers to "reduce the perception of pain",<ref>{{REFwebREFdocument |quotetitle=During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions.Autopsy of Demetrius Manker |url=http://www.pollockclinics.com/circumcision/circumcision-before.html |titlecontribution=Before the CircumcisionCase 93-1711 |last=Wetli |first=CV |publisher=Miami: Dade County Medical Examiner Department |format= |date=20111993-0406-0823 |accessdate=2011-04-08}}</ref> but in at least one study, data shows that giving sugar to a child doesn't help to reduce the perception of pain in the child.<ref name="Lancet, The 2010-10-09">{{REFjournal |last=Slater |first=RebeccahHiss |init=RJ |first2last2=LauraHorowitz |init2=LA |last2last3=Cornelissen |first3=LorenzoKahana |init3=LT |last3title=FabriziFatal haemorrhage following male ritual circumcision |first4=Debbie |init4=D |last4=Patten |first5=Jan |init5journal=JClin Forensic Med |last5date=Yoxen2000 |first6volume=Alan7 |init6issue=A |last6pages=Worley32-4 |first7url=Stewarthttps://www.cirp.org/library/death/hiss1/ |init7accessdate=S2019-11-06 |last7=Boyd}}</ref><ref>{{REFdocument |first8title=JudithJudgement of inquiry into the death of McWillis, Ryleigh Roman Bryan |init8url=Jhttp://www.circumstitions.com/death-exsang.html |last8contribution=Meek |first9last=MariaNewell |init9first=MTEC |last9publisher=ProfBurnaby, B.C.: B.C. FitzgeraldCoroner's Service |titleformat=Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial |journaldate=The Lancet2004-01-19 |volumeaccessdate=3762019-11-26}}</ref> |issue=9748* Post operative [[lymphoedema]]. * Postoperative [[Infection|pages=1225-32infections]]. This includes both local infections, which can be treated with local therapy, and systemic infections, requiring systemic antibiotic treatment.<ref>{{REFconference |urllast=http://wwwDr.thelancetmed.com/journals/lancet/article/PIIS0140-6736%2810%2961303-7/fulltextHartmann |quotefirst=Our data suggest that oral sucrose does not significantly affect activity in neonatal brain or spinal cord nociceptive circuits, and therefore might not be an effective analgesic drug. The ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief.Wolfgang |pubmedIDurl= |pubmedCIDplace=Rechtsausschuss des Bundestages [Legal Committee of the Bundestag] (German) |DOItitle=Stellungnahme zur Anhörung am 26. November 2012 [Opinion on the hearing on 26 November 2012] (German) |date=20102012-1011-0926 |accessdate=2011-04-08}}</ref> Post-operative pain and the pain the child must endure during recovery is hardly, if ever, addressed by professionals. It has been shown that an infant's response to * [[painWound dehiscence]] can be altered for years as a consequence of circumcision.<ref>{{TaddioA etal 1995}}</ref><ref>{{TaddioA KatzJ IlersichAL KorenG 1997}}</ref> {{Box|Boxtext=<big><b>However, none meaning the separation of the above three procedures totally eliminate pain. A baby boy will still experience some pain despite any edges of those analgesic proceduresthe wound or the tissue after suturing. Prevention * Adhesion between the surface or rim of the [[Glans penis|glans]] with the neighbouring [[penile skin]], causing [[painskin]] requires protecting pockets and bridges, as well as visually unpleasant results like uneven scars, which make a boy from elective neonatal nonre-therapeutic circumcisionnecessary. Only boys who are protected from the medically unnecessary circumcision surgery experience no pain or * Postoperative [[traumaphimosis]]: a phimotic ring can develop during scarring, which makes a re-circumcision necessary.</b></big>}} === Sexual effects === Circumcision and frenectomy remove tissues with heightened erogenous sensitivity. Boyle According to a study by Blalock et al. (2002) wrote, "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings&mdash;many of which are lost to circumcision."<ref>{{REFjournal |last=BoyleBlalock |firstinit=Gregory J.HJ |initlast2=GJVemulakonda |author-linkinit2=Gregory BoyleV |first2last3=Gillian A.Ritchey |init3=ML |init2last4=GARibbeck |last2init4=BensleyM |title=Adverse Sexual and Psychological Effects Outpatient management of Male Infant Circumcision[[phimosis]] Following newborn circumcision |journal=Psychological reportsJ Urol |date=2003 |volume=88169 |issue=3, Part 26 |pages=1105–62332-4 |url=httphttps://www.cirp.org/library/psychcomplications/boyle5blalock1/ |quoteaccessdate=2019-11-26}}</ref>, the prevalence is 2.9%, according to Leitch<ref>{{REFjournal |pubmedIDlast=11597060Leitch |pubmedCIDinit=IOW |DOItitle=10.1046/j.1464Circumcision -410x.1999.0830s1085.xa continuing enigma |journal=Aust Paediatr J |date=July 20011970 |volume=6 |issue= |pages=59-65 |url=https://www.cirp.org/library/general/leitch1/ |accessdate=2019-12-15}}</ref> They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well5.5%." The * [[amputationSudden Infant Death Syndrome]] (SIDS).* Knot formation of the prepuce results veins. If the dorsal vein, which originates in the loss tip of the majority [[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 finethe [[penis]] (micro-touch neuroreceptors found in the penis) and induratio [[penis]]plastica (skewed penis).* Medical malpractice can also not be ruled out. Injuries, leaving only partly or entirely severing the uninhibited protopathic sensibility of [[Glans penis|glans]] or the artificially externalized [[glans penis]]can occur.* In rare cases, [[necrosis]], gangrene, ischaemia, keloid formation, and circulatory problems may also occur. The imbalance caused * When the circumcision is followed by not having the input ultra-orthodox Jewish ritual of Metzitzah B'Peh (which consists of sucking blood from the now ablated fine-touch receptors may be wound with the mouth), there is a leading cause risk of the changes in sexual behavior noted in infection with [[herpes]] simplex type 1, which can lead to brain damage or [[circumciseddeath]] human males.<ref>{{REFjournal |last=Van Howe |init=RS |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=1052-7REFweb |url=http://www.ncbinytimes.nlm.nih.govcom/2012/03/08/pubmednyregion/9218663 |quoteinfants-death-renews-debate-over-a-circumcision-ritual.html?_r=0 |pubmedIDtitle=9218663Baby’s Death Renews Debate Over a Circumcision Ritual |pubmedCIDlast=Robbins |DOIfirst=Liz |date=19972012-0403-0207 |accessdate=2019-10-11

A study in 2010 estimated approximately 117 neonatal circumcision-related [[Death| 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

Human babies, because they are not yet in possession of language, are incapable of giving or refusing consent for being to be [[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

}}</ref> Parental consent is required.<ref>See, e.g., Shephard and Shephard, ''The Complete Guide'', p. 125.</ref> A statement published by the [[American Academy of Pediatrics ]] in 1999 declares claimed that "parents should determine what is in the best interest of the child... It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in additions to the medical factors, when making a decision."<ref>Lannon and Bailey, "Circumcision Policy Statement," p. 691.</ref> however surrogate consent for non-therapeutic circumcision is now viewed as unethical. In the [[United Kingdom]], where non-therapeutic circumcision has now become far less prevalent than in the [[United States]], a the written consent of both parents is required, if a physician is to perform a non-therapeutic circumcision of a child.<ref>{{REFjournal

|url=httphttps://www.cirp.org/library/legal/Re_J/2000.html

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"/> 

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Two ethicists, Myers & Earp (2020), have conducted a detailed review and analysis of the claimed medical benefits of ''non-therapeutic '' [[circumcision]]. They have determined that than the alleged benefits are not material, so they do not support granting of consent by a surrogate. In other words, ''Non-therapeutic'' circumcision is not truly healthcare. Moreover, they comment that even the most perfectly executed surgery produces [[trauma]] and harm to the patient. Circumcision also produces tissue loss and loss of function, therefore, circumcision should be performed only after the individual reaches the age of consent. <u>Consent by a surrogate for a ''non-therapeutic'' circumcision of a minor child is an unethical practice.</u><ref name="myers2020">{{REFjournal

|url=httphttps://www.cirp.org/library/anatomy/garcia/

|title=What is the medical evidence on non-therapeutic child circumcision? |trans-title= |language= |journal= Int J Impot Res |location= |date=2022-01-08 |volume= |issue= |article= |page= |pages= |url=https://www.nature.com/articles/s41443-021-00502-y |archived= |quote= |pubmedID=34997197 |pubmedCID= |DOI=10.1038/s41443-021-00502-y |accessdate=2023-04-30}}* {{REFweb |url=https://intactamerica.org/pros-and-cons-of-circumcision/ |title=Pros and Cons of Circumcision (Spoiler: You’ve Been Lied to) |last=Garrett |first= |init=CJ |publisher=Intact America |date=2023-11-10 |accessdate=2024-03-22}}* {{REFweb |url=https://intactamerica.org/groups-who-pressure-you-to-circumcise/ |title=The 4 Authority Figures and Groups Who Will Pressure You to Circumcise (and What You Can Do) |last=Anonymous |first= |init= |publisher=Intact America |date=2024-01-24 |accessdate=2024-01-27}}* {{REFweb |url=https://intactamerica.org/keeping-your-sons-penis-intact/ |title=Keeping Your Son’s Penis Intact: A Guide for Parents |last=Anonymous |first= |init= |publisher=Intact America |date=2024-01-24 |accessdate=2024-01-29}}* {{REFweb |url=https://intactamerica.org/timeline-of-circumcision-suffering/ |title=A Timeline of Circumcision Suffering: A Detailed Look |last=Anonymous |first= |init= |publisher=Intact America |date=2024-02-02 |accessdate=2024-02-09}}{{REF}}   [[Category:Circumcision]][[Category:Genital mutilation]][[Category:Body modification]][[Category:Genital surgery]][[Category:Islam]][[Category:Judaism]][[Category:Male circumcision]][[Category:Parental information]][[Category:Penile surgery]][[Category:Medical term]][[Category:Male genital mutilation]]