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'''Adolescent and adult circumcision''' is rare when compared to the millions upon millions of medically-unnecessary, non-therapeutic [[Circumcision| circumcisions ]] of boys that are carried out in Islamic [[Islam]]ic nations, [[Israel]], the [[United States]], and elsewhere, however they are promoted by a [[medical trade association]] and its members.
[[Rosemary Romberg]] commented on adult circumcision in the [[United States]]:
<blockquote>
<i>In the United States doctors tend to consider the [[foreskin ]] as something "dispensible."
…
It is difficult to ascertain the true percentage of actual need for adult circumcision among [[intact ]] males. In a circumcision-oriented society such as ours many doctors prescribe the operation for conditions which could be resolved, often easily, without resort to surgery.…</i><ref>{{REFbook
|last=Romberg
|first=Rosemary
==Consent==
Male [[circumcision ]] is an ''elective'' surgical [[amputation]] of the [[foreskin]] part of the [[penis]]. Legally, the patient or his surrogate must grant [[Informed consent| ''informed'' consent]] before the surgery can be performed. A surrogate's powers are limited to granting consent for medically-indicated and necessary surgerydiagnosis and treatment of existing disease.<ref name="myers2020">{{REFjournal
|last=Myers
|first=
|last=Masood
|init=S
|last2=Patel
|first2=
|init2=HRH
|author2-link=
|last3=Himpson
|first3=
|init3=RC
|author3-link=
|etal=yes
|title=Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly?
|issue=1
|pages=62-6
|url=https://www.kargercirp.comorg/Articlelibrary/Abstractsex_function/masood1/85930
|pubmedID=16037710
|pubmedCID=
}}</ref> which would be lost through [[amputation]] if consent should be granted.
[[Issues_with_American_urologists_and_the_practice_of_male_circumcision| Urologic surgeons ]] in the [[United States]] derive a substantial fee from the performance of a [[circumcision]], so some may have a [[bias]] in favor of circumcision and [[Issues_with_American_urologists_and_the_practice_of_male_circumcision#Issues_with_care_of_adult_intact_males| may inappropriately recommend adult circumcision to patients]] when a conservative treatment would be satisfactory or even when no treatment is necessary. Patients should be wary and do their own research before granting consent for an <u>irreversible</u> [[circumcision]]. Milos (2022) advises:<blockquote> * A penis without a foreskin doesn’t work as nature intended for its owner or his sexual partner.* Amputating the foreskin eliminates the penis’ “command and control” nerve center, the normal skin system that allows for comfortable erections and the gliding mechanism necessary for sensory pleasure, foreplay, and normal intromission (entry during intercourse).* Circumcision amputates the tens of thousands of specialized, erogenous nerve endings that signal to the man where he is in relation to the orgasmic threshold.* It denudes and exposes the glans (head of the penis), causing it to become dry, calloused, and desensitized. Circumcised men talk about becoming impotent during their 50s or 60s while intact males tell me the urge doesn’t come around as often but their sensitivity hasn’t diminished.* Circumcision makes the penis smaller, too.<ref name="milos2022-05-02">{{REFweb |url=https://intactamerica.org/ask-marilyn-a-19-year-old-considers-circumcision/ |title=Ask Marilyn – 19-year-old Considers Circumcision |last=Milos |first= |init=MF |author-link=Marilyn Fayre Milos |publisher=Intact America |date=2022-05-02 |accessdate=2024-10-24}}</ref></blockquote>
==Reasons for circumcision==
All circumcisions are injurious because they amputate a [http://www.intactaus.org/information/functionsoftheforeskin/ multi-functional body part], but in rare cases the benefit obtained by removing a deformed, diseased, or damaged foreskin may be of more value than the amputated [[foreskin]].
* Deformed foreskins — The common type of deformed foreskin is the narrow non-retractable foreskin of [[phimosis]]. Circumcision was the traditional treatment for phimosis, however circumcision is less performed today because newer conservative treatments are now available that preserve the [[foreskin ]] and its many useful functions.
* Diseased foreskins — Diseases for which circumcision may be indicated include [[Penile cancer|malignant tumor]],[[Balanitis xerotica obliterans| lichen sclerosis]], recurrent yeast infection in diabetic males (after conservative treatment fails),<ref name="verma2011">{{REFjournal
}}</ref> recurrent [[balanoposthitis]], and gangrene.
* Damaged foreskins — This includes any type of physical [[trauma ]] and injury that is beyond surgical repair. Zipper injury does not require circumcision.<ref name="flowerdew1977">{{REFjournal
|last=Flowerdew
|init=R
===Dorsal slit===
[[Dorsal slit]] is a cut on the top of the [[foreskin ]] to widen the opening, allowing the foreskin to retract and fall below the shaft of the [[penis]]. Dorsal slit does not cut around and does not remove tissue, so it is not a true circumcision. Dorsal slit is a first step in the circumcision of a phimotic foreskin by the sleeve technique.<ref name="holman1999" />
===Sleeve technique===
They reported the indications for adult circumcision are uncommon. The most common is [[phimosis]].
They recommended [[dorsal penile nerve block ]] or [[ring block ]] local anesthesia for the [[pain]] of circumcision surgery.
[[Informed consent]] must be obtained. They stated:
<blockquote>
Specifically, the patient should be told about the risks of [[bleeding]], hematoma formation, [[infection]], inadvertent damage to the [[glans]], removal of too much or too little [[skin]], aesthetically unpleasing results, and a change of sensation during intercourse. The patient should also be informed that, during the postoperative period, [[erection]]s can cause pain and [[Wound dehiscence| disruption of the suture line ]] that may require replacement of the sutures. Full recovery following circumcision generally requires four to six weeks of abstinence from all genital stimulation and sexual activity.<ref name="holman1999" />
</blockquote>
Recovery from an adult circumcision is frequently said to be six weeks.
===Complications===
Erections tend to be painful and may cause [[wound dehiscence]].<ref name="wang2023">{{REFjournal
|last=Wang
|first=
}}</ref>
There is danger of [[infection]] until the [[circumcision ]] wound heals closed.<ref name="wang2023" />
===Lymphoedema===
[[Lymphoedema]] of the [[penis]] is a normal and expected [[complication]] of male adult circumcision due to the adverse effect on blood circulation. Ferhatoglu et al. (2019) reported edema in 108 of 198 patients or 54.5 percent.<ref>{{REFjournal
Money & Davison thought the loss of sensation is "secondary to diminished sensory input from stretch receptors in the less mobile [[shaft skin|skin of the shaft]] of the penis, as well as loss of foreskin stretch receptors".<ref name="money1983" />
Denniston (2004) carried out a survey of 38 adult males who were [[circumcised ]] at least 2 years after they commenced sexual intercourse. Thirteen men felt that sexual intercourse was better after circumcision, but 22 felt that intercourse was worse and would not have the circumcision again, because of loss of sexual pleasure.<ref>{{REFjournal
|last=Denniston
|first=George C.
Masood et al. (2005) suggested "before circumcision, men should be warned of the long-term consequences (penile sensations and effect on erectile function) as well as be talked through the more traditional subjects (peri-operative complications)."<ref name="masood2005" />
Kim & Pang (2007) studied the effect of adult circumcision on 138 males in [[South Korea]]. They concluded:<blockquote>There were no significant differences in sexual drive, [[erection]], [[ejaculation]], and ejaculation latency time between [[circumcised ]] and [[uncircumcised ]] men. Masturbatory pleasure decreased after circumcision in 48% of the respondents, while 8% reported increased pleasure. Masturbatory difficulty increased after circumcision in 63% of the respondents but was easier in 37%. About 6% answered that their sex lives improved, while 20% reported a worse sex life after circumcision.<ref>{{REFjournal |last=Kim |first=DaiSik |init= |author-link= |last2=Pang |first2=Myung-Geol |init2= |author2-link= |etal=no |title=The effect of male circumcision on sexuality |trans-title= |language= |journal=BJU Int |location= |date=KimDS PangMG 2007-03 |volume=99 |issue=3 |article= |page=619-22 |pages= |url=https://www.researchgate.net/profile/Mg-Pang/publication/6643531_The_effect_of_male_circumcision_on_sexuality/links/5a13976a4585158aa3e63676/The-effect-of-male-circumcision-on-sexuality.pdf |pubmedID=17155977 |pubmedCID= |DOI=10.1111/j.1464-410X.2006.06646.x |accessdate=}}</ref>
</blockquote>
===Other adverse effects===
# Circumcision causes both physical and psychic [[trauma]].
# Circumcision severs blood vessels and disrupts blood circulation in the [[penis]]. This frequently causes [[lymphoedema]] and [[erection]] difficulties.
# Circumcision invariably excises the [[ridged band]].
# Circumcision is a surgical [[amputation]] of functional tissue. The various [https://foreskinfunction.org/ functions] cease to operate. If the patient does not like the results, it cannot be reversed or undone.
# Recovery from adolescent or adult circumcision is slow and painful. [[Erection]]s are painful because the [[skin]] is stretched and the sutures are stressed. [[Wound dehiscence]] may occur.
# The exposed [[glans penis]] will protect itself from friction by developing a layer of [[keratin]] and become cracked and hardened. The [[keratinization]] of the [[glans penis]] will reduce its sensitivity.
# There are possible [[Psychological issues of male circumcision| emotional issues]] secondary to a partial loss of the [[penis]] through circumcision.
==Financial considerations==
Medical insurance policies vary with the provider of insurance. Most will pay for circumcision only if it is done to treat a medical condition. When circumcision is carried out for cosmetic reasons or personal desire, it is very unlikely that medical insurance would pay. The cost of an adult circumcision would include a facility fee, a surgeon's fee, an anesthesiologist's fee, and pre-operative and post-operative care. Garrett (2024) says the cost may range from $1,650 to $6,450.<ref name="garrett2024-03-07">{{REFweb
|url=https://intactamerica.org/adult-circumcision-cost/
|title=Adult Circumcision Cost: The Profit Motives and Hidden Toll
|last=Garrett
|first=Connor
|init=
|author-link=Connor Judson Garrett
|publisher=Intact America
|date=2024-03-07
|accessdate=2024-05-15
}}</ref>
==Warning==
==== Circumcised at 18 ====
<youtube>v=NAHGFx95D80</youtube>
====Circumcised at 46====
<youtube>v=pZ3n8CtcmRY</youtube>
==== Why I Regret Getting Circumcised At 19 ====
==== Got Circumcised as an Adult (Just saw the Penn & Teller episode) ====
<youtube>v=QtN7JmMUfZE</youtube>
==== Circumcision Care - After Circumcision - 5 Post Circumcision Surgery Recovery Tips!====
<youtube>v=xdrvq_10vTM</youtube>
== Rite of passage ==
=== Ulwaluko ===
Traditional [[Circumcision]] and Initiation into Manhood (ulwaluko) is an ancient initiation ritual practiced by the amaXhosa of the Eastern Cape region Province of [[South Africa]]. The ritual is traditionally intended as a teaching institution to prepare boys for the responsibilities of manhood. The principles that lie at the very core of the ritual are respect for self (including self control and integrity), respect for family (not to bring shame to them), and respect for community (to protect them from harm).
Every single initiation season the media writes about complications accompanying the ritual of Traditional [[Circumcision]] and Initiation into Manhood ''(ulwaluko)''. The magnitude of these complications is horrific: From 1995 till 2014, 919 boys have lost their lives in the mountains and hills of the Eastern Cape. Many others were mutilated or even lost their manhood. [[Ulwaluko|Many of these mutilations are documented (graphic content).]]
===Tuli===
[[Tuli]] is a [[genital mutilation ]] rite of boys and adolescents practiced in the Philippine Islands.
{{SEEALSO}}
* [[Circumcision methods]]
* [[Circumcision scar]]
* [[Development of retractable foreskin]]
* [[Doctors Cut Off Man’s Penis During Circumcision]]
* [[Ischemia of the glans penis]]
* [[Issues with American urologists and the practice of male circumcision]]
* [[Penis]]
* [[Phimosis]]
* [[Phimosis#Preputioplasty| Preputioplasty]]
* [[Stretching]]
* [[Trauma]]
{{LINKS}}
====Medical circumcision====* {{REFwebREFjournal |urllast=http://www.circumstitions.com/Resent.htmlHolman |title=The tip of the iceberg: Men who resent being circumcised |lastfirst=Young |firstinit=HughJR
|author-link=
|publisherlast2=CircumstitionsStuessi |websitefirst2= |init2=KA |author2-link= |etal=no |title=Adult circumcision |trans-title= |language= |journal=American Family Physician |location= |date=1999-03-15 |season= |volume=59 |issue=6 |article= |accessdatepage=2020 |pages=1514-12-2918 |url=https://www.aafp.org/pubs/afp/issues/1999/0315/p1514.html |formatarchived=
|quote=
|pubmedID=10193593
|accessdate=2024-05-03
}}
* {{REFjournal
}}
* {{REFweb
|url=httphttps://wwwdavidlouis77.intactauswordpress.orgcom/2010/men05/08/adult-circumcisedcircumcision-my-experience-2-years-on/comment-aspage-adults4/#comment-24567 |title=Men Circumcised As AdultsAdult Circumcision: My experience two years on. |last=Louis |first=David |author-link= |publisher=Intact AustraliaDavidLouis77's Blog |website=wordpress.com |date=20172010-05-0308 |accessdate=2020-12-29 |format= |quote=}}* {{REFweb |url=http://www.circumstitions.com/Resent.html |title=The tip of the iceberg: Men who resent being circumcised |last=Young |first=Hugh |author-01link= |publisher=Circumstitions |website= |date= |accessdate=2020-12-2129
|format=
|quote=
}}
* {{REFweb
|url=httpshttp://davidlouis77www.wordpressintactaus.comorg/2010/05/08/adult-circumcision-my-experience-2-yearsmen-on/commentcircumcised-pageas-4adults/#comment-24567 |title=Adult Circumcision: My experience two years on. |last=Louis |first=David |author-link=Men Circumcised As Adults |publisher=DavidLouis77's Blog |website=wordpress.comIntact Australia |date=20102017-0503-0801 |accessdate=2020-12-2921
|format=
|quote=
|date=2017-07-17
|accessdate=2021-02-14
}}
* {{REFdocument
|title=Circumcision (Complete Removal of the Foreskin}
|url=https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Circumcision.pdf
|contribution=
|last=
|first=
|publisher=British Association of Paediatric Surgeons
|format=PDF
|date=2020-12
|accessdate=2024-02-12
}}
* {{REFweb
|journal=Cult Health Sex
|location=
|date=20222021-0501-29
|volume=24
|issue=5
|accessdate=2022-10-14
}}
* NSFW {{REFweb |url=httphttps://wwwintactamerica.ulwaluko.co.zaorg/adult-circumcision-cost/Complications.html |title=UlwalukoAdult Circumcision Cost: ComplicationsThe Profit Motives and Hidden Toll |last=Garrett |first=Connor |author-link=Connor Judson Garrett |init= |publisher=Intact America |date=2024-03-07 |accessdate=20202024-1203-2110
}}
* NSFW {{REFweb |url=httphttps://wwwwikionlymen.ulwaluko.co.zacom/Photos.html?s=circumcision |title=Ulwaluko: PhotosDisadvantages Of Circumcision In Man |last= |first= |init= |author-link= |publisher=Wiki Only Men |date=2021-11-05 |accessdate=20202024-1210-2105
}}
====Traditional circumcision====
* {{NSFW}} [[Ulwaluko]]
{{REF}}
[[Category:Body modification]]
[[Category:Male circumcision]]
[[Category:Male genital mutilation]]
[[Category:Penile surgery]]
[[de:Jugendlichen- und Erwachsenenbeschneidung]]