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}}</ref> [...] The procedure is most often an elective non-therapeutic surgery performed on neonates and children for religious and cultural reasons, but in other cases may be indicated for both therapeutic and prophylactic reasons. It is a 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." (Source: [http://en.wikipedia.org/wiki/Circumcision Wikipedia]) '''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.  With reference to involuntary, non-therapeutic circumcision of children, [[Child Genital Cutting (CGC)]] is a new term that has been introduced to avoid issues associated with more traditional terms.

In the Jewish religion, the tradition of circumcision goes back to a passage in the Book of Genesis (17, 10-14). It is seen as a [[Abrahamic covenant| covenant between God and man]], dating back to the patriarch Abraham.

According to the anthropologist and sociologist Nissan Rubin, the 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 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 that circumcision was necessary, as it diminished sexual desires and reduced the pleasure to a degree just sufficient for mere reproduction.

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

In some cases, circumcision is legitimately indicated; a patient may be suffering recurring infections, and other methods of treatment have failed. In other cases, a patient may be suffering from a severe case of [[phimosis]]. Overall, the actual medical necessity for circumcision is extremely rare. All circumcisions injure the patient by amputating the [[foreskin]] its with many protective, immunological, sensory, and sexual [[Foreskin#Physiological_functions| functions]].  # '''Deformed or malformed foreskin'''. A foreskin so deformed or malformed that it does not function properly may be removed by circumcision. # '''Traumatically injured foreskin'''. A foreskin so traumatically injured foreskin that cannot be surgically repaird is a valid medical reason for circumcision. # '''Diseased foreskin.''' A foreskin that is diseased is a valid indication for cirumcision. Some diseases that qualify are malignancy, lichen sclerosis, yeast infection in men with diabetes, and recurrent posthitis. In such cases, the benefit of removing the problem foreskin may exceed the maleficial results of tissue and function destruction.

The practice of finding prophylactic reasons for infant circumcision started in Germany in the nineteenth century, when Christian non-Jewish Germans criticized the Jewish practice of infant circumcisionas being barbaric, Jewish doctors sprang to the defense of the religious practice by claiming health benefits.<ref name="ephron2001">{{REFbook

}}</ref>, in .  In the 1940s, prostate and tongue cancer as well as STDs. Eugene H. Hand (1949) falsely explains that circumcision somehow protects against venereal diseases and tongue cancer.<ref name="hand1949">{{REFjournal

}}</ref></ref>, in  In the late 1960s it was neuroses. Morris Fishbein (1969) calls for circumcision to prevent nervousness and, of course, [[masturbation]].<ref>{{REFbook

}}</ref></ref>, in  In the 1970s bladder- and rectal cancer. Abraham Ravich (1971) claims that circumcision would prevent bladder cancer and rectal cancer.<ref>{{REFjournal

}}</ref></ref>

Aaron J. Fink (1986) , with no evidence whatsoever, claims that circumcision protects against AIDSfollowed.<ref name="fink1986">{{REFjournal

}}</ref></ref> followed.  Retrospectively, circumcision was always advertised as a cure for whatever disease was in the public spotlight at the time.[[Doctors Opposing Circumcision]] (2016) states:<blockquote>These claims date originally from before the advent of evidence-based medicine, when doctors relied on the opinions of other clinicians to inform their practice, rather than on scientifically collected evidence.<ref name="doc2016">{{REFweb |url=https://www.doctorsopposingcircumcision.org/for-professionals/alleged-medical-benefits/ |title=Alleged Medical Benefits |trans-title= |language= |last= |first= |author-link= |publisher=Doctors Opposing Circumcision |website= |date=2016-05 |accessdate=2019-11-20 |format= |quote=}}</ref></blockquote>

* The studies by Fleiss ''et al.'' (1998) support this.<refname="fleiss-hodges-vanhowe1998">{{REFjournal

}}</ref> support this. According to the [[AAP]], the general sexual behaviour of the male - such as frequent change in partners and the use of condoms - has a much higher impact on sexually transmitted diseases then the circumcision status.<ref>{{REFjournal

A common reason stated for circumcision is the assumption of hygienic benefits. This argument has ''Hygiene'' refers to be viewed in the context of the environment the person in question grows up in. It is commonly known that bad hygienic circumstances, especially insufficient access health and only secondarily to clean drinking water, pose a serious problem. The situation in disaster areas or refugee camps in the so-called third world keep reminding us of thatcleanliness.

One should note that the human foreskin is endowed by nature with [[Foreskin#Immunological_functions| immunological functions]] that serve to protect the human body from disease.<ref name="fleiss-hodges-vanhowe1998" /> The glans penis receives blood through the frenular artery.<ref>{{REFjournal |last=Persad |first=R. |author-link= |last2=Sharma |first2=S. |author2-link= |last3=McTavish |first3=J. |author3-link= |etal=yes |title=Clinical presentation and pathophysiology of meatal stenosis following circumcision |journal=Brit J Urol |date=1995 |volume=75 |issue=1 |pages=91-3 |url=https://www.onlinelibrary.wiley.com/doi/abs/10.1111/j.1464-410X.1995.tb07242.x |quote= |pubmedID=7850308 |pubmedCID= |DOI=10.1111/j.1464-410x.1995.tb07242.x |accessdate=2019-11-26}}</ref> These facts are generally overlooked in arguments for alleged hygienic benefits of circumcision. A common reason stated for circumcision is the assumption of hygienic benefits. This argument has to be viewed in the context of the environment the person in question grows up in. It is commonly known that bad hygienic circumstances, especially insufficient access to clean drinking water, pose a serious problem. The situation in disaster areas or refugee camps in the so-called third world keep reminding us of that. In western industrial nations, however, this problem does not exist, in view of the availability of clean water for daily personal hygiene. If the cleaning of the genitals is performed on a daily basis - and that may be assumed - no pathogens can accumulate under the [[foreskin]]. Cleaning of the [[Glans penis|glans]] and the area underneath the [[foreskin]] is easy - they are simply washed along with the rest of the body, just like the areas between the toes.

Circumcision is surgery. Surgical complications of circumcision generally may be classified as hemorrhage, infection, or surgical misadventure up to and including loss of the penis and [[death]].<ref name="williams-kapilla1993">{{REFjournal |last=Williams |first=N |author-link= |last2=Kapilla |first2=L |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=http://www.cirp.org/library/complications/williams-kapila/ |quote= |pubmedID=8242285 |pubmedCID= |DOI=10.1002/bjs.1800801005 |accessdate=2019-11-27}}</ref>

|url=http://www.cirp.org/library/pain/gunnar/ |accessdate=2019-11-26

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

|url=http://www.circumstitions.com/death-exsang.html

|accessdate=2019-11-26

|url=http://www.cirp.org/library/complications/blalock1/ |accessdate=2019-11-26

|url=http://www.cirp.org/library/general/leitch1/ |accessdate=2019-12-15

* Meatal stenosis* Knot formation of the veins. If the dorsal vein, a pathological narrowing which originates in the tip of the opening [[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 urethra[[Glans penis|glans]] or the [[penis]] can occur.* In rare cases, necrosis, gangrene, ischaemia, which mostly occurs in infancy keloid formation and early childhoodcirculatory problems may also occur. It * When the circumcision is one followed by the ultra-orthodox Jewish ritual of Metzitzah B'Peh (which consists of sucking blood from the most common complications wound with the mouth), there is a risk of infant 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. A study 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> === Physical late effects === * 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 2006 found meatal stenosis exclusively friction and drying out by developing a callus layer. This reduces the sensitivity of the remaining nerves in previously circumcised boysthe [[Glans penis|glans]] gradually over the years. The incidence rate after a circumcision is at approximately 10%study conducted by Sorrells ''et al.''<ref>{{REFjournal |last=Van HoweSorrells |first=RM.SL. |titlelast2=Snyder |first2=J..L. |last3=Reiss |first3=Incidence of meatal stenosis following neonatal circumcision in a primary care settingM.D. |journaletal=Clin Pediatr (Phila)yes |notetitle=JanFine-Feb 2006touch pressure thresholds in the adult [[penis]] |journal=BJU Int |date=2006-012007 |volume=4599 |issue=1 |pages=49864-54869 |url=

}}</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). * Painful tension can occur when there is too little reserve skin left to support a full erection<ref>{{REFjournal |last=StenramTaylor |first=AJ.R. |last2=MalmforsLockwood |first2=GA.P. |last3=OkmianTaylor |first3=LA.J. |title=Circumcision for The prepuce: <q>Specialized mucosa of the [[penis]] and its loss to circumcision</q> |journal=British Journal of Urology |date=1996 |volume=77 |issue= |pages=291-295 |url= |accessdate=}}</ref>. This risk is partly dependent on the anatomy of the [[penis]]. While some [[penis]]es already have the majority of their full size when flaccid ([[Flesh Penis]], or "[[shower]]"), others are rather short when flaccid and double or more their size during an erection ([[Blood Penis]], or "[[grower]]"). Especially in children's circumcision, where the [[phimosispenis]]is not yet fully developed, the amount of reserve skin needed in adulthood cannot be estimated. * Erectile dysfunction: a follow-up studyBoth 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 |first=J. |last2=Davison |first2=J. |title=Adult penile circumcision: Erotosexual and cosmetic sequelae |journal=Scandinavian journal Journal of urology and nephrologySex Research |date=19861983 |volume=2019 |issue=2 |pages=89289-292

=== Physical late effects === * An unavoidable late effect of any circumcision is Orgasm problems: In the permanent loss wake of reduced sexual sensitivity. This is partly , due to the removal loss of sensory tissue. The and gradual keratinization of the surface of the [[foreskinGlans penis|glans]] contains very many nerve endings and touch receptors, which account for orgasm problems may develop with increasing age. In this case, the major part of male sexual sensation. If the arousal created by intercourse or [[foreskinmasturbation]] is removed, they can no longer provide sexual stimulationnot enough to achieve orgasm. It A preliminary stage of this late effect is also partly due the prolonged time circumcised men need to reach an orgasm. This is often fielded as the fact that "cut men have more endurance" argument for circumcision.* Vaginal dryness: Due to the surface loss of the [[Glans penis|glans]] reacts to the missing protection natural gliding action, which comes from friction and drying out by developing a callus layer. This reduces the sensitivity mobility of the remaining nerves in the fore- and shaft skin, a much increased friction between [[Glans penis|glans]] gradually over the yearsand vagina occurs during intercourse. The This can make intercourse painful for both partners and lead to abrasions<ref>{{REFjournal |last=Frisch |first=Morten |author-link=Morten Frisch |first2=Morten |last2=Lindholm |first3=Morten |last3=Grønbæk |title=Male circumcision and sexual function in men and women: a survey-based, cross-sectional study conducted by Sorrells ''et alin Denmark |journal=International Journal of Epidemiology |date=2011-10 |volume=40 |issue=5 |pages=1367-1381 |url= |pubmedID=21672947 |DOI=10.''1093/ije/dyr104 |accessdate=}}</ref><ref>{{REFjournal |last=SorrellsCortés-González |first=M.LJ. |last2=SnyderArratia-Maqueo |first2=J..L. |last3=ReissGómez-Guerra |first3=M.DL. |etal=yes |title=Fine-touch pressure thresholds in the adult [[penis]]Does circumcision has an effect on female's perception of sexual satisfaction? |journal=BJU IntRev Invest Clin |date=20072008 |volume=9960 |issue=3 |pages=864-869227

}}</ref> found a significant reduction of sensitivity The prolonged time it takes circumcised men to touch for circumcised reach orgasm, as well as the often longer and more vigorous thrusting movements - compared to intact [[penis]]es men - play a part in adult malesthis. Other studies revealed that circumcised men use condoms significantly less often than intact men, since they further limit the sexual sensitivity (see above).* Painful tension can occur when there is too little reserve skin left to support a full erection<ref>{{REFjournal |last=TaylorCold |first=C.J.R. |last2=LockwoodTaylor |first2=AJ.P. |last3=Taylor |first3=A.JR. |title=The prepuce: <q>Specialized mucosa of the [[penis]] and its loss to circumcision</q> |journal=British Journal of UrologyBJU Int |date=19961999 |volume=7783 |issue=Suppl. 1 |pages=29134-29544

}}</ref>. This risk is partly dependent on the anatomy of the [[penis]]. While some [[penis]]es already have the majority of their full size when flaccid ([[Flesh Penis]], or "[[shower]]"), others are rather short when flaccid and double or more their size during an erection ([[Blood Penis]], or "[[grower]]"). Especially in children's circumcision, where the [[penis]] is not yet fully developed, the amount of reserve skin needed in adulthood cannot be estimated.* 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=MoneyFink |first=JK.S. |last2=DavisonCarson |first2=JC.C. |last3=DeVellis |first3=R.F. |title=Adult penile circumcisionCircumcision Outcomes Study: Erotosexual Effect on Erectile Function, Penile Sensitivity, Sexual Activity and cosmetic sequelaeSatisfaction |journal=Journal of Sex ResearchJ Urol |date=19832002 |volume=19167 |issue=5 |pages=2892113-2922116

 * Orgasm problems: In the wake [[Lymphoedema]] of reduced sexual sensitivity, due to the loss of sensory tissue penis is a normal and gradual keratinization expected complication of the surface of the male circumcision. * [[Glans penis|glansMeatal stenosis]], orgasm problems may develop with increasing age. In this case, a pathological narrowing of the sexual arousal created by intercourse or [[masturbation]] is not enough to achieve orgasm. A preliminary stage opening of this late effect is the prolonged time circumcised men need to reach an orgasmurethra, which mostly occurs in infancy and early childhood. This It is often fielded as one of the "cut men have more endurance" argument for most common complications of infant circumcision.* Vaginal dryness: Due to the loss of the natural gliding action, which comes A study from the mobility of the fore- and shaft skin, 2006 found meatal stenosis exclusively in previously circumcised boys. The incidence rate after a much increased friction between [[penis]] and vagina occurs during intercoursecircumcision is approximately 10 to 20 percent. This can make intercourse painful for both partners and lead to abrasions<refname="vanhowe2006">{{REFjournal |last=FrischVan Howe |first=MortenR.S. |author-linktitle=Morten FrischIncidence of meatal stenosis following neonatal circumcision in a primary care setting |first2=Morten |last2=Lindholm |first3=Morten |last3journal=GrønbækClin Pediatr (Phila) |titlenote=Male circumcision and sexual function in men and women: a surveyJan-based, cross-sectional study in Denmark |journal=International Journal of EpidemiologyFeb 2006 |date=20112006-1001 |volume=4045 |issue=51 |pages=136749-138154 |url= |pubmedID=21672947 |DOI=10https://www.academia.1093edu/ije6992015/dyr104Incidence_of_Meatal_Stenosis_following_Neonatal_Circumcision_in_a_Primary_Care_Setting |accessdate=2019-12-15

|last=Cortés-GonzálezStenram |first=JA. |last2=Arratia-MaqueoMalmfors |first2=JG. |last3=Gómez-GuerraOkmian

|title=Does circumcision has an effect on female's perception of sexual satisfaction?Circumcision for [[phimosis]]: a follow-up study |journal=Rev Invest ClinScandinavian journal of urology and nephrology |date=20081986 |volume=6020 |issue=32 |pages=22789

|pubmedID=188077353749823

}}</ref> The prolonged time it takes circumcised men to reach orgasm, as well as the often longer and more vigorous thrusting movements - compared to intact men - play a part in this.<ref>{{REFjournal |last=Cold |first=C.J. |last2=Taylor |first2=J.R. |title=The prepuce |journal=BJU Int |date=1999 |volume=83 |issue=Suppl. 1 |pages=34-44REFweb |url= |accessdate=}}<http://ref><ref>{{REFjournal |last=Fink |first=Kemedicine.S. |last2=Carson |first2=C.C. |last3=DeVellis |first3=R.Fmedscape.com/article/1016016-overview |title=Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and SatisfactionMeatal Stenosis |journalpublisher=J UrolMedscape |dateaccessdate=2002 |volume=167 |issue=5 |pages=21132019-10-2116 |url= |accessdate=11}}</ref>

[[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.

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|url=https://pediatrics.aappublications.org/content/103/3/686#sec-9 |accessdate=2019-11-26

The [[AAFP ]] states quite simply in their [[Position Statements on Infant Circumcision|position paper]], ''"Newborns experience pain during circumcision".''<ref>{{REFweb

|title=Pain During Mogen or PlastiBell Plastibell Circumcision

<!--=== United States military ===

}}</ref> This practice was discontinued at least six decades ago.-->

}}</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 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> In the United Kingdom, where routine non-therapeutic circumcision has now become far less prevalent than in the United States, a written consent of both parents is required, if a physician is to perform a non-therapeutic circumcision of a child.<ref>{{REFjournal

|pages=307-314 |url=http://www.cirp.org/library/legal/Re_J/2000.html |accessdate=2019-10-12}}</ref>(The National Health Service does not provide non-therapeutic circumcision.) In recent years, legal writers in several English-speaking countries have been questioning the practice of acceding to parental wishes.<ref>See, e.g., Somerville, "Therapeutic and Non-Therapeutic Medical Procedures"; Poulter, ''English Criminal Law''; 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"/>refer<ref>{{REFweb |quote= |url=http://www.icgi.org/2010/04/infant-circumcision-causes-100-deaths-each-year-in-us |title=Infant circumcision causes 100 deaths each year in US |last=Bollinger |first=Dan |author-link=Dan Bollinger |publisher=International Coalition for Genital Integrity |date=2010-04-26 |accessdate=2019-10-12}}</ref> {{SEEALSO}}* [[Sexual effects of circumcision]]* [[FGM]]* [[MGM]]* [[Risks and complications]]* [[Documented severe complications of circumcision]]* [[Circumcision scar]]* [[Circumpendium]]* [[Human rights]]* [[Ethics of non-therapeutic child circumcision]]* [[Rights situation on circumcision]]* [[Circumcision methods]]* [[Case Histories]]* [[Lymphoedema]]* [[Psychological issues of male circumcision]]