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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.

}}</ref></ref>.

* 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

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> * Intolerance or allergic reactions to the narcotics used.

|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, a pathological narrowing * Knot formation of the opening of veins. If the urethradorsal vein, which mostly occurs originates in infancy the tip of the [[foreskin]], is cut during circumcision without being clamped and early childhoodsutured at its origin separately, it starts to develop new branches over time, which can lead to the development of knots. It is one * Possible deformities due to circumcision include hypoplasia of the most common complications of infant circumcision[[penis]] (micro-penis) and induratio [[penis]] plastica (skewed penis).* Medical malpractice can also not be ruled out. Injuries, partly or entirely severing the [[Glans penis|glans]] or the [[penis]] can occur. A study from 2006 found meatal stenosis exclusively in previously circumcised boys* In rare cases, necrosis, gangrene, ischaemia, keloid formation and circulatory problems may also occur. The incidence rate after a * When the circumcision is at approximately 10%followed by the ultra-orthodox Jewish ritual of Metzitzah B'Peh (which consists of sucking blood from the wound with the mouth), there is a risk of infection with [[herpes]] simplex type 1, which can lead to brain damage or death.<ref>{{REFjournalREFweb |lasturl=Van Howe |first=Rhttp://www.Snytimes.com/2012/03/08/nyregion/infants-death-renews-debate-over-a-circumcision-ritual.html?_r=0 |title=Incidence of meatal stenosis following neonatal circumcision in Baby’s Death Renews Debate Over a primary care settingCircumcision Ritual |journallast=Clin Pediatr (Phila)Robbins |notefirst=Jan-Feb 2006Liz |date=20062012-01 |volume=45 |issue=1 |pages=4903-54 |url=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 friction and drying out by developing a callus layer. This reduces the sensitivity of the remaining nerves in the [[Glans penis|glans]] gradually over the years. The study conducted by Sorrells ''et al.''<ref>{{REFjournal |last=StenramSorrells |first=AM.L. |last2=MalmforsSnyder |first2=GJ..L. |last3=OkmianReiss |first3=LM.D. |etal=yes |title=Circumcision for Fine-touch pressure thresholds in the adult [[phimosispenis]]: a follow-up study |journal=Scandinavian journal of urology and nephrologyBJU Int |date=19862007 |volume=2099 |issue=2 |pages=89864-869

}} </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>{{REFwebREFjournal |urllast=Taylor |first=http://emedicineJ.medscapeR.com/article/1016016-overview |titlelast2=Meatal StenosisLockwood |publisherfirst2=MedscapeA.P. |accessdatelast3=Taylor |first3=2019-10-11A.J.}} |title=The prepuce: </refq>* Knot formation of the veins. If the dorsal vein, which originates in the tip Specialized mucosa of the [[foreskinpenis]], 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 loss to circumcision include hypoplasia of the [[penis]] (micro-penis) and induratio [[penis]] plastica (skewed penis).</q>* Medical malpractice can also not be ruled out. Injuries, partly or entirely severing the [[Glans penis |glans]] or the [[penis]] can occur.* In rare cases, necrosis, gangrene, ischaemia, keloid formation and circulatory problems may also occur.* When the circumcision is followed by the ultra-orthodox Jewish ritual of Metzitzah B'Peh (which consists of sucking blood from the wound with the mouth), there is a risk journal=British Journal of infection with herpes simplex type 1, which can lead to brain damage or death.<ref>{{REFwebUrology |url=http://www.nytimes.com/2012/03/08/nyregion/infants-death-renews-debate-over-a-circumcision-ritual.html?_rdate=01996 |titlevolume=Baby’s Death Renews Debate Over a Circumcision Ritual77 |lastissue=Robbins |firstpages=Liz291-295 |dateurl=2012-03-07 |accessdate=2019-10-11}}</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.

=== Physical late effects === * An unavoidable late effect of any circumcision is Erectile dysfunction: Both the permanent loss of sexual sensitivity. This is partly due damage inflicted to the removal of sensory tissue. The blood vessels in the [[foreskin]] contains very many nerve endings and touch receptors, which account for the major part of male reduced sexual sensation. If the [[foreskin]] is removed, they sensitivity can no longer provide sexual stimulationbe causes for reduced erectile function with advancing age. It is also partly due to the fact that the surface of the [[Glans penis|glans]] reacts to the missing protection from friction and drying out by developing a callus layer. This reduces the sensitivity of the remaining nerves in the [[Glans penis|glans]] gradually over the years. The study conducted by Sorrells ''et al.''<ref>{{REFjournal |last=SorrellsMoney |first=M.LJ. |last2=SnyderDavison |first2=J..L. |last3=Reiss |first3=M.D. |etal=yes |title=Fine-touch pressure thresholds in the adult [[penis]]Adult penile circumcision: Erotosexual and cosmetic sequelae |journal=BJU IntJournal of Sex Research |date=20071983 |volume=9919

|pages=864289-869292

}}</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 Orgasm problems: In the wake of reduced sexual sensitivity, due to the loss of sensory tissue and gradual keratinization of the surface of the [[Glans penis|glans]], orgasm problems may develop with increasing age. In this case, the sexual arousal created by intercourse or [[masturbation]] is not enough to achieve orgasm. A preliminary stage of this late effect is the prolonged time circumcised men need to reach an orgasm. This is too little reserve often fielded as the "cut men have more endurance" argument for circumcision.* Vaginal dryness: Due to the loss of the natural gliding action, which comes from the mobility of the fore- and shaft skin left , a much increased friction between [[penis]] and vagina occurs during intercourse. This can make intercourse painful for both partners and lead to support a full erectionabrasions<ref>{{REFjournal |last=TaylorFrisch |first=J.R.Morten |last2author-link=LockwoodMorten Frisch |first2=A.P.Morten |last3last2=TaylorLindholm |first3=A.J.Morten |last3=Grønbæk |title=The prepuceMale circumcision and sexual function in men and women: <q>Specialized mucosa of the [[penis]] and its loss to circumcision</q>a survey-based, cross-sectional study in Denmark |journal=British International Journal of UrologyEpidemiology |date=19962011-10 |volume=7740 |issue=5 |pages=2911367-2951381

}}</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=MoneyCortés-González

|last2=DavisonArratia-Maqueo

|last3=Gómez-Guerra |first3=L. |title=Adult penile Does circumcision: Erotosexual and cosmetic sequelaehas an effect on female's perception of sexual satisfaction? |journal=Journal of Sex ResearchRev Invest Clin |date=19832008 |volume=1960 |issue=3 |pages=289-292227

}}</ref> * Orgasm problems: In the wake of reduced sexual sensitivity, due to the loss of sensory tissue and gradual keratinization of the surface of the [[Glans penis|glans]], orgasm problems may develop with increasing age. In this case, the sexual arousal created by intercourse or [[masturbation]] is not enough to achieve orgasm. A preliminary stage of this late effect is the The prolonged time it takes circumcised men need to reach an orgasm. This is often fielded , as well as the "cut men have often longer and more endurance" argument for circumcision.* Vaginal dryness: Due vigorous thrusting movements - compared to the loss of the natural gliding action, which comes from the mobility of the foreintact men - and shaft skin, play a much increased friction between [[penis]] and vagina occurs during intercoursepart in this. This can make intercourse painful for both partners and lead to abrasions<ref>{{REFjournal |last=FrischCold |first=MortenC.J. |author-linklast2=Morten FrischTaylor |first2=Morten |last2=Lindholm |first3=Morten |last3=GrønbækJ.R. |title=Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in DenmarkThe prepuce |journal=International Journal of EpidemiologyBJU Int |date=2011-101999 |volume=4083 |issue=5Suppl. 1 |pages=136734-138144

|last=Cortés-GonzálezFink |first=JK.S. |last2=Arratia-MaqueoCarson |first2=JC.C. |last3=Gómez-GuerraDeVellis |first3=LR.F. |title=Does circumcision has an effect Adult Circumcision Outcomes Study: Effect on female's perception of sexual satisfaction? |journal=Rev Invest Clin |date=2008 |volume=60 |issue=3 |pages=227 |url= |pubmedID=18807735 |accessdate=}}</ref> The prolonged time it takes circumcised men to reach orgasmErectile Function, Penile Sensitivity, as well as the often longer Sexual Activity and more vigorous thrusting movements - compared to intact men - play a part in this.<ref>{{REFjournalSatisfaction |last=Cold |firstjournal=C.J. |last2=Taylor |first2=J.R. |title=The prepuce |journal=BJU IntUrol |date=19992002 |volume=83167 |issue=Suppl. 15 |pages=342113-442116

|last=FinkStenram |first=K.SA. |last2=CarsonMalmfors |first2=C.CG. |last3=DeVellisOkmian |first3=R.FL. |title=Adult Circumcision Outcomes Studyfor [[phimosis]]: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfactiona follow-up study |journal=J UrolScandinavian journal of urology and nephrology |date=20021986 |volume=16720 |issue=52 |pages=2113-211689

[[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]]