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Circumcision

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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| painful]] surgery. The un-anesthetized and un-sedated newborn infant is restrained by being strapped to a special plastic board called the [[circumstraint]]. The procedure is most often an elective, non-therapeutic surgery without [[medical indication]] performed on neonates and children for religious and cultural reasons in violation of the child's [[human rights]] to [[physical integrity]], but in older patients may be rarely indicated for therapeutic reasons. It is a radical treatment option for pathological [[phimosis]], refractory [[balanoposthitis]] and chronic [[urinary tract infection]]s (UTIs); it is contraindicated in cases of certain genital structure abnormalities or poor general health. ~~'''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~~.

'''Posthectomy''' is the 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 newer term that has been introduced to avoid issues associated with more traditional terms. Bollinger (2023) identifed CGC as an [[Adverse Childhood Experiences (ACEs)| adverse childhood experience]].<ref name="bollinger2023">{{REFjournal

|last=Bollinger

}}</ref>

Circumcision was popularized in English-speaking nationns in the nineteeth century. The practice of non-therapeutic circumcision of boys now has greatly declined in [[Australia]], [[Canada]], [[New Zealand]] and the [[United Kingdom]]. It has been gradually declining since 1985 in the [[United States]]. It has ''never'' been a popular practice in other western nations.

== Historical background ==

===Judaism===

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 covenant between God and man, dating back to the patriarch Abraham. The validity of this passage is increasingly being questioned.

{{Citation

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]] claimed that circumcision was necessary, as it diminished sexual desires and reduced the pleasure to a degree just sufficient for mere reproduction.

===Christianity===

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

|url=https://www.biblegateway.com/passage/?search=Luke+2%3A21&version=NASB

|title=Gospel of Luke

}}</ref>

In Christianity, circumcision is practiced only in the Coptic ~~churches~~denomination. There is no general belief that circumcision is a requirement of Christianity.<ref name="hill2004">{{REFweb |url=~~http~~https://www.cirp.org/pages/cultural/christian.~~html~~php

|title=The Holy Bible, Circumcision, False Prophets, and Christian Parents

|last=Hill

Nevertheless, Christian moral notions had decisive influence on the spread of this practice. In the puritan influenced USA, circumcision of children was popular in the 19th century as a means to prevent [[masturbation]]. In those days, this so-called ‘self-abuse‘ was not only considered immoral, but was supposedly responsible for a variety of diseases. Masturbation, however, is not mentioned anywhere in the Holy Bible, so there is no support for the belief that it is somehow immoral or sinful.

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:

{{Citation

Many cultures perform circumcision as a rite of passage into manhood. This is common in the Middle East and amongst some indigenous African and Southeast Asian peoples.

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]].

===Religious===

The circumcision of newborn boys is seen as a [[Abrahamic covenant| divine commandment]] in the [[Judaism| Jewish faith]]. Though absent in the Koran, male circumcision is considered a religious requirement in [[Islam]], and it is performed on male children of varying ages. Converts to these faiths may also choose to undergo [[Adolescent and adult circumcision| circumcision]], but it is not always required.

=== [[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]].

# '''Deformed or malformed foreskin'''. A foreskin so deformed or malformed that it does not function properly may be removed by circumcision.

====Arguments of prophylaxia====

Though the practice of ritual circumcision of males, both consenting and non-consenting, has existed for millenia, the search for "potential medical benefits" began relatively recently. {''Potential'' means to exist in possibility, but not in actuality, so a "''potential'' benefit" is not a genuine proven benefit.) The discussion of circumcision in the Ninth Edition of the ''Encyclopǽdia Britannica'' (1876) made no mention of any prophylactic, medical, or therapeutic value or function.<ref>{{REFweb

|url=~~http~~https://www.cirp.org/library/history/encyclopaediabritannica1876/

|title=Circumcision

|last=Cheyne

}}</ref>

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.

Male and female circumcision involves the removal and disruption of normal anatomical structures that are primary areas of sexual sensation.<ref name="taylor1996"/> In the past, some advocates of mass circumcision have considered the [[prepuce]] to be a "mistake of nature," but this notion has no validity because the prepuce is ubiquitous in primates and because it provides functional advantages.<ref name="cold-mcgrath1995">{{REFbook

|year=1999

|title=Male and female circumcision: medical, legal, and ethical considerations in pediatric practice

|url=~~http~~https://www.cirp.org/library/anatomy/cold-mcgrath/

|work=

|editor=

}}</ref>

All claims that circumcision prevents future disease are false.<ref>{{REFweb

|url=https://www.doctorsopposingcircumcision.org/for-professionals/alleged-medical-benefits/conclusions-and-references/

|title=Conclusions

|last=Anonymous

|first=

|init=

|publisher=Doctors Opposing Circumcision

|date=2016

|accessdate=2023-10-22

}}</ref> They are made to enable a physician to perform circumcision and collect a fee.

<!--

===Search for prophylactic reasons===

|year=2001

|title=Medicine and the German Jews

|url=~~http~~https://www.cirp.org/library/history/ephron1/

|work=

|editor=

''The following text is taken from the [[Circumpendium]].''

-->

=== Prophylactic reasons ===

Some people claim that circumcision has prophylactic benefits. Especially in the [[USA ]] those arguments have persisted for more then a 100 years, with ever changing diseases circumcision is said to protect against. At first, these were diseases where [[masturbation]] was believed to be the cause. After bacteria and viruses had been discovered, arguments changed, and one after another miscellaneous diseases were cited.

* [[Phimosis]]: as mentioned earlier, true [[phimosis]] is rare and can be treated effectively without surgery. According to a study by Blalock et al. (2003)<ref name="blalock2003">{{REFjournal

|issue=6

|pages=2332-4

|url=~~http~~https://www.cirp.org/library/complications/blalock1/

|accessdate=2019-11-07

}}</ref>, 2.9% of those circumcised develop a post-operative [[phimosis]], in which the circumcision scar constricts. In [[intact]] patients, the rate of [[phimosis]] is only 1% (see also the study by [[Jakob Øster]]). Therefore, circumcision is not a preventive measure for [[phimosis]].

|issue=

|pages=1052-7

|url=~~http~~https://www.cirp.org/library/general/laumann/

|accessdate=2019-11-06

}}</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

|last=Task Force on Circumcision

|first=

|issue=3

|pages=686-93

|url=~~http~~https://www.cirp.org/library/statements/aap1999/

|accessdate=2019-11-15

}}</ref>

|issue=

|pages=1052-7

|url=~~http~~https://www.cirp.org/library/general/laumann/

|accessdate=2019-11-06

}}</ref>

* Two studies that have been published in early 2007<ref>{{RCT Gray et al 2007}}</ref><ref>{{RCT Bailey et al 2007}}</ref>, which investigated the effectiveness of circumcision as a means of reducing the spread of [[HIV]] from infected women to heterosexual men in African high risk areas, have been repeatedly subjected to strong criticism. Both studies were ended prematurely, which distorted the results. The men who had been [[circumcised]] for the study had to stay sexually inactive during the wound healing, which gave the intact control group more relative opportunity to become infected. These African randomized clinical trials have been demonstrated to have very serious methodological and statistical errors that distort the results in favor of circumcision.<ref name="boyle-hill2011">{{BoyleGJ HillG 2011}}</ref>

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

|last=Grosskurth

|init=H

|issue=8

|pages=552-5

|url=~~http~~https://www.cirp.org/library/disease/UTI/mccracken/

|accessdate=2019-11-19

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

|url=

|accessdate=

}}</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

|last=Mueller

|init=ER

|accessdate=

}}</ref> did not find a significant difference in UTI rates between [[circumcised]] and [[intact]] boys with normal urinary tract anatomy.

* 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

|last=Menahem

|init=S

|accessdate=

}}</ref>

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

* Penile and cervical cancer / HPV: first studies on those diseases and their assumed prevention by circumcision date back to 1932, a time when the cause for those illnesses was not yet fully understood.<ref>{{Wolbarst1932}}</ref> Today, it is known that sexually transmitted human papillomavirus (HPV) is a major risk factor<ref>{{REFjournal

|last=McCance

The visual appearance of the [[penis]] is changed radically after circumcision. In this case, personal taste is decisive whether an [[intact]] or a [[circumcised]] [[penis]] is more appealing. Since a circumcision cannot be undone, it is essential to be fully informed about the risks and possible later complications before embarking on an aesthetically motivated circumcision, to decide whether the appearance will justify such bodily modification.

It should be noted that every circumcision operation leaves a life-long [[circumcision scar]] that encircles the shaft of the [[penis]]. In addition, there frequently a a color change at the circumcision scar which results in a two-tone appearance.

Since this modification and its possible late effects will be the lifelong burden of the person who undertakes an aesthetically motivated circumcision to suit his personal preferences, a valid decision to proceed can only be made by the person to be [[circumcised]] himself, once he has reached the necessary age and level of maturity to make that decision. This should normally be the case when adulthood is reached.

It should be noted that every circumcision operation leaves a life-long [[circumcision scar]] that encircles the shaft of the penis. In addition, there frequently a a color change at the circumcision scar which results in a two-tone appearance.

===Financial reasons===

''Hygiene'' refers to health and only secondarily to cleanliness.

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

|init=R

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~~ [[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 problem~~concern.

The opening of the [[foreskin]] in small boys is often quite narrow and serves as a one-way valve, allowing the [[urine]] to flow out, but preventing entry of microbes, for example from a dirty diaper. As long as the child is able to pass water, everything works as nature intended.

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.

== Circumcision methods ==

The [[Circumcision methods]] are discussed in a separate article.

== Pain ==

In the past, advocates of circumcision claimed that a newborn child's nerve system was not yet fully developed, and that as a result, the child felt no [[pain]] during the circumcision procedure. [[Kanwaljeet J. Singh Anand| Anand]] & Hickey (1987) have shown that newborn children do in fact feel [[pain]], and more acutely than adults.<ref name="anand-hickey1987">{{REFjournal

|last=Anand

|first=KJS

|author-link=Kanwaljeet J. Singh Anand

|last2=Hickey

|first2=PR

|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=https://www.cirp.org/library/pain/anand/

|quote=However, in decisions about the use of these techniques, current knowledge suggests that humane considerations should apply as forcefully to the care of neonates and young, nonverbal infants as they do to children and adults in similar painful and stressful situations.

|pubmedID=3317037

|pubmedCID=

|DOI=10.1056/NEJM198711193172105

|accessdate=2019-11-08

}}</ref> This has led American health associations to recommend doctors take measures to reduce the [[pain]] of circumcision in infants.

~~== 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 al~~cirp. org/library/statements/aap1999/|AAP Circumcision Policy Statement] (~~2022~~1999) ~~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, ~~physical~~the pain is quite severe, and ~~sexual associations that lead to significant emotional distress directed both internally~~ requires injections for proper pain management. Sucrose and ~~externally~~Acetaminophen ''"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 genitals~~clamp"''."<ref ~~name ="uberoi2022"~~>{{REFjournal |last=~~Uberoi~~

|first=

|~~init~~title=MAmerican Academy of Pediatrics: Circumcision Policy Statement; Task Force on Circumcision |~~author-link~~journal=Pediatrics |~~last2~~date=~~Abdulcadir~~ ~~|first2=~~ ~~|init2=J~~ ~~|author2~~1999-~~link=~~03 |~~last3~~volume=~~Ohi~~103 |~~first3~~issue=3 |~~init3~~pages=DA ~~|author3~~686-~~link=~~93 |~~last4~~url=~~Santiago~~https://pediatrics.aappublications.org/content/103/3/686#sec-9 |~~first4~~accessdate= ~~|init4=JE~~ ~~|author4~~2019-11-~~link=~~26 |~~last5~~note=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 |~~last6~~title=Circumcision: Position Paper on Neonatal Circumcision. Board Approved: August 2007 Reaffirmed |~~first6~~website=Official American Academy of Family Physicians Website |~~init6~~url=http://www.aafp.org/online/en/home/clinical/clinicalrecs/children/circumcision.html |~~author6-link=~~ ~~|last7=~~ ~~|first7=~~ ~~|init7~~accessdate= ~~|author7~~2011-~~link=~~ ~~|last8=~~ ~~|first8=~~ ~~|init8=~~ ~~|author8~~05-~~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=~~ ~~|author9~~Penile 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 under~~assn.org/ama/no-~~recognized late~~index/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 forum~~obstetricians"''.<ref>{{REFweb |~~trans-~~title=Report 10 of the Council on Scientific Affairs (I-99): Neonatal Circumcision |~~language~~website=American Medical Association Official Website |~~journal~~url=~~Int J Impot Res~~http://www.ama-assn.org/ama/no-index/about-ama/13585.shtml |~~location~~accessdate= ~~|date=2022~~2011-1005-2304 ~~|volume=~~}}</ref> ~~|issue=~~ ~~|article=~~ ~~|page=~~ ~~|pages=~~ ~~|url=https~~The AAP's [http://www.~~nature~~healthychildren.~~com~~org/English/ages-stages/prenatal/decisions-to-make/~~articles~~pages/~~s41443~~Where-~~022~~We-~~00619~~Stand-8Circumcision.aspx Heatlhy Children website] suggests ''"Your pediatrician (or your obstetrician) should discuss the forms of analgesia that are available"''.<ref>{{REFweb |~~archived~~title=Where We Stand: Circumcision |~~quote~~publisher=[[AAP]] |~~pubmedID~~date=~~36274189~~2011-03-23 |~~pubmedCID~~url= ~~|DOI=10~~http://www.healthychildren.~~1038~~org/English/ages-stages/prenatal/decisions-to-make/pages/~~s41443~~Where-~~022~~We-~~00619~~Stand-8Circumcision.aspx |accessdate=~~2023~~2019-0110-0812}}</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. ~~=== Possible operative~~ 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 ~~postoperative complications ===~~ ~~Circumcision~~ make sure your baby is ~~surgery~~given an injection. ~~Surgical complications of circumcision generally~~ This is your responsibility, because your doctor may or may not be ~~classified as~~ up to date on the latest understandings of infant sensitivity to [[~~Bleeding| hemorrhage~~pain]]during circumcision."'' The AAP may be holding back, however, ~~[[infection]]~~perhaps because this would upset the doctor/parent power relationship, ~~or surgical misadventure up~~ and may cause too much questioning of doctors in general. One may not expect to ~~and including loss~~ find this kind of ~~the penis~~ advice on such a website, and yet, anything less than this is a dangerously weak statement. To control [[~~death~~pain]]., some physicians that circumcise use Tylenol, sugar,<ref ~~name="deacon2022" /><ref name="williams-kapilla1993"~~>{{~~REFjournal~~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. |~~last~~url=~~Williams~~http://www.pollockclinics.com/circumcision/circumcision-guide.html |~~init~~title=NParents' Guide to Circumcision |~~author-link~~last= |~~last2~~first=~~Kapilla~~ |~~init2~~publisher=L |~~author2-link~~date= |~~etal~~accessdate=no2011-04-08}}</ref><ref>{{REFweb |~~title~~quote=~~Complications of~~ During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions. |~~trans~~url=http://www.pollockclinics.com/circumcision/circumcision-before.html |title=Before the Circumcision |~~language~~last= |~~journal~~first=~~Brit J Surg~~ |~~location~~publisher= |date=~~1993~~2011-1004-08 |~~volume~~accessdate=802011-04-08 ~~|issue=10~~}}</ref> a topical cream,<ref>{{REFweb |~~pages~~quote=~~1231-6~~Then in our office, he will have topical anesthetic applied to his penis. |url=http://www.~~cirp~~pollockclinics.~~org~~com/~~library~~circumcision/~~complications/williams~~circumcision-~~kapila/~~before.html |title=Before the Circumcision |~~quote~~last= |~~pubmedID~~first=~~8242285~~ |~~pubmedCID~~publisher= |~~DOI~~date=~~10.1002/bjs.1800801005~~2011-04-08 |accessdate=~~2019~~2011-1104-2708}}</ref> * Intolerance and/or ~~allergic reactions to the narcotics used~~a local anaesthetic injection called a dorsal penile ring block.<ref>{{REFweb* Especially in newborns, where the bodily |quote=We use extensive pain ~~reduction mechanisms are not yet fully developed~~control methods including Tylenol, ~~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~~ a sugar solution (to ~~provide sufficient anaesthetic even for experienced anaesthetists is still 5-10%. The general anaesthesia that would be needed for newborns~~reduce pain perceptions), ~~however, poses significant risks for the child~~a topical freezing cream, and~~, therefore, is only likely to be used in emergencies~~a local anesthetic injection. ~~A surgical operation without proper [[pain]] control can lead to the development of a specific pain memory<ref>{{REFweb~~ |url=http://www.~~spiegel~~pollockclinics.decom/~~spiegel~~circumcision/~~vorab/experte-warnt-rituelle-beschneidung~~circumcision-~~veraendert-das-gehirn-der-kinder-a-849534~~guide.html |title=~~Kinderschmerz-Experte warnt: Rituelle Beschneidung verändert das Gehirn der Kinder~~ ~~|trans-title=Children~~Parents'~~s pain expert warns: Ritual circumcision changes the brain of children~~ ~~|language=German~~Guide to Circumcision |last=~~Prof. Dr. med. Boris Zernikow~~

|first=

|publisher~~=Spiegel Online~~ ~~|website~~= |date=~~2012-08-12~~ |accessdate=~~2019~~2011-1004-11 ~~|format=~~ ~~|quote=~~08}}</ref>~~. In unsedated and partially sedated infants increased secretion~~ Topical anaesthetic only serves to numb the area to lessen the pain of the ~~stress hormone cortisol could be observed for months after~~ injection, but studies have shown that a [[dorsal penile nerve block]] is only partially effective in stopping the ~~operation. Overall, their~~ [[Pain| pain ~~threshold was lower and the risk~~ of ~~chronic pain increased~~circumcision]]. ~~Regardless of these findings, infant circumcisions with insufficient or no anaesthetic are still common practice~~<refname="Journal of Perinatology April/May 2002">{{REFjournal |last=~~Garry~~Taeusch |first=H. William |init=THW |~~title~~last2=Martinez |first2=~~Circumcision: a survey of fees and practices~~Alma M. |~~journal~~init2=~~OBG Management~~AM |~~date~~last3=~~1994~~Partridge |~~volume~~first3=~~October~~J. Colin |~~issue~~init3=JC |~~pages~~last4=~~34-6~~Sniderman |~~url~~first4=Susan |~~accessdate~~init4=S~~}}</ref><ref>{{REFjournal~~ |last5=Armstrong-Wells |~~last~~first5=~~Howard~~Jennifer |~~init~~init5=CRJ |~~last2~~last6=~~Howard~~Fuentes-Afflick |~~init2~~first6=FMElena |~~last3~~init6=~~Garfunkel~~E |~~init3~~title=LCPain During Mogen or Plastibell Circumcision |~~last4~~journal=~~de Blieck~~Journal of Perinatology |~~init4~~volume=EA22 |~~last5~~issue=~~Weitzman~~3 |~~init5~~pages=M214-8 |~~title~~url=~~Neonatal circumcision and pain relief~~http: ~~current training practices~~//www.nature.com/jp/journal/v22/n3/full/7210653a.html |~~journal~~quote=~~Pediatrics~~...more than half of the study group had what we considered excessive pain/discomfort over the course of the entire procedure. |~~date~~pubmedID=~~1998~~ |~~volume~~pubmedCID=~~101~~ |~~issue~~DOI= |~~pages~~note=~~423-8~~April/May 2002 |~~url~~date=2002-04 |accessdate=2011-04-08}}</ref><refname="Clinical Pediatrics August 1986">{{REFjournal |last=~~Stang~~Williamson |first=Paul S. |init=HJPS |last2=~~Snellman~~Evans |first2=Nolan Donovan |init2=LWND |title=Neonatal Cortisol Response to Circumcision ~~practice patterns in the United States~~with Anesthesia |journal=Clinical Pediatrics ~~|date=1998~~ |volume=~~101~~25 |issue=e58 |pages=412-6 |url=http://cpj.sagepub.com/content/25/8/412.abstract |~~accessdate~~quote= ~~|note=Link~~ The adrenal cortisol response to ~~[[AAP]] website}}</ref>. During procedures which take several minutes, babies tend to fall into a state of stupor, which in the past~~ surgery was ~~falsely interpreted as peaceful sleep, nurturing~~ not significantly reduced by 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~~ administration of ~~severe [[shock]]~~lidocaine.~~<ref>{{REFjournal~~ |~~last~~pubmedID=~~Gunnar~~ |~~init~~pubmedCID=MR |~~last2~~DOI=~~Fisch~~ |~~init2~~date=RO1986-08 |~~last3~~accessdate=~~Korsvik~~2011-04-08 ~~|init3=S~~}}</ref> During circumcision, somp physicians give children sugar pacifiers to "reduce the perception of pain",<ref>{{REFweb |~~last4~~quote=~~Donhowe~~During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions. |~~init4~~url=JMhttp://www.pollockclinics.com/circumcision/circumcision-before.html |title=~~The effects of circumcision on serum cortisol and behavior~~Before the Circumcision |~~journal~~last=~~Psychoneuroendocrinology~~ |~~date~~first=~~1981~~ |~~volume~~publisher=6 |~~issue~~date=3 ~~|pages=269~~2011-04-75 ~~|url=http://www.cirp.org/library/pain/gunnar/~~08 |accessdate=~~2019~~2011-1104-2608}}</ref>* Postoperative wound painbut in at least one study, ~~in the case of children~~data shows that giving sugar to a child doesn'~~s circumcisions conceivably worsened by~~ t help to reduce the ~~forceful breaking~~ perception 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 deathchild.<refname="Lancet, The 2010-10-09">{{~~REFbook~~REFjournal |last=Slater |first=Rebeccah |~~year~~init=~~2000~~R |~~title~~first2=~~Paediatric Handbook~~Laura |~~url~~init2=L |~~work~~last2=Cornelissen |~~editors~~first3=~~Smart J, Nolan T.~~Lorenzo |~~edition~~init3=6L |~~volume~~last3=Fabrizi |~~chapter~~first4=Debbie |~~page~~init4=82D |~~location~~last4=~~{{AUSC|VIC}}, Australia~~Patten |~~publisher~~first5=~~Blackwell Science Asia~~Jan |~~isbn~~init5=J |~~quote~~last5=Yoxen |~~accessdate~~first6=Alan |~~note~~init6=~~}}</ref><ref>{{REFdocument~~A |~~title~~last6=~~Autopsy of Demetrius Manker~~Worley |~~url~~first7=Stewart |~~contribution~~init7=~~Case 93-1711~~ ~~|last=Wetli~~ ~~|first=CV~~ ~~|publisher=Miami: Dade County Medical Examiner Department~~ ~~|format=~~ ~~|date=1993-06-23~~S |~~accessdate~~last7=~~}}</ref> <ref>{{REFjournal~~Boyd |~~last~~first8=~~Hiss~~Judith |~~init~~init8=J |~~last2~~last8=~~Horowitz~~Meek |~~init2~~first9=AMaria |~~last3~~init9=~~Kahana~~M |~~init3~~last9=TProf. Fitzgerald |title=~~Fatal haemorrhage following male ritual circumcision~~Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial |journal=~~J Clin Forensic Med~~ ~~|date=2000~~The Lancet |volume=7376 |issue=9748 |pages=1225-32-4 |url=http://www.~~cirp~~thelancet.~~org~~com/~~library~~journals/~~death~~lancet/~~hiss1~~article/ ~~|accessdate=2019~~PIIS0140-116736%2810%2961303-06~~}}<~~7/~~ref><ref>{{REFdocument~~fulltext |~~title~~quote=~~Judgement of inquiry into the death of McWillis~~Our data suggest that oral sucrose does not significantly affect activity in neonatal brain or spinal cord nociceptive circuits, ~~Ryleigh Roman Bryan~~ ~~|url=http://www~~and therefore might not be an effective analgesic drug.~~circumstitions~~The 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~~ ~~|contribution=~~ ~~|last=Newell~~ |~~first~~pubmedID=~~TEC~~ |~~publisher~~pubmedCID=~~Burnaby, B.C.: B.C. Coroner's Service~~ |~~format~~DOI= |date=~~2004~~2010-0110-1909 |accessdate=~~2019~~2011-1104-2608}}</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| infections~~pain]]~~. This includes both local infections, which~~ can be ~~treated with local therapy, and systemic infections, requiring systemic antibiotic treatment~~altered 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>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 suturing~~those analgesic procedures.* Adhesion between the surface or rim Prevention of ~~the~~ [[~~Glans penis|glans~~pain]] ~~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 skin~~pain]]~~, causing~~ or [[~~skin~~trauma]] ~~pockets~~ .</big>}} == Risks and ~~bridges, as well as visually unpleasant results~~ effects ==Just like ~~uneven scars~~tonsil or appendix surgery, ~~which make~~ circumcision is a ~~re-circumcision necessary~~surgical 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 scarring~~complex negative constellation of psychological, physical, ~~which makes a re-circumcision necessary~~and 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 al~~others to modify their genitals."<refname ="uberoi2022">{{REFjournal |last=~~Blalock~~Uberoi |first= |init=HJM |author-link= |last2=~~Vemulakonda~~Abdulcadir |first2= |init2=VJ |author2-link= |last3=~~Ritchey~~Ohi |first3= |init3=MLDA |author3-link= |last4=~~Ribbeck~~Santiago |first4= |init4=MJE |author4-link= |last5= |~~title~~first5=~~Outpatient management of [[phimosis]] Following newborn circumcision~~ |~~journal~~init5=~~J Urol~~ |~~date~~author5-link=~~2003~~ |~~volume~~last6=~~169~~ |~~issue~~first6=6 |~~pages~~init6=~~2332~~ |author6-4link= |last7= |~~url~~first7=~~http://www.cirp.org/library/complications/blalock1/~~ |~~accessdate~~init7=~~2019~~ |author7-11link= |last8= |first8= |init8= |author8-26link=~~}}</ref>, the prevalence is 2.9%, according to Leitch<ref>{{REFjournal~~ |last9= |first9= |init9= |~~last~~author9-link=~~Leitch~~ |~~init~~etal=~~IOW~~yes |title=~~Circumcision~~ Potentially under-recognized late-stage physical and psychosexual complications of non- therapeutic neonatal penile circumcision: a ~~continuing enigma~~qualitative and quantitative analysis of self-reports from an online community forum |trans-title= |language= |journal=~~Aust Paediatr~~ Int JImpot Res |location= |date=~~1970~~2022-10-23 |volume=6

|issue=

|~~pages~~article=~~59-65~~ |~~url~~page=~~http://www.cirp.org/library/general/leitch1/~~ |~~accessdate~~pages=~~2019-12-15}}</ref> 5.5%.~~* [[Sudden Infant Death Syndrome]] (SIDS).* Knot formation of the veins. If the dorsal vein, which originates in the tip of the [[foreskin]], is cut during circumcision without being clamped and sutured at its origin separately, it starts to develop new branches over time, which can lead to the development of knots.* Possible deformities due to circumcision include hypoplasia of the [[penis]] (micro-penis) and induratio [[penis]] plastica (skewed penis).* Medical malpractice can also not be ruled out. Injuries, partly or entirely severing the [[Glans penis|glans]] or the [[penis]] can occur.* In rare cases, [[necrosis]], gangrene, ischaemia, keloid formation, and circulatory problems may also occur.* When the circumcision is followed by the ultra-orthodox Jewish ritual of Metzitzah B'Peh (which consists of sucking blood from the wound with the mouth), there is a risk of infection with [[herpes]] simplex type 1, which can lead to brain damage or [[death]].<ref>{{REFweb |url=~~http~~https://www.~~nytimes~~nature.com/~~2012~~articles/~~03/08/nyregion/infants~~s41443-~~death~~022-~~renews~~00619-~~debate-over-a-circumcision-ritual.html?_r~~8 |archived=0 |~~title~~quote=~~Baby’s Death Renews Debate Over a Circumcision Ritual~~ |~~last~~pubmedID=~~Robbins~~36274189 |~~first~~pubmedCID=~~Liz~~ |~~date~~DOI=~~2012~~10.1038/s41443-022-0300619-078 |accessdate=~~2019~~2023-1001-1108}}</ref> ~~=== Physical late effects ===~~

=== Physical 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).

* Painful tension can occur when there is too little reserve [[skin]] left to support a full [[erection]]<ref name="taylor1996"/>. This risk is partly dependent on the anatomy of the [[penis]]. While some [[penis]]es already have the majority of their full size when flaccid ([[Flesh Penis]], or "[[shower]]"), others are rather short when flaccid and double or more their size during an [[erection]] ([[Blood Penis]], or "[[grower]]"). Especially in children's circumcision, where the [[penis]] is not yet fully developed, the amount of reserve [[skin]] needed in adulthood cannot be estimated.

}}

=== ~~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 childhood~~including erectile function, sensation, masturbatory pleasure, orgasm, and sexual satisfaction. ~~On this occasion a variety~~ The authors also cited three studies of severe distress in [[~~trauma~~circumcised]] ~~may occur~~men, ~~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 beforehand~~complaints of [[glans]] insensitivity, ~~if he was~~ delayed [[~~circumcised~~ejaculation]] ~~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~~unpleasant 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=~~Marshall~~Cepe da-Emiliani |first= |init=REA |author-link=Alfonso Cepeda-Emiliani |last2=~~Porter~~Gándara-Cortés |first2= |init2=FLM |author2-link= |last3=~~Rogers~~Otero-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=~~yes~~no |title=~~Circumcision~~Immunohistological study of the density and distribution of human penile neural tissue: ~~II effects upon mother~~gradient hypothesis |trans-~~infant interaction~~title= |language= |journal=~~Early Hum Dev~~Int J Impot Res |location= |date=~~1982~~2023-05-02 |volume=735 |issue=43 |article= |page= |pages=~~367~~286-74305 |url=~~http~~https://www.~~cirp~~nature.~~org~~com/~~library~~articles/~~birth/marshall2~~s41443-022-00561-9 |archived= |quote= |pubmedID=35501394 |pubmedCID= |DOI=10.1038/s41443-022-00561-9 |accessdate=~~2020~~2023-0211-0126}}</ref>~~, as well as problems~~ Circumcision and frenectomy remove tissues with ~~nurturing~~heightened 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 disturbed~~accumulate that male circumcision may result in lifelong physical, sexual, ~~with prolonged non-REM sleep~~ and ~~increased waking~~sometimes psychological harm as well."

* In boys The [[~~circumcised~~amputation]] of the prepuce results in ~~childhood, [[post~~the loss of the majority of fine-~~traumatic stress disorder]] (~~touch neuroreceptors found in the [[~~PTSD~~penis]]~~) 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 [[~~circumcised~~glans 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 operation~~human males.<ref>{{~~REFbook~~REFjournal |last=~~Ramos~~Van Howe |init=SRS |~~last2~~author-link=~~Boyle~~Robert S. Van Howe |~~init2~~last2=GJCold |~~year~~init2=~~2001~~CJ |title=~~Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem~~Advantages 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]]~~ ~~|edition~~journal=The Journal of the American Medical Association |volume=277 |~~chapter~~issue=~~Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder~~13 |pages=~~253~~1052-707 |~~location~~url=~~New York~~ ~~|publisher=Kluwer Academic~~http://www.ncbi.nlm.nih.gov/pubmed/~~Plenum Publishers~~ ~~|isbn=~~9218663

|quote=

}}</ref>

* Circumcisions, especially those that happen without consent, can spark feelings Histology of ~~helplessness and alienation, which can persist as~~ the male circumcision scar shows [[~~trauma~~amputation]]neuromas, Schwann cell proliferation and the bulbous collection of variably sized neurites. ~~These feeling can also be triggered later, when someone~~ [[~~circumcised~~Amputation]] neuromas do not mediate normal sensation and are notorious for generating pain.<ref name="ColdCJ TaylorJR 1999"/> Cepeda-Emiliani et al. (2023) commented:<blockquote> 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 ~~mother~~penile body, ~~50%~~ and to the extent that the prepuce is still conceived by segments of the ~~father~~medical 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 ~~doctor~~belief 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="~~GSoCH~~cepeda2023"/>~~{{REFweb~~ ~~|url=http://www.circumcisionharm.org~~</blockquote> ~~|title=Global Survey of Circumcision Harm~~ ~~|accessdate=2019~~The 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 ~~denied~~most 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~~ [[~~circumcised~~physical integrity]] , but in ~~order not to~~ older patients may be ~~reminded of their own loss~~rarely 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 [[~~foreskin~~Sexual effects of circumcision]] ~~redefined as a foreign object~~for 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 intact~~childhood. ~~The father wants to be~~ On this occasion a ~~"good" father later in life as well~~variety of [[trauma]] may occur, which depend, among others, on age and ~~so, following an idealised image~~ circumstances of ~~his own parents~~the 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=~~Goldman~~Marshall |init=RRE |last2=Porter |~~author-link~~init2=FL |last3=Rogers |init3=~~Ronald Goldman~~AG |~~url~~etal=~~http://www.cirp.org/library/psych/goldman1/~~yes |title=~~The psychological impact of circumcision~~Circumcision: II effects upon mother-infant interaction |journal=~~BJU Int~~Early Hum Dev |date=~~1999~~1982 |volume=837 |issue=~~Suppl. 1~~4 |pages=93367-~~103~~74 |url=https://www.cirp.org/library/birth/marshall2/ |accessdate=~~2019~~2020-1002-1201}}</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 incomplete~~in 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 [[~~foreskin~~circumcised]] ~~disadvantaged compared to~~ in the traditional ritual and 51% of those [[~~intact~~circumcised]] ~~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 subconscious~~operation.<ref>{{~~REFjournal~~REFbook |last=~~Rhinehart~~Ramos |init=JS |last2=Boyle |init2=GJ |year=2001 |title=Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem |url=~~http~~https://~~www~~link.~~cirp~~springer.~~org~~com/~~library~~chapter/~~psych/rhinehart1~~10.1007/978-1-4757-3351-8_14 |~~title~~work=~~Neonatal circumcision reconsidered~~ |~~journal~~editors=~~Transactional Analysis J~~[[George C. Denniston]], [[Frederick M. Hodges]], [[Marilyn Fayre Milos]] |~~date~~edition=~~1999~~ |volume=29 |~~issue~~chapter=3Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder |pages=~~215~~253-2170 |location=New York |publisher=Kluwer Academic/Plenum Publishers |isbn= |quote= |accessdate=~~2019-10-12~~ |note=}}</ref>* Circumcisions, especially those that happen without consent, can spark feelings of helplessness and alienation, which can persist as [[trauma]]. These feeling can also be triggered later, when someone [[circumcised]] as an infant becomes aware of his circumcision. In an online study, ~~75% of those~~ interviewed men stated ~~that~~ they felt ~~incomplete~~betrayed - 55% by the mother, 50% by the father, and 58% by the doctor, and 6673% ~~said they~~ felt ~~inferior compared with~~ that their [[~~intact~~human rights]] ~~males~~had been violated.<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~~REFweb |url=http://www.~~cirp~~circumcisionharm.org~~/library/psych/cansever~~/ |title=~~Psychological effects~~ Global Survey of ~~circumcision~~ ~~|journal=Brit. J. Med. Psychol~~ ~~|volume=38~~ ~~|pages=321-31~~Circumcision Harm

|accessdate=2019-10-12

}}</ref>

* ~~Fear~~ It can frequently be found that the loss is denied, much as happens with the loss of ~~being alone or darkness~~other body parts.This denial can lead to fathers having their sons [[circumcised]] in order not to be reminded of their own loss. In this process, their own body is defined as "normal" and the [[foreskin]] redefined as a foreign object. Their own parents are seen as "good", so that this image is projected onto the circumcision their parents carried out as well, in order to keep the positive emotion intact. The father wants to be a "good" father later in life as well, and so, following an idealised image of his own parents, circumcision, which has been redefined as a "good thing", is passed on to his son by having him [[circumcised]] as well.<ref>{{VanderKolkBA 1989}}</ref><ref ~~name="Levy1945"~~>{{REFjournal |last=~~Levy~~Goldman |~~first~~init=~~David M.~~R |~~init~~author-link=DMRonald Goldman |url=~~http~~https://www.cirp.org/library/psych/~~levy1~~goldman1/ |title=~~Psychic trauma~~ The psychological impact of ~~operations in children; and a note on combat neurosis~~circumcision |journal=~~American Journal of Diseases of Children~~BJU Int |date=1999 |volume=6983 |~~date~~issue=~~1945~~Suppl. 1 |pages=793-25103

|accessdate=2019-10-12

}}</ref>

* If the [[circumcised]] male feels incomplete, or due to the missing [[foreskin]] disadvantaged compared to [[intact]] males, an inferiority complex and [[depression]] may occur. This can be accompanied by conscious recognition of his own incompleteness, or the deficiency may remain completely subconscious<ref>{{REFjournal |last=Rhinehart |init=J |url=https://www.cirp.org/library/psych/rhinehart1/ |title=Neonatal circumcision reconsidered |journal=Transactional Analysis J |date=1999 |volume=29 |issue=3 |pages=215-21 |accessdate=2019-10-12}}</ref>. In an online study, 75% of those interviewed stated that they felt incomplete, and 66% said they felt inferior compared with [[intact]] males.<ref name="GSoCH"/>* Cases in which children felt ill treated or punished have been documented as well. G. Cansever found in her study on 12 boys aged between 4 and 7 years, who had previously been prepared for their impending circumcision, that the children experienced the operation as an aggressive assault on their bodies.<ref>{{REFjournal |last=Cansever |init=G |date=1965 |url=https://www.cirp.org/library/psych/cansever/ |title=Psychological effects of circumcision |journal=Brit. J. Med. Psychol |volume=38 |pages=321-31 |accessdate=2019-10-12}}</ref>* Fear of being alone or darkness.<ref name="Levy1945">{{REFjournal |last=Levy |first=David M. |init=DM |url=https://www.cirp.org/library/psych/levy1/ |title=Psychic trauma of operations in children; and a note on combat neurosis |journal=American Journal of Diseases of Children |volume=69 |date=1945 |pages=7-25 |accessdate=2019-10-12}}</ref>* Fear of doctors, clinics and also closed rooms.<ref name="Levy1945"/>* Relapse into the state of bed-wetting, even if the child was already dry before.<ref name="Levy1945"/>* [[Circumcised ]] males who become fathers frequently manifest [[adamant father syndrome]]. [[Intact America]] (2019) called circumcision as an [[Adverse Childhood Experiences (ACEs)| adverse childhood experience]],<ref name-"bollinger2019">{{REFdocument |title=Child genital cutting as an adverse childhood experience |url=http://adversechildhoodexperiences.net/CGC_as_an_ACE.pdf |last=Bollinger

|first=Dan

|author-link=Dan Bollinger

== Complications ==

=== ~~Pain~~ Possible operative and postoperative complications ===~~In the past, advocates~~ Circumcision is surgery. Surgical complications of circumcision ~~claimed that a newborn child's nerve system was not yet fully developed, and that~~ generally may be classified as ~~a result~~[[Bleeding| hemorrhage]], ~~the child felt no~~ [[~~pain~~infection]] ~~during~~ , or surgical misadventure up to and including loss of the ~~circumcision procedure. Anand & Hickey (1987) have shown that newborn children do in fact feel~~ penis and [[~~pain~~death]]~~, and more acutely than adults~~.<ref name="~~anand~~deacon2022" /><ref name="williams-~~hickey1987~~kapilla1993">{{REFjournal |last=~~Anand~~Williams |~~first~~init=N

|author-link=

|last2=~~Hickey~~Kapilla |~~first2~~init2=L

|author2-link=

|etal=no

|title=~~Pain and its effects in the human neonate and fetus~~Complications of circumcision

|trans-title=

|language=

|journal=~~New Engl~~ Brit J ~~Med~~Surg

|location=

|quote=

|pubmedID=~~3317037~~8242285

|pubmedCID=

|DOI=10.1002/bjs.1800801005 |accessdate=2019-11-0827}}</ref> ~~This has led American health associations to recommend doctors take measures to reduce the pain of circumcision in infants.~~

~~The [http://www~~* Intolerance or allergic reactions to the narcotics used.~~cirp.org/library/statements/aap1999/|AAP Circumcision Policy Statement] (1999) states quite clearly that ''"There is considerable evidence that~~ * Especially in newborns ~~who~~ , where the bodily pain reduction mechanisms are not yet fully developed, local anaesthesia is often insufficient for the operation. Even in conjunction with regional anaesthesia of the dorsal nerve of the [[~~circumcised~~penis]] ~~without analgesia experience pain and physiologic stress"''. Furthermore~~, the ~~pain~~ rate of failure to provide sufficient anaesthetic even for experienced anaesthetists is ~~quite severe~~still 5-10%. The general anaesthesia that would be needed for newborns, however, ~~and requires injections~~ poses significant risks for ~~proper pain management. Sucrose~~ the child, and ~~Acetaminophen ''"cannot~~ , therefore, is only likely to be ~~recommended as the sole method of analgesia"''~~used in emergencies. ~~Topical cream is no longer thought sufficient as ''"~~A surgical operation without proper [[pain]] control can lead to the ~~analgesic effect is limited during the phases associated with extensive tissue trauma such as...tightening~~ development of ~~the clamp"''.~~a specific pain memory<ref>{{~~REFjournal~~REFweb |url=http://www.spiegel.de/spiegel/vorab/experte-warnt-rituelle-beschneidung-veraendert-das-gehirn-der-kinder-a-849534.html |title=Kinderschmerz-Experte warnt: Rituelle Beschneidung verändert das Gehirn der Kinder |trans-title=Children's pain expert warns: Ritual circumcision changes the brain of children |language=German |last=Prof. Dr. med. Boris Zernikow

|first=

|~~title~~publisher=~~American Academy of Pediatrics: Circumcision Policy Statement; Task Force on Circumcision~~Spiegel Online |~~journal~~website=~~Pediatrics~~ |date=~~1999~~2012-0308-12 |~~volume~~accessdate=~~103~~ ~~|issue=3~~ ~~|pages=686~~2019-93 ~~|url=https://pediatrics.aappublications.org/content/103/3/686#sec~~10-911 |~~accessdate~~format=~~2019-11-26~~ |~~note~~quote=~~Statement Reaffirmed Sept. 1, 2005~~}}</ref> ~~The [[AAFP]] (2002) states quite simply in their [http://www~~.~~cirp~~In unsedated and partially sedated infants increased secretion of the stress hormone cortisol could be observed for months after the operation.~~org/library/statements/aafp2002/| position paper]~~Overall, ~~''"Newborns experience~~ their pain threshold was lower and the risk of chronic pain ~~during circumcision"~~increased.''Regardless of these findings, infant circumcisions with insufficient or no anaesthetic are still common practice<ref>{{~~REFweb~~REFjournal |last=Garry |init=T |title=Circumcision: ~~Position Paper on Neonatal Circumcision. Board Approved: August 2007 Reaffirmed~~a survey of fees and practices |~~website~~journal=~~Official American Academy of Family Physicians Website~~OBG Management |~~url~~date=~~http://www.aafp.org/online/en/home/clinical/clinicalrecs/children/circumcision.html~~1994 |~~accessdate~~volume=~~2011-05-02~~}}</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. Penile injections of anesthetic are now recommended by all of the major medical institutions. In their [http://www.ama-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>{{REFwebOctober |~~title~~issue=~~Report 10 of the Council on Scientific Affairs (I-99): Neonatal Circumcision~~ |~~website~~pages=~~American Medical Association Official Website~~34-6 |url=~~http://www.ama-assn.org/ama/no-index/about-ama/13585.shtml~~ |accessdate=~~2011-05-04~~}}</ref> The AAP's [http://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/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~~REFjournal |~~title~~last=~~Where We Stand: Circumcision~~Howard |~~publisher~~init=~~[[AAP]]~~CR |~~date~~last2=~~2011-03-23~~Howard |~~url~~init2=~~http://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/pages/Where-We-Stand-Circumcision.aspx~~FM |~~accessdate~~last3=~~2019-10-12~~Garfunkel}}</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. |init3=LC |last4=de BlieckGiven 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. |init4=EA |last5=Weitzman~~To control [[pain]], some physicians that circumcise use Tylenol, sugar,<ref>{{REFweb~~ |init5=M |~~quote~~title=~~To calm the baby during the procedure, a sugar filled gauze pacifier soaked with sweet juice is used,~~ Neonatal circumcision and ~~soothing music is played in the room.~~pain relief: current training practices |~~url~~journal=~~http://www.pollockclinics.com/circumcision/circumcision-guide.html~~Pediatrics |~~title~~date=~~Parents' Guide to Circumcision~~1998 |~~last~~volume=101 |~~first~~issue= |~~publisher~~pages=423-8 |~~date~~url= |accessdate=~~2011-04-08~~}}</ref><ref>{{~~REFweb~~REFjournal |last=Stang |~~quote~~init=HJ |last2=~~During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions.~~Snellman |~~url~~init2=~~http://www.pollockclinics.com/circumcision/circumcision-before.html~~LW |title=~~Before~~ Circumcision practice patterns in the ~~Circumcision~~United States |journal=Pediatrics |date=1998 |~~last~~volume=101 |~~first~~issue=e5 |~~publisher~~pages= |~~date~~url=~~2011-04-08~~ |accessdate=~~2011-04-08~~ |note=Link 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 ~~topical cream~~typically 3- to 4-fold increase in cortisol levels,which equals a state of severe [[shock]].<ref>{{~~REFweb~~REFjournal |last=Gunnar |init=MR |last2=Fisch |init2=RO |~~quote~~last3=~~Then in our office, he will have topical anesthetic applied to his penis.~~Korsvik |~~url~~init3=~~http://www.pollockclinics.com/circumcision/circumcision-before.html~~S |~~title~~last4=~~Before the Circumcision~~Donhowe |~~last~~init4=JM |~~first~~title=The effects of circumcision on serum cortisol and behavior |~~publisher~~journal=Psychoneuroendocrinology |date=~~2011-04-08~~1981 |~~accessdate~~volume=~~2011-04-08~~6~~}}</ref> and/or a local anaesthetic injection called a dorsal penile ring block.<ref>{{REFweb~~ |issue=3 |~~quote~~pages=~~We use extensive pain control methods including Tylenol, a sugar solution (to reduce pain perceptions), a topical freezing cream, and a local anesthetic injection.~~269-75 |url=~~http~~https://www.~~pollockclinics~~cirp.~~com~~org/library/pain/~~circumcision~~gunnar/~~circumcision-guide.html~~ |~~title~~accessdate=~~Parents~~2019-11-26}}</ref>* Postoperative wound pain, in the case of children' ~~Guide~~ s circumcisions conceivably worsened by the forceful breaking of the preputial adhesions.* Postoperative pain from the exposure of the sensitive glans penis to ~~Circumcision~~clothing. This pain will endure for several weeks or even longer in some cases.* Postoperative [[bleeding]] of the wound. This can have severe consequences especially for very young infants, if they are not treated promptly. Their blood volume is only about 85 ml per kilogram of body weight, and even moderate blood loss can lead to hypovolaemia, hypovolaemic [[shock]] and even death.<ref>{{REFbook

|last=

|first=

|~~publisher~~year=2000 |title=Paediatric Handbook |~~date~~url= |~~accessdate~~work=~~2011-04-08}}</ref> Topical anaesthetic only serves to numb the area to lessen the pain of the injection~~ |editors=Smart J, ~~but studies have shown that a dorsal penile ring block is not always effective in stopping the pain of circumcision~~Nolan T.~~<ref name~~ |edition=6 |volume= |chapter= |page=82 |location=~~"Journal of Perinatology April/May 2002">~~{{~~REFjournal~~AUSC|VIC}}, Australia |~~last~~publisher=~~Taeusch~~Blackwell Science Asia |~~first~~isbn=~~H. William~~ |~~init~~quote=HW |~~last2~~accessdate=~~Martinez~~ |~~first2~~note=~~Alma M.~~}}</ref><ref>{{REFdocument |~~init2~~title=AMAutopsy of Demetrius Manker |~~last3~~url=~~Partridge~~ |~~first3~~contribution=~~J. Colin~~Case 93-1711 |~~init3~~last=JCWetli |~~last4~~first=~~Sniderman~~CV |~~first4~~publisher=~~Susan~~Miami: Dade County Medical Examiner Department |~~init4~~format=S |~~last5~~date=~~Armstrong~~1993-~~Wells~~06-23 |accessdate=}}</ref> <ref>{{REFjournal |~~first5~~last=~~Jennifer~~Hiss |~~init5~~init=J |~~last6~~last2=~~Fuentes-Afflick~~Horowitz |~~first6~~init2=~~Elena~~A |~~init6~~last3=EKahana |init3=T |title=~~Pain During Mogen or Plastibell Circumcision~~Fatal haemorrhage following male ritual circumcision |journal=~~Journal of Perinatology~~J Clin Forensic Med |date=2000 |volume=227 |issue=3 |pages=~~214~~32-84 |url=~~http~~https://www.~~nature~~cirp.~~com~~org/jplibrary/~~journal~~death/~~v22~~hiss1/n3 |accessdate=2019-11-06}}</~~full/7210653a.html~~ref><ref>{{REFdocument |title=Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan |~~quote~~url=http://www.circumstitions.~~.more than half of the study group had what we considered excessive pain~~com/~~discomfort over the course of the entire procedure~~death-exsang.html |contribution= |~~pubmedID~~last=Newell |~~pubmedCID~~first=TEC |~~DOI~~publisher=Burnaby, B.C.: B.C. Coroner's Service |~~note~~format=~~April/May 2002~~ |date=~~2002~~2004-0401-19 |accessdate=~~2011~~2019-0411-0826}}</ref>* Post operative [[lymphoedema]].* Postoperative [[Infection| infections]]. This includes both local infections, which can be treated with local therapy, and systemic infections, requiring systemic antibiotic treatment.<ref ~~name="Clinical Pediatrics August 1986"~~>{{~~REFjournal~~REFconference |last=~~Williamson~~Dr. med. Hartmann |first=~~Paul S~~Wolfgang |url= |place=Rechtsausschuss des Bundestages [Legal Committee of the Bundestag] (German) |title=Stellungnahme zur Anhörung am 26. November 2012 [Opinion on the hearing on 26 November 2012] (German) |date=2012-11-26 |accessdate=}}</ref>* [[Wound dehiscence]], meaning the separation of the edges of the wound or the tissue after suturing.* Adhesion between the surface or rim of the [[Glans penis|glans]] with the neighbouring [[penile skin]], causing [[skin]] pockets and bridges, as well as visually unpleasant results like uneven scars, which make a re-circumcision necessary.* Postoperative [[phimosis]]: a phimotic ring can develop during scarring, which makes a re-circumcision necessary. According to a study by Blalock et al.<ref>{{REFjournal |last=Blalock |init=PSHJ |last2=~~Evans~~Vemulakonda |init2=V |last3=Ritchey |~~first2~~init3=~~Nolan Donovan~~ML |last4=Ribbeck |~~init2~~init4=NDM |title=~~Neonatal Cortisol Response to Circumcision with Anesthesia~~Outpatient management of [[phimosis]] Following newborn circumcision |journal=~~Clinical Pediatrics~~J Urol |date=2003 |volume=25169 |issue=86 |pages=~~412~~2332-64 |url=~~http~~https://~~cpj~~www.~~sagepub~~cirp.~~com~~org/~~content~~library/25complications/8blalock1/~~412.abstract~~ |~~quote~~accessdate=~~The adrenal cortisol response to surgery was not significantly reduced by~~ 2019-11-26}}</ref>, the ~~administration of lidocaine~~prevalence is 2.9%, according to Leitch<ref>{{REFjournal |last=Leitch |~~pubmedID~~init=IOW |~~pubmedCID~~title=Circumcision - a continuing enigma |~~DOI~~journal=Aust Paediatr J |date=~~1986~~1970 |volume=6 |issue= |pages=59-0865 |url=https://www.cirp.org/library/general/leitch1/ |accessdate=~~2011~~2019-0412-0815}}</ref> ~~During~~ 5.5%.* [[Sudden Infant Death Syndrome]] (SIDS).* Knot formation of the veins. If the dorsal vein, which originates in the tip of the [[foreskin]], is cut during circumcisionwithout being clamped and sutured at its origin separately, it starts to develop new branches over time, ~~somp physicians give children sugar pacifiers~~ which can lead to the development of knots.* Possible deformities due to ~~"reduce~~ circumcision include hypoplasia of the [[penis]] (micro-penis) and induratio [[penis]] plastica (skewed penis).* Medical malpractice can also not be ruled out. Injuries, partly or entirely severing the [[Glans penis|glans]] or the [[penis]] can occur.* In rare cases, [[necrosis]], gangrene, ischaemia, keloid formation, and circulatory problems may also occur.* When the circumcision is followed by the ultra-orthodox Jewish ritual of Metzitzah B'Peh (which consists of sucking blood from the wound with the ~~perception~~ mouth), there is a risk of ~~pain"~~infection with [[herpes]] simplex type 1,which can lead to brain damage or [[death]].<ref>{{REFweb ~~|quote=During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions.~~ |url=http://www.~~pollockclinics~~nytimes.com/~~circumcision~~2012/03/08/nyregion/infants-death-renews-debate-over-a-circumcision-~~before~~ritual.html?_r=0 |title=~~Before the~~ Baby’s Death Renews Debate Over a CircumcisionRitual |last=Robbins |first= ~~|publisher=~~Liz |date=~~2011~~2012-0403-0807 |accessdate=~~2011~~2019-0410-0811}}</ref> ~~but~~ === Death ===A study in 2010 estimated approximately 117 neonatal circumcision-related [[Death| deaths]] occur annually in ~~at least~~ the [[United States]], about one ~~study~~out of every 77 male neonatal deaths, more than suffocation, auto accidents, ~~data shows that giving sugar to a child doesn't help to reduce the perception of pain in the child~~or even [[SIDS]].<ref name="~~Lancet, The~~ Bollinger 2010~~-10-09~~">{{REFjournal |last=~~Slater~~Bollinger |first=~~Rebeccah~~Dan |init=RD |~~first2=Laura~~ ~~|init2~~author-link=LDan Bollinger |last2=~~Cornelissen~~Boy's Health Advisory |~~first3=Lorenzo~~ ~~|init3=L~~ ~~|last3=Fabrizi~~ ~~|first4=Debbie~~ ~~|init4=D~~ ~~|last4=Patten~~ ~~|first5=Jan~~ ~~|init5=J~~ ~~|last5=Yoxen~~ ~~|first6=Alan~~ ~~|init6=A~~ ~~|last6=Worley~~ ~~|first7=Stewart~~ ~~|init7~~title=Lost Boys: An Estimate of U.S ~~|last7=Boyd~~ ~~|first8=Judith~~ ~~|init8=J~~ ~~|last8=Meek~~ ~~|first9=Maria~~ ~~|init9=M~~ ~~|last9=Prof~~. ~~Fitzgerald~~Circumcision-Related Infant Deaths |~~title~~journal=~~Oral sucrose as an analgesic drug for procedural pain in newborn infants~~Thymos: ~~a randomised controlled trial~~ ~~|journal=The Lancet~~Journal of Boyhood Studies |volume=~~376~~4 |issue=~~9748~~1 |pages=~~1225~~78-3290 |url=http://www.~~thelancet~~mensstudies.com/~~journals~~content/~~lancet~~b64n267w47m333x0/~~article/PIIS0140-6736%2810%2961303-7/fulltext~~?p=7ebbd6b446d940cbbd4274c095754b12π=5 |quote=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.

|pubmedID=

|pubmedCID=

|DOI=10.3149/thy.0401.78 |date=2010-1004-0926 |accessdate=~~2011~~2019-0410-0812}}</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 [[pain]] 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>However, none of the above three procedures totally eliminate pain. A baby boy will still experience some pain despite any of those analgesic procedures. Prevention of [[pain]] requires protecting a boy from elective neonatal non-therapeutic circumcision. Only boys who are protected from the medically unnecessary circumcision surgery experience no [[pain]] or [[trauma]].</big>}} ~~=== Sexual effects ===~~ Circumcision and frenectomy remove tissues with heightened erogenous sensitivity. Boyle et al. (2002) wrote, "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings—many of which are lost to circumcision."<ref>{{~~REFjournal~~ ~~|last=Boyle~~ ~~|first=Gregory J.~~ ~~|init=GJ~~ ~~|author-link=Gregory Boyle~~ ~~|first2=Gillian A.~~ ~~|init2=GA~~ ~~|last2=Bensley~~ ~~|title=Adverse Sexual and Psychological Effects of Male Infant Circumcision~~ ~~|journal=Psychological reports~~ ~~|volume=88~~ ~~|issue=3, Part 2~~ ~~|pages=1105–6~~REFweb |url=http://www.~~cirp~~icgi.org/~~library~~2010/~~psych/boyle5~~04/infant-circumcision-causes-100-deaths-each-year-in-us |title=Infant circumcision causes 100 deaths each year in US |~~quote~~last= |~~pubmedID~~first=~~11597060~~ |~~pubmedCID~~publisher=ICGI |~~DOI~~website=~~10.1046/j.1464-410x.1999.0830s1085.x~~[[International Coalition for Genital Integrity]] |date=~~July 2001~~2010-04-26

|accessdate=

}}</ref> ~~They concluded, "Evidence has~~ See also ~~started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well~~the list of [[fatalities]]."

~~The [[amputation]] of the prepuce results in the loss of the majority of fine~~== Forced circumcision ==<!--~~touch neuroreceptors found~~ === United States military ===American soldiers serving in ~~the [[penis]], leaving only the uninhibited protopathic sensibility~~ World War II were subjected to regular inspections of ~~the artificially externalized [[glans penis]]~~their genitals. ~~The imbalance caused by not having the input from the now ablated fine-touch receptors may be a leading cause of~~ If intact, the ~~changes in sexual behavior noted in [[circumcised]] human males~~soldiers risked being ordered to undergo immediate circumcision.<ref>{{~~REFjournal~~REFbook |last=~~Van Howe~~Schoen |first=Ed |init=RSE |author-link=~~Robert S~~Edgar J. ~~Van Howe~~Schoen |~~last2~~year=~~Cold~~2005 |~~init2~~title=CJOn Circumcision |~~title~~url=https://books.google.de/books?id=~~Advantages and Disadvantages of Neonatal Circumcision~~-zUhdvSt7cgC |~~journal~~work=~~The Journal of the American Medical Association~~ |~~volume~~editor=~~277~~Dianne Yeakey |~~issue~~edition=13 |~~pages~~volume=~~1052-7~~ |~~url~~chapter=~~http://www.ncbi.nlm.nih.gov/pubmed/9218663~~ |~~quote~~pages=72-3 |~~pubmedID~~location=~~9218663~~Georgetown, Canada |~~pubmedCID~~publisher=RDR Books |~~DOI~~isbn=1-157143-123-3 |~~date~~quote=~~1997-04-02~~For a critical view, see Sorrells, "The History of Circumcision," p. 333

|accessdate=

|note=}}</ref>This practice was discontinued at least six decades ago.-->=== Non-therapeutic circumcision of male children ===

~~Histology~~ Human babies, because they are not yet in possession of language, are incapable of giving or refusing consent 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 ~~male~~ abuses of power rampant throughout the nation's social institutions, influential grass-roots movements protesting the forced circumcision ~~scar shows~~ of American children sprang up nationwide." F. Hodges, "A Short History," p. 31; see also [[~~amputation~~Leonard B. Glick|Glick]] ~~neuromas~~, ~~Schwann cell proliferation~~ ''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 ~~the bulbous collection~~ circumcision is widely accepted as a postnatal procedure in American hospitals.<ref>{{REFbook |last=Fletcher |first=Christopher R. |init=CR |year=1999 |title=Circumcision in America in 1998: Attitudes, Beliefs, and Charges of ~~variably sized neurites~~American Physicians |url=http://www.springerlink. com/content/h2150v731233m177/ |work=Male and Female Circumcision |editors=[[~~Amputation~~George C. Denniston]] ~~neuromas do not mediate normal sensation~~ , [[Frederick M. Hodges]], [[Marilyn Fayre Milos]] |edition= |volume= |chapter=Section 5 |pages=259-71 |location=New York |publisher=Kluwer Academic/Plenum Publishers |isbn= |quote= |accessdate=2019-10-12 |note=ID 10.1007/978-0-585-39937-9_19}}</ref> Parental consent is required.<ref>See, e.g., Shephard and ~~are notorious~~ Shephard, ''The Complete Guide'', p. 125.</ref> A statement published by the [[American Academy of Pediatrics]] in 1999 claimed that "parents should determine what is in the best interest of the child... It is legitimate for ~~generating pain~~parents to take into account cultural, religious, and ethnic traditions, in additions to the medical factors, when making a decision."<ref ~~name=~~>Lannon and Bailey, "~~ColdCJ TaylorJR 1999~~Circumcision Policy Statement,"p. 691.</ref>however surrogate consent for non-therapeutic circumcision is now viewed as unethical.

~~=== Death ===A study in 2010 estimated approximately 117 neonatal~~ In the [[United Kingdom]], where non-therapeutic circumcision~~-related deaths occur annually~~ has now become far less prevalent than in the [[United States]], ~~about one out~~ the written consent of ~~every 77 male neonatal deaths~~both parents is required, ~~more than suffocation, auto accidents, or even [[SIDS]]~~if a physician is to perform a non-therapeutic circumcision of a child.<ref ~~name="Bollinger 2010"~~>{{REFjournal |last=~~Bollinger~~ |first=~~Dan~~ |~~init=D~~ ~~|author-link~~title=~~Dan Bollinger~~ ~~|last2=Boy~~Re J (child's ~~Health Advisory~~religious upbringing and circumcision) |~~title~~journal=~~Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths~~Family Court Reports |~~journal~~date=~~Thymos: Journal of Boyhood Studies~~2000 |volume=41 |issue=1 |pages=78307-9014 |url=~~http~~https://www.~~mensstudies~~cirp.~~com~~org/~~content~~library/~~b64n267w47m333x0~~legal/~~?p=7ebbd6b446d940cbbd4274c095754b12π=5~~ ~~|quote=~~ ~~|pubmedID=~~ ~~|pubmedCID=~~ ~~|DOI=10.3149~~Re_J/~~thy~~2000.~~0401.78~~ ~~|date=2010-04-26~~html

|accessdate=2019-10-12

}}</ref>~~<ref>{{REFweb~~ ~~|url=http://www.icgi.org/2010/04/infant-circumcision-causes-100-deaths-each-year-in~~(The National Health Service does not provide non-us ~~|title=Infant~~ therapeutic circumcision ~~causes 100 deaths each year in US~~ ~~|last=~~ ~~|first=~~ ~~|publisher=ICGI~~ ~~|website=[[International Coalition for Genital Integrity]]~~ ~~|date=2010-04-26~~ ~~|accessdate=}}</ref> See also the list of [[fatalities]]~~.)

In recent years, legal writers in several English-speaking countries have been questioning the practice of acceding to parental wishes.<ref>See, e.g., [[Margaret A. Somerville|Somerville]], "Therapeutic and Non-Therapeutic Medical Procedures"; Poulter, ''English Criminal Law''; [[Abbie Chessler|Chessler]], "Justifying the Unjustifiable"; Smith, "Male Circumcision."</ref> For example, critics have pointed out that, in the [[United States]], more than 1.3% of male neonatal deaths are attributable to the complications of non-therapeutic circumcision surgery.<ref name="Bollinger 2010"/>==Video===== ~~Forced~~ Is circumcision healthy?===The video ''Is Circumcision Healthy'' is recommended for parental viewing. <youtube>D_3LQjZgdbQ</youtube>

~~<!--~~=== ~~United States military~~ Dr. Christopher Guest discusses circumcision=== <youtube>v=TQIp9f4krVQ</youtube>

~~American soldiers serving in World War II were subjected to regular inspections of their genitals. If intact, the soldiers risked being ordered to undergo immediate circumcision.<ref>{{REFbook~~ ~~|last~~=~~Schoen~~ ~~|first~~=Ed ~~|init~~=E ~~|author-link=Edgar J. Schoen~~ ~~|year=2005~~ ~~|title=On Circumcision~~ ~~|url=https://books.google.de/books?id=-zUhdvSt7cgC~~ ~~|work=~~ ~~|editor=Dianne Yeakey~~ ~~|edition=~~ ~~|volume=~~ ~~|chapter=~~ ~~|pages=72-3~~ ~~|location=Georgetown, Canada~~ ~~|publisher=RDR Books~~ ~~|isbn=1-157143-123-3~~ ~~|quote~~Plastibel circumcision=~~For a critical view, see Sorrells, "The History of Circumcision," p. 333~~ ~~|accessdate~~= ~~|note~~=~~}}</ref> This practice was discontinued at least six decades ago.-->~~

~~=== Non~~{{UNI|Stanford University|SU}} has published a video of an actual non-therapeutic plastibell circumcision . The infant has received two injections of ~~male children ===~~local anesthesia to deaden the dorsal nerves. The ventral nerves were not deadened so the infant still feels pain. One can his cries on the soundtrack.* [https://med.stanford.edu/newborns/professional-education/circumcision/plastibell-technique.html Plastibell Technique]

Human babies, because they are not yet in possession of language, are incapable of giving or refusing consent for being 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 ~~|last=Fletcher~~ ~~|first=Christopher R.~~ ~~|init=CR~~ ~~|year=1999~~ ~~|title=Circumcision in America in 1998: Attitudes, Beliefs, and Charges of American Physicians~~ ~~|url=http://www.springerlink.com/content/h2150v731233m177/~~ ~~|work=Male and Female Circumcision~~ ~~|editors=[[George C. Denniston]], [[Frederick M. Hodges]], [[Marilyn Fayre Milos]]~~ ~~|edition=~~ ~~|volume=~~ ~~|chapter=Section 5~~ ~~|pages=259-71~~ ~~|location=New York~~ ~~|publisher=Kluwer Academic/Plenum Publishers~~ ~~|isbn=~~ ~~|quote~~= ~~|accessdate~~=~~2019-10-12~~ ~~|note~~=~~ID 10.1007/978-0-585-39937-9_19~~}}</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 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 Gomco clamp circumcision ~~of a child.<ref>{{REFjournal~~ ~~|last=~~ ~~|first~~= ~~|title~~=~~Re J (child's religious upbringing and circumcision)~~ ~~|journal~~=~~Family Court Reports~~ ~~|date=2000~~ ~~|volume=1~~ ~~|issue=~~ ~~|pages=307-14~~ ~~|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~~ '''Not for the ~~practice of acceding to parental wishes.<ref>See, e.g., [[Margaret A. Somerville|Somerville]], "Therapeutic and Non-Therapeutic Medical Procedures"; Poulter,~~ squeamish:''~~English Criminal Law~~''; [[Abbie Chessler|Chessler]], "Justifying the Unjustifiable"; Smith, "Male Circumcision."</ref> For example, critics have pointed out that, in the United States, more than 1.3% of male neonatal deaths are attributable to the complications of non-therapeutic circumcision surgery.<ref name="Bollinger 2010"/>

~~==Video=====Is circumcision healthy?===The video ''Is Circumcision Healthy'' is recommended for parental viewing. ~~ ~~<youtube>D_3LQjZgdbQ</youtube>~~ ~~===Dr. Christopher Guest discusses circumcision=== <youtube>v=TQIp9f4krVQ</youtube>~~ ~~===Plastibel circumcision===~~ {{UNI|Stanford University|SU}} has published a video of an actual non-therapeutic plastibell circumcision. The infant has received two injections of local anesthesia to deaden the dorsal nerves. The ventral nerves were not deadened so the infant still feels pain. One can his cries on the soundtrack.* [https://med.stanford.edu/newborns/professional-education/circumcision/plastibell-technique.html Plastibell Technique] ~~===Gomco clamp circumcision===~~ ~~'''Not for the squeamish:'''~~ This is a video of an actual circumcision with a Gomco clamp. The infant boy received two dorsal penile nerve block (DPNB) analgesic injections but they did not seem to work.

* [https://www.reddit.com/r/Intactivism/comments/qbpzqr/trained_medical_professionals_restrain_infant_to/ Circumcision video]

</blockquote>

* Andrew E. MacNeiiy, Head, Division of Pediatric Urology, Department of Urological Sciences, {{UNI|University of British Columbia|UBC}}, Vancouver, BC, (2008) said:

Newborn circumcision remains an area of controversy. Social, cultural, aesthetic and religious pressures form the most common reasons for non-therapeutic circumcision. Although penile cancer and UTIs are reduced compared with uncircumcised males, the incidence of such illness is so low that circumcision cannot be justified as prophylaxis. The role of the foreskin in [[HIV]] transmission in developed countries is unclear, and safe sexual practice remains the cornerstone of prevention. There remains a lack of knowledge regarding what constitutes the normal foreskin both among parents and among primary care providers. This lack of knowledge results in a burden of costs to our health care system in the form of unnecessary urological referrals, expansion of wait times and circumcisions. Routine circumcision of all infants is not justified from a health or cost-benefit perspective.<ref>{{REFjournal

* [[Adolescent and adult circumcision]]

* [[Bodily harm]]

* [[Breastfeeding]]

* [[Case Histories]]

* {{REFweb

|url=~~http~~https://www.cirp.org/library/anatomy/garcia/

|title=What exactly is circumcision and what is it not?

|last=Garcia

|last=Winkel

|first=Rich

|author-link=Rich Winkel

|date=2005-05-12

|accessdate=2021-01-27

|author2-link=

|etal=no

|title=Libertarianism and circumcision |trans-title= |language= |journal=Int J Health Poiicy Manag |location= |date=2014-05-26 |volume=3 |issue= |article= |page= |pages=33-40 |url=https://www.academia.edu/7587653/Libertarianism_and_Circumcision?email_work_card=view-paper |pubmedID=24987720 |pubmedCID=4075101 |DOI=10.15171/ijhpm.2014.51 |accessdate=}} * {{REFweb |url=https://intaction.org/what-is-circumcision/ |title=What is circumcision? |last=Simone |first=Judy |author-link= |publisher=Intaction |website=https://intaction.org/ |date=2020-07-26 |accessdate=2020-10-04 |format= |quote=}}* {{REFjournal |last=Deacon |first= |init=M |author-link= |last2=Muir |first2= |init2=G |author2-link= |etal=no |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}}

* {{REFweb

~~|url=https://intaction.org/what-is-circumcision/~~

~~|title=What is circumcision?~~

~~|last=Simone~~

~~|first=Judy~~

~~|author-link=~~

~~|publisher=Intaction~~

~~|website=https://intaction.org/~~

~~|date=2020-07-26~~

~~|accessdate=2020-10-04~~

~~|format=~~

~~|quote=~~

}}

* {{REFjournal

~~|last=Deacon~~

~~|first=~~

~~|init=M~~

~~|author-link=~~

~~|last2=Muir~~

~~|first2=~~

~~|init2=G~~

~~|author2-link=~~

~~|etal=no~~

~~|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~~

}}

~~{{REF}}~~

[[Category:Circumcision]]

[[Category:Male circumcision]]

[[Category:Parental information]]

[[Category:Penile surgery]]

[[Category:Medical term]]

[[Category:Male genital mutilation]]

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