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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.
'''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.
}}</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. Circumcision is classified as a form of [[genital mutilation]].
== 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
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===
=== 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.
|accessdate=2023-10-22
}}</ref> They are made to enable a physician to perform circumcision and collect a fee.
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===Search for prophylactic reasons===
''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
|url=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=
* 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
|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
''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 problemconcern.
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
|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.
The [https://www.cirp.org/library/statements/aap1999/|AAP Circumcision Policy Statement] (1999) states quite clearly that ''"There is considerable evidence that newborns who are [[circumcised]] without analgesia experience pain and physiologic stress"''. Furthermore, the pain is quite severe, and requires injections for proper pain management. Sucrose and Acetaminophen ''"cannot be recommended as the sole method of analgesia"''. Topical cream is no longer thought sufficient as ''"the analgesic effect is limited during the phases associated with extensive tissue trauma such as...tightening of the clamp"''.<ref>{{REFjournal
}}</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 local anesthetic are now recommended by all of the major medical institutionsif a circumcision is to be performed. 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 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 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>{{REFweb
|title=Report 10 of the Council on Scientific Affairs (I-99): Neonatal Circumcision
|website=American Medical Association Official Website
}}</ref> Be that as it may, few forms of analgesia are recommended. There are basically two types of injections to choose from, and the website does not go into the difference between a 'dorsal nerve block' and a 'ring block' injection.
Given what is known from aforementioned official documents, the AAP website may be more informative and effective if it would say ''"Make sure your doctor knows of the ineffectiveness of anything short of local anesthesia, and make sure your baby is given an injection. This is your responsibility, because your doctor may or may not be up to date on the latest understandings of infant sensitivity to [[pain ]] during circumcision."'' The AAP may be holding back, however, perhaps because this would upset the doctor/parent power relationship, and may cause too much questioning of doctors in general. One may not expect to find this kind of advice on such a website, and yet, anything less than this is a dangerously weak statement.
To control [[pain]], some physicians that circumcise use Tylenol, sugar,<ref>{{REFweb
|date=
|accessdate=2011-04-08
}}</ref> Topical anaesthetic only serves to numb the area to lessen the pain of the injection, but studies have shown that a [[dorsal penile ring nerve block ]] is not always only partially effective in stopping the [[Pain| pain of circumcision]].<ref name="Journal of Perinatology April/May 2002">{{REFjournal
|last=Taeusch
|first=H. William
{{Box|Boxtext=<big><b>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]].</b></big>}}
 
== Risks and 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 effects. Uberoi et al. (2022) report "some men are experiencing a complex negative constellation of psychological, physical, and sexual associations that lead to significant emotional distress directed both internally and externally. The posts also reveal a discovery phenomenon wherein men discover the physical and psychological manifestations of the decisions made by others to modify their genitals."<ref name ="uberoi2022">{{REFjournal
|last=Uberoi
|accessdate=2023-01-08
}}</ref>
=== Possible operative and postoperative complications ===
=== Physical effects ===* [[Bodily harm]]* [[Circumcision scar]] is surgeryan invariable effect. Surgical complications * An unavoidable effect of any circumcision generally may be classified as is the permanent loss of sexual sensitivity. This is partly due to the removal of sensory tissue. The [[Bleeding| hemorrhageforeskin]]contains very many nerve endings and touch receptors, which account for the major part of male sexual sensation. If the [[infectionforeskin]]is removed, or surgical misadventure up 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 including loss 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 and ]]es in adult males. Other studies revealed that [[circumcised]] men use condoms significantly less often than [[deathintact]]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="deacon2022taylor1996" />. This risk is partly dependent on the anatomy of the [[penis]]. While some [[penis]]es already have the majority of their full size when flaccid ([[Flesh Penis]], or "[[shower]]"), others are rather short when flaccid and double or more their size during an [[erection]] ([[Blood Penis]], or "[[grower]]"). Especially in children's circumcision, where the [[penis]] is not yet fully developed, the amount of reserve [[skin]] needed in adulthood cannot be estimated. * Erectile dysfunction: Both the damage inflicted to the blood vessels in the [[foreskin]] and the reduced sexual sensitivity can be causes for reduced erectile function with advancing age.<ref name="williams-kapilla1993">{{REFjournal |last=WilliamsMoney |init=N |author-link=J |last2=KapillaDavison |init2=L |author2-link= |etal=noJ |title=Complications of Adult penile circumcision |trans-title= |language=: Erotosexual and cosmetic sequelae |journal=Brit J Surg |location=Journal of Sex Research |date=1993-101983 |volume=8019 |issue=10 |pages=1231289-692 |url=https://www.cirp.org/library/complications/williams-kapila/ |quote= |pubmedID=8242285 |pubmedCID= |DOI=10.1002/bjs.1800801005 |accessdate=2019-11-27
}}</ref>
* Intolerance or allergic reactions Orgasm problems: In the wake of reduced sexual sensitivity, due to the narcotics usedloss of sensory tissue and gradual [[keratinization]] of the surface of the [[Glans penis|glans]], orgasm problems may develop with increasing age.* Especially in newbornsIn this case, where the bodily pain reduction mechanisms are sexual arousal created by intercourse or [[masturbation]] is not yet fully developed, local anaesthesia enough to achieve orgasm. A preliminary stage of this late effect is the prolonged time [[circumcised]]] men need to reach an orgasm. This is often insufficient fielded as the "cut men have more endurance" argument for the operationcircumcision. Even in conjunction with regional anaesthesia of * Vaginal dryness: Due to the dorsal nerve loss of the natural [[penisgliding action]], which comes from the rate mobility of failure to provide sufficient anaesthetic even for experienced anaesthetists is still 5-10%. The general anaesthesia that would be needed for newborns, however, poses significant risks for the child[[foreskin]] and [[shaft skin]], a much increased friction between [[penis]] and, therefore, is only likely to be used in emergencies. A surgical operation without proper [[painvagina]] control occurs during intercourse. This can make intercourse painful for both partners and lead to the development of a specific pain memoryabrasions<ref>{{REFweb |url=http:FrischM LindholmM GroenbaekM 2011}}<//www.spiegel.de/spiegel/vorab/experte-warnt-rituelle-beschneidung-veraendert-das-gehirn-der-kinder-a-849534.htmlref><ref>{{REFjournal |titlelast=KinderschmerzCortés-Experte warnt: Rituelle Beschneidung verändert das Gehirn der KinderGonzález |trans-titleinit=Children's pain expert warns: Ritual circumcision changes the brain of childrenJ |languagelast2=German |last=Prof. Dr. med. Boris ZernikowArratia-Maqueo |firstinit2=J |publisherlast3=Spiegel Online |website= |date=2012Gómez-08-12Guerra |accessdateinit3=2019-10-11 |format= |quote=}}</ref>. In unsedated and partially sedated infants increased secretion of the stress hormone cortisol could be observed for months after the operation. Overall, their pain threshold was lower and the risk of chronic pain increased. Regardless of these findings, infant circumcisions with insufficient or no anaesthetic are still common practice<ref>{{REFjournal |last=Garry |init=TL |title=Circumcision: a survey Does circumcision has an effect on female's perception of fees and practicessexual satisfaction? |journal=OBG ManagementRev Invest Clin |date=19942008 |volume=October60 |issue=3 |pagespage=34-6227
|url=
|pubmedID=18807735
|accessdate=
}}</ref> The prolonged time it takes [[circumcised]] men to reach orgasm, as well as the often longer and more vigorous thrusting movements - compared to [[intact]] men - play a part in this.<ref name="ColdCJ TaylorJR 1999">{{ColdCJ TaylorJR 1999}}</ref><ref>{{REFjournal |last=HowardFink |init=CRKS |last2=HowardCarson |init2=FMCC |last3=GarfunkelDeVellis |init3=LC |last4=de Blieck |init4=EA |last5=Weitzman |init5=MRF |title=Neonatal circumcision Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and pain relief: current training practicesSatisfaction |journal=PediatricsJ Urol |date=19982002 |volume=101167 |issue=5 |pages=4232113-86
|url=
|accessdate=
}}</ref>
 
* [[Lymphoedema]] of the penis is a normal and expected complication of male circumcision.
 
* [[Meatal stenosis]], a pathological narrowing of the opening of the [[urethra]], which mostly occurs in infancy and early childhood. It is one of the most common complications of infant circumcision. A study from 2006 found meatal stenosis exclusively in previously [[circumcised]] boys. The incidence rate after a circumcision is approximately 10 to 20 percent.<ref name="vanhowe2006">{{REFjournal
|last=Van Howe
|init=RS
|author-link=Robert S. Van Howe
|title=Incidence of meatal stenosis following neonatal circumcision in a primary care setting
|journal=Clin Pediatr (Phila)
|note=Jan-Feb 2006
|date=2006-01
|volume=45
|issue=1
|pages=49-54
|url=https://www.academia.edu/6992015/Incidence_of_Meatal_Stenosis_following_Neonatal_Circumcision_in_a_Primary_Care_Setting
|accessdate=2019-12-15
}}</ref><ref>{{REFjournal
|last=StangStenram |init=HJA |last2=SnellmanMalmfors |init2=LWG |last3=Okmian |init3=L |title=Circumcision practice patterns in the United Statesfor [[phimosis]]: a follow-up study |journal=PediatricsScandinavian journal of urology and nephrology |date=19981986 |volume=10120 |issue=e52 |pagespage=89
|url=
|pubmedID=3749823
|accessdate=
|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 typically 3- to 4-fold increase in cortisol levels, which equals a state of severe [[shock]].<ref>{{REFjournalREFweb |lasturl=Gunnarhttp://emedicine.medscape.com/article/1016016-overview |inittitle=MRMeatal Stenosis |last2publisher=FischMedscape |init2accessdate=RO2019-10-11 |last3=Korsvik}}</ref> |init3=S |last4=Donhowe |init4=JM |title=The effects * Shorter adult penile length was reported by Park et al. (2016) as a result of NMC (newborn male circumcision on serum cortisol and behavior). |journal=Psychoneuroendocrinology{{Citation |dateTitle=1981 |volumeText=6In conclusion, second to fourth digit ratio, flaccid penile length, and age of circumcision were significant predictive factors for erectile penile length. Furthermore, the penile lengths of the NMC group were shorter than those of the non-NMC group. |issueAuthor=3Park et al. |pagesSource=269-75 |urlref=https://www.cirp.org/library/pain/gunnar/ |accessdate=2019-11-26}}</ref>* Postoperative wound pain, in the case of children's circumcisions conceivably worsened by the forceful breaking of the preputial adhesions.* Postoperative pain from the exposure of the sensitive glans penis to clothing. This pain will endure for several weeks or even longer in some cases.* Postoperative [[bleeding]] of the wound. This can have severe consequences especially for very young infants, if they are not treated promptly. Their blood volume is only about 85 ml per kilogram of body weight, and even moderate blood loss can lead to hypovolaemia, hypovolaemic [[shock]] and even death.<ref>{{REFbookREFjournal |last=Park
|first=
|yearinit=2000JK |author-link= |last2=Doo |first2= |init2=AR |author2-link= |last3=Kim |first3= |init3=JH |author3-link= |last4=Park |first4= |init4=HS |author4-link= |etal=yes |title=Paediatric HandbookProspective investigation of penile length with newborn male circumcision and second to fourth digit ratio. |urltrans-title= |worklanguage= |editorsjournal=Smart Can Urol Assoc J, Nolan T. |editionlocation= |date=2016-09 |season=6 |volume=10 |issue=9-10 |chapterarticle= |page=82 |locationpages={{AUSC|VIC}}, Australia |publisherurl=Blackwell Science Asiahttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028213/ |isbnarchived=
|quote=
|accessdatepubmedID=27695583 |pubmedCID=5028213 |DOI=10.5489/cuaj.3590 |noteaccessdate=2022-09-04}}</ref><ref>{{REFdocument |title=Autopsy of Demetrius Manker}}  |url= |contribution=Case 93-1711 |last=Wetli |firstSexual effects =CV |publisher=Miami: Dade County Medical Examiner Department |format= |date=1993Cepeda-06-23 |accessdate=}}</ref> Emiliani et al (2023) cited six reports in the literature of detrimental effects of circumcision, including erectile function, sensation, masturbatory pleasure, orgasm, and sexual satisfaction. The authors also cited three studies of severe distress in [[circumcised]] men, due to their infant circumcision, with complaints of [[glans]] insensitivity, delayed [[ejaculation]], and unpleasant sensation.<refname="cepeda2023">{{REFjournal |last=HissCepe da-Emiliani |init=J |last2first=Horowitz |init2init=A |last3author-link=KahanaAlfonso Cepeda-Emiliani |init3last2=TGándara-Cortés |titlefirst2=Fatal haemorrhage following male ritual circumcision |journalinit2=J Clin Forensic MedM |dateauthor2-link=2000 |volume=7 |issuelast3= |pages=32Otero-4 |url=https://www.cirp.org/library/death/hiss1/Alén |accessdatefirst3=2019-11-06}}</ref><ref>{{REFdocument |titleinit3=Judgement of inquiry into the death of McWillis, Ryleigh Roman BryanM |url=http://www.circumstitions.com/deathauthor3-exsang.html |contributionlink= |lastlast4=NewellGarcía |firstfirst4=TEC |publisherinit4=Burnaby, B.C.: B.C. Coroner's ServiceH |formatauthor4-link= |datelast5=2004Suárez-01-19Quintanilla |accessdatefirst5=2019-11-26}}</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>{{REFconference |lastinit5=Dr. med. HartmannJ |firstauthor5-link=Wolfgang |urllast6=García-Caballero |placefirst6=Rechtsausschuss des Bundestages [Legal Committee of the Bundestag] (German) |titleinit6=Stellungnahme zur Anhörung am 26. November 2012 [Opinion on the hearing on 26 November 2012] (German)T |dateauthor6-link=2012-11-26 |accessdatelast7=}}</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>{{REFjournalGallego |lastfirst7=Blalock |initinit7=HJR |last2author7-link=Vemulakonda |init2last8=VGarcía-Caballero |last3first8=Ritchey |init3init8=MLR |last4author8-link=Ribbeck |init4etal=Mno |title=Outpatient management Immunohistological study of [[phimosis]] Following newborn circumcisionthe density and distribution of human penile neural tissue: gradient hypothesis |journaltrans-title=J Urol |datelanguage=2003 |volumejournal=169Int J Impot Res |issuelocation=6 |pagesdate=23322023-4 |url=https://www.cirp.org/library/complications/blalock1/ |accessdate=2019-11-26}}</ref>, the prevalence is 2.9%, according to Leitch<ref>{{REFjournal |last=Leitch |init=IOW |title=Circumcision 05- a continuing enigma02 |journalvolume=Aust Paediatr J35 |dateissue=19703 |volumearticle=6 |issuepage= |pages=59286-65305 |url=https://www.cirpnature.orgcom/libraryarticles/general/leitch1/ |accessdate=2019s41443-12022-15}}</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]] (micro00561-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>{{REFweb9 |url=http://www.nytimes.com/2012/03/08/nyregion/infants-death-renews-debate-over-a-circumcision-ritual.html?_rarchived=0 |titlequote=Baby’s Death Renews Debate Over a Circumcision Ritual |lastpubmedID=Robbins35501394 |firstpubmedCID=Liz |dateDOI=201210.1038/s41443-03022-0700561-9 |accessdate=20192023-1011-1126
}}</ref>
Circumcision and frenectomy remove tissues with heightened erogenous sensitivity.<ref name="cepeda2023" /> <ref name="winkleman1959">{{WinkelmannRK 1959}}</ref> They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well." The [[amputation]] of the prepuce results in the loss of the majority of fine-touch neuroreceptors found in the [[penis]], leaving only the uninhibited protopathic sensibility of the artificially externalized [[glans penis]]. The imbalance caused by not having the input from the now ablated fine-touch receptors may be a leading cause of the changes in sexual behavior noted in [[circumcised]] human males.<ref>{{REFjournal |last= Physical late effects Van Howe |init=RS |author-link=Robert S. Van Howe |last2=Cold |init2=CJ |title=Advantages and Disadvantages of Neonatal Circumcision |journal=The Journal of the American Medical Association |volume=277 |issue=13 |pages=1052-7 |url=http://www.ncbi.nlm.nih.gov/pubmed/9218663 |quote= |pubmedID=9218663 |pubmedCID= |DOI= |date=1997-04-02 |accessdate=}}</ref> Histology of the male circumcision scar shows [[amputation]] neuromas, Schwann cell proliferation and the bulbous collection of variably sized neurites. [[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 example of surgical flexibility during circumcision, 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 penile body, and to the extent that the prepuce is still conceived by segments of the medical community as "just a small piece of skin", we are concerned that aggressive circumcisions are intentionally or unintentionally being performed in pediatric and adult patients in the belief that "redundant" or " extra" tissue is being excised, or in the belief that "excesive sensitivity" is being reduced to augment ejaculatory latency time.<ref name="cepeda2023" /></blockquote>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.  See [[Sexual effects of circumcision]] for more information.
* An unavoidable === Psychological effects ===[[Psychological_issues_of_male_circumcision#Circumcision_trauma_in_adults| Psychological late effect of any effects]] are also possible after a circumcision is , especially if the permanent loss of sexual sensitivityoperation was carried out in childhood. This is partly due to the removal On this occasion a variety of sensory tissue. The [[foreskintrauma]] contains very many nerve endings and touch receptorsmay occur, which account for depend, among others, on age and circumstances of the major part of male sexual sensationcircumcision. If For example, whether the [[foreskin]] is removedcircumcision took place with or without sufficient anaesthesia, they can no longer provide sexual stimulation. It is also partly due to if the fact that the surface of individual has been informed about the operation beforehand, if he was [[Glans penis|glanscircumcised]] reacts to the missing protection from friction against his will or without his consent, and drying out by developing a callus layer. This reduces the sensitivity of the remaining nerves also, 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 case of sensitivity infant circumcision, if he was told about it during childhood or had 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)find it out coincidentally on his own.
* 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 The psychological late effects of the [[penis]]. While some [[penis]]es already have the majority of their full size when flaccid ([[Flesh Penis]]circumcision are not yet fully researched, or "[[shower]]"), others are and many studies took place on rather short when flaccid and double or more their size during an [[erection]] ([[Blood Penis]], or "[[grower]]")a small scale. Especially in children's circumcisionThis situation needs to be rectified, where because the [[penis]] is not yet fully developedavailable studies, as well as the amount histories of reserve [[skin]] needed in adulthood cannot be estimatednegatively affected men, suggest that these late effects may have more impact than previously assumed.
* Erectile dysfunction: Both the damage inflicted to the blood vessels in the It was observed that infants, following circumcision without [[foreskinpain]] and the reduced sexual sensitivity can be causes for reduced erectile function control, had a disturbed bond with advancing age.their mother<ref>{{REFjournal |last=MoneyMarshall |init=JRE |last2=DavisonPorter |init2=JFL |last3=Rogers |init3=AG |etal=yes |title=Adult penile circumcisionCircumcision: Erotosexual and cosmetic sequelaeII effects upon mother-infant interaction |journal=Journal of Sex ResearchEarly Hum Dev |date=19831982 |volume=197 |issue=4 |pages=289367-9274 |url=https://www.cirp.org/library/birth/marshall2/ |accessdate=2020-02-01}}</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.
* Orgasm problems: In the wake of reduced sexual sensitivityboys [[circumcised]] in childhood, due to the loss of sensory tissue and gradual [[keratinizationpost-traumatic stress disorder]] of the surface of the ([[Glans penis|glansPTSD]], orgasm problems may develop with increasing age) could be diagnosed. In this casea study on Philippine boys, the sexual arousal created by intercourse or in whom no [[masturbationPTSD]] is not enough was found prior to achieve orgasm. A preliminary stage the operation, 69% of this late effect is the prolonged time boys [[circumcised]]] men need to reach an orgasm. This is often fielded as in the "cut men have more endurance" argument for circumcision.* Vaginal dryness: Due to the loss traditional ritual and 51% of the natural those [[gliding actioncircumcised]], which comes from by standard medical procedures (including anaesthesia) fulfilled the mobility of DSM-IV criteria for PTSD following the [[foreskin]] and [[shaft skin]], a much increased friction between [[penis]] and [[vagina]] occurs during intercourseoperation. This can make intercourse painful for both partners and lead to abrasions<ref>{{FrischM LindholmM GroenbaekM 2011}}</ref><ref>{{REFjournalREFbook |last=Cortés-GonzálezRamos |init=JS |last2=Arratia-MaqueoBoyle |init2=JGJ |last3year=Gómez-Guerra |init3=L2001 |title=Does Understanding circumcision has an effect on female's perception of sexual satisfaction? |journal=Rev Invest Clin |date=2008 |volume=60 |issue=3 |page=227: A Multi-Disciplinary Approach to a Multi-Dimensional Problem |url=https://link.springer.com/chapter/10.1007/978-1-4757-3351-8_14 |pubmedIDwork=18807735 |accessdateeditors=}}</ref> The prolonged time it takes [[circumcisedGeorge C. Denniston]], [[Frederick M. Hodges]] men to reach orgasm, as well as the often longer and more vigorous thrusting movements - compared to [[intactMarilyn Fayre Milos]] men - play a part in this.<ref name="ColdCJ TaylorJR 1999">{{ColdCJ TaylorJR 1999}}</ref><ref>{{REFjournal |lastedition=Fink |initvolume=KS |last2chapter=Carson |init2=CC |last3=DeVellis |init3=RF |title=Adult Circumcision Outcomes StudyRitual and medical circumcision among Filipino boys: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfactionevidence of post-traumatic stress disorder |journalpages=J Urol253-70 |datelocation=2002New York |volumepublisher=167 |issue=5Kluwer Academic/Plenum Publishers |pagesisbn=2113-6 |urlquote=
|accessdate=
|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, interviewed men stated they felt betrayed - 55% by the mother, 50% by the father, and 58% by the doctor, and 73% felt that their [[human rights]] had been violated.<ref name="GSoCH">{{REFweb
|url=http://www.circumcisionharm.org/
|title=Global Survey of Circumcision Harm
|accessdate=2019-10-12
}}</ref>
 * [[Lymphoedema]] of It can frequently be found that the penis loss is a normal and expected complication denied, much as happens with the loss of male circumcisionother body parts. * This denial can lead to fathers having their sons [[Meatal stenosiscircumcised]]in order not to be reminded of their own loss. In this process, a pathological narrowing of the opening of their own body is defined as "normal" and the [[urethraforeskin]]redefined as a foreign object. Their own parents are seen as "good", which mostly occurs in infancy and early childhood. It so that this image is one of projected onto the most common complications of infant circumcisiontheir parents carried out as well, in order to keep the positive emotion intact. A study from 2006 found meatal stenosis exclusively The father wants to be a "good" father later in previously 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]] boys. The incidence rate after a circumcision is approximately 10 to 20 percentas well.<ref name="vanhowe2006">{{VanderKolkBA 1989}}</ref><ref>{{REFjournal |last=Van HoweGoldman |init=RSR |author-link=Robert SRonald Goldman |url=https://www.cirp. Van Howeorg/library/psych/goldman1/ |title=Incidence The psychological impact of meatal stenosis following neonatal circumcision in a primary care setting |journal=Clin Pediatr (Phila) |note=Jan-Feb 2006BJU Int |date=2006-011999 |volume=4583 |issue=Suppl. 1 |pages=4993-54 |url=https://www.academia.edu/6992015/Incidence_of_Meatal_Stenosis_following_Neonatal_Circumcision_in_a_Primary_Care_Setting103 |accessdate=2019-10-12-15}}</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=StenramRhinehart |init=AJ |url=https://www.cirp.org/library/psych/rhinehart1/ |title=Neonatal circumcision reconsidered |last2journal=MalmforsTransactional Analysis J |init2date=G1999 |last3volume=Okmian29 |init3issue=L3 |titlepages=215-21 |accessdate=Circumcision for 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 [[phimosisintact]]: a follow-up males.<ref name="GSoCH"/>* Cases in which children felt ill treated or punished have been documented as well. G. Cansever found in her studyon 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 |journallast=Cansever |init=Scandinavian journal of urology and nephrologyG |date=19861965 |volumeurl=20https://www.cirp.org/library/psych/cansever/ |issuetitle=2Psychological effects of circumcision |pagejournal=89Brit. J. Med. Psychol |urlvolume=38 |pubmedIDpages=3749823321-31 |accessdate=2019-10-12}}</ref>* Fear of being alone or darkness.<refname="Levy1945">{{REFwebREFjournal |last=Levy |first=David M. |init=DM |url=httphttps://emedicinewww.medscapecirp.comorg/articlelibrary/psych/levy1/1016016-overview |title=Meatal StenosisPsychic trauma of operations in children; and a note on combat neurosis |journal=American Journal of Diseases of Children |volume=69 |publisherdate=Medscape1945 |pages=7-25 |accessdate=2019-10-1112
}}</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]].
* Shorter adult penile length was reported by Park et al. [[Intact America]] (20162019) as a result of NMC called circumcision an [[Adverse Childhood Experiences (newborn male circumcisionACEs).| adverse childhood experience]],<ref name-"bollinger2019">{{CitationREFdocument |Titletitle=Child genital cutting as an adverse childhood experience |Texturl=In conclusion, second to fourth digit ratio, flaccid penile length, and age of circumcision were significant predictive factors for erectile penile lengthhttp://adversechildhoodexperiences.net/CGC_as_an_ACE. Furthermore, the penile lengths of the NMC group were shorter than those of the nonpdf |last=Bollinger |first=Dan |author-link=Dan Bollinger |last2=Chapin |first2=Georganne |author2-NMC group. link=Georganne Chapin |publisher=Intact America |location=Tarrytown |Authorformat=Park et al.PDF |Sourcedate=2019-08 |accessdate=2021-11-02}}</ref> == Complications ===== Possible operative and postoperative complications ===Circumcision is surgery. Surgical complications of circumcision generally may be classified as [[Bleeding| hemorrhage]], [[infection]], or surgical misadventure up to and including loss of the penis and [[death]].<refname="deacon2022" /><ref name="williams-kapilla1993">{{REFjournal |last=Park |first=Williams |init=JKN
|author-link=
|last2=Doo |first2=Kapilla |init2=ARL
|author2-link=
|last3=Kim |first3= |init3=JH |author3-link= |last4=Park |first4= |init4=HS |author4-link= |etal=yesno |title=Prospective investigation Complications of penile length with newborn male circumcision and second to fourth digit ratio. |trans-title= |language= |journal=Can Urol Assoc Brit JSurg
|location=
|date=20161993-09 |season=10 |volume=1080 |issue=9-10 |article= |page= |pages=1231-6 |url=https://www.ncbicirp.nlm.nih.govorg/pmclibrary/articlescomplications/PMC5028213williams-kapila/ |archived=
|quote=
|pubmedID=276955838242285 |pubmedCID=5028213 |DOI=10.54891002/cuajbjs.3590 1800801005 |accessdate=20222019-0911-0427
}}</ref>
}}
=== Sexual effects ===
Circumcision and frenectomy remove tissues with heightened erogenous sensitivity* Intolerance or allergic reactions to the narcotics used.<ref name="cepeda2023" /> <ref name="winkleman1959">{{WinkelmannRK 1959}}</ref> They concluded, "Evidence has also started to accumulate that male circumcision may result * Especially in lifelong physicalnewborns, sexualwhere the bodily pain reduction mechanisms are not yet fully developed, and sometimes psychological harm as welllocal anaesthesia is often insufficient for the operation." The [[amputation]] of the prepuce results Even in the loss conjunction with regional anaesthesia of the majority dorsal nerve of fine-touch neuroreceptors found in the [[penis]], leaving only the uninhibited protopathic sensibility rate of the artificially externalized [[glans penis]]failure to provide sufficient anaesthetic even for experienced anaesthetists is still 5-10%. The imbalance caused by not having general anaesthesia that would be needed for newborns, however, poses significant risks for the input from the now ablated fine-touch receptors may child, and, therefore, is only likely to be a leading cause of the changes in sexual behavior noted used in emergencies. A surgical operation without proper [[circumcisedpain]] human males.control can lead to the development of a specific pain memory<ref>{{REFjournalREFweb |lasturl=Van Howehttp://www.spiegel.de/spiegel/vorab/experte-warnt-rituelle-beschneidung-veraendert-das-gehirn-der-kinder-a-849534.html |inittitle=RSKinderschmerz-Experte warnt: Rituelle Beschneidung verändert das Gehirn der Kinder |authortrans-linktitle=Robert S. Van HoweChildren's pain expert warns: Ritual circumcision changes the brain of children |last2language=ColdGerman |init2last=CJProf. Dr. med. Boris Zernikow |titlefirst=Advantages and Disadvantages of Neonatal Circumcision |journalpublisher=The Journal of the American Medical AssociationSpiegel Online |volumewebsite=277 |issuedate=132012-08-12 |pagesaccessdate=10522019-10-711 |urlformat=http://www.ncbi.nlm.nih.gov/pubmed/9218663
|quote=
}}</ref>. In unsedated and partially sedated infants increased secretion of the stress hormone cortisol could be observed for months after the operation. Overall, their pain threshold was lower and the risk of chronic pain increased. Regardless of these findings, infant circumcisions with insufficient or no anaesthetic are still common practice<ref>{{REFjournal |last=Garry |pubmedIDinit=9218663T |pubmedCIDtitle=Circumcision: a survey of fees and practices |DOIjournal=OBG Management |date=19971994 |volume=October |issue= |pages=34-04-026 |url=
|accessdate=
}}</ref> Histology of the male circumcision scar shows [[amputation]] neuromas, Schwann cell proliferation and the bulbous collection of variably sized neurites. [[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 example of surgical flexibility during circumcision, 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 penile body, and to the extent that the prepuce is still conceived by segments of the medical community as "just a small piece of skin", we are concerned that aggressive circumcisions are intentionally or unintentionally being performed in pediatric and adult patients in the belief that "redundant" or " extra" tissue is being excised, or in the belief that "excesive sensitivity" is being reduced to augment ejaculatory latency time.<ref name="cepeda2023">{{REFjournal |last=Cepeda-EmilianiHoward |init=CR |last2=Howard |init2=FM |firstlast3=Garfunkel |initinit3=ALC |author-linklast4=Alfonso Cepeda-Emilianide Blieck |last2init4=Gándara-Cortés EA |first2last5=Weitzman |init2init5=M |author2-linktitle=Neonatal circumcision and pain relief: current training practices |journal=Pediatrics |last3date=Otero-Alén1998 |first3volume=101 |init3issue=M |author3pages=423-link8 |url= |last4accessdate=García }}</ref><ref>{{REFjournal |first4last=Stang |init4init=HHJ |author4-linklast2=Snellman |last5init2=Suárez-QuintanillaLW |first5title=Circumcision practice patterns in the United States |init5journal=JPediatrics |author5-linkdate=1998 |last6volume=García-Caballero101 |first6issue=e5 |init6pages=T |author6-linkurl= |last7accessdate=Gallego |first7note=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 typically 3- to 4-fold increase in cortisol levels, which equals a state of severe [[shock]].<ref>{{REFjournal |init7last=RGunnar |author7-linkinit=MR |last8last2=García-CaballeroFisch |first8init2=RO |init8last3=RKorsvik |author8-linkinit3=S |etallast4=noDonhowe |titleinit4=Immunohistological study of the density and distribution of human penile neural tissue: gradient hypothesisJM |trans-title=The effects of circumcision on serum cortisol and behavior |journal= Int J Impot ResPsychoneuroendocrinology |date=2023-05-021981 |volume=356
|issue=3
|article= |page= |pages=286269-30575 |url=https://www.naturecirp.comorg/library/articlespain/s41443-022-00561-9 |archived= |quote= |pubmedID=35501394 |pubmedCID= |DOI=10.1038gunnar/s41443-022-00561-9 |accessdate=20232019-11-2326
}}</ref>
</blockquote>The un-anesthetized and un-sedated newborn infant is restrained * Postoperative wound pain, in the case of children's circumcisions conceivably worsened by being strapped to a special plastic board called the [[circumstraint]]forceful breaking of the preputial adhesions. 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 * Postoperative pain from the exposure of the child's [[human rights]] sensitive glans penis to [[physical integrity]], but in older patients may be rarely indicated for therapeutic reasonsclothing. It is a radical treatment option This pain will endure for pathological [[phimosis]], refractory [[balanoposthitis]] and chronic [[urinary tract infection]]s (UTIs); it is contraindicated several weeks or even longer in some cases of certain genital structure abnormalities or poor general health.  See [[Sexual effects of circumcision]] for more information. === Psychological effects === * Postoperative [[Psychological_issues_of_male_circumcision#Circumcision_trauma_in_adults| Psychological late effectsbleeding]] are also possible after a circumcision, especially if the operation was carried out in childhood. On this occasion a variety of [[trauma]] may occur, which depend, among others, on age and circumstances of the circumcisionwound. For example, whether the circumcision took place with or without sufficient anaesthesia, if the individual has been informed about the operation beforehandThis can have severe consequences especially for very young infants, 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 they 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 well as the histories of negatively affected men, suggest that these late effects may have more impact than previously assumedtreated promptly. * It was observed that infants, following circumcision without [[pain]] control, had a disturbed bond with their mother<ref>{{REFjournal |last=Marshall |init=RE |last2=Porter |init2=FL |last3=Rogers |init3=AG |etal=yes |title=Circumcision: II effects upon mother-infant interaction |journal=Early Hum Dev |date=1982 |Their blood volume=7 |issue=4 |pages=367-74 |url=https://www.cirp.org/library/birth/marshall2/ |accessdate=2020-02-01}}</ref>, as well as problems with nurturing, up to the point is only about 85 ml per kilogram of refusal to be fed. The sleeping habits of these babies were also disturbedbody weight, with prolonged non-REM sleep and increased waking. * In boys [[circumcised]] in childhood, [[post-traumatic stress disorder]] ([[PTSD]]) could be diagnosed. In a study on Philippine boys, in whom no [[PTSD]] was found prior even moderate blood loss can lead to the operationhypovolaemia, 69% of the boys hypovolaemic [[circumcisedshock]] in the traditional ritual and 51% of those [[circumcised]] by standard medical procedures (including anaesthesia) fulfilled the DSM-IV criteria for PTSD following the operationeven death.<ref>{{REFbook |last=Ramos |init=S |last2=Boyle |init2first=GJ |year=20012000 |title=Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional ProblemPaediatric Handbook |url=https://link.springer.com/chapter/10.1007/978-1-4757-3351-8_14 |work= |editors=[[George C. Denniston]]Smart J, [[Frederick MNolan T. Hodges]], [[Marilyn Fayre Milos]] |edition=6 |volume= |chapter=Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder |pagespage=253-7082 |location=New York{{AUSC|VIC}}, Australia |publisher=Kluwer Academic/Plenum PublishersBlackwell Science Asia |isbn= |quote=
|accessdate=
|note=
}}</ref><ref>{{REFdocument
|title=Autopsy of Demetrius Manker
|url=
|contribution=Case 93-1711
|last=Wetli
|first=CV
|publisher=Miami: Dade County Medical Examiner Department
|format=
|date=1993-06-23
|accessdate=
}}</ref> <ref>{{REFjournal
|last=Hiss
|init=J
|last2=Horowitz
|init2=A
|last3=Kahana
|init3=T
|title=Fatal haemorrhage following male ritual circumcision
|journal=J Clin Forensic Med
|date=2000
|volume=7
|issue=
|pages=32-4
|url=https://www.cirp.org/library/death/hiss1/
|accessdate=2019-11-06
}}</ref><ref>{{REFdocument
|title=Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan
|url=http://www.circumstitions.com/death-exsang.html
|contribution=
|last=Newell
|first=TEC
|publisher=Burnaby, B.C.: B.C. Coroner's Service
|format=
|date=2004-01-19
|accessdate=2019-11-26
}}</ref>
* Circumcisions, especially those that happen without consent, can spark feelings of helplessness and alienation, which can persist as Post operative [[traumalymphoedema]]. These feeling can also be triggered later, when someone * Postoperative [[circumcisedInfection| infections]] as an infant becomes aware of his circumcision. In an online studyThis includes both local infections, interviewed men stated they felt betrayed - 55% by the mother, 50% by the father, and 58% by the doctor, and 73% felt that their [[human rights]] had been violated.<ref name="GSoCH">{{REFweb |url=http://www.circumcisionharm.org/ |title=Global Survey of Circumcision Harm |accessdate=2019-10-12}}</ref>* It which can frequently be found that the loss is denied, much as happens treated with the loss of 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 processlocal therapy, 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"systemic infections, is passed on to his son by having him [[circumcised]] as wellrequiring systemic antibiotic treatment.<ref>{{VanderKolkBA 1989}}</ref><ref>{{REFjournalREFconference |last=Goldman |init=R |author-link=Ronald Goldman |url=https://wwwDr.cirpmed.org/library/psych/goldman1/Hartmann |titlefirst=The psychological impact of circumcisionWolfgang |journalurl=BJU Int |dateplace=1999 |volume=83 |issue=Suppl. 1 |pages=93-103 |accessdate=2019-10-12}}</ref>* If the Rechtsausschuss des Bundestages [[circumcised]] male feels incomplete, or due to Legal Committee of the missing [[foreskinBundestag]] 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/ (German) |title=Neonatal circumcision reconsidered |journal=Transactional Analysis J |date=1999 |volume=29 |issue=3 |pages=215-21 |accessdate=2019-10-12}}</ref>Stellungnahme zur Anhörung am 26. In an online study, 75% of those interviewed stated that they felt incomplete, and 66% said they felt inferior compared with November 2012 [[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 Opinion 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 hearing on their bodies.<ref>{{REFjournal |last=Cansever |init=G26 November 2012] (German) |date=1965 |url=https://www.cirp.org/library/psych/cansever/ |title=Psychological effects of circumcision |journal=Brit. J. Med. Psychol |volume=38 |pages=3212012-11-3126 |accessdate=2019-10-12
}}</ref>
* Fear [[Wound dehiscence]], meaning the separation of being alone the edges of the wound or the tissue after suturing.* Adhesion between the surface or darknessrim 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 name="Levy1945">{{REFjournal |last=LevyBlalock |init=HJ |last2=Vemulakonda |firstinit2=V |last3=Ritchey |init3=ML |last4=Ribbeck |init4=David M. |inittitle=Outpatient management of [[phimosis]] Following newborn circumcision |journal=J Urol |date=2003 |volume=169 |issue=6 |pages=DM2332-4 |url=https://www.cirp.org/library/psychcomplications/levy1blalock1/ |accessdate=2019-11-26}}</ref>, the prevalence is 2.9%, according to Leitch<ref>{{REFjournal |last=Leitch |init=IOW |title=Psychic trauma of operations in children; and Circumcision - a note on combat neurosiscontinuing enigma |journal=American Journal of Diseases of ChildrenAust Paediatr J |date=1970 |volume=696 |dateissue=1945 |pages=759-2565 |url=https://www.cirp.org/library/general/leitch1/ |accessdate=2019-1012-1215}}</ref>5.5%.* Fear [[Sudden Infant Death Syndrome]] (SIDS).* Knot formation of doctorsthe veins. If the dorsal vein, clinics which originates in the tip of the [[foreskin]], is cut during circumcision without being clamped and also closed roomssutured at its origin separately, it starts to develop new branches over time, which can lead to the development of knots.<ref name="Levy1945"/>* Relapse into Possible deformities due to circumcision include hypoplasia of the state of bed[[penis]] (micro-wetting, even if the child was already dry beforepenis) and induratio [[penis]] plastica (skewed penis).<ref name="Levy1945"/>* Circumcised males who become fathers frequently manifest Medical malpractice can also not be ruled out. Injuries, partly or entirely severing the [[adamant father syndromeGlans penis|glans]]or the [[penis]] can occur. * In rare cases, [[Intact Americanecrosis]] , 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 (2019which consists of sucking blood from the wound with the mouth) called circumcision an , there is a risk of infection with [[Adverse Childhood Experiences (ACEs)| adverse childhood experienceherpes]]simplex type 1,which can lead to brain damage or [[death]].<ref name-"bollinger2019">{{REFdocument |title=Child genital cutting as an adverse childhood experienceREFweb |url=http://adversechildhoodexperienceswww.nytimes.com/2012/03/08/nyregion/infants-death-renews-debate-over-a-circumcision-ritual.nethtml?_r=0 |title=Baby’s Death Renews Debate Over a Circumcision Ritual |last=Robbins |first=Liz |date=2012-03-07 |accessdate=2019-10-11}}</CGC_as_an_ACEref>=== Death ===A study in 2010 estimated approximately 117 neonatal circumcision-related [[Death| deaths]] occur annually in the [[United States]], about one out of every 77 male neonatal deaths, more than suffocation, auto accidents, or even [[SIDS]].pdf<ref name="Bollinger 2010">{{REFjournal |last=Bollinger
|first=Dan
|init=D
|author-link=Dan Bollinger
|last2=Chapin |first2=Georganne |author2-link=Georganne Chapin |publisher=Intact America |location=Tarrytown |format=PDF |date=2019-08 |accessdate=2021-11-02}}</ref> == Complications == === Death ===A study in 2010 estimated approximately 117 neonatal circumcision-related deaths occur annually in the United States, about one out of every 77 male neonatal deaths, more than suffocation, auto accidents, or even [[SIDS]].<ref name="Bollinger 2010">{{REFjournal |last=Bollinger |first=Dan |init=D |author-link=Dan Bollinger |last2=Boy's Health Advisory
|title=Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths
|journal=Thymos: Journal of Boyhood Studies
== Forced circumcision ==
 
<!--=== United States military ===
 
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
|note=
}}</ref> This practice was discontinued at least six decades ago.-->
 
=== Non-therapeutic circumcision of male children ===
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==
===Is circumcision healthy?===
</blockquote>
* Andrew E. MacNeiiy, Head, Division of Pediatric Urology, Department of Urological Sciences, {{UNI|University of British Columbia|UBC}}, Vancouver, BC, (2008) said:
 
<blockquote>
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
|accessdate=2023-05-18
}}</ref>
== Tipping point ==
[[Intact America]] (2024) argues that public opinion regarding non-therapeutic [[circumcision]] of children is approaching or at a "tipping point" at which [[intact]] genitals would be preferred over the [[circumcised]] variety.<ref>{{REFweb
|url=https://intactamerica.org/public-opinion-on-circumcision/
|title=Public Opinion on Circumcision: Can Intactivists Hit A Tipping Point?
|last=Anonymous
|first=
|init=
|publisher=Intact America
|date=2024-03-23
|accessdate=2024-04-09
}}</ref>
{{SEEALSO}}
* [[Adolescent and adult circumcision]]
* [[Bodily harm]]
* [[Breastfeeding]]
* [[Case Histories]]
|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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