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Circumcision

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{{GraphicWarning}}"Male '''circumcision''' (from Latin ''circumcidere'', meaning "to cut around") is the surgical removal or [[amputation]] of the [[foreskin]] (prepuce) from , a major part of the human [[penis]]. The foreskin comprises ''more than fifty percent'' of the epithelium of the [[penis]]...] The procedure <ref name="taylor1996">{{TaylorJR LockwoodAP TaylorAJ 1996}}</ref> When the "cutting around" is most often an elective surgery performed on neonates and children for religious and cultural reasons, but in other cases may be indicated for both therapeutic the foreskin falls off, so [[amputation]] and prophylactic reasons[[mutilation]] is the result. It is a treatment option for pathological phimosisThe amputation destroys the [[Foreskin#Physiological_functions| many protective, immunological, sexual, refractory balanoposthitis and chronic urinary tract infections (UTIs); sensory physiological functions]] of the foreskin, so it is contraindicated in cases of certain genital structure abnormalities or poor general health." (Source: a very harmful and [[http://en.wikipediaPain| painful]] surgery.org/wiki/Circumcision Wikipedia])
'''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
|init=D
|author-link=Dan Bollinger
|last2=
|init2=
|author2-link=
|url=https://kindredmedia.org/2023/02/adverse-childhood-experiences-dysfunctional-households-and-circumcision/
|title=Adverse Childhood Experiences, Dysfunctional Households, And Circumcision.
|journal=Kindred
|date=2023-02-28
|volume=
|issue=
|pages=
|accessdate=2023-03-01
}}</ref>
 
Deacon & Muir (2022) have reviewed the evidence and concluded that "there is no medical justification for performing a circumcision prior to an age that he can assess the known risks and potential benefits, and choose to give or withhold [[informed consent]] himself."<ref name="deacon2022">{{REFjournal
|last=Deacon
|first=Matthew
|init=M
|author-link=
|last2=Muir
|first2=Gordon
|init2=G
|author2-link=
|etal=no
|title=What is the medical evidence on non-therapeutic child circumcision?
|journal= Int J Impot Res
|date=2022-01-08
|url=https://www.nature.com/articles/s41443-021-00502-y
|pubmedID=34997197
|DOI=10.1038/s41443-021-00502-y
|accessdate=2022-01-30
}}</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 ==
 
The [[amputation]] of the [[foreskin]] is a very old ritual, whose exact origin cannot be verified beyond doubt. Circumcision is believed to have originated in east Africa near the Red Sea well before the dawn of recorded history.<ref name="demeo1997">{{REFbook
|last=DeMeo
|first=
|author-link=
|year=1997
|title=The geography of sexual mutilations
|url=https://www.academia.edu/4212007/The_Geography_of_Male_and_Female_Genital_Mutilations
|work=Sexual Mutilations: A Human Tragedy
|editors=George C. Denniston, Marilyn Milos
|edition=
|volume=
|chapter=
|pages=
|location=New York
|publisher=Plenum
|isbn=0-306-45589-7
|quote=
|accessdate=2021-11-13
|note=
}}</ref> Medical historians assume that circumcision already served in ancient history as a way to control the sexuality of slaves and members of the lower classes without compromising their ability to reproduce. In religious history circumcision may be seen as a substitute for human sacrifice. In prehistoric times it was not uncommon to placate the gods with human sacrifice. Castration of slaves or conquered enemies was common as well. Following religious changes this sacrifice was altered, and only a part of the very organ responsible for the creation of new life was sacrificed.
 
[[Image:Circumcision Sakkara 3.jpg|200px|right]] For the [[Aborigines]], the [[Australia| Australian]] natives, the tradition of circumcision is said to go back to 10,000 BC. On the African continent, the first circumcisions are assumed to have emerged around 6000 BC. From ancient Egypt hints of various forms of circumcision date back to the time around 3000-2000 BC. The oldest known depiction<ref>{{REFweb
|url=https://commons.wikimedia.org/wiki/File:Circumcision_Sakkara_3.jpg
|title=File:Circumcision Sakkara 3.jpg
|accessdate=2019-10-12
}}</ref> is an Egyptian tomb relief from the 6th dynasty, approximately 2300-2000 BC. It is not known precisely who was circumcised and why in those times.
 
In many cultures circumcision during puberty serves as a rite of passage, bringing adolescents into the community. As with other painful or humiliating initiation rites, proof of courage and mastering of critical situations are the key motivations. From some African tribes it is also known that the [[amputation]] of the [[foreskin]] is seen as the removal of an inborn piece of femininity from the boys, thus making them men.
 
===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 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
|Text=10 This is my covenant with you and your descendants after you, the covenant you are to keep: Every male among you shall be circumcised. 11 You are to undergo circumcision, and it will be the sign of the covenant between me and you. 12 For the generations to come every male among you who is eight days old must be circumcised, including those born in your household or bought with money from a foreigner—those who are not your offspring. 13 Whether born in your household or bought with your money, they must be circumcised. My covenant in your flesh is to be an everlasting covenant. 14 Any [[uncircumcised]] male, who has not been circumcised in the flesh, will be cut off from his people; he has broken my covenant.”
|Author=Bible
|Source=Gen 17, 10-14, NIV
}}
 
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
|last=Luke
|first=
|publisher=NASB
|website=Bible Gateway
|date=
|accessdate=2019-11-10
|format=
|quote=And when eight days had passed, before His circumcision, His name was then called Jesus, the name given by the angel before He was conceived in the womb.
}}</ref>
 
The first Christians had been born Jewish, so a question arose whether one must be [[circumcised]] to be a Christian. When Christian leaders met at the [[Council at Jerusalem]] in the First Century to decide what was required to be a Christian, a letter was written to explain the requirements, but circumcision was omitted from the requirements.<ref>{{REFweb
|url=https://www.biblegateway.com/passage/?search=Acts+15%3A1-30&version=NASB
|title=Acts 15:1-30
|last=Luke
|first=
|accessdate=2019-11-10
}}</ref>
 
In Christianity, circumcision is practiced only in the Coptic denomination. There is no general belief that circumcision is a requirement of Christianity.<ref name="hill2004">{{REFweb
|url=https://www.cirp.org/pages/cultural/christian.php
|title=The Holy Bible, Circumcision, False Prophets, and Christian Parents
|last=Hill
|first=George
|author-link=George Hill
|publisher=Circumcision Reference Library
|website=
|date=2004-08-29
|accessdate=2019-11-10
|format=HTML
|quote=The falseness of those who advocate circumcision is a recurrent theme in the New Testament.
}}</ref>
 
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
|Text=A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of [[phimosis]]. The operation should be performed by a surgeon without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. In females, the author has found the application of pure carbolic acid to the [[clitoris]] an excellent means of allaying the abnormal excitement, and preventing the recurrence of the practice in those whose will-power has become so weakened that the patient is unable to exercise entire self-control.
|Author=[[John Harvey Kellogg]]
|Source=
|ref=<ref>{{REFbook
|last=Kellogg
|first=John Harvey
|init=JH
|author-link=John Harvey Kellogg
|url=https://archive.org/details/plainfaorold00kell/page/290
|chapter=Treatment for Self-abuse and Its Effects
|title=Plain Facts for Old and Young
|location=Burlington, Iowa
|publisher=F. Segner & Co.
|year=1888
|page=107
}}</ref>
}}
 
===Islam===
In [[Islam]], circumcision is also religiously founded, even though there is no mention of it in the Koran itself. According to tradition, the Prophet Mohammed was born without a [[foreskin]]. It is seen as a sign of prophets that they are born without a [[foreskin]] already. It is considered an honour to "resemble the example of the Prophet", meaning to be [[circumcised]]. In Islam, unlike [[Judaism]], there is no specific age at which the circumcision should be performed. Most circumcisions take place at ages between 6 and 10 years, but the range goes from birth to adulthood.
 
== Rationale ==
 
Reasons for performing circumcision range widely by culture, religion, location, and age.
 
===Cultural===
 
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]]''The following text , so it inflicted the maximum injury. In a few cases with older patients, circumcision is taken legitimately indicated; a patient may be suffering recurring infections, and other methods of treatment have failed. In other cases, a patient may be suffering from a severe case of [[phimosis]]. Overall, the actual medical necessity for circumcision is extremely rare since many conditions respond to conservative treatment. All circumcisions injure the patient by amputating the [[Circumpendiumforeskin]] its with many protective, immunological, sensory, and sexual [[Foreskin#Physiological_functions| functions]].  # '''Deformed or malformed foreskin'''. A foreskin so deformed or malformed that it does not function properly may be removed by circumcision. # '''Traumatically injured foreskin'''. A foreskin so traumatically damaged foreskin that cannot be surgically repaired is a valid medical reason for circumcision. # '''Diseased foreskin.'''A foreskin that is diseased is a valid indication for cirumcision. Some diseases that qualify are malignancy, lichen sclerosis, [[Balanitis#Diabetic_males| yeast infection in men with diabetes]], and recurrent [[balanoposthitis]]. In such cases, the benefit of removing the problem foreskin may exceed the maleficial harms of tissue and function destruction.
== Non==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 indications for 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=https://www.cirp.org/library/history/encyclopaediabritannica1876/ |title=Circumcision |last=Cheyne |first=T. K. |author-link= |publisher=Encyclopǽdia Brittanica |website=Circumcision Reference Library |date=1876 |accessdate=2019-11-10 |format= |quote=}}</ref>
Apart Initially, circumcision was adopted in the 19th century as a way to stop boys and men from masturbating, when [[masturbation]] was 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 indication benefits" of pathological phimosis, there also are other reasons for 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,"<!--{{Cold and Wiswell (1995)}} | [[Template:Cold and Wiswell (1995)|see more]]--> but this notion has no validity because the prepuce is ubiquitous in primates and because it provides functional advantages.<ref name="cold-mcgrath1995">{{REFbook |last= Aesthetic Cold |first=Christopher |init=C |last2=McGrath |first2=Kenneth |init2=K |author2-link=Ken McGrath |year=1999 |title=Male and female circumcision: medical, legal, and ethical considerations in pediatric practice |url=https://www.cirp.org/library/anatomy/cold-mcgrath/ |work= |editor= |edition= |volume= |chapter=Anatomy and histology of the penile and clitoral prepuce in primates |pages= |location=New York |publisher= |isbn=0306461315 |quote= |accessdate=2019-10-12 |note=}}</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 ===
The visual appearance practice of finding prophylactic reasons for infant circumcision started in Germany in the [[penis]] is changed radically after circumcision. In this casenineteenth century, personal taste is decisive whether an intact or a cut [[penis]] is more appealing. Since a when non-Jewish Germans criticized the Jewish practice of infant circumcision cannot be undoneas being barbaric, it is essential Jewish doctors sprang to be fully informed about the risks defense of the religious practice by claiming health benefits.<ref name="ephron2001">{{REFbook |last=Ephron |first=John M. |init=JM |author-link= |year=2001 |title=Medicine and possible later complications before embarking on an aesthetically motivated the German Jews |url=https://www.cirp.org/library/history/ephron1/ |work= |editor= |edition= |volume= |chapter=6 |pages=222-33 |location=New Haven |publisher={{UNI|Yale University|Yale}} Press |isbn=0-300-08377-7 |quote= |accessdate=2019-11-20 |note=}}</ref> And so started the long tradition of Jewish doctors inventing reasons for circumcision, to decide whether the appearance will justify such bodily modification(and deceving gentile doctors).
Since this modification and its possible late effects will be Following the lifelong burden discovery of the person who undertakes an aesthetically motivated circumcision to suit his personal preferences, bacteria as a valid decision to proceed can only be made by the person to be circumcised himself, once he has reached cause of many diseases – such as tuberculosis – the necessary age and level of maturity to make search began for other illnesses that decision. This should normally could be the case when adulthood is reachedprevented by circumcision.
It should be noted that every In 1870 the prominent Dr. [[Lewis Albert Sayre|Lewis A. Sayre]] of NYC’s famed Bellevue Hospital<ref>https://nypost.com/2016/12/03/bellevues-doctors-invented-the-procedures-you-take-for-granted/</ref> claimed to cure a boy’s paralyzed legs with circumcision. Sayre's wild advocacy of circumcision operation leaves a life long [exemplified how some [https://intaction.org/circumcision-facts-and-myths/ circumcision scarfacts and myths]] that encircles originated. He also claimed to cure epilepsy, mental disorders, hip-joint pain, & hernias with circumcision. “Genital irritations” & masturbation were deemed to be the cause of these issues. Sayre was later elected as the President of the shaft American Medical Association. <ref>American Medical Association. Transactions of the penisAmerican Medical Association.1870;21:205–11</ref>
In the 1920s it was penile cancer. [[Abraham L. Wolbarst]] (1926) claims that circumcision can prevent penile cancer.<ref name="wolbarst1926">{{REFjournal |last=Wolbarst |first=Financial reasonsAbraham L. |init=AL |author-link=Abraham L. Wolbarst |title=Is circumcision a prophylactic against penis cancer? |journal=Cancer |date=Jul 1926 |volume=3 |issue=4 |pages=301-10}}</ref>
In the United States1940s, payment for non-therapeutic prostate and tongue cancer as well as STDs. [[Eugene H. Hand]] (1949) falsely explains that circumcision is made by most thirdsomehow protects against venereal diseases and tongue cancer.<ref name="hand1949">{{REFjournal |last=Hand |first=Eugene H. |init=EH |author-party payers without questionlink=Eugene H. Hand |url=https://pubmed. Doctors frequently perform medicallyncbi.nlm.nih.gov/18135844/ |title=Circumcision and venereal disease |journal=Archives of Dermatology and Syphilology |date=1949-unnecessary, non09 |volume=60 |issue=3 |pages341-therapeutic circumcision of infants and children simply to collect a fee for the surgical operation6 |pubmedID=18135844 |DOI=10.1001/archderm.1949. The only beneficiary of such surgery is the [[Financial Incentive01530030037004 | bank account of the medical doctor]].accessdate=2021-10-08}}</ref>
In the 1950s it was cervical cancer. [[Abraham Ravich]] (1951) invents the myth that circumcision reduces the risk of women getting cervical cancer.<ref name=== Moral reasons ==="ravich1951">{{Ravich1951}}</ref>
With In the late 1960s it was neuroses. [[foreskinMorris Fishbein]], (1969) calls for circumcision removes approximately 70% of the sensitive tissue of the [[penis]]to prevent nervousness and, lowering the potential for sexual stimulation accordingly. Due to the loss of around 50% of the entire penile skincourse, the [[penis]] loses the reserve skin that provides cutaneous mobility in the erect [[penis]] and the [[gliding actionmasturbation]].<ref>{{Fishbein1969}}</ref>
In the past, this circumstance was used to make it harder for boys to masturbate 1970s bladder- and [[masturbation]] less fun, as [[masturbation]] was viewed as immoral and was assumed to cause a variety of diseasesrectal cancer. More on that can be found in the chapter "[[Circumcision#Historical_background|Historical backgroundAbraham Ravich]]". Today, it is known (1971) claims that [[masturbation]] has no negative health effects, but can contribute positively to the child's sexual development. Sexuality is no longer a taboo nowadays, while [[masturbation]] is considered to be a natural part of human sexuality and is no longer seen as immoral. Therefore, circumcision for moral reasons - which would only affect boys too young to give informed consent - is no longer justifiable nowadaysprevent bladder cancer and rectal cancer.<ref>{{Ravich1971}}</ref>
In the 1980s, UTIs. [[Thomas E. Wiswell]] (1985) claims that circumcision, using a methodologically flawed report, reduces the risk of urinary tract infections.<ref name="wiswell1985">{{REFjournal |last=Wiswell |first= Hygiene reasons Thomas E. |init=TE |author-link=Thomas E. Wiswell |url=https://pediatrics.aappublications.org/content/75/5/901 |title=Decreased incidence of urinary tract infections in circumcised male infants |journal=Pediatrics |date=May 1985 |volume=75 |issue=5 |pages=901-3 |accessdate=2019-10-12}}</ref> [[Aaron J. Fink]] (1986), with no evidence whatsoever, claims that circumcision protects against [[AIDS]] followed.<ref name="fink1986">{{REFjournal |last=Fink |first=Aaron J. |init=AJ |author-link=Aaron J. Fink |title=A possible explanation for heterosexual male infection with AIDS |journal=New England Journal of Medicine |date=1986-10-30 |volume=31 |issue=18 |page=1167 |url=https://www.nejm.org/doi/full/10.1056/NEJM198610303151818 |DOI=10.1056/NEJM198610303151818 |accessdate=2019-11-20}}</ref> Retrospectively, circumcision was always advertised as a cure for whatever disease was in the public spotlight at the time. [[Doctors Opposing Circumcision (D.O.C.)]] (2016) state:<blockquote>These claims date originally from before the advent of evidence-based medicine, when doctors relied on the opinions of other clinicians to inform their practice, rather than on scientifically collected evidence.<ref name="doc2016">{{REFweb |url=https://www.doctorsopposingcircumcision.org/for-professionals/alleged-medical-benefits/ |title=Alleged Medical Benefits |publisher=[[Doctors Opposing Circumcision (D.O.C.)]] |website= |date=2016-05 |accessdate=2019-11-20 |format= |quote=}}</ref></blockquote>
A common reason stated for circumcision is the assumption The sheer mass of hygienic benefits. This argument has to be viewed in studies and publications that were released during those almost 180 years on this topic are the context of the environment the person in question grows up in. It is commonly known reason that even arguments that bad hygienic circumstanceshave been disproved multiple times, especially insufficient access to clean drinking waterregarding infant and child circumcision, pose a serious problem. The situation in disaster areas or refugee camps in the so-called third world keep reminding us of thattenaciously persist up until today.
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 An ever- no pathogens can accumulate under the [[foreskin]]. Cleaning recurring element of the [[Glans penis|glans]] and the area underneath the [[foreskin]] initiation rites found in many different cultures is easy - they are simply washed along with the rest of the body, just like the areas between fixation upon the toesgenitalia.
It reflects the fascination that emerges from the ability to create new life. In small boysmost cultures, fertility is seen as the most precious good, and the body parts involved frequently find themselves in the focus of ritual acts. In many parts of the world, those rites take place when the boy reaches puberty, where and are meant to symbolize his transition from boy to man. The removal of the male [[foreskin]] cannot be retracted yet, cleaning is not necessary, since just one of many phenomena that developed in this context. They range from the removal of the frenulum in boys and men through partial or complete removal of the [[Synechia| membraneforeskin]] that fuses the up to radical operations. Australian [[Aborigines]], as mentioned above, have their [[foreskin]] to the s removed. It is also usual that, a few weeks later, young men have their [[Glans penis|glans]] prevents the accumulation of micro-organisms. The so-called "ballooning", where the es sliced open in a [[foreskinsubincision]] inflates during urination, is not resulting in a serious problempartly or completely divided [[urethra]].
The opening Another known, particularly massive, intervention is the stripping of the entire [[foreskinskin]] in small off the [[penis]]. In Indonesia, boys is often quite narrow and serves as a one-way valve, allowing have metal or bamboo balls inserted into their [[penis]] shaft or [[Glans penis|glans]] at the urine to flow out, but preventing entry beginning of microbes, for example from a dirty diaper. As long as the child is able to pass waterpuberty, everything works as nature intendedwhich form little "humps".
But even in areas where there are poorer hygienic conditions and an insufficient access For many cultures it is also common to medical careperform similar rituals on girls. This can range from relatively small interventions such as piercing or cutting the clitoral hood, 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 its complete removal and up to radical removal of germs under the clitoral hood, [[foreskinclitoris]], 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 inner and outer labia followed by sewing up the wound. This also applies to the treatment of common complications like post-operative bleedingvagina.
''The benefit of easier cleaning must be balanced against following text is taken from the risk of promoting serious infections [[Circumpendium]].''- 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.>
=== 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)<refname="blalock2003">{{REFjournal
|last=Blalock
|firstinit=H.J.HJ
|last2=Vemulakonda
|first2init2=V.
|last3=Ritchey
|first3init3=M.L.ML
|last4=Ribbeck
|first4init4=M.
|title=Outpatient management of [[phimosis]] Following newborn circumcision
|journal=J Urol
|volume=169
|issue=6
|pages=2332-23344 |url=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 above]]). Therefore, circumcision is not a preventive measure for [[phimosis]].
* Sexually Transmitted Diseases (STDs): a vast number of studies has been conducted on the subject of transmission of STDs.
* First, it has to be noted that any form of protection against these diseases only affects people who are sexually active. Circumcision in childhood cannot be justified on these grounds, since any assumed protective effect will not occur before the boy is already old enough to decide about circumcision for himself.
* As mentioned above, the [[foreskin]] keeps the [[Glans penis|glans]] moist. This subpreputial moisture contains, among other substances, the enzyme lysozyme, which breaks up the cell wall of bacteria, thereby providing a natural antibacterial screen. This explains the results of several studies, such as Laumann ''et al.''<ref>{{REFjournal
|last=Laumann
|firstinit=E.O.EO
|last2=Masi
|first2init2=C.M.CM
|last3=Zuckerman
|first3init3=E.W.EW
|title=Circumcision in the United States: prevalence, prophylactic effects, and sexual practice
|journal=JAMA
|volume=277
|issue=
|pages=1052-10577 |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.<refname="fleiss-hodges-vanhowe1998">{{REFjournal |last=Fleiss |first=P.M. |last2=Hodges |first2=F.M. |last3=Van Howe |first3=R.S. |title=Immunological functions of the human prepuce |journal=Sex Transm Inf |date=FleissP HodgesF VanHoweRS 1998 |volume=74 |issue= |pages=364-367 |url= |accessdate=}}</ref> support this. According to the [[AAP]], the general sexual behaviour of the male - — such as frequent change in partners and the use of condoms - — has a much higher impact on sexually transmitted diseases then the circumcision status.<ref>{{REFjournal
|last=Task Force on Circumcision
|first=
|volume=103
|issue=3
|pages=686-69393 |url=https://www.cirp.org/library/statements/aap1999/ |accessdate=2019-11-15
}}</ref>
* [[HIV ]] / [[AIDS]]: in the recent past, the argument that circumcision could help to contain the spread of [[HIV ]] has been stated numerous times.
*:First, two notes: for one, the use of condoms is still by far the most effective protection against an infection. During intercourse with that preventive measure, circumcision status does not make a difference.
*:Secondly, the assumed protection would only affect healthy men who have intercourse with an infected woman. An infected man can infect a women by transmission of his bodily fluids, so that his circumcision status is irrelevant. Therefore, the use of condoms remains vital in containing the spread of [[HIV]], which in return renders circumcision unnecessary
* Due to the inevitable loss of sensitivity as a result of circumcision, there is also the temptation to go without condoms, in order not to lose even more sensitivity.<ref>{{REFjournal
|last=Hooykaas
|firstinit=C.
|last2=van der Velde
|first2init2=F.W.FW
|last3=van der Linden
|first3init3=M.M.MM
|etal=yes
|title=The importance of ethnicity as a risk factor for STDs and sexual behaviour among heterosexuals
|volume=67
|issue=5
|pages=378-38383 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1194736/pdf/genitmed00041-0022.pdf |accessdate=2019-11-15
}}</ref><ref>{{REFjournal
|last=Michael
|firstinit=R.T.RT
|last2=Wadsworth
|first2init2=J.
|last3=Feinleib
|first3init3=J.
|etal=yes
|title=Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison
|volume=88
|issue=5
|pages=749-75454 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1508929/pdf/amjph00017-0039.pdf |accessdate=2019-11-15
}}</ref><ref>{{REFjournal
|last=Laumann
|firstinit=E.O.EO
|last2=Masi
|first2init2=C.M.CM
|last3=Zuckerman
|first3init3=E.W.EW
|title=Circumcision in the United States: prevalence, prophylactic effects, and sexual practice
|journal=JAMA
|volume=277
|issue=
|pages=1052-10577 |url=https://www.cirp.org/library/general/laumann/ |accessdate=2019-11-06
}}</ref>
* Two studies that have been published in early 2007<ref>{{REFjournal |last=RCT Gray, R.H. and colleagues |first= |title=Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial |journal=Lancet |date=et al 2007 |volume=369 |issue= |pages=657-666 |url= |accessdate=}}</ref><ref>{{REFjournal |last=[[Robert C. Bailey|RCT Bailey, R.C.]] and colleagues |first= |title=Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial |journal=Lancet |date=et al 2007 |volume=369 |issue= |pages=643-656 |url= |accessdate=}}</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
|firstinit=H.
|last2=Mosha
|first2init2=F.
|last3=Todd
|first3init3=J.
|etal=yes
|title=A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results
|volume=9
|issue=8
|pages=927-93434 |url=https://insights.ovid.com/aids/aids/1995/08/000/community-trial-impact-improved-sexually/15/00002030 |accessdate=2019-11-15
}}</ref><ref>{{REFjournal
|last=Barongo
|firstinit=L.R.LR
|last2=Borgdorff
|first2init2=M..W.MW
|last3=Mosha
|first3init3=F.F.FF
|etal=yes
|title=The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania
|volume=6
|issue=12
|pages=1521-15288
|url=
|accessdate=
|first=
|title=Prevalence of male circumcision and its association with HIV and sexually transmitted infections in a U.S. navy population (Abstract no. TuPeC4861)
|url=https://apps.dtic.mil/dtic/tr/fulltext/u2/a458066.pdf
|place=Bangkok, Thailand
|source=Presented at the 15th International AIDS Conference
|datefrom=2004-07-11
|dateto=2004-07-16
|accessdate=2019-11-15
}}</ref>
* Urinary tract infections (UTI): a [[UTI ]] can be effectively treated with antibiotics, this was also proven by studies.<ref>{{REFjournal
|last=McCracken
|firstinit=G.
|title=Options in antimicrobial management of urinary tract infections in infants and children
|journal=Pediatr Infect Dis J
|volume=8
|issue=8
|pages=552-5555 |url=https://www.cirp.org/library/disease/UTI/mccracken/ |accessdate=2019-11-19
}}</ref><ref>{{REFjournal
|last=Larcombe
|firstinit=J.
|title=Urinary tract infection in children
|journal=BMJ
|volume=319
|issue=
|pages=1173-11755
|url=
|accessdate=
}}</ref>. A Swedish study <ref>{{REFjournal
|last=Mårild
|firstinit=S.
|last2=Jodal
|first2init2=U.
|title=Incidence rate of first–time symptomatic urinary tract infection in children under 6 years of age
|journal=Acta Paediatr
|volume=87
|issue=5
|pages=549-55252
|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
|firstinit=E.R.ER
|last2=Steinhardt
|first2init2=G.
|last3=Naseer
|first3init3=S. |title=The incidence of genitourinary abnormalities in [[circumcised ]] and [[uncircumcised ]] boys presenting with an initial urinary tract infection by 6 months of age
|journal=Pediatrics
|date=1997
|volume=100 (Supplement)
|issue=
|pagespage=580
|url=
|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
|firstinit=S.
|title=Complications arising from ritual circumcision: pathogenesis and possible prevention
|journal=Isr J Med Sci
|volume=17
|issue=1
|pages=45-488
|url=
|accessdate=
}}</ref><ref>{{REFjournal
|last=Cohen
|firstinit=H.A.HA
|last2=Drucker
|first2init2=M.M.MM
|last3=Vainer
|first3init3=S.
|etal=yes
|title=Postcircumcision urinary tract infection
|volume=31
|issue=6
|pages=322-3244
|url=
|accessdate=
}}</ref><ref>{{REFjournal
|last=Goldman
|firstinit=M.
|last2=Barr
|first2init2=J.
|last3=Bistritzer
|first3init3=T.
|last4=Aladjem
|first4init4=M.
|title=Urinary tract infection following ritual Jewish circumcision
|journal=Isr J Med Sci
|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>{{REFjournal |last=Wolbarst |first=A. |title=Circumcision and penile cancer |journal=Lancet |date=1932 |volume=1 |issue=5655 |pages=150-153 |url= |accessdate=Wolbarst1932}}</ref>. Today, it is known that sexually transmitted human papillomavirus (HPV) is a major risk factor<ref>{{REFjournal
|last=McCance
|firstinit=D.J.DJ
|last2=Kalache
|first2init2=A.
|last3=Ashdown
|first3init3=K.
|etal=yes
|title=Human papillomavirus types 16 and 18 in carcinomas of the penis from Brazil
|volume=37
|issue=1
|pages=55-599
|url=
|accessdate=
}}</ref>, as well as smoking<ref>{{REFjournal
|last=Harish
|firstinit=K.
|last2=Ravi
|first2init2=R.
|title=The role of tobacco in penile carcinoma
|journal=Brit J Urol
|volume=75
|issue=3
|pages=375-3777
|url=
|accessdate=
}}</ref>. Studies have shown that there is no significant difference in the risk of getting penile cancer between [[circumcised ]] and [[intact ]] men. To prevent a single case of penile cancer, it would statistically take 600 to 900 circumcisions<ref>{{REFdocument
|title=Position Paper on Neonatal Circumcision
|url=
In conclusion, circumcision does not provide any proven benefits in preventive medicine.
== Circumcision methods Non-medical indications for circumcision ==The [[Circumcision methods]] are discussed in a separate article.
== Risks and late effects ==Apart from the [[medical indication]] of pathological phimosis, there also are other reasons for circumcision.
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.=== Aesthetic reasons ===
=== Possible operative 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 postoperative possible later complications ===before embarking on an aesthetically motivated circumcision, to decide whether the appearance will justify such bodily modification.
Circumcision is surgery. Surgical complications of It should be noted that every circumcision operation leaves a life-long [[circumcision generally may be classified as hemorrhage, infection, or surgical misadventure up to and including loss scar]] that encircles the shaft of the [[penis and death]]. In addition, there frequently a a color change at the circumcision scar which results in a two-tone appearance.
* Intolerance or allergic reactions to the narcotics used.* Especially in newborns, 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 [[penis]], the rate 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, Since this modification and, therefore, is only likely to its possible late effects will be used in emergencies. A surgical operation without proper pain control can lead to the development lifelong burden of a specific pain memory<ref>{{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= |publisher=Spiegel Online |website= |date=2012-08-12 |accessdate=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 |first=T. |title=Circumcision: a survey of fees and practices |journal=OBG Management |date=1994 |volume=October |issue= |pages=34-36 |url= |accessdate=}}</ref><ref>{{REFjournal |last=Howard |first=C.R. |last2=Howard |first2=F.M. |last3=Garfunkel |first3=L.C. |last4=de Blieck |first4=E.A. |last5=Weitzman |first5=M. |title=Neonatal person who undertakes an aesthetically motivated circumcision and pain relief: current training practices |journal=Pediatrics |date=1998 |volume=101 |issue= |pages=423-428 |url= |accessdate=}}</ref><ref>{{REFjournal |last=Stang |first=H.J. |last2=Snellman |first2=L.W. |title=Circumcision practice patterns in the United States |journal=Pediatrics |date=1998 |volume=101 |issue=e5 |pages= |url= |accessdate= |note=Link to [[AAP]] website}}</ref>. During procedures which take several minutessuit his personal preferences, 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- valid decision to 4-fold increase in cortisol levels, which equals a state of severe shock.<ref>{{REFjournal |last=Gunnar |first=M.R. |last2=Fisch |first2=R.O. |last3=Korsvik |first3=S. |last4=Donhowe |first4=J.M. |title=The effects of circumcision on serum cortisol and behavior |journal=Psychoneuroendocrinology |date=1981 |volume=6 |issue=3 |pages=269-275 |url= |accessdate=}}</ref>* Postoperative wound pain, in the case of children's circumcisions conceivably worsened by the forceful breaking of the preputial adhesions.* Postoperative bleeding of the wound. This proceed 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=Smart J, Nolan T. (Editors) |first= |year=2000 |title=Paediatric Handbook |url= |work= |editor= |edition=6 |volume= |chapter= |pages=82 |location=Victoria, Australia |publisher=Blackwell 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 |first=J. |last2=Horowitz |first2=A. |last3=Kahana |first3=T. |title=Fatal haemorrhage following male ritual circumcision |journal=J Clin Forensic Med |date=2000 |volume=7 |issue= |pages=32-34 |url= |accessdate=}}</ref><ref>{{REFdocument |title=Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan |url= |contribution= |last=Newell |first=TEC |publisher=Burnaby, B.C.: B.C. Coroner's Service |format= |date=2004-01-19 |accessdate=}}</ref>* Postoperative infections. This includes both local infections, which can be treated with local therapy, and systemic infections, requiring systemic antibiotic treatment.<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=}}</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 made by 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 person to a study by Blalock ''et al.''<ref>{{REFjournal |last=Blalock |first=H.J. |last2=Vemulakonda |first2=V. |last3=Ritchey |first3=M.L. |last4=Ribbeck |first4=M. |title=Outpatient management of be [[phimosis]] Following newborn circumcision |journal=J Urol |date=2003 |volume=169 |issue=6 |pages=2332-2334 |url= |accessdate=}}</ref>, the prevalence is 2.9%, according to Leitch<ref>{{REFjournal |last=Leitch |first=I.O.W. |title=Circumcision - a continuing enigma |journal=Aust Paediatr J |date=1970 |volume=6 |issue= |pages=59-65 |url= |accessdate=}}</ref> 5.5%.* 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 at approximately 10%.<ref>{{REFjournal |last=Van Howe |first=R.S. |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= |accessdate=}}</ref><ref>{{REFjournal |last=Stenram |first=A. |last2=Malmfors |first2=G. |last3=Okmian |first3=L. |title=Circumcision for [[phimosis]]: a follow-up study |journal=Scandinavian journal of urology and nephrology |date=1986 |volume=20 |issue=2 |pages=89 |url= |pubmedID=3749823 |accessdate=}} </ref><ref>{{REFweb |url=http://emedicine.medscape.com/article/1016016-overview |title=Meatal Stenosis |publisher=Medscape |accessdate=2019-10-11}}</ref>* Knot formation of the veins. If the dorsal veinhimself, which originates in once he has reached the tip of the [[foreskin]], is cut during circumcision without being clamped necessary age and sutured at its origin separately, it starts to develop new branches over time, which can lead to the development level of knots.* Possible deformities due maturity to circumcision include hypoplasia of the [[penis]] (micro-penis) and induratio [[penis]] plastica (skewed penis)make that decision.* Medical malpractice can also not This should normally 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 case when adulthood 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://www.nytimesreached.com/2012/03/08/nyregion/infants-death-renews-debate-over-a-circumcision-ritual.html?_r=0 |title=Baby’s Death Renews Debate Over a Circumcision Ritual |last=Robbins |first=Liz |date=2012-03-07 |accessdate=2019-10-11}}</ref>
=== Physical late effects Financial reasons=== * An unavoidable late effect of any circumcision is the permanent loss of sexual sensitivity. This is partly due to the removal of sensory tissue. The [[foreskin]] contains very many nerve endings and touch receptors, which account for the major part of male sexual sensation. If the [[foreskin]] is removed, they can no longer provide sexual stimulation. It is also partly due to the fact that the surface of the [[Glans penis|glans]] reacts to the missing protection from friction and drying out by developing a callus layer. This reduces the sensitivity of the remaining nerves in the [[Glans penis|glans]] gradually over the years. The study conducted by Sorrells ''et al.''<ref>{{REFjournal |last=Sorrells |first=M.L. |last2=Snyder |first2=J..L. |last3=Reiss |first3=M.D. |etal=yes |title=Fine-touch pressure thresholds in the adult [[penis]] |journal=BJU Int |date=2007 |volume=99 |issue= |pages=864-869 |url= |accessdate=}}</ref> found a significant reduction of sensitivity to touch for circumcised compared to intact [[penis]]es in adult males. Other studies revealed that circumcised men use condoms significantly less often than intact men, since they further limit the sexual sensitivity (see above).* Painful tension can occur when there is too little reserve skin left to support a full erection<ref>{{REFjournal |last=Taylor |first=J.R. |last2=Lockwood |first2=A.P. |last3=Taylor |first3=A.J. |title=The prepuce: <q>Specialized mucosa of the [[penis]] and its loss to circumcision</q> |journal=British Journal of Urology |date=1996 |volume=77 |issue= |pages=291-295 |url= |accessdate=}}</ref>. This risk is partly dependent on the anatomy of the [[penis]]. While some [[penis]]es already have the majority of their full size when flaccid ([[Flesh Penis]], or "[[shower]]"), others are rather short when flaccid and double or more their size during an erection ([[Blood Penis]], or "[[grower]]"). Especially in children's circumcision, where the [[penis]] is not yet fully developed, the amount of reserve skin needed in adulthood cannot be estimated.* Erectile dysfunction: Both the damage inflicted to the blood vessels in the [[foreskin]] and the reduced sexual sensitivity can be causes for reduced erectile function with advancing age.<ref>{{REFjournal |last=Money |first=J. |last2=Davison |first2=J. |title=Adult penile circumcision: Erotosexual and cosmetic sequelae |journal=Journal of Sex Research |date=1983 |volume=19 |issue= |pages=289-292 |url= |accessdate=}}</ref>* Orgasm problems: In the wake of reduced sexual sensitivity, due to the loss of sensory tissue and gradual keratinization of the surface of the [[Glans penis|glans]], orgasm problems may develop with increasing age. In this case, the sexual arousal created by intercourse or [[masturbation]] is not enough to achieve orgasm. A preliminary stage of this late effect is the prolonged time circumcised men need to reach an orgasm. This is often fielded as the "cut men have more endurance" argument for circumcision.* Vaginal dryness: Due to the loss of the natural gliding action, which comes from the mobility of the fore- and shaft skin, a much increased friction between [[penis]] and vagina occurs during intercourse. This can make intercourse painful for both partners and lead to abrasions<ref>{{REFjournal |last=Frisch |first=Morten |author-link=Morten Frisch |first2=Morten |last2=Lindholm |first3=Morten |last3=Grønbæk |title=Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark |journal=International Journal of Epidemiology |date=2011-10 |volume=40 |issue=5 |pages=1367-1381 |url= |pubmedID=21672947 |DOI=10.1093/ije/dyr104 |accessdate=}}</ref><ref>{{REFjournal |last=Cortés-González |first=J. |last2=Arratia-Maqueo |first2=J. |last3=Gómez-Guerra |first3=L. |title=Does circumcision has an effect on female's perception of sexual satisfaction? |journal=Rev Invest Clin |date=2008 |volume=60 |issue=3 |pages=227 |url= |pubmedID=18807735 |accessdate=}}</ref> The prolonged time it takes circumcised men to reach orgasm, as well as the often longer and more vigorous thrusting movements - compared to intact men - play a part in this.<ref>{{REFjournal |last=Cold |first=C.J. |last2=Taylor |first2=J.R. |title=The prepuce |journal=BJU Int |date=1999 |volume=83 |issue=Suppl. 1 |pages=34-44 |url= |accessdate=}}</ref><ref>{{REFjournal |last=Fink |first=K.S. |last2=Carson |first2=C.C. |last3=DeVellis |first3=R.F. |title=Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction |journal=J Urol |date=2002 |volume=167 |issue=5 |pages=2113-2116 |url= |accessdate=}}</ref>
=== Psychological late effects ===In the United States, payment for non-therapeutic circumcision is made by most [[third-party payment| third-party payers]] without question of necessity. Doctors frequently perform medically-unnecessary, non-therapeutic circumcision of infants and children simply to collect a fee for the surgical operation. The only beneficiary of such surgery is the [[Financial Incentive| bank account of the medical doctor]].
Psychological late effects are also possible after a circumcision, especially if the operation was carried out in childhood. On this occasion a variety of trauma may occur, which depend, among others, on age and circumstances of the circumcision. For example, whether the circumcision took place with or without sufficient anaesthesia, if the individual has been informed about the operation beforehand, if he was circumcised against his will or without his consent, and also, in the case of infant circumcision, if he was told about it during childhood or had to find it out coincidentally on his own.=== Moral reasons ===
The psychological late effects With the [[foreskin]], circumcision removes approximately 70% of the sensitive tissue of circumcision are not yet fully researchedthe [[penis]], and many studies took place on rather a small scalelowering the potential for sexual stimulation accordingly. This situation needs Due to be rectifiedthe loss of around 50% of the entire [[penile skin]], because the available studies, as well as [[penis]] loses the histories of negatively affected men, suggest reserve skin that these late effects may have more impact than previously assumedprovides cutaneous mobility in the erect [[penis]] and the [[gliding action]].
* It was observed that infants, following circumcision without pain control, had a disturbed bond with their mother<ref>{{REFjournal |last=Marshall |first=R.E. |last2=Porter |first2=F.L. |last3=Rogers |first3=A.G. |etal=yes |title=Circumcision: II effects upon mother-infant interaction |journal=Early Hum Dev |date=1982 |volume=7 |issue=4 |pages=367-374 |url=http://www.cirp.org/library/birth/marshall2/ |accessdate=}}</ref>, as well as problems with nurturing, up to In the point of refusal to be fed. The sleeping habits of these babies were also disturbedpast, 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 this circumstance was found prior used to the operation, 69% of the boys circumcised in the traditional ritual and 51% of those circumcised by standard medical procedures (including anaesthesia) fulfilled the DSM-IV criteria make it harder for PTSD following the operation.<ref>{{REFbook |last=Ramos |first=S |last2=Boyle |first2=GJ |year=2001 |title=Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder |url=https://link.springer.com/chapter/10.1007/978-1-4757-3351-8_14 |work=Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem |editor=Denniston GC, Hodges FM, Milos MF |edition= |volume= |chapter= |pages=253-270 |location=New York |publisher=Kluwer Academic/Plenum Publishers |isbn= |quote= |accessdate= |note=}}</ref>* Circumcisions, especially those that happen without consent, can spark feelings of helplessness masturbate and alienation[[masturbation]] less fun, which can persist as trauma. These feeling can also be triggered later, when someone circumcised [[masturbation]] was viewed as an infant becomes aware immoral and was assumed to cause a variety of his circumcision. In an online study, interviewed men stated they felt betrayed - 55% by the mothermental diseases, 50% caused by the father, and 58% by the doctor, and 73% felt thinking of immoral thoughts! More on 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 can frequently be found that in the loss is denied, much as happens 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 process, their own body is defined as chapter "normal" and the [[foreskinCircumcision#Historical_background|Historical background]] redefined as a foreign object". Their own parents are seen as "good"Today, so it is known that this image is projected onto the circumcision their parents carried out as well[[masturbation]] has no negative health effects, in order but can contribute positively to keep the positive emotion intactchild's sexual development. The father wants Sexuality is no longer a taboo nowadays, while [[masturbation]] is considered to be a "good" father later in life as well, natural part of human sexuality 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 no longer seen as well.<ref>{{REFjournal |last=van der Kolk |first=Bimmoral.A. |url=http://www.cirp.org/library/psych/vanderkolk/ |title=The compulsion to repeat the trauma: re-enactmentTherefore, revictimization, and masochism |journal=Psychiatr Clin North Am |date=1989 |volume=12 |issue=2 |pages=389-411 |accessdate=2019-10-12}}</ref><ref>{{REFjournal |last=Goldman |first=R. |author-link=Ronald Goldman |url=http://www.cirp.org/library/psych/goldman1/ |title=The psychological impact of circumcision |journal=BJU Int |date=1999 |volume=83 |issue=Suppl. 1 |pages=93for moral reasons -103 |accessdate=2019-10-12}}</ref>* If the circumcised male feels incomplete, or due which would only affect boys too young to the missing give [[foreskininformed consent]] 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 |first=J. |url=http://www.cirp.org/library/psych/rhinehart1/ |title=Neonatal circumcision reconsidered |journal=Transactional Analysis J |date=1999 |volume=29 |issue=3 |pages=215-221 |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 |first=G. |date=1965 |url=http://www.cirp.org/library/psych/cansever/ |title=Psychological effects of circumcision |journal=Brit. J. Med. Psychol |volume=38 |pages=321-331 |accessdate=2019-10-12}}</ref>* Fear of being alone or darkness.<ref name="Levy1945">{{REFjournal |last=Levy |first=David M. |url=http://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 roomsis no longer justifiable nowadays.<ref name="Levy1945"/>* Relapse into the state of bed-wetting, even if the child was already dry before.<ref name="Levy1945"/>
== Historical background = Hygiene reasons ===
The amputation of the [[foreskin]] is a very old ritual, whose exact origin cannot be verified beyond doubt. Medical historians assume that circumcision already served in ancient history as a way ''Hygiene'' refers to control the sexuality of slaves health and members of the lower classes without compromising their ability to reproduce. In religious history circumcision may be seen as a substitute for human sacrifice. In prehistoric times it was not uncommon only secondarily to placate the gods with human sacrifice. Castration of slaves or conquered enemies was common as well. Following religious changes this sacrifice was altered, and only a part of the very organ responsible for the creation of new life was sacrificedcleanliness.
[[Image:Circumcision Sakkara 3.jpg|200px|right]] For the Aborigines, the Australian natives, the tradition of circumcision is said to go back to 10,000 BC. On the African continent, the first circumcisions are assumed to have emerged around 6000 BC. From ancient Egypt hints of various forms of circumcision date back to the time around 3000-2000 BC. The oldest known depiction<ref>{{REFweb |url=https://commons.wikimedia.org/wiki/File:Circumcision_Sakkara_3.jpg |title=File:Circumcision Sakkara 3.jpg |accessdate=2019-10-12}}</ref> is an Egyptian tomb relief from the 6th dynasty, approximately 2300-2000 BC. It is not known precisely who was circumcised and why in those times. In many cultures circumcision during puberty serves as a rite of passage, bringing adolescents into the community. As with other painful or humiliating initiation rites, proof of courage and mastering of critical situations are the key motivations. From some African tribes it is also known One should note that the amputation of the human [[foreskin]] is seen as the removal of an inborn piece of femininity from the boys, thus making them men. In the Jewish religion, the tradition of circumcision goes back to a passage in the Book of Genesis (17, 10-14). It is seen as a covenant between God and man, dating back to the patriarch Abraham. {{Citation |Text=10 This is my covenant endowed by nature with you and your descendants after you, the covenant you are to keep: Every male among you shall be circumcised. 11 You are to undergo circumcision, and it will be the sign of the covenant between me and you. 12 For the generations to come every male among you who is eight days old must be circumcised, including those born in your household or bought with money from a foreigner—those who are not your offspring. 13 Whether born in your household or bought with your money, they must be circumcised. My covenant in your flesh is to be an everlasting covenant. 14 Any uncircumcised male, who has not been circumcised in the flesh, will be cut off from his people; he has broken my covenant.” |Author=Bible |Source=Gen 17, 10-14, NIV}} According to the anthropologist and sociologist Nissan Rubin, the Jewish form of circumcision, called 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 penisForeskin#Immunological_functions|glans]]. This was only added around 135 AD, to make it impossible to restore the [[foreskin]] by stretching, which became popular in the wake of Hellenic influence. While originally only the tip of the [[foreskinimmunological functions]] 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 Maimonides pointed out that circumcision was necessary, as it diminished sexual desires and reduced the pleasure to a degree just sufficient for mere reproduction. In Islam, circumcision is also religiously founded, even though there is no mention of it in the Koran itself. According serve to tradition, protect the Prophet Mohammed was born without a [[foreskin]]. It is seen as a sign of prophets that they are born without a [[foreskin]] already. It is considered an honour to "resemble the example of the Prophet", meaning to be circumcised. In Islam, unlike Judaism, there is no specific age at which the circumcision should be performed. Most circumcisions take place at ages between 6 and 10 years, but the range goes human body from birth to adulthooddisease. In Christianity, circumcision is only common in a few orthodox churches. 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. Even the mere existence of a [[foreskin]] was 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 <ref name. In 1888, he wrote: {{Citation |Text=A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of [[phimosis]]. The operation should be performed by a surgeon without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement, and preventing the recurrence of the practice in those whose will"fleiss-power has become so weakened that the patient is unable to exercise entire selfhodges-control. |Author=vanhowe1998"/> The [[John Harvey Kelloggglans penis]] |Source= |ref=<ref>{{REFbook |url=https://archive.org/details/plainfaorold00kell/page/290 |chapter=Treatment for Self-abuse and Its Effects |title=Plain Facts for Old and Young |location=Burlington, Iowa |publisher=F. Segner & Co. |year=1888 |pages=107}}</ref>}}Following receives blood through the discovery of bacteria as a cause of many diseases – such as tuberculosis – the search began for other illnesses that could be prevented by circumcisionfrenular artery. In the 1920s it was penile cancer<ref>Abraham L. Wolbarst claims that circumcision can prevent penile cancer. {{REFjournal |last=WolbarstPersad |firstinit=Abraham L.R |author-link=Abraham L. Wolbarst |title=Is circumcision a prophylactic against penis cancer? |journal=Cancer |date=Jul 1926 |volume=3 |issue=4 |pages=301-10}}</ref>, in the 1940 prostate- and tongue cancer as well as STDs<ref>Eugene H. Hand explains that circumcision somehow protects against venereal diseases and tongue cancer. {{REFjournal |title=Circumcision and venereal disease. |last=Hand |first=Eugene H. |journal=Archives of Dermatology and Syphilology |date=Sep 1949 |volume=60 |issue=3 |pages=341-346}}</ref>. In the 1950s it was cervical cancer<ref>Abraham Ravich invents the myth that circumcision reduces the risk of women getting cervical cancer. {{REFjournal |url=https://www.ncbi.nlm.nih.gov/pubmed/14853120 |title=Prophylaxis of cancer of the prostate, penis, and cervix by circumcision |last=Ravich |first=Abraham |last2=Ravich |first2=R.A. |journal=New York State Journal of Medicine |date=Jun 1951Sharma |volumeinit2=51S |issue=12 |pages=1519author2-1520 |pubmedIDlink=14853120 |accessdatelast3=2019-10-12}}</ref>, in the late 1960s it was neuroses<ref>Morris Fishbein calls for circumcision to prevent nervousness and, of course, [[masturbation]]. {{REFbookMcTavish |lastinit3=FishbeinJ |first=Morris |chapter=Sex hygiene |title=Modern Home Medical Adviser |location=Garden City, New York |publisher=Doubleday & Co |year=1969 |pages=90, 119 |url=https://openlibrary.org/works/OL95362W/Modern_home_medical_adviser |accessdate=2019author3-10-12}}</ref>, in the 1970s bladder- and rectal cancer<ref>Abraham Ravich claims that circumcision would prevent bladder cancer and rectal cancer. {{REFjournal |lastlink=Ravich |firstetal=Abraham |url=https://www.deepdyve.com/lp/wiley/viral-carcinogenesis-in-venereally-susceptible-organs-HCeWmTLmKlyes |title=Viral carcinogenesis in venereally susceptible organs |journal=Cancer |date=Jun 1971 |volume=27 |issue=6 |pages=1493-1496 |accessdate=2019-10-12 }}</ref>, Clinical presentation and in the 1980s UTIs<ref>Thomas E. Wiswell claims that pathophysiology of meatal stenosis following circumcision reduces the risk of urinary tract infections. {{REFjournal |last=Wiswell |first=Thomas E. |author-link=Thomas E. Wiswell |url=https://pediatrics.aappublications.org/content/75/5/901 |title=Decreased incidence of urinary tract infections in circumcised male infants |journal=PediatricsBrit J Urol |date=May 19851995
|volume=75
|issue=51 |pages=90191-9033 |accessdateurl=2019-https://www.onlinelibrary.wiley.com/doi/abs/10.1111/j.1464-12}}</ref> and AIDS<ref>Aaron J410X. Fink claims that circumcision protects against AIDS1995. {{REFjournal |last=Fink |first=Aaron Jtb07242.x |author-linkquote=Aaron J. Fink |titlepubmedID=A possible explanation for heterosexual male infection with AIDS7850308 |journalpubmedCID=New England Journal of Medicine |dateDOI=1986-10-30 |volume=31 |issue=18 |pages=1167 |url=https:.1111//wwwj.nejm1464-410x.org/doi/full/101995.1056/NEJM198610303151818 |DOI=10tb07242.1056/NEJM198610303151818x |accessdate=2019-11-26}}</ref> followed. Retrospectively, These facts are generally overlooked in arguments for alleged hygienic benefits of circumcision was always advertised as a cure for whatever disease was in the public spotlight at the time.
The sheer mass A common reason stated for circumcision is the assumption of hygienic benefits. This argument has to be viewed in the context of studies and publications that were released during those almost 180 years on this topic are the reason that even arguments environment the person in question grows up in. It is commonly known that have been disproved multiple timesbad hygienic circumstances, especially regarding infant and child circumcisioninsufficient access to clean drinking water, tenaciously persist up until todaypose a serious problem. The situation in disaster areas or refugee camps in the so-called third world keep reminding us of that.
An ever-recurring element 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 initiation rites found in many different cultures the [[Glans penis|glans]] and the [[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 fixation upon areas between the genitaliatoes.
It reflects the fascination that emerges from the ability to create new life. In most culturessmall boys, fertility is seen as where the most precious good[[foreskin]] cannot be retracted yet, and the body parts involved frequently find themselves in the focus of ritual acts. In many parts of the world, those rites take place when the boy reaches pubertycleaning is not necessary, and are meant to symbolize his transition from boy to man. The removal of since the male [[foreskinSynechia| membrane]] is just one of many phenomena that developed in this context. They range from the removal of the frenulum in boys and men through partial or complete removal of fuses the [[foreskin]] up to radical operationsthe [[Glans penis|glans]] prevents the accumulation of micro-organisms. Australian Aborigines, as mentioned above, have their The so-called "[[Ballooning of the foreskin| ballooning]]s removed. It is also usual that", a few weeks later, young men have their where the [[penisforeskin]]es sliced openinflates during urination, resulting in is not a partly or completely divided urethraconcern.
Another known, particularly massive, intervention is the stripping The opening of the entire skin off the [[penisforeskin]]. In Indonesiain small boys is often quite narrow and serves as a one-way valve, boys have metal or bamboo balls inserted into their allowing the [[penisurine]] shaft or [[Glans penis|glans]] at to flow out, but preventing entry of microbes, for example from a dirty diaper. As long as the beginning of pubertychild is able to pass water, which form little "humps"everything works as nature intended.
For many cultures it is also common 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 perform similar rituals on girlsbe viewed with a critical eye. This can range from relatively small interventions such as piercing or cutting Although even longer periods without personal hygiene will not result in an accumulation of germs under the clitoral hood[[foreskin]], to its complete removal and up to radical removal circumcision itself is not without risk of clitoral hoodcomplications. If the operation is carried out without proper sterility, clitoris, inner and outer labia followed by sewing up there is a high risk of an [[infection]] of the wound. This also applies to the vaginatreatment of common complications like post-operative [[bleeding]].
== Rights and Ethics ==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.
The [[Rights situation on circumcision|rights situation]] is discussed in separate article.== Circumcision methods ==
 -----  {{FromIntactWiki |URL=http://intactwiki.org/wiki/Circumcision |Title=Circumcision}} [[Image:Intact vs circumcised.JPG |thumbnail|right|300px| The intact and circumcised human penis, side by side.]] The term "circumcision" without a gender qualifier refers specifically to male circumcision. It means "to cut around," and it refers to the excision of the [[foreskin]] from the penis. Circumcision is most often performed in healthy males for [[Religion and Culture|religious or culturalmethods]] reasons. The procedure may be performed on consenting adults, but it is most often performed on non-consenting minors, particularly newborn children, which is why the ritual is so controversial. Opponents of circumcision consider the circumcision of non-consenting minors to be unethical and a human rights violation, unless there is concrete medical indication. Proponents of circumcision consider the circumcision of non-consenting minors to be a "religious freedom" and a "parental right." == Rationale == Reasons for performing circumcision range widely by culture, religion, location, and age. ===Cultural=== 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 discussed in the world to have a high incidence of routine 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]]separate article. ===Religious=Pain ==The circumcision of newborn boys is seen as a divine commandment in the Jewish faith. Though absent in In the Koranpast, male advocates of circumcision is considered claimed that a religious requirement in Islamnewborn child's nerve system was not yet fully developed, and it is performed on male children of varying ages. Converts to these faiths may also choose to undergo circumcision, but it is not always required. ===Medical indication===In some cases, circumcision is legitimately indicated; that as a patient may be suffering recurring infectionsresult, and other methods of treatment have failed. In other cases, a patient may be suffering from a severe case of the child felt no [[phimosispain]]. Overall, during the actual medical necessity for circumcision is extremely rareprocedure. ====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[[Kanwaljeet J. Initially, circumcision was adopted as a way to stop boys and men from masturbating, where mastubration was seen as the cause for many diseases. As the myth Singh Anand| Anand]] & Hickey (1987) have shown that circumcision prevented newborn children do in fact feel [[masturbationpain]] 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 sensationmore acutely than adults.<refname="anand-hickey1987">{{REFjournal |last=TaylorAnand |first=KJS |author-link=Kanwaljeet J.R.Singh Anand |last2=LockwoodHickey |first2=A.P.PR |last3author2-link=Taylor |first3etal=A.J.no |title=The prepuce: Specialized mucosa of Pain and its effects in the penis human neonate and its loss to circumcisionfetus |trans-title= |language= |journal=British Journal of Urology InternationalNew Engl J Med |location= |date=1987-11-19 |volume=77317 |issue=21 |pages=2911321-959 |url=httphttps://www.cirp.org/library/anatomypain/tayloranand/ |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=88009023317037
|pubmedCID=
|DOI= |date=1996-210.1056/NEJM198711193172105 |accessdate=2019-1011-1208}}</ref> In This has led American health associations to recommend doctors take measures to reduce the past, some advocates of mass circumcision have considered the prepuce to be a "mistake of nature,"<ref><nowiki>{{Cold and Wiswell (1995)}} | [[Template:Cold and Wiswell (1995)|see morepain]]</nowiki></p></ref> but this notion has no validity because the prepuce is ubiquitous in primates and because it provides functional advantages.<ref>{{REFbook |last=Cold |first=Christopher |last2=McGrath |first2=Kenneth |author2-link=Ken McGrath |year=1999 |title=Male and female of circumcision: medical, legal, and ethical considerations in pediatric practice |url=http://wwwinfants.cirp.org/library/anatomy/cold-mcgrath/ |work= |editor= |edition= |volume= |chapter=Anatomy and histology of the penile and clitoral prepuce in primates |pages= |location=New York |publisher= |isbn=0306461315 |quote= |accessdate=2019-10-12 |note=}}</ref>
== Complications ===== 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 procedureThe [https://www. Research has shown that newborn children do in fact feel pain, and more acutely than adultscirp. This has led American health associations to recommend doctors take measures to reduce the pain of circumcision in infants. The [[Position Statements on Infant Circumcisionorg/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 recommend 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
|last=
|first=
|title=American Academy of Pediatrics: Circumcision Policy Statement; Task Force on Circumcision
|journal=Pediatrics
|date=March 1999-03
|volume=103
|issue=3
|pages=686-69393 |url=https://pediatrics.aappublications.org/content/103/3/686#sec-9 |accessdate=2019-11-26
|note=Statement Reaffirmed Sept. 1, 2005
}}</ref>
The [[AAFP ]] (2002) states quite simply in their [[Position Statements on Infant Circumcisionhttps://www.cirp.org/library/statements/aafp2002/|position paper]], ''"Newborns experience pain during circumcision".''<ref>{{REFweb
|title=Circumcision: Position Paper on Neonatal Circumcision. Board Approved: August 2007 Reaffirmed
|website=Official American Academy of Family Physicians Website
|url=http://www.aafp.org/online/en/home/clinical/clinicalrecs/children/circumcision.html
|accessdate=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 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 | 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. | url=http://www.pollockclinics.com/circumcision/circumcision-guide.html | title=Parents' Guide to Circumcision | last= | first= | publisher= | work= | date= | accessdate=2011-04-08
}}</ref><ref>{{REFweb
| quote=During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions. | url=http://www.pollockclinics.com/circumcision/circumcision-before.html | title=Before the Circumcision | last= | first= | publisher= | work= | date=2011-04-08 | accessdate=2011-04-08
}}</ref> a topical cream,<ref>{{REFweb
| quote=Then in our office, he will have topical anesthetic applied to his penis. | url=http://www.pollockclinics.com/circumcision/circumcision-before.html | title=Before the Circumcision | last= | first= | publisher= | work= | date=2011-04-08 | accessdate=2011-04-08
}}</ref> and/or a local anaesthetic injection called a dorsal penile ring block.<ref>{{REFweb
| quote=We use extensive pain control methods including Tylenol, a sugar solution (to reduce pain perceptions), a topical freezing cream, and a local anesthetic injection. | url=http://www.pollockclinics.com/circumcision/circumcision-guide.html | title=Parents' Guide to Circumcision | last= | first= | publisher= | work= | 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
|init=HW
|last2=Martinez
|first2=Alma M.
|init2=AM
|last3=Partridge
|first3=J. Colin
|init3=JC
|last4=Sniderman
|first4=Susan
|init4=S
|last5=Armstrong-Wells
|first5=Jennifer
|init5=J
|last6=Fuentes-Afflick
|first6=Elena
|init6=E |title=Pain During Mogen or PlastiBell Plastibell Circumcision
|journal=Journal of Perinatology
|volume=22
|issue=3
|pages=214-2188
|url=http://www.nature.com/jp/journal/v22/n3/full/7210653a.html
|quote=...more than half of the study group had what we considered excessive pain/discomfort over the course of the entire procedure.
|date=2002-04
|accessdate=2011-04-08
}}</ref><ref name='"Clinical Pediatrics August 1986'">{{REFjournal
|last=Williamson
|first=Paul S.
|init=PS
|last2=Evans
|first2=Nolan Donovan
|init2=ND
|title=Neonatal Cortisol Response to Circumcision with Anesthesia
|journal=Clinical Pediatrics
|volume=25
|issue=8
|pages=412-4166
|url=http://cpj.sagepub.com/content/25/8/412.abstract
|quote=The adrenal cortisol response to surgery was not significantly reduced by the administration of lidocaine.
|accessdate=2011-04-08
}}</ref> During circumcision, somp physicians give children sugar pacifiers to "reduce the perception of pain",<ref>{{REFweb
| quote=During the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions. | url=http://www.pollockclinics.com/circumcision/circumcision-before.html | title=Before the Circumcision | last= | first= | publisher= | work= | date=2011-04-08 | accessdate=2011-04-08}}</ref> but in at least one study, data shows that giving sugar to a child doesn't help to reduce the perception of pain in the child.<ref name='"Lancet, The 2010-10-09'">{{REFjournal
|last=Slater
|first=Rebeccah
|init=R
|first2=Laura
|init2=L
|last2=Cornelissen
|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=S
|last7=Boyd
|first8=Judith
|init8=J
|last8=Meek
|first9=Maria
|init9=M
|last9=Prof. Fitzgerald
|title=Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial
|volume=376
|issue=9748
|pages=1225-123232
|url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961303-7/fulltext
|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.
}}</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><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=TaddioUberoi |first=Anna |init=M |author-link= |last2=Abdulcadir |first2=Morton |last2init2=J |author2-link= |last3=GoldbachOhi |first3=Moshe |last3init3=DA |author3-link= |last4=IppSantiago |first4=Bonnie |last4init4=JE |author4-link= |last5=Stevens |first5=Gideon |last5init5= |author5-link= |last6= |first6= |init6= |author6-link= |last7= |first7= |init7= |author7-link= |last8= |first8= |init8= |author8-link= |last9= |first9= |init9= |author9-link= |etal=Korenyes |title=Effect Potentially under-recognized late-stage physical and psychosexual complications of non-therapeutic neonatal penile circumcision on pain responses during vaccination in boys: a qualitative and quantitative analysis of self-reports from an online community forum |trans-title= |language= |journal=The LancetInt J Impot Res |location= |date=2022-10-23 |volume=345 |issue=8945 |article= |page= |pages=291-2 |url=httphttps://www.cirpnature.orgcom/library/pain/taddioarticles/s41443-022-00619-8 |archived=
|quote=
|pubmedID=783786336274189
|pubmedCID=
|DOI=10.1038/s41443-022-00619-8 |accessdate=2023-01-08}}</ref> === Physical effects ===* [[Bodily harm]]* [[Circumcision scar]] is an invariable effect.* An unavoidable 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. * Erectile dysfunction: Both the damage inflicted to the blood vessels in the [[foreskin]] and the reduced sexual sensitivity can be causes for reduced erectile function with advancing age.<ref>{{REFjournal |last=Money |init=J |last2=Davison |init2=J |title=Adult penile circumcision: Erotosexual and cosmetic sequelae |journal=Journal of Sex Research |date=1983 |volume=19 |issue= |pages=289-92 |url= |accessdate=}}</ref> * Orgasm problems: In the wake of reduced sexual sensitivity, due to the loss of sensory tissue and gradual [[keratinization]] of the surface of the [[Glans penis|glans]], orgasm problems may develop with increasing age. In this case, the sexual arousal created by intercourse or [[masturbation]] is not enough to achieve orgasm. A preliminary stage of this late effect is the prolonged time [[circumcised]]] men need to reach an orgasm. This is often fielded as the "cut men have more endurance" argument for circumcision.* Vaginal dryness: Due to the loss of the natural [[gliding action]], which comes from the mobility of the [[foreskin]] and [[shaft skin]], a much increased friction between [[penis]] and [[vagina]] occurs during intercourse. This can make intercourse painful for both partners and lead to abrasions<ref>{{FrischM LindholmM GroenbaekM 2011}}</ref><ref>{{REFjournal |last=Cortés-González |init=J |last2=Arratia-Maqueo |init2=J |last3=Gómez-Guerra |init3=L |title=Does circumcision has an effect on female's perception of sexual satisfaction? |journal=Rev Invest Clin |date=2008 |volume=60 |issue=3 |page=227 |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=Fink |init=KS |last2=Carson |init2=CC |last3=DeVellis |init3=RF |title=Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction |journal=J Urol |date=19952002 |volume=167 |issue=5 |pages=2113-6 |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=TaddioStenram |init=A |last2=Malmfors |init2=G |last3=Okmian |init3=L |title=Circumcision for [[phimosis]]: a follow-up study |journal=Scandinavian journal of urology and nephrology |date=1986 |volume=20 |issue=2 |page=89 |url= |pubmedID=3749823 |accessdate=}}</ref><ref>{{REFweb |url=http://emedicine.medscape.com/article/1016016-overview |title=Meatal Stenosis |publisher=Medscape |accessdate=2019-10-11}}</ref> * Shorter adult penile length was reported by Park et al. (2016) as a result of NMC (newborn male circumcision).{{Citation |Title= |Text=In 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. |Author=Park et al. |Source= |ref=<ref>{{REFjournal |last=Park |first=Anna |init=JK |author-link= |last2=KatzDoo |first2=J. |init2=AR |author2-link= |last3=IlersichKim |first3=A.L. |init3=JH |author3-link= |last4=KorenPark |first4=G. |init4=HS |author4-link= |etal=yes |title=Effects Prospective investigation of neonatal penile length with newborn male circumcision on pain response during subsequent routine vaccinationand second to fourth digit ratio. |trans-title= |language= |journal=The LancetCan Urol Assoc J |location= |date=2016-09 |season= |volume=34910 |issue=90529-10 |article= |page= |pages=599-603 |url=httphttps://www.thelancetncbi.nlm.nih.comgov/journalspmc/lancetarticles/articlePMC5028213/PIIS0140-6736(96)10316-0/fulltext |archived=
|quote=
|pubmedID=905773127695583 |pubmedCID=5028213 |DOI=10.10165489/S0140-6736(96)10316-0 |date=March 1997cuaj.3590 |accessdate=2022-09-04
}}</ref>
}}
=== Sexual effects ===
 Circumcision and frenectomy remove tissues with heightened erogenous sensitivity. Boyle ''Cepeda-Emiliani et al.'' (20022023) wrote, "cited six reports in the genitally intact male has thousands literature of detrimental effects of fine touch receptors circumcision, including erectile function, sensation, masturbatory pleasure, orgasm, and other highly erogenous nerve endings&mdash;many sexual satisfaction. The authors also cited three studies of which are lost severe distress in [[circumcised]] men, due to their infant circumcision, with complaints of [[glans]] insensitivity, delayed [[ejaculation]], and unpleasant sensation."<refname="cepeda2023">{{REFjournal |last=BoyleCepe da-Emiliani |first=Gregory J. |init=A |author-link=Gregory BoyleAlfonso Cepeda-Emiliani |last2=Gándara-Cortés |first2=Gillian A. |last2init2=M |author2-link= |last3=Otero-Alén |first3= |init3=M |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=Bensleyno |title=Adverse Sexual Immunohistological study of the density and Psychological Effects distribution of Male Infant Circumcisionhuman penile neural tissue: gradient hypothesis |trans-title= |language= |journal=Psychological reportsInt J Impot Res |location= |date=2023-05-02 |volume=8835 |issue=3, Part 2 |article= |page= |pages=1105–1106286-305 |url=httphttps://www.cirpnature.orgcom/library/psych/boyle5articles/s41443-022-00561-9 |archived=
|quote=
|pubmedID=1159706035501394
|pubmedCID=
|DOI=10.10461038/j.1464s41443-022-00561-410x.1999.0830s1085.x9 |dateaccessdate=July 20012023-11-26}}</ref> |accessdateCircumcision 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=Van Howe
|firstinit=R.S.RS |author-link=Robert S. Van Howe
|last2=Cold
|first2init2=C.J.CJ
|title=Advantages and Disadvantages of Neonatal Circumcision
|journal=The Journal of the American Medical Association
}}</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. === Psychological effects ===[[Psychological_issues_of_male_circumcision#Circumcision_trauma_in_adults| Psychological late effects]] are also possible after a circumcision, especially if the operation was carried out in childhood. On this occasion a variety of [[trauma]] may occur, which depend, among others, on age and circumstances of the circumcision. For example, whether the circumcision took place with or without sufficient anaesthesia, if the individual has been informed about the operation beforehand, if he was [[circumcised]] against his will or without his consent, and also, in the case of infant circumcision, if he was told about it during childhood or had to find it out coincidentally on his own. 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 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<ref>{{REFjournal |last=ColdMarshall |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 |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 of refusal to be fed. The sleeping habits of these babies were also disturbed, 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 to the operation, 69% of the boys [[circumcised]] in the traditional ritual and 51% of those [[circumcised]] by standard medical procedures (including anaesthesia) fulfilled the DSM-IV criteria for PTSD following the operation.<ref>{{REFbook |last=Ramos |init=S |last2=Boyle |init2=GJ |year=2001 |title=Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem |firsturl=https://link.springer.com/chapter/10.1007/978-1-4757-3351-8_14 |work= |editors=[[George C.JDenniston]], [[Frederick M. Hodges]], [[Marilyn Fayre Milos]] |edition= |volume= |chapter=Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder |pages=253-70 |location=New York |publisher=Kluwer Academic/Plenum Publishers |isbn= |quote= |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/ |first2title=JGlobal Survey of Circumcision Harm |accessdate=2019-10-12}}</ref>* It can frequently be found that the loss is denied, much as happens 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 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>{{REFjournal |last=Goldman |init=R. |last2author-link=Ronald Goldman |url=Taylorhttps://www.cirp.org/library/psych/goldman1/ |title=The prepucepsychological impact of circumcision |journal=British Journal of Urology InternationalBJU Int |date=1999
|volume=83
|issue=Suppl. 1
|pages=93-103
|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 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
|last2=Chapin
|first2=Georganne
|author2-link=Georganne Chapin
|publisher=Intact America
|location=Tarrytown
|format=PDF
|date=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]].<ref name="deacon2022" /><ref name="williams-kapilla1993">{{REFjournal
|last=Williams
|init=N
|author-link=
|last2=Kapilla
|init2=L
|author2-link=
|etal=no
|title=Complications of circumcision
|trans-title=
|language=
|journal=Brit J Surg
|location=
|date=1993-10
|volume=80
|issue=10
|pages=1231-6
|url=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 to the narcotics used.
* Especially in newborns, 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 [[penis]], the rate 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, and, therefore, is only likely to be used in emergencies. A surgical operation without proper [[pain]] control can lead to the development of a specific pain memory<ref>{{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=
|publisher=Spiegel Online
|website=
|date=2012-08-12
|accessdate=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=T
|title=Circumcision: a survey of fees and practices
|journal=OBG Management
|date=1994
|volume=October
|issue=
|pages=34-6
|url=
|accessdate=
}}</ref><ref>{{REFjournal
|last=Howard
|init=CR
|last2=Howard
|init2=FM
|last3=Garfunkel
|init3=LC
|last4=de Blieck
|init4=EA
|last5=Weitzman
|init5=M
|title=Neonatal circumcision and pain relief: current training practices
|journal=Pediatrics
|date=1998
|volume=101
|issue=
|pages=34423-448 |url=http |accessdate=}}</ref><ref>{{REFjournal |last=Stang |init=HJ |last2=Snellman |init2=LW |title=Circumcision practice patterns in the United States |journal=Pediatrics |date=1998 |volume=101 |issue=e5 |pages= |url= |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>{{REFjournal |last=Gunnar |init=MR |last2=Fisch |init2=RO |last3=Korsvik |init3=S |last4=Donhowe |init4=JM |title=The effects of circumcision on serum cortisol and behavior |journal=Psychoneuroendocrinology |date=1981 |volume=6 |issue=3 |pages=269-75 |url=https://www.cirp.org/library/anatomypain/coldgunnar/ |accessdate=2019-taylor11-26}}</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>{{REFbook |last= |first= |year=2000 |title=Paediatric Handbook |url= |work= |editors=Smart J, Nolan T. |edition=6 |volume= |chapter= |page=82 |location={{AUSC|VIC}}, Australia |publisher=Blackwell Science Asia |isbn=
|quote=
|pubmedID=10349413
|pubmedCID=
|DOI=
|date=1999-1
|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>
* 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
|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=
}}</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=HJ
|last2=Vemulakonda
|init2=V
|last3=Ritchey
|init3=ML
|last4=Ribbeck
|init4=M
|title=Outpatient management of [[phimosis]] Following newborn circumcision
|journal=J Urol
|date=2003
|volume=169
|issue=6
|pages=2332-4
|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 - a continuing enigma
|journal=Aust Paediatr J
|date=1970
|volume=6
|issue=
|pages=59-65
|url=https://www.cirp.org/library/general/leitch1/
|accessdate=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://www.nytimes.com/2012/03/08/nyregion/infants-death-renews-debate-over-a-circumcision-ritual.html?_r=0
|title=Baby’s Death Renews Debate Over a Circumcision Ritual
|last=Robbins
|first=Liz
|date=2012-03-07
|accessdate=2019-10-11
}}</ref>
 
=== 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]].<ref name="Bollinger 2010">{{REFjournal
|last=Bollinger
|first=Dan
|init=D
|author-link=Dan Bollinger
|last2=Boy's Health Advisory
|accessdate=2019-10-12
}}</ref><ref>{{REFweb
| quote= | url=http://www.icgi.org/2010/04/infant-circumcision-causes-100-deaths-each-year-in-us | title=Infant circumcision causes 100 deaths each year in US | last= | first= | publisher=ICGI | website=[[International Coalition for Genital Integrity]] | date=2010-04-26 | accessdate=
}}</ref> See also the list of [[fatalities]].
== Forced circumcision ==
 <!--=== United States Military military === American soldiers serving in World War II were subjected to regular inspections of their genitals. If uncircumcisedintact, the soldiers risked being ordered to undergo immediate circumcision.<ref>{{REFbook
|last=Schoen
|first=Ed
|init=E
|author-link=Edgar J. Schoen
|year=2005
|volume=
|chapter=
|pages=72-733
|location=Georgetown, Canada
|publisher=RDR Books
|accessdate=
|note=
}}</ref> This practice was discontinued at least six decades ago.-->
=== Non-therapeutic circumcision of male children ===
Human babies, because they are not yet in possession of language, are incapable of giving or refusing consent for being 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 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 routine 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
|editoreditors=[[George C. Denniston]], [[Frederick M. Hodges|Frederick Mansfield Hodges]], [[Marilyn Fayre Milos]]
|edition=
|volume=
|chapter=Section 5
|pages=259-27171
|location=New York
|publisher=Kluwer Academic/Plenum Publishers
|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 claimed 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> however surrogate consent for non-therapeutic circumcision is now viewed as unethical. In the [[United Kingdom]], where routine non-therapeutic circumcision has now become far less prevalent than in the [[United States]], a the written consent of both parents is required, if a physician is to perform a non-therapeutic circumcision of a child.<ref>{{REFjournal
|last=
|first=
|volume=1
|issue=
|pages=307-31414 |url=httphttps://www.cirp.org/library/legal/Re_J/2000.html
|accessdate=2019-10-12
}}</ref> (The National Health Service does not provide non-therapeutic circumcision.)
 
In recent years, legal writers in several English-speaking countries have been questioning the practice of acceding to parental wishes.<ref>See, e.g., [[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?===
The video ''Is Circumcision Healthy'' is recommended for parental viewing.
<br><br>
<youtube>D_3LQjZgdbQ</youtube>
 
===Dr. Christopher Guest discusses circumcision===
<br>
<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]
 
==Recommendations of medical authorities==
* [[George Hill| Hill]] (2007) said:
<blockquote>
Male circumcision is harmful because it excises healthy tissue and permanently impairs beneficial physiological functions. Male circumcision also causes psychological problems that tend to perpetuate the cycle of abuse. Male circumcision is a costly diversion of medical resources away from beneficial services. Male circumcision violates legal rights, [[human rights]], and ethical standards. Finally, we must remember that males are the more vulnerable and sensitive of the two genders and, therefore, deserve the greater degree of protection from traumatic, invasive, injurious,and unnecessary surgery. For all of these reasons the non-therapeutic circumcision of boys should not be performed and the [[genital integrity]] of all children should be respected and protected.<ref name="hill2007">{{REFjournal
|last=Hill
|first=George
|init=G
|author-link=George Hill
|title=The case against circumcision
|journal=Journal of Men's Health and Gender
|date=2007
|volume=4
|issue=3
|pages=318-23
|url=https://www.academia.edu/8367383/The_Case_Against_Circumcision
|quote=
|pubmedID=
|pubmedCID=
|DOI=
|accessdate=2021-05-30
}}</ref>
</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
|last=MacNeily
|first=Andrew
|init=
|author-link=
|etal=no
|title=Routine circumcision: the opposing view
|trans-title=
|language=
|journal=Can Urol Assoc J
|location=
|date=2007-11
|volume=1
|issue=4
|article=
|page=
|pages=395-7
|url=http://europepmc.org/article/PMC/2422979
|pubmedID=18542825
|pubmedCID=
|DOI=10.5489/cuaj.455
|accessdate=2021-11-08
}}</ref>
</blockquote>
 
* The [[Royal Dutch Medical Association]] (KNMG) (2010) said:
 
<blockquote>
The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity. Contrary to popular belief, circumcision can cause complications – [[bleeding]], infection, [[urethra]]l stricture and panic attacks are particularly common. KNMG is therefore urging a strong policy of deterrence. KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications.<ref>{{REFdocument
|title=Non-therapeutic circumcision of male minors
|url=https://www.doctorsopposingcircumcision.org/wp-content/uploads/2016/09/knmg-non-therapeutic-circumcision-of-male-minors-27-05-2010.pdf
|contribution=
|last=
|first=
|publisher=Royal Dutch Medical Association
|format=PDF
|date=2010
|accessdate=2021-11-08
}}</ref>
</blockquote>
 
* The [[Royal Australasian College of Physicians]] (2010) said:
In recent years<blockquote>Ethical and [[human rights]] concerns have been raised regarding elective infant male circumcision because it is recognised that the foreskin has a functional role, the operation is non-therapeutic and the infant is unable to consent.  After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, legal writers the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in several English-speaking countries have been questioning Australia and New Zealand. However it is reasonable for parents to weigh the practice benefits and risks of acceding circumcision and to parental wishesmake the decision whether or not to circumcise their sons.<refname="racp2010">See, e{{REFdocument |title=Circumcision of Infant Males |url=https://www.racp.gedu., Somerville, "Therapeutic and Nonau//docs/default-source/advocacy-library/circumcision-of-infant-Therapeutic Medical Procedures"; Poulter, ''English Criminal Law''; Chessler, "Justifying the Unjustifiable"; Smith, "Male Circumcisionmales."pdf |contribution= |last= |first= |publisher=The Royal Australasian College of Physicians |format=PDF |date=2010-09-01 |accessdate=2021-11-08}}</ref> For example</blockquote> * The [[American Academy of Pediatrics]] (AAP) has not re-affirmed its disastrous, critics have pointed out thatfailed 2012 Circumcision Policy Statement, which expired in the United States2017, more than 1so currently has no position on child circumcision.3% of male neonatal deaths are attributable to the  * Medical historian [[Robert Darby]] (2014) wrote simply:<blockquote>"To avoid circumcision complications of non-therapeutic , avoid circumcision surgery.<ref name="Bollinger 2010"/>refer<ref>{{REFwebREFjournal |last=Darby |first= |init=R |author-link=Robert Darby |etal=no |title=To avoid circumcision complications, avoid circumcision |trans-title= |language= |journal=Can Urol Assoc J |location= |date=2014-08-14 |volume=8 |issue=7-8 |article= |page=231 |pages= |url=https://cuaj.ca/index.php/journal/article/view/1709/1823 |archived=
|quote=
|pubmedID= |pubmedCID= |DOI=10.5489/cuaj.1709 |accessdate=2022-12-16}}</ref></blockquote>* The [[Canadian Paediatric Society]] (CPS) (2015) said: <blockquote>In most jurisdictions, authority is limited only to interventions deemed to be medically necessary. In cases in which medical necessity is not established or a proposed treatment is based on personal preference, interventions should be deferred until the individual concerned is able to make their own choices.<ref name="CPS2015">{{REFjournal |last=Sorokin |first=S. Todd |init=ST |author-link= |last2=Finlay |first2=JC |author2-link= |last3=Jeffries |first3=AL |author3-link= |etal=yes |title=Newborn male circumcision |journal=Paediatr Child Health |location= |date=2015-08 |volume=20 |issue=6 |pages=311-20 |url=httphttps://www.icgincbi.orgnlm.nih.gov/pmc/articles/PMC4578472/2010 |quote= |pubmedID=26435672 |pubmedCID=4578472 |DOI=10.1093/04pch/infant20.6.311 |accessdate=2019-10-27}}</ref></blockquote> * The [[Canadian Urological Association]] (CUA) considered the matter of circumcisionand issued a statement in February 2018. The CUA concluded: <blockquote>"Given the socioeconomic, educational status, and health demographics of our population, universal neonatal circumcision cannot be justified based on the current evidence available.<ref name="cua2018">{{REFjournal |last=Dave |first=Sumit |init=S |author-causeslink= |etal=yes |title=Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (abridged version) |journal=Can Urol Assoc J |location= |date=2018-10002 |volume=12 |issue=2 |pages=18-deaths28 |url=https://cuaj.ca/index.php/journal/article/view/5034/3470 |quote= |pubmedID= |pubmedCID= |DOI= |accessdate=2021-each11-year09}}</ref></blockquote>==British family court opinion==The issue of non-therapeutic circumcision of male children came before the court inthe case of ''[[Re B and G (children) (No 2) EWFC 3]] (2015)'' . In that case, Judge Sir James Munby ruled that circumcision of male children caused ''significant harm''. == Rights and ethics == The [[Rights situation on circumcision|rights situation]] is discussed in a separate article. [[Image:Intact vs circumcised.JPG |thumbnail|right|300px| The intact and circumcised human penis, side by side.]] The term "circumcision" without a gender qualifier refers specifically to male circumcision. It means "to cut around," and it refers to the [[excision]] of the [[foreskin]] from the penis. The term is inaccurate and a euphemism because the operation actually cuts off or [[amputation| amputates]] the [[foreskin]], which in adults comprises about fifteen square inches of highly functional erogenous tissue.  Circumcision is most often performed in healthy males for [[Religion and Culture|religious or cultural]] reasons. The procedure may be performed on consenting adults, but it is most often performed on non-consenting minors, particularly newborn children, which is why the ritual is so controversial. Opponents of circumcision consider the circumcision of non-usconsenting minors to be unethical and a [[human rights]] violation, unless there is concrete [[medical indication]].=== Consent by surrogates ===Medical ethics has long recognized limitations on the power of consent by surrogates.<ref>{{REFjournal |last=Committee on Bioethics, American Academy of Pediatrics |etal=no |title=Infant circumcision causes 100 deaths each year Informed consent, parental permission, and assent in USpediatric practice |trans-title= |language= |journal=Pediatrics |location= |date=1995 |volume=95 |issue=2 |article= |page= |pages=314-17 |url=https://www.cirp.org/library/ethics/AAP/ |archived= |quote= |pubmedID=7478854 |pubmedCID= |DOI= |accessdate=2023-05-21}}</ref> <ref>{{REFjournal |last=BollingerCommittee on Bioethics |firstetal=no |title=DanInformed Consent in Decision-Making in Pediatric Practice |authortrans-linktitle= |language= |journal=Dan BollingerPediatrics |publisherlocation=International Coalition for Genital Integrity |date=20102016-08 |volume=138 |issue=2 |article= |page=e20161485 |pages= |url=https://watermark.silverchair.com/peds_20161485.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAApwwggKYBgkqhkiG9w0BBwagggKJMIIChQIBADCCAn4GCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQM8zYHFd0Ylu9Annq_AgEQgIICT24ikc839aJMYOiypqC2G9f7_yKGAGkAekzzbCtck5TElALWVCGNoVSOaA6rDA_dOkQ_LyJnxYlZ88J9-uk15tvlIBbE82_aNyYfq5e9xmEfqD2vh374q3Naz57dxZaUbgxUkKX4PqsiLmYHLvVrr7bQK2MZuuUOKiQU8JZy7lLjkp-04PjJO1U9cyIplTAgs_EdvgK8MWWoIsj-26X-ZUDImAG63-rlj_qLsy5dYwytmxfCuVa47RdZseLSr2_bdDpwKAKGhq_Ly9rlHZeW_f7fYktVfF_sFTgcJziAlvEQmdyWIw0qf-hlO31Qb3sH6kDdcvHAbm7llY5xa34XLYIt8QR0YFIimgDGFliN4-ce2vjvvrwS85WeeNFhpn-Ywn4Qjpy06hPuLDL-MtI2Z3BZbBsKq4dp8qGu1q9GlXaKw193riTFG9G5bF5GCKmxmt0nCQTthrb_CcK2UhKjZwPekC9zkIUHPZ9BXJt0SM03F_g-GgqbE0hTYKMqNdJ3sHDQu2luFrJ9JEiMzxtP28gJoYh20d2APA0xrRbXBYsFdAlr50gb1BSAbNJhTyx-Kh3geoSHsAYMjPaG7cIbh0jd42pWCUx30vjlAGK8zXTuf7-31oi81CLbHTAJLuzK3NT4Whi17jVq1SbXsIXlWpKc_d-HujCvlb74rkZQ6RG9wkxW7gAKaDqtKv5zTOTMBD9vLVxgp8lDmVA8PFB59Bqd6w-fi86tW132oWQM-mTfwdIBXFbUFXkeTUC5RYyqJQIXAEwLJSRm1RX-LRbKRzgaRQ |archived= |quote= |pubmedID=27456510 |pubmedCID= |DOI=10.1542/peds.2016-1485 |format=PDF |accessdate=20192023-05-21}}</ref> <ref>{{REFjournal |last=Committee on Bioethics ||etal=no |title=Informed Consent in Decision-Making in Pediatric Practice |trans-title= |language= |journal=Pediatrics |location= |date=2016-08 |volume=138 |issue=2 |article= |page=e20161484 |pages= |url=https://watermark.silverchair.com/peds_20161484.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAApwwggKYBgkqhkiG9w0BBwagggKJMIIChQIBADCCAn4GCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMYv3coRY-UCYMgTaqAgEQgIICT4di03qn2Hbho3i8Li_78lod0lNMunch25nx1rKvaM_aeFerz5eN6_k8VVeNv-DLocZp28whQr1x4WYDVwSs4uF73vZpYZYuDphYQkwxV1HHgMbZAbHBFuE8QyCHyDvSY-fhQcUl-JrYxa3TbhYgd4bKiU9zfIyXUsCnItroCc9iNrMicPg0v_A0AJJlhxioOlAU-im6OPI06OcCBj78yqkPO0J4nMTN1FLochsOyvZZdtFQQzLhrnM_Gey8K75lFYIBJHA7uzMmP2o5KZ-FTGUkEA_eSpEIpwv2WI4SbtrA8WYk3cQqXOmLIWjkSs9CTELD7CQP29xarr1ANrF_id4CiCX7zIomC2Ciz9lHBEgz8EH2i9Woke_YuZeLax52_6JpdhH1qdMQyF1bByjP8mU98V5_B4BPPiBpKt4pVA_UgtaABRHL8oPv6SwOUQZ2Bc-0_E2tod0VIF1FJBwZRZJm2ZkJPgBSKUo8VBe5Pz_6Vpt2DqLzwqVUYscPsIJMvxl09mMtvJrsBa8yVoTRWj4Rd0OBTMV7zhZskDnYYyrAZ6sHMk0MzvbHilPNbNgU5o7mXmcbFGDgGgWbqrIdT6sVSSfPJm4TnR0HSWbc_EnHhhyye7tVlFGjAsR0R46_DSwEMz8M5DkSln8xfKtX_so9rjCvYeq45wqn09g8DqtV-WHEA9PIrcw5kTcz5I0JkNuW4-vKVU1Xz9XHiYi4Zqbq0vx9NWLdNSYHQSOGMZ1MCAxT152evQdipQB5wokR8Q4rICoJYII5bsmRMYd7JQ |archived= |quote= |pubmedID=27456514 |pubmedCID= |DOI=10.1542/peds.2016-1484 |format=PDF |accessdate=2023-1205-21
}}</ref>
Two ethicists, Myers & Earp (2020), have conducted a detailed review and analysis of the claimed medical benefits of ''non-therapeutic'' [[circumcision]]. They have determined than the alleged benefits are not material, so they do not support granting of consent by a surrogate. In other words, ''Non-therapeutic'' circumcision is not truly healthcare. Moreover, they comment that even the most perfectly executed surgery produces [[trauma]] and harm to the patient. Circumcision also produces tissue loss and loss of function, therefore, circumcision should be performed only after the individual reaches the age of consent. <u>Consent by a surrogate for a ''non-therapeutic'' circumcision of a minor child is an unethical practice.</u><ref name="myers2020">{{REFjournal
|last=Myers
|first=
|init=A
|author-link=
|last2=Earp
|first2=
|init2=BD
|author2-link=Brian D. Earp
|etal=no
|title=What is the best age to circumcise? A medical and ethical analysis
|trans-title=
|language=
|journal=J Biosoc Sci
|location=
|date=2020-09
|volume=34
|issue=7
|pages=560-72
|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/bioe.12714
|archived=
|quote=
|pubmedID=32068898
|pubmedCID=
|DOI=10.1111/bioe.12714
|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]]
* [[Circumcision maps]]
* [[Circumcision methods]]
* [[Circumcision scar]]
* [[Circumpendium]]
* [[Circumstraint]]
* [[Documented severe complications of circumcision]]
* [[Ethics of non-therapeutic child circumcision]]
* [[FGM]]
* [[Human rights]]
* [[Lymphoedema]]
* [[MGM]]
* [[Circumcision scarPain]]* [[Psychological issues of male circumcision]]* [[Rights situation on circumcision]]* [[Risks and complications]]* [[Sexual effects of circumcision]]* [[Sudden Infant Death Syndrome]](SIDS)* [[CircumpendiumTrauma]]{{LINKS}} * {{REFweb |url=https://www.cirp.org/library/anatomy/garcia/ |title=What exactly is circumcision and what is it not? |last=Garcia |first=Francisco |date=1995-12-11 |accessdate=2020-09-08}}* {{REFjournal |last=Fleiss |first=Paul |init=P |author-link=Paul M. Fleiss |title=The foreskin is necessary |journal=Mothering |date=1997-01 |volume= |issue= |pages=36-45 |url=http://www.noharmm.org/mothering.htm |accessdate=2020-06-29}}*{{REFweb |url=https://15square.org.uk/losses-from-circumcision/ |title=Losses from Circumcision |last=Ball |first=Peter |publisher=15 Square |date=2003-08-09 |accessdate=2023-02-23}}* {{REFweb |url=http://members.tranquility.net/~rwinkel/MGM/primer.html |title=Male Circumcision in the USA: A Human Rights Primer |last=Winkel |first=Rich |author-link=Rich Winkel |date=2005-05-12 |accessdate=2021-01-27}} * {{REFjournal |last=Testa |first=Patrick |init= |author-link= |last2=Block |first2=Walter E. |init2= |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}}
 
 
 
[[Category:Circumcision]]
[[Category:Genital mutilation]]
[[Category:Body modification]]
[[Category:Genital surgery]]
[[Category:Islam]]
[[Category:Judaism]]
[[Category:Male circumcision]]
[[Category:Parental information]]
[[Category:Penile surgery]]
[[Category:Medical term]]
[[Category:Male genital mutilation]]
[[Category:From Intactipedia]]
[[Category:From IntactWiki]]
[[Category:Male circumcision]]
[[Category:Genital surgery]]
[[Category:Terms]]
[[de:Zirkumzision]]
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