Changes

"Male '''circumcision''' (from Latin ''circumcidere'', meaning "to cut around") is the surgical removal of the [[foreskin]] (prepuce) part of the human [[penis]]. The foreskin comprises ''more than fifty percent'' of the epithelium of the penis.<ref name="taylor1996">{{REFjournal

|last=Taylor

|author-link=John R. Taylor

|last2=Lockwood

|author2-link=

|last3=Taylor

|title=The prepuce: specialized mucosa of the penis and its loss to circumcision

|journal=Brit J Urol

|last=Wolbarst

|first=Abraham L.

|author-link=Abraham L. Wolbarst

|title=Is circumcision a prophylactic against penis cancer?

|last=Hand

|first=Eugene H.

|journal=Archives of Dermatology and Syphilology

|date=Sep 1949

|last=Ravich

|first=Abraham

|last2=Ravich

|journal=New York State Journal of Medicine

|date=Jun 1951

|last=Ravich

|first=Abraham

|url=https://www.deepdyve.com/lp/wiley/viral-carcinogenesis-in-venereally-susceptible-organs-HCeWmTLmKl

|title=Viral carcinogenesis in venereally susceptible organs

|last=Wiswell

|first=Thomas E.

|author-link=Thomas E. Wiswell

|url=https://pediatrics.aappublications.org/content/75/5/901

|last=Fink

|first=Aaron J.

|author-link=Aaron J. Fink

|title=A possible explanation for heterosexual male infection with AIDS

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

|last=Blalock

|last2=Vemulakonda

|last3=Ritchey

|last4=Ribbeck

|title=Outpatient management of [[phimosis]] Following newborn circumcision

|journal=J Urol

* 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

|last2=Masi

|last3=Zuckerman

|title=Circumcision in the United States: prevalence, prophylactic effects, and sexual practice

|journal=JAMA

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

|last=Fleiss

|last2=Hodges

|last3=Van Howe

|title=Immunological functions of the human prepuce

|journal=Sex Transm Inf

* 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

|last2=van der Velde

|last3=van der Linden

|etal=yes

|title=The importance of ethnicity as a risk factor for STDs and sexual behaviour among heterosexuals

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

|last=Michael

|last2=Wadsworth

|last3=Feinleib

|etal=yes

|title=Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison

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

|last=Laumann

|last2=Masi

|last3=Zuckerman

|title=Circumcision in the United States: prevalence, prophylactic effects, and sexual practice

|journal=JAMA

}}</ref>

* Two studies that have been published in early 2007<ref>{{REFjournal

|title=Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial

|journal=Lancet

|accessdate=

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

|title=Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial

|journal=Lancet

|last=Boyle

|first=Gregory J.

|author-link=Gregory Boyle

|last2=Hill

The fact that the USA has both the highest rate 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

|last2=Mosha

|last3=Todd

|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

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

|last=Barongo

|last2=Borgdorff

|last3=Mosha

|etal=yes

|title=The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania

* Urinary tract infections (UTI): a UTI can be effectively treated with antibiotics, this was also proven by studies<ref>{{REFjournal

|last=McCracken

|title=Options in antimicrobial management of urinary tract infections in infants and children

|journal=Pediatr Infect Dis J

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

|last=Larcombe

|title=Urinary tract infection in children

|journal=BMJ

}}</ref>. A Swedish study <ref>{{REFjournal

|last=Mårild

|last2=Jodal

|title=Incidence rate of first–time symptomatic urinary tract infection in children under 6 years of age

|journal=Acta Paediatr

}}</ref> found that, during the first 6 years of life, the incidence of UTIs 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

|last2=Steinhardt

|last3=Naseer

|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

* 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

|title=Complications arising from ritual circumcision: pathogenesis and possible prevention

|journal=Isr J Med Sci

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

|last=Cohen

|last2=Drucker

|last3=Vainer

|etal=yes

|title=Postcircumcision urinary tract infection

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

|last=Goldman

|last2=Barr

|last3=Bistritzer

|last4=Aladjem

|title=Urinary tract infection following ritual Jewish circumcision

|journal=Isr J Med Sci

<ref>{{REFjournal

|last=Wolbarst

|title=Circumcision and penile cancer

|journal=Lancet

}}</ref>. Today, it is known that sexually transmitted human papillomavirus (HPV) is a major risk factor<ref>{{REFjournal

|last=McCance

|last2=Kalache

|last3=Ashdown

|etal=yes

|title=Human papillomavirus types 16 and 18 in carcinomas of the penis from Brazil

}}</ref>, as well as smoking<ref>{{REFjournal

|last=Harish

|last2=Ravi

|title=The role of tobacco in penile carcinoma

|journal=Brit J Urol

One should note that the human foreskin is endowed by nature with [[Foreskin#Immunological_functions| immunological functions]] that serve to protect the human body from disease.<ref name="fleiss-hodges-vanhowe1998" /> The glans penis receives blood through the frenular artery.<ref>{{REFjournal

|last=Persad

|author-link=

|last2=Sharma

|author2-link=

|last3=McTavish

|author3-link=

|etal=yes

Circumcision is surgery. Surgical complications of circumcision generally may be classified as hemorrhage, infection, or surgical misadventure up to and including loss of the penis and [[death]].<ref name="williams-kapilla1993">{{REFjournal

|last=Williams

|author-link=

|last2=Kapilla

|author2-link=

|etal=no

}}</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

|title=Circumcision: a survey of fees and practices

|journal=OBG Management

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

|last=Howard

|last2=Howard

|last3=Garfunkel

|last4=de Blieck

|last5=Weitzman

|title=Neonatal circumcision and pain relief: current training practices

|journal=Pediatrics

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

|last=Stang

|last2=Snellman

|title=Circumcision practice patterns in the United States

|journal=Pediatrics

}}</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

|last2=Fisch

|last3=Korsvik

|last4=Donhowe

|title=The effects of circumcision on serum cortisol and behavior

|journal=Psychoneuroendocrinology

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

|last=Hiss

|last2=Horowitz

|last3=Kahana

|title=Fatal haemorrhage following male ritual circumcision

|journal=J Clin Forensic Med

* 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

|last2=Vemulakonda

|last3=Ritchey

|last4=Ribbeck

|title=Outpatient management of [[phimosis]] Following newborn circumcision

|journal=J Urol

}}</ref>, the prevalence is 2.9%, according to Leitch<ref>{{REFjournal

|last=Leitch

|title=Circumcision - a continuing enigma

|journal=Aust Paediatr J

* 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

|last2=Snyder

|last3=Reiss

|etal=yes

|title=Fine-touch pressure thresholds in the adult [[penis]]

* Painful tension can occur when there is too little reserve skin left to support a full erection<ref>{{REFjournal

|last=Taylor

|last2=Lockwood

|last3=Taylor

|title=The prepuce: <q>Specialized mucosa of the [[penis]] and its loss to circumcision</q>

|journal=British Journal of Urology

* 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

|last2=Davison

|title=Adult penile circumcision: Erotosexual and cosmetic sequelae

|journal=Journal of Sex Research

|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

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

|last=Cortés-González

|last2=Arratia-Maqueo

|last3=Gómez-Guerra

|title=Does circumcision has an effect on female's perception of sexual satisfaction?

|journal=Rev Invest Clin

}}</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

|last2=Taylor

|title=The prepuce

|journal=BJU Int

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

|last=Fink

|last2=Carson

|last3=DeVellis

|title=Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction

|journal=J Urol

* [[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

|title=Incidence of meatal stenosis following neonatal circumcision in a primary care setting

|journal=Clin Pediatr (Phila)

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

|last=Stenram

|last2=Malmfors

|last3=Okmian

|title=Circumcision for [[phimosis]]: a follow-up study

|journal=Scandinavian journal of urology and nephrology

* It was observed that infants, following circumcision without pain control, had a disturbed bond with their mother<ref>{{REFjournal

|last=Marshall

|last2=Porter

|last3=Rogers

|etal=yes

|title=Circumcision: II effects upon mother-infant interaction

* 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>{{REFjournal

|last=van der Kolk

|url=http://www.cirp.org/library/psych/vanderkolk/

|title=The compulsion to repeat the trauma: re-enactment, revictimization, and masochism

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

|last=Goldman

|author-link=Ronald Goldman

|url=http://www.cirp.org/library/psych/goldman1/

* 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

|url=http://www.cirp.org/library/psych/rhinehart1/

|title=Neonatal circumcision reconsidered

* 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

|date=1965

|url=http://www.cirp.org/library/psych/cansever/

|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

|last=Taeusch

|first=H. William

|last2=Martinez

|first2=Alma M.

|last3=Partridge

|first3=J. Colin

|last4=Sniderman

|first4=Susan

|last5=Armstrong-Wells

|first5=Jennifer

|last6=Fuentes-Afflick

|first6=Elena

|title=Pain During Mogen or Plastibell Circumcision

|journal=Journal of Perinatology

|last=Williamson

|first=Paul S.

|last2=Evans

|first2=Nolan Donovan

|title=Neonatal Cortisol Response to Circumcision with Anesthesia

|journal=Clinical Pediatrics

|last=Slater

|first=Rebeccah

|first2=Laura

|last2=Cornelissen

|first3=Lorenzo

|last3=Fabrizi

|first4=Debbie

|last4=Patten

|first5=Jan

|last5=Yoxen

|first6=Alan

|last6=Worley

|first7=Stewart

|last7=Boyd

|first8=Judith

|last8=Meek

|first9=Maria

|last9=Prof. Fitzgerald

|title=Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial

|last=Taddio

|first=Anna

|first2=Morton

|last2=Goldbach

|first3=Moshe

|last3=Ipp

|first4=Bonnie

|last4=Stevens

|first5=Gideon

|last5=Koren

|title=Effect of neonatal circumcision on pain responses during vaccination in boys

|last=Taddio

|first=Anna

|last2=Katz

|last3=Ilersich

|last4=Koren

|title=Effects of neonatal circumcision on pain response during subsequent routine vaccination

|journal=The Lancet

|last=Boyle

|first=Gregory J.

|author-link=Gregory Boyle

|first2=Gillian A.

|last2=Bensley

|title=Adverse Sexual and Psychological Effects of Male Infant Circumcision

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

|author-link=Robert Van Howe

|last2=Cold

|title=Advantages and Disadvantages of Neonatal Circumcision

|journal=The Journal of the American Medical Association

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>{{REFjournal

|last=Cold

|last2=Taylor

|title=The prepuce

|last=Bollinger

|first=Dan

|author-link=Dan Bollinger

|last2=Boy's Health Advisory

|last=Fleiss

|first=Paul

|author-link=Paul M. Fleiss

|title=The foreskin is necessary