Changes

"Male '''circumcision''' (from Latin ''circumcidere'', meaning "to cut around") is the surgical removal or [[amputation]] of the [[foreskin]] (prepuce) , a major part of the human [[penis]]. The foreskin comprises ''more than fifty percent'' of the epithelium of the [[penis]].<ref name="taylor1996">{{TaylorJR LockwoodAP TaylorAJ 1996}}</ref> When the "cutting around" is performed, the foreskin falls off, so [[amputation]] and [[mutilation]] is the result. The amputation destroys the [[Foreskin#Physiological_functions| many protective, immunological, sexual, and sensory physiological functions]] of the foreskin, so it is a very harmful and [[Pain| painful]] surgery. '''Posthectomy''' is the more accurate medical term that more accurately reflects the injury and loss of functional body tissue, but the Biblical [[euphemism]], ''circumcision'', is more commonly used.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=TaylorBollinger |init=JRD |author-link=John R. TaylorDan Bollinger |last2=Lockwood |init2=AP

|last3url=Taylor |init3=AJhttps://kindredmedia.org/2023/02/adverse-childhood-experiences-dysfunctional-households-and-circumcision/ |title=The prepuce: specialized mucosa of the penis and its loss to circumcisionAdverse Childhood Experiences, Dysfunctional Households, And Circumcision. |journal=Brit J UrolKindred |date=19962023-02-28 |volume=77

|pages=291 |accessdate=2023-503-01}}</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=httphttps://onlinelibrarywww.wileynature.com/doiarticles/10.1046/j.1464s41443-021-00502-410X.1996.85023.x/full |quote=y |pubmedID=8800902 |pubmedCID=34997197 |DOI=10.10461038/j.1464s41443-021-00502-410X.1996.85023.xy |accessdate=20192022-1001-1430}}</ref> [...] The procedure is most often an elective, non-therapeutic surgery performed on neonates and children for religious and cultural reasons in violation of their [[human rights]], but in other cases may be indicated for both therapeutic and prophylactic reasons. It is a radical treatment option for pathological [[phimosis]], refractory [[Balanitis| balanoposthitis]] and chronic [[urinary tract infection]]s (UTIs); it is contraindicated in cases of certain genital structure abnormalities or poor general health.

'''Posthectomy''' is a more accurate medical term that more accurately reflects Circumcision was popularized in English-speaking nationns in the injury and loss nineteeth century. The practice of non-therapeutic circumcision of functional body tissueboys now has greatly declined in [[Australia]], [[Canada]], but [[New Zealand]] and the [[United Kingdom]]. It has been gradually declining since 1985 in the Biblical euphemism, [[United States]]. It has ''circumcisionnever'', is more commonly usedbeen a popular practice in other western nations.

With reference to involuntary, non-therapeutic circumcision Circumcision is classified as a form of children, [[Child Genital Cutting (CGC)genital mutilation]] is a new term that has been introduced to avoid issues associated with more traditional terms.

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

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.

In the Jewish religion[[Judaism]], the tradition of [[Brit Milah| circumcision ]] goes back to the [[Abrahamic covenant]] in a passage in the Book of Genesis (17, :10-14). It is was seen as a [[Abrahamic covenant| covenant between God and man]], dating back to the patriarch Abraham. The validity of this passage is increasingly being questioned.

|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.”

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

Jesus was born into a Jewish family in [[Israel]], where [[Judaism ]] was the prevailing religion, so He was [[circumcised ]] on the eighth day.<ref name="luke2:21>{{REFweb

The first Christians had been born Jewish, so a question arose whether one must be [[circumcised ]] to be a Christian. When Christian leaders met at the [[Council at Jerusalem]] in the First Century to decide what was required to be a Christian, a letter was written to explain the requirements, but circumcision was omitted from the requirements.<ref>{{REFweb

In Christianity, circumcision is practiced only in a few the Coptic churchesdenomination. There is no general belief that circumcision is a requirement of Christianity.<ref name="hill2004">{{REFweb |url=httphttps://www.cirp.org/pages/cultural/christian.htmlphp

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:

|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.

|pagespage=107

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.

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]].

The circumcision of newborn boys is seen as a [[Abrahamic covenant| divine commandment]] in the [[Judaism| Jewish faith]]. Though absent in the Koran, male circumcision is considered a religious requirement in [[Islam]], and it is performed on male children of varying ages. Converts to these faiths may also choose to undergo [[Adolescent and adult circumcision| circumcision]], but it is not always required. === Medical indication ===There are no [[medical indication| medical indications]] for circumcision of the newborn. The [[circumcision industry]] offers circumcision of the newborn to the public because of the [[financial incentive]].  The form of circumcision adopted by the medical community essentially was equivalent to the Jewish form with ''[[periah]]'', so it inflicted the maximum injury.

===Medical indication===In a few cases with older patients, circumcision is legitimately indicated; a patient may be suffering recurring infections, and other methods of treatment have failed. In other cases, a patient may be suffering from a severe case of [[phimosis]]. Overall, the actual medical necessity for circumcision is extremely raresince many conditions respond to conservative treatment. All circumcisions injure the patient by amputating the [[foreskin]] its with many protective, immunological, sensory, and sexual [[Foreskin#Physiological_functions| functions]].

# '''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 [[Balanitis| balanoposthitis]].

Though the practice of ritual circumcision of males, both consenting and non-consenting, has existed for millenia, the search for "potential medical benefits" began relatively recently. {''Potential'' means to exist in possibility, but not in actuality, so a "''potential'' benefit" is not a genuine proven benefit.) The discussion of circumcision in the Ninth Edition of the ''Encyclopǽdia Britannica'' (1876) made no mention of any prophylactic, medical, or therapeutic value or function.<ref>{{REFweb |url=httphttps://www.cirp.org/library/history/encyclopaediabritannica1876/

Initially, circumcision was adopted in the 19th century as a way to stop boys and men from masturbating, where when [[masturbation ]] was seen as claimed to be the cause for many diseases. As the myth that circumcision prevented [[masturbation]] became debunked, advocates of circumcision began the great search to find the "medical benefits" of circumcision.

Male and female circumcision involves the removal and disruption of normal anatomical structures that are primary areas of sexual sensation.<ref name="taylor1996" /> In the past, some advocates of mass circumcision have considered the [[prepuce ]] to be a "mistake of nature,"<ref><nowiki>!--{{Cold and Wiswell (1995)}} | [[Template:Cold and Wiswell (1995)|see more]]</nowiki></p></ref--> but this notion has no validity because the prepuce is ubiquitous in primates and because it provides functional advantages.<ref name="cold-mcgrath1995">{{REFbook

|url=httphttps://www.cirp.org/library/anatomy/cold-mcgrath/

|url=httphttps://www.cirp.org/library/history/ephron1/

|pages=222-23333

|publisher={{UNI|Yale University |Yale}} Press

In 1870 the promiment 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 exemplified how some [https://intaction.org/circumcision-facts-and-myths/ circumcision facts and myths] 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 American Medical Association. <ref>American Medical Association. Transactions of the American Medical Association. 1870;21:205–11</ref>

}}</ref>.

In the 1940s, prostate and tongue cancer as well as STDs. [[Eugene H. Hand ]] (1949) falsely explains that circumcision somehow protects against venereal diseases and tongue cancer.<ref name="hand1949">{{REFjournal |title=Circumcision and venereal disease.

|date=Sep 1949-09

|pagespages341-6 |pubmedID=18135844 |DOI=10.1001/archderm.1949.01530030037004 |accessdate=3412021-34610-08}}</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="ravich1951">{{REFjournalRavich1951}}</ref> |url=https://www.ncbi.nlm.nih.gov/pubmed/14853120 |title=Prophylaxis of cancer of In the prostatelate 1960s it was neuroses. [[Morris Fishbein]] (1969) calls for circumcision to prevent nervousness and, penisof course, and cervix by circumcision |last=Ravich |first=Abraham |init=A |last2=Ravich |init2=RA |journal=New York State Journal of Medicine |date=Jun 1951 |volume=51 |issue=12 |pages=1519-1520 |pubmedID=14853120 |accessdate=2019-10-12[[masturbation]].<ref>{{Fishbein1969}}</ref>

In the late 1960s it was neuroses. Morris Fishbein (1969) calls for circumcision to prevent nervousness and, of course, [[masturbation]].<ref>{{REFbook |last=Fishbein |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=2019-10-12}}</ref> In the 1970s bladder- and rectal cancer. [[Abraham Ravich ]] (1971) claims that circumcision would prevent bladder cancer and rectal cancer.<ref>{{REFjournal |last=Ravich |first=Abraham |init=A |url=https://www.deepdyve.com/lp/wiley/viral-carcinogenesis-in-venereally-susceptible-organs-HCeWmTLmKl |title=Viral carcinogenesis in venereally susceptible organs |journal=Cancer |date=Jun 1971 |volume=27 |issue=6 |pages=1493-1496 |accessdate=2019-10-12 Ravich1971}}</ref>

|pages=901-9033

[[Aaron J. Fink]] (1986), with no evidence whatsoever, claims that circumcision protects against [[AIDS ]] followed.<ref name="fink1986">{{REFjournal

|pagespage=1167

}}</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) statesstate:

|trans-title= |language= |last= |first= |author-link= |publisher=[[Doctors Opposing Circumcision(D.O.C.)]]

It reflects the fascination that emerges from the ability to create new life. In most 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, and are meant to symbolize his transition from boy to man. The removal of the male [[foreskin]] 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 the [[foreskin]] up to radical operations. Australian [[Aborigines]], as mentioned above, have their [[foreskin]]s removed. It is also usual that, a few weeks later, young men have their [[penis]]es sliced openin a [[subincision]], resulting in a partly or completely divided [[urethra]].

Another known, particularly massive, intervention is the stripping of the entire [[skin ]] off the [[penis]]. In Indonesia, boys have metal or bamboo balls inserted into their [[penis]] shaft or [[Glans penis|glans]] at the beginning of puberty, which form little "humps".

For many cultures it is also common to perform similar rituals on girls. This can range from relatively small interventions such as piercing or cutting the clitoral hood, to its complete removal and up to radical removal of clitoral hood, [[clitoris]], inner and outer labia followed by sewing up the vagina.

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

|pages=2332-23344 |url=httphttps://www.cirp.org/library/complications/blalock1/

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

* 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

|pages=1052-10577 |url=httphttps://www.cirp.org/library/general/laumann/

}}</ref>, which found a higher rate of infection with bacterial venereal diseases in [[circumcised ]] than in [[intact ]] men.* The studies by Fleiss ''et al.'' (1998) support this.<ref name="fleiss-hodges-vanhowe1998">{{REFjournal |last=Fleiss |init=PM |last2=Hodges |init2=FM |last3=Van Howe |init3=RS |title=Immunological functions of the human prepuce |journal=Sex Transm Inf |date=FleissP HodgesF VanHoweRS 1998 |volume=74 |issue= |pages=364-367 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1758142/pdf/v074p00364.pdf |accessdate=2019-11-06}}</ref> According to the [[AAP]], the general sexual behaviour of the male - — such as frequent change in partners and the use of condoms - — has a much higher impact on sexually transmitted diseases then the circumcision status.<ref>{{REFjournal

|url=httphttps://www.cirp.org/library/statements/aap1999/

* [[HIV ]] / [[AIDS]]: in the recent past, the argument that circumcision could help to contain the spread of [[HIV ]] has been stated numerous times.

*: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

|pages=378-38383

|pages=749-75454

|pages=1052-10577 |url=httphttps://www.cirp.org/library/general/laumann/

* Two studies that have been published in early 2007<ref>{{REFjournal |last=RCT Gray |init=RH |etal=yes |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=RCT Bailey |first=Robert C. |init=RC |author-link=Robert C. Bailey |etal=yes |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

|pages=927-93434

|pages=1521-15288

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

|pages=552-5555 |url=httphttps://www.cirp.org/library/disease/UTI/mccracken/

|pages=1173-11755

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

|pages=549-55252

}}</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

|title=The incidence of genitourinary abnormalities in [[circumcised ]] and [[uncircumcised ]] boys presenting with an initial urinary tract infection by 6 months of age

|pagespage=580

}}</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

|pages=45-488

|pages=322-3244

* 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 |init=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

|pages=55-599

|pages=375-3777

}}</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

Apart from the [[medical indication ]] of pathological phimosis, there also are other reasons for circumcision.

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

Since this modification and its possible late effects will It should be noted that every circumcision operation leaves a life-long [[circumcision scar]] that encircles the lifelong burden shaft of the person who undertakes an aesthetically motivated circumcision to suit his personal preferences[[penis]]. In addition, there frequently a valid decision to proceed can only be made by a color change at the person to be circumcised himself, once he has reached the necessary age and level of maturity to make that decision. This should normally be the case when adulthood is reachedcircumcision scar which results in a two-tone appearance.

It should Since this modification and its possible late effects will be noted that every the lifelong burden of the person who undertakes an aesthetically motivated circumcision operation leaves to suit his personal preferences, a life-long valid decision to proceed can only be made by the person to be [[circumcision scarcircumcised]] that encircles himself, once he has reached the shaft necessary age and level of maturity to make that decision. This should normally be the peniscase when adulthood is reached.

In the United States, payment for non-therapeutic circumcision is made by most [[third-party payment| third-party payers]] without questionof 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]].

With the [[foreskin]], circumcision removes approximately 70% of the sensitive tissue of the [[penis]], lowering the potential for sexual stimulation accordingly. Due to the loss of around 50% of the entire [[penile skin]], the [[penis]] loses the reserve skin that provides cutaneous mobility in the erect [[penis]] and the [[gliding action]].

In the past, this circumstance was used to make it harder for boys to masturbate and [[masturbation]] less fun, as [[masturbation]] was viewed as immoral and was assumed to cause a variety of mental diseases, caused by the thinking of immoral thoughts! More on that can be found in the chapter "[[Circumcision#Historical_background|Historical background]]". Today, it is known 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 nowadays.

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

In western industrial nations, however, this problem does not exist, in view of the availability of clean water for daily personal hygiene. If the cleaning of the genitals is performed on a daily basis - — and that may be assumed - — no pathogens can accumulate under the [[foreskin]]. Cleaning of the [[Glans penis|glans]] and the area [[preputial sac]] underneath the [[foreskin]] is easy - — they are simply [[Preputial_sac#Washing| washed with warm water along with the rest of the body]], just like the areas between the toes.

In small boys, where the [[foreskin]] cannot be retracted yet, cleaning is not necessary, since the [[Synechia| membrane]] that fuses the [[foreskin]] to the [[Glans penis|glans]] prevents the accumulation of micro-organisms. The so-called "[[Ballooning of the foreskin| ballooning]]", where the [[foreskin]] inflates during urination, is not a serious problemconcern.

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

But even in areas where there are poorer hygienic conditions and an insufficient access to medical care, the benefits of easier cleaning of a [[circumcised ]] [[penis]] are to be viewed with a critical eye. Although even longer periods without personal hygiene will not result in an accumulation of germs under the [[foreskin]], circumcision itself is not without risk of complications. If the operation is carried out without proper sterility, there is a high risk of an [[infection ]] of the wound. This also applies to the treatment of common complications like post-operative [[bleeding. The benefit of easier cleaning must be balanced against the risk of promoting serious infections - among others HIV - during the operation. In parts of Africa, several dozen of one tribe's boys die each year as a result of their circumcision]].

 == Risks and late effects Pain == Just like tonsil or appendix surgeryIn the past, advocates of circumcision is claimed that a surgical intervention and brings the usual risks related to surgical operationsnewborn child's nerve system was not yet fully developed, alongside several specific risks of complications and late effects. === Possible operative and postoperative complications === Circumcision is surgery. Surgical complications of circumcision generally may be classified that as hemorrhagea result, infection, or surgical misadventure up to and including loss of the penis and child felt no [[pain]] during the circumcision procedure. [[Kanwaljeet J. Singh Anand| Anand]] & Hickey (1987) have shown that newborn children do in fact feel [[deathpain]], and more acutely than adults.<ref name="williamsanand-kapilla1993hickey1987">{{REFjournal |last=WilliamsAnand |initfirst=NKJS |author-link=Kanwaljeet J. Singh Anand |last2=KapillaHickey |init2first2=LPR |author2-link= |etal=no |title=Complications of circumcisionPain and its effects in the human neonate and fetus

|journal=Brit New Engl J SurgMed

|date=19931987-1011-19 |volume=80317 |issue=1021 |pages=12311321-69 |url=httphttps://www.cirp.org/library/complicationspain/williams-kapilaanand/ |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=82422853317037

|DOI=10.10021056/bjsNEJM198711193172105 |accessdate=2019-11-08}}</ref> This has led American health associations to recommend doctors take measures to reduce the [[pain]] of circumcision in infants.1800801005 The [https://www.cirp.org/library/statements/aap1999/|AAP Circumcision Policy Statement] (1999) states quite clearly that ''"There is considerable evidence that newborns who are [[circumcised]] without analgesia experience pain and physiologic stress"''. Furthermore, the pain is quite severe, and requires injections for proper pain management. Sucrose and Acetaminophen ''"cannot be recommended as the sole method of analgesia"''. Topical cream is no longer thought sufficient as ''"the analgesic effect is limited during the phases associated with extensive tissue trauma such as...tightening of the clamp"''.<ref>{{REFjournal |last= |first= |title=American Academy of Pediatrics: Circumcision Policy Statement; Task Force on Circumcision |journal=Pediatrics |date=1999-03 |volume=103 |issue=3 |pages=686-93 |url=https://pediatrics.aappublications.org/content/103/3/686#sec-9 |accessdate=2019-11-2726 |note=Statement Reaffirmed Sept. 1, 2005

* Intolerance or allergic reactions to the narcotics usedThe [[AAFP]] (2002) states quite simply in their [https://www.cirp.* Especially in newbornsorg/library/statements/aafp2002/| position paper], where the bodily ''"Newborns experience pain reduction mechanisms are 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 fully developed, local anaesthesia it is often insufficient not widely accepted, even by some doctors. It might be hard for some doctors to accept, as they may have been taught that the operationinfant 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 institutions if a circumcision is to be performed. In their [http://www.ama-assn.org/ama/no-index/about-ama/13585. Even in conjunction shtml Report 10 of the Council on Scientific Affairs], the AMA states ''"When the decision is made to proceed with regional anaesthesia of circumcision, local anesthesia should be provided for the procedure. [[Ring block]] or [[dorsal penile nerve of the block]] [injections] are most effective. [[penisEMLA]]cream has limited utility"''. Alarmingly, ''"Despite the rate clear evidence that newborn males generate brisk pain responses during circumcision, a recent survey of failure to provide sufficient anaesthetic even for experienced anaesthetists is still 5-10residency training programs found that 26%of programs that taught circumcision provided no instruction on the use of local anesthesia". The general anaesthesia AMA reports that would be needed for newborns"Of physicians performing circumcision, 45% use anesthesia, however71% of pediatricians, poses significant risks for the child56% of family practitioners, and, therefore, is only likely to be used in emergencies25% of obstetricians"''. A surgical operation without proper pain control can lead to the development of a specific pain memory<ref>{{REFweb |title=Report 10 of the Council on Scientific Affairs (I-99): Neonatal Circumcision |website=American Medical Association Official Website |url=http://www.spiegelama-assn.deorg/spiegelama/vorabno-index/experteabout-warntama/13585.shtml |accessdate=2011-rituelle05-beschneidung04}}</ref> The AAP's [http://www.healthychildren.org/English/ages-veraendertstages/prenatal/decisions-dasto-gehirnmake/pages/Where-derWe-kinderStand-a-849534Circumcision.html |title=Kinderschmerz-Experte warnt: Rituelle Beschneidung verändert das Gehirn der Kinder |trans-title=aspx Heatlhy Childrenwebsite] suggests 's pain expert warns: Ritual circumcision changes '"Your pediatrician (or your obstetrician) should discuss the brain forms of children |language=German |last=Profanalgesia that are available"''. Dr. med. Boris Zernikow<ref>{{REFweb |firsttitle=Where We Stand: Circumcision |publisher=Spiegel Online[[AAP]] |websitedate=2011-03-23 |dateurl=2012http://www.healthychildren.org/English/ages-08stages/prenatal/decisions-to-make/pages/Where-We-Stand-12Circumcision.aspx |accessdate=2019-10-11 |format= |quote=12}}</ref>Be that as it may, few forms of analgesia are recommended. In unsedated 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 partially sedated infants increased secretion effective if it would say ''"Make sure your doctor knows of the stress hormone cortisol could 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 observed for months after up to date on the operationlatest understandings of infant sensitivity to [[pain]] during circumcision. Overall"'' The AAP may be holding back, however, perhaps because this would upset the doctor/parent power relationship, their pain threshold was lower and the risk may cause too much questioning of chronic pain increaseddoctors in general. Regardless One may not expect to find this kind of these findingsadvice 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, infant circumcisions with insufficient or no anaesthetic are still common practice<ref>{{REFjournalREFweb |lastquote=GarryTo 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. |initurl=Thttp://www.pollockclinics.com/circumcision/circumcision-guide.html |title=Parents' Guide to Circumcision: a survey of fees and practices |journallast=OBG Management |datefirst=1994 |volumepublisher=October |issuedate= |pagesaccessdate=342011-36 |url= |accessdate=04-08}}</ref><ref>{{REFjournalREFweb |lastquote=HowardDuring the circumcision, your son will receive sugar pacifiers to suck on which reduce his pain perceptions. |initurl=CRhttp://www.pollockclinics.com/circumcision/circumcision-before.html |last2title=HowardBefore the Circumcision |init2last=FM |last3first=Garfunkel |init3publisher=LC |last4date=de Blieck2011-04-08 |init4accessdate=EA2011-04-08 |last5=Weitzman}}</ref> a topical cream,<ref>{{REFweb |init5quote=MThen in our office, he will have topical anesthetic applied to his penis. |titleurl=Neonatal http://www.pollockclinics.com/circumcision/circumcision and pain relief: current training practices-before.html |journaltitle=PediatricsBefore the Circumcision |datelast=1998 |volumefirst=101 |issuepublisher= |pagesdate=4232011-428 |url=04-08 |accessdate=2011-04-08}}</ref>and/or a local anaesthetic injection called a dorsal penile ring block.<ref>{{REFjournalREFweb |lastquote=StangWe use extensive pain control methods including Tylenol, a sugar solution (to reduce pain perceptions), a topical freezing cream, and a local anesthetic injection. |initurl=HJ |last2=Snellman |init2=LWhttp://www.pollockclinics.com/circumcision/circumcision-guide.html |title=Parents' Guide to Circumcision practice patterns in the United States |journallast=Pediatrics |datefirst=1998 |volumepublisher=101 |issue=e5 |pages= |urldate= |accessdate= |note=Link to [[AAP]] website2011-04-08}}</ref>. During procedures which take several minutes, babies tend Topical anaesthetic only serves to numb the area to fall into a state lessen the pain of stupor, which in the past was falsely interpreted as peaceful sleepinjection, nurturing the belief but studies have shown that babies felt no pain. Measurements taken in those cases revealed a typically 3- to 4-fold increase [[dorsal penile nerve block]] is only partially effective in cortisol levels, which equals a state stopping the [[Pain| pain of severe shockcircumcision]].<refname="Journal of Perinatology April/May 2002">{{REFjournal |last=GunnarTaeusch |first=H. William |init=MRHW |last2=FischMartinez |first2=Alma M. |init2=ROAM |last3=KorsvikPartridge |first3=J. Colin |init3=SJC |last4=DonhoweSniderman |first4=Susan |init4=JMS |last5=Armstrong-Wells |titlefirst5=Jennifer |init5=J |last6=Fuentes-Afflick |first6=Elena |init6=The effects of circumcision on serum cortisol and behaviorE |journaltitle=PsychoneuroendocrinologyPain During Mogen or Plastibell Circumcision |datejournal=1981Journal of Perinatology |volume=622

|pages=269214-2758 |url=http://www.cirpnature.orgcom/jp/journal/libraryv22/n3/full/7210653a.html |quote=...more than half of the study group had what we considered excessive pain/gunnardiscomfort over the course of the entire procedure. |pubmedID= |pubmedCID= |DOI= |note=April/May 2002 |date=2002-04 |accessdate=20192011-1104-2608}}</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.<refname="Clinical Pediatrics August 1986">{{REFbookREFjournal |last=Williamson |first=Paul S. |yearinit=2000PS |titlelast2=Paediatric HandbookEvans |urlfirst2=Nolan Donovan |workinit2=ND |editorstitle=Smart J, Nolan T.Neonatal Cortisol Response to Circumcision with Anesthesia |editionjournal=6Clinical Pediatrics |volume=25 |chapterissue=8 |pages=82412-6 |url=http://cpj.sagepub.com/content/25/8/412.abstract |locationquote=Victoria, AustraliaThe adrenal cortisol response to surgery was not significantly reduced by the administration of lidocaine. |publisherpubmedID=Blackwell Science Asia |isbnpubmedCID= |quoteDOI= |accessdatedate=1986-08 |noteaccessdate=2011-04-08}}</ref>During circumcision, somp physicians give children sugar pacifiers to "reduce the perception of pain",<ref>{{REFdocumentREFweb |titlequote=Autopsy of Demetrius MankerDuring 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 |contributiontitle=Case 93-1711Before the Circumcision |last=Wetli |first=CV |publisher=Miami: Dade County Medical Examiner Department |format= |date=19932011-0604-2308 |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.<refname="Lancet, The 2010-10-09">{{REFjournal |last=HissSlater |first=Rebeccah |init=JR |first2=Laura |init2=L |last2=HorowitzCornelissen |first3=Lorenzo |init2init3=AL |last3=KahanaFabrizi |first4=Debbie |init4=D |init3last4=TPatten |titlefirst5=Fatal haemorrhage following male ritual circumcisionJan |journalinit5=J Clin Forensic Med |datelast5=2000Yoxen |volumefirst6=7Alan |issueinit6=A |pageslast6=32-34Worley |urlfirst7=http://www.cirp.org/library/death/hiss1/Stewart |accessdateinit7=2019-11-06S}}</ref><ref>{{REFdocument |last7=Boyd |titlefirst8=Judgement of inquiry into the death of McWillis, Ryleigh Roman BryanJudith |urlinit8=http://www.circumstitions.com/death-exsang.htmlJ |contributionlast8=Meek |lastfirst9=NewellMaria |firstinit9=TECM |publisherlast9=Burnaby, B.CProf.Fitzgerald |title=Oral sucrose as an analgesic drug for procedural pain in newborn infants: B.C. Coroner's Servicea randomised controlled trial |journal=The Lancet |formatvolume=376 |dateissue=2004-01-199748 |accessdatepages=20191225-11-2632}}< |url=http://ref>* Post operative [[lymphoedema]]www.* Postoperative infectionsthelancet. This includes both local infections, which can be treated with local therapy, and systemic infections, requiring systemic antibiotic treatment.<ref>{{REFconferencecom/journals/lancet/article/PIIS0140-6736%2810%2961303-7/fulltext |lastquote=DrOur 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. medThe ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief. Hartmann |firstpubmedID=Wolfgang |urlpubmedCID= |placeDOI=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=20122010-1110-2609 |accessdate=2011-04-08}}</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 [[Wound dehiscencepain]]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, meaning the separation none of the edges above three procedures totally eliminate pain. A baby boy will still experience some pain despite any of the wound or the tissue after suturingthose analgesic procedures.* Adhesion between the surface or rim Prevention of the [[Glans penis|glanspain]] with the neighbouring penile skin, causing skin pockets and bridges, as well as visually unpleasant results like uneven scars, which make requires protecting a reboy from elective neonatal non-therapeutic circumcision necessary.* Postoperative Only boys who are protected from the medically unnecessary circumcision surgery experience no [[pain]] or [[phimosistrauma]]: .</b></big>}} == Risks and effects ==Just like tonsil or appendix surgery, circumcision is a phimotic ring can develop during scarringsurgical intervention and brings the usual risks related to surgical operations, which makes alongside several specific risks of complications and late effects. Uberoi et al. (2022) report "some men are experiencing a re-circumcision necessarycomplex negative constellation of psychological, physical, and sexual associations that lead to significant emotional distress directed both internally and externally. According to The posts also reveal a study discovery phenomenon wherein men discover the physical and psychological manifestations of the decisions made by Blalock ''et alothers to modify their genitals.''"<refname ="uberoi2022">{{REFjournal |last=BlalockUberoi |first= |init=HJM |author-link= |last2=VemulakondaAbdulcadir |first2= |init2=VJ |author2-link= |last3=RitcheyOhi |first3= |init3=MLDA |author3-link= |last4=RibbeckSantiago |first4= |init4=MJE |author4-link= |last5= |titlefirst5=Outpatient management of [[phimosis]] Following newborn circumcision |journalinit5=J Urol |dateauthor5-link=2003 |volumelast6=169 |issuefirst6=6 |pagesinit6=2332 |author6-2334link= |last7= |urlfirst7=http://www.cirp.org/library/complications/blalock1/ |accessdateinit7=2019 |author7-11link= |last8= |first8= |init8= |author8-26link= |last9= |first9=}}</ref>, the prevalence is 2.9%, according to Leitch<ref>{{REFjournal |init9= |lastauthor9-link=Leitch |initetal=IOWyes |title=Circumcision Potentially under-recognized late-stage physical and psychosexual complications of non- therapeutic neonatal penile circumcision: a continuing enigmaqualitative and quantitative analysis of self-reports from an online community forum |trans-title= |language= |journal=Aust Paediatr Int JImpot Res |location= |date=19702022-10-23 |volume=6

|pagesarticle=59-65 |urlpage=http://www.cirp.org/library/general/leitch1/ |accessdatepages=2019-12-15}}</ref> 5.5%.** 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=httphttps://www.nytimesnature.com/2012/03articles/08/nyregion/infantss41443-death022-renews00619-debate-over-a-circumcision-ritual.html?_r8 |archived=0 |titlequote=Baby’s Death Renews Debate Over a Circumcision Ritual |lastpubmedID=Robbins36274189 |firstpubmedCID=Liz |dateDOI=201210.1038/s41443-022-0300619-078 |accessdate=20192023-1001-1108

=== Physical late 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).

* An unavoidable late effect of any circumcision is the permanent loss of sexual sensitivity. This is partly due to the removal of sensory tissue. The [[foreskin]] contains very many nerve endings and touch receptors, which account for the major part of male sexual sensation. If the [[foreskin]] is removed, they can no longer provide sexual stimulation. It is also partly due to the fact that the surface of the [[Glans penis|glans]] reacts to the missing protection from friction and drying out by developing a callus layer. This reduces the sensitivity of the remaining nerves in the [[Glans penis|glans]] gradually over the years. The study conducted by Sorrells ''et al.''<ref>{{Sorrells etal 2007}}</ref> found a significant reduction of sensitivity to touch for circumcised compared to intact [[penis]]es in adult males. Other studies revealed that circumcised men use condoms significantly less often than intact men, since they further limit the sexual sensitivity (see above). * Painful tension can occur when there is too little reserve [[skin ]] left to support a full erection<ref>{{REFjournal |last=Taylor |init=JR |last2=Lockwood |init2=AP |last3=Taylor |init3=AJ |title=The prepuce: <q>Specialized mucosa of the [[peniserection]] and its loss to circumcision</q> |journalref name=British Journal of Urology |date=1996 |volume=77 |issue= |pages=291-295 |url= |accessdate=}}<"taylor1996"/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.

|pages=289-29292

* 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- [[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>{{REFjournal |last=Frisch |first=Morten |init=M |author-link=Morten Frisch |first2=Morten |last2=Lindholm |init2=M |first3=Morten |last3=Grønbæk |init3=M |title=Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark |journal=International Journal of Epidemiology |date=FrischM LindholmM GroenbaekM 2011-10 |volume=40 |issue=5 |pages=1367-1381 |url= |pubmedID=21672947 |DOI=10.1093/ije/dyr104 |accessdate=}}</ref><ref>{{REFjournal |last=Cortés-González |init=J |last2=Arratia-Maqueo

|pagespage=227

}}</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.<refname="ColdCJ TaylorJR 1999">{{REFjournal |last=Cold |init=CJ |last2=Taylor |init2=JR |title=The prepuce |journal=BJU Int |date=ColdCJ TaylorJR 1999 |volume=83 |issue=Suppl. 1 |pages=34-44 |url= |accessdate=}}</ref><ref>{{REFjournal

|pages=2113-21166

* [[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

|pagespage=89

}} </ref><ref>{{REFweb

=== Psychological late effects === [[Psychological_issues_of_male_circumcision#Circumcision_trauma_in_adults| Psychological late effects]] are also possible after a circumcision, especially if the operation * Shorter adult penile length was carried out in childhoodreported by Park et al. On this occasion (2016) as a variety result of trauma may occurNMC (newborn male circumcision).{{Citation |Title= |Text=In conclusion, which dependsecond to fourth digit ratio, among othersflaccid penile length, on and age and circumstances of the circumcisionwere significant predictive factors for erectile penile length. For exampleFurthermore, whether the circumcision took place with or without sufficient anaesthesia, if penile lengths of the individual has been informed about NMC group were shorter than those of 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 ownnon-NMC group. 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 |Author=Park et al. |Source=* It was observed that infants, following circumcision without pain control, had a disturbed bond with their mother |ref=<ref>{{REFjournal |last=MarshallPark |first= |init=REJK |author-link= |last2=PorterDoo |first2= |init2=FLAR |author2-link= |last3=RogersKim |first3= |init3=AGJH |author3-link= |last4=Park |first4= |init4=HS |author4-link=

|title=Circumcision: II effects upon motherProspective investigation of penile length with newborn male circumcision and second to fourth digit ratio. |trans-infant interactiontitle= |language= |journal=Early Hum DevCan Urol Assoc J |location= |date=19822016-09 |season= |volume=710 |issue=49-10 |article= |page= |pages=367-374 |url=httphttps://www.cirpncbi.nlm.nih.orggov/librarypmc/birtharticles/marshall2PMC5028213/ |archived= |quote= |pubmedID=27695583 |pubmedCID=5028213 |DOI=10.5489/cuaj.3590 |accessdate=20202022-0209-0104}}</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 === Sexual effects ===Cepeda-Emiliani et al (2023) cited six reports in childhoodthe literature of detrimental effects of circumcision, including erectile function, post traumatic stress disorder (PTSD) could be diagnosedsensation, masturbatory pleasure, orgasm, and sexual satisfaction. In a study on Philippine boysThe authors also cited three studies of severe distress in [[circumcised]] men, in whom no PTSD was found prior due to the operationtheir infant circumcision, 69% with complaints of the boys circumcised in the traditional ritual [[glans]] insensitivity, delayed [[ejaculation]], and 51% of those circumcised by standard medical procedures (including anaesthesia) fulfilled the DSM-IV criteria for PTSD following the operationunpleasant sensation.<refname="cepeda2023">{{REFbookREFjournal |last=RamosCepe da-Emiliani |first=S |init=A |author-link=Alfonso Cepeda-Emiliani |last2=BoyleGándara-Cortés |first2=GJ |yearinit2=2001M |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=no |title=Understanding circumcisionImmunohistological study of the density and distribution of human penile neural tissue: A Multigradient hypothesis |trans-title= |language= |journal= Int J Impot Res |location= |date=2023-05-Disciplinary Approach to a Multi02 |volume=35 |issue=3 |article= |page= |pages=286-Dimensional Problem305 |url=https://linkwww.springernature.com/chapterarticles/s41443-022-00561-9 |archived= |quote= |pubmedID=35501394 |pubmedCID= |DOI=10.10071038/978-1s41443-4757022-335100561-8_149 |workaccessdate=2023-11-26}}</ref> Circumcision and frenectomy remove tissues with heightened erogenous sensitivity.<ref name="cepeda2023" /> <ref name="winkleman1959">{{WinkelmannRK 1959}}</ref> |editors=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 [[George C. Dennistonpenis]], leaving only the uninhibited protopathic sensibility of the artificially externalized [[Frederick M. Hodgesglans 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 [[Marilyn Fayre Miloscircumcised]]human males.<ref>{{REFjournal |editionlast=Van Howe |volumeinit=RS |author-link=Robert S. Van Howe |last2=Cold |init2=CJ |chaptertitle=Ritual Advantages and medical circumcision among Filipino boys: evidence Disadvantages of Neonatal Circumcision |journal=The Journal of post-traumatic stress disorderthe American Medical Association |pagesvolume=253-270277 |locationissue=New York13 |publisherpages=Kluwer Academic/Plenum Publishers1052-7 |isbnurl=http://www.ncbi.nlm.nih.gov/pubmed/9218663

* CircumcisionsHistology of the male circumcision scar shows [[amputation]] neuromas, especially those that happen without consent, can spark feelings Schwann cell proliferation and the bulbous collection of helplessness variably sized neurites. [[Amputation]] neuromas do not mediate normal sensation and alienation, which can persist as traumaare notorious for generating pain.<ref name="ColdCJ TaylorJR 1999"/> Cepeda-Emiliani et al. These feeling can also be triggered later, when someone circumcised (2023) commented:<blockquote> Taking the sleve technique as an infant becomes aware example of his surgical flexibility during circumcision. In an online study, interviewed men stated they felt betrayed - 55% by to the extent that this technique is of such versatility that it allows highly variable quantities of cutaneous and subcutaneous tissue to be excised directly from the motherpenile body, 50% and to the extent that the prepuce is still conceived by segments of the fathermedical community as "just a small piece of skin", we are concerned that aggressive circumcisions are intentionally or unintentionally being performed in pediatric and 58% by adult patients in the doctorbelief that "redundant" or " extra" tissue is being excised, and 73% felt or in the belief that their human rights had been violated"excesive sensitivity" is being reduced to augment ejaculatory latency time.<ref name="GSoCHcepeda2023"/>{{REFweb |url=http://www.circumcisionharm.org</blockquote> |title=Global Survey of Circumcision Harm |accessdate=2019The un-10anesthetized and un-12}}</ref>* It can frequently be found that sedated newborn infant is restrained by being strapped to a special plastic board called the loss [[circumstraint]]. The procedure is deniedmost often an elective, much as happens with non-therapeutic surgery without [[medical indication]] performed on neonates and children for religious and cultural reasons in violation of the loss of other body parts. This denial can lead child's [[human rights]] to fathers having their sons circumcised [[physical integrity]], but in order not to older patients may be reminded of their own lossrarely indicated for therapeutic reasons. In this process It is a radical treatment option for pathological [[phimosis]], their own body refractory [[balanoposthitis]] and chronic [[urinary tract infection]]s (UTIs); it is defined as "normal" and the contraindicated in cases of certain genital structure abnormalities or poor general health.  See [[foreskinSexual effects of circumcision]] redefined as a foreign objectfor more information. Their own parents  === Psychological effects ===[[Psychological_issues_of_male_circumcision#Circumcision_trauma_in_adults| Psychological late effects]] are seen as "good"also possible after a circumcision, so that this image is projected onto especially if the circumcision their parents operation was carried out as well, in order to keep the positive emotion intactchildhood. The father wants to be On this occasion a "good" father later in life as wellvariety of [[trauma]] may occur, which depend, among others, on age and so, following an idealised image circumstances of his own parentsthe circumcision. For example, whether the circumcisiontook place with or without sufficient anaesthesia, which if the individual has been redefined as a "good thing"informed about the operation beforehand, 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, is passed and many studies took place on rather a small scale. This situation needs to his son by having him circumcised be rectified, because the available studies, as wellas the histories of negatively affected men, suggest that these late effects may have more impact than previously assumed. * It was observed that infants, following circumcision without [[pain]] control, had a disturbed bond with their mother<ref>{{REFjournal |last=van der KolkMarshall |init=BARE |urllast2=http://www.cirp.org/library/psych/vanderkolk/Porter |titleinit2=The compulsion to repeat the trauma: re-enactment, revictimization, and masochismFL |journallast3=Psychiatr Clin North AmRogers |dateinit3=1989AG |volumeetal=12yes |issuetitle=2Circumcision: II effects upon mother-infant interaction |pagesjournal=389-411Early Hum Dev |accessdatedate=2019-10-12}}</ref><ref>{{REFjournal1982 |lastvolume=Goldman7 |initissue=R4 |authorpages=367-link=Ronald Goldman74 |url=httphttps://www.cirp.org/library/psychbirth/goldman1marshall2/ |title=The psychological impact of circumcision |journal=BJU Int |date=1999 |volume=83 |issue=Suppl. 1 |pages=93-103 |accessdate=20192020-1002-1201}}</ref>, as well as problems with nurturing, up to the point of refusal to be fed. The sleeping habits of these babies were also disturbed, with prolonged non-REM sleep and increased waking. * If the In boys [[circumcised male feels incomplete]] in childhood, [[post-traumatic stress disorder]] ([[PTSD]]) could be diagnosed. In a study on Philippine boys, or due in whom no [[PTSD]] was found prior to the missing operation, 69% of the boys [[foreskincircumcised]] disadvantaged compared to intact males, an inferiority complex in the traditional ritual and depression may occur. This can be accompanied 51% of those [[circumcised]] by conscious recognition of his own incompleteness, or standard medical procedures (including anaesthesia) fulfilled the DSM-IV criteria for PTSD following the deficiency may remain completely subconsciousoperation.<ref>{{REFjournalREFbook |last=RhinehartRamos |init=JS |last2=Boyle |init2=GJ |year=2001 |title=Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem |url=httphttps://wwwlink.cirpspringer.orgcom/librarychapter/psych/rhinehart110.1007/978-1-4757-3351-8_14 |titlework=Neonatal circumcision reconsidered |journaleditors=Transactional Analysis J[[George C. Denniston]], [[Frederick M. Hodges]], [[Marilyn Fayre Milos]] |dateedition=1999 |volume=29 |issuechapter=3Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder |pages=215253-22170 |location=New York |publisher=Kluwer Academic/Plenum Publishers |isbn= |quote= |accessdate=2019-10-12 |note=}}</ref>* Circumcisions, especially those that happen without consent, can spark feelings of helplessness and alienation, which can persist as [[trauma]]. These feeling can also be triggered later, when someone [[circumcised]] as an infant becomes aware of his circumcision. In an online study, 75% of those interviewed men stated that they felt incompletebetrayed - 55% by the mother, 50% by the father, and 6658% by the doctor, and 73% said they felt inferior compared with intact malesthat their [[human rights]] had been violated.<ref name="GSoCH"/>* Cases in which children felt ill treated or punished have been documented as well. G. Cansever found in her study on 12 boys aged between 4 and 7 years, who had previously been prepared for their impending circumcision, that the children experienced the operation as an aggressive assault on their bodies.<ref>{{REFjournal |last=Cansever |init=G |date=1965REFweb |url=http://www.cirpcircumcisionharm.org/library/psych/cansever/ |title=Psychological effects Global Survey of circumcision |journal=Brit. J. Med. Psychol |volume=38 |pages=321-331Circumcision Harm

* Fear It can frequently be found that the loss is denied, much as happens with the loss of being alone or darknessother body parts.This denial can lead to fathers having their sons [[circumcised]] in order not to be reminded of their own loss. In this process, their own body is defined as "normal" and the [[foreskin]] redefined as a foreign object. Their own parents are seen as "good", so that this image is projected onto the circumcision their parents carried out as well, in order to keep the positive emotion intact. The father wants to be a "good" father later in life as well, and so, following an idealised image of his own parents, circumcision, which has been redefined as a "good thing", is passed on to his son by having him [[circumcised]] as well.<ref>{{VanderKolkBA 1989}}</ref><ref name="Levy1945">{{REFjournal |last=LevyGoldman |firstinit=David M.R |initauthor-link=DMRonald Goldman |url=httphttps://www.cirp.org/library/psych/levy1goldman1/ |title=Psychic trauma The psychological impact of operations in children; and a note on combat neurosiscircumcision |journal=American Journal of Diseases of ChildrenBJU Int |date=1999 |volume=6983 |dateissue=1945Suppl. 1 |pages=793-25103

* 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]]. == Rights and ethics == The [[Rights situation on circumcision|rights situation]] is discussed in separate article.  -----

 [[Intact America]] (2019) called circumcision an [[Adverse Childhood Experiences (ACEs)| adverse childhood experience]],<ref name-"bollinger2019">{{FromIntactWikiREFdocument |URLtitle=Child genital cutting as an adverse childhood experience |url=http://intactwikiadversechildhoodexperiences.orgnet/wiki/CircumcisionCGC_as_an_ACE.pdf |last=Bollinger |Titlefirst=CircumcisionDan}} |author-link=Dan Bollinger |last2=Chapin[[Image:Intact vs circumcised.JPG |thumbnailfirst2=Georganne |rightauthor2-link=Georganne Chapin |300pxpublisher=Intact America | The intact and circumcised human penis, side by side.]]location=Tarrytown |format=PDFThe 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 cultural]] reasons. The procedure may be performed on consenting adults, but it is most often performed on nondate=2019-consenting minors, particularly newborn children, which is why the ritual is so controversial. Opponents of circumcision consider the circumcision of non08 |accessdate=2021-consenting minors to be unethical and a human rights violation, unless there is concrete medical indication. Proponents of circumcision consider the circumcision of non11-consenting minors to be a "religious freedom" and a "parental right."02}}</ref>

=== Pain Possible operative and postoperative complications ===In the past, advocates Circumcision is surgery. Surgical complications of circumcision claimed that a newborn child's nerve system was not yet fully developed, and that generally may be classified as a result[[Bleeding| hemorrhage]], the child felt no pain during the circumcision procedure. Anand & Hickey (1987) have shown that newborn children do in fact feel [[paininfection]], or surgical misadventure up to and including loss of the penis and more acutely than adults[[death]].<ref name="ananddeacon2022" /><ref name="williams-hickey1987kapilla1993">{{REFjournal |last=AnandWilliams |firstinit=N

|last2=HickeyKapilla |first2init2=L

|title=Pain and its effects in the human neonate and fetusComplications of circumcision

|journal=New Engl Brit J MedSurg

|date=19871993-11-1910 |volume=31780 |issue=2110 |pages=13211231-96 |url=httphttps://www.cirp.org/library/paincomplications/anandwilliams-kapila/

|pubmedID=33170378242285

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

The * 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 [[Position Statements on Infant Circumcision|AAP Circumcision Policy Statementpenis]] states quite clearly that ''"There , the rate of failure to provide sufficient anaesthetic even for experienced anaesthetists is considerable evidence still 5-10%. The general anaesthesia that would be needed for newborns who are circumcised without analgesia experience pain and physiologic stress"''. Furthermore, however, poses significant risks for the pain is quite severechild, and requires injections for , therefore, is only likely to be used in emergencies. A surgical operation without proper [[pain management. Sucrose and Acetaminophen ''"cannot be recommended as ]] control can lead to the sole method development 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"''.a specific pain memory<ref>{{REFjournalREFweb |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

|titlepublisher=American Academy of Pediatrics: Circumcision Policy Statement; Task Force on CircumcisionSpiegel Online |journalwebsite=Pediatrics |date=19992012-0308-12 |volumeaccessdate=1032019-10-11 |issueformat=3 |pagesquote=686-693 |url=https:}}<//pediatricsref>.aappublicationsIn unsedated and partially sedated infants increased secretion of the stress hormone cortisol could be observed for months after the operation.org/content/103/3/686#sec-9Overall, 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 |accessdatelast=2019-11-26Garry |noteinit=Statement Reaffirmed Sept. 1, 2005T}}</ref> |title=Circumcision: a survey of fees and practices |journal=OBG Management |date=1994The [[AAFP]] states quite simply in their [[Position Statements on Infant Circumcision |position paper]], ''"Newborns experience pain during circumcision".''<ref>{{REFwebvolume=October |titleissue=Circumcision: Position Paper on Neonatal Circumcision. Board Approved: August 2007 Reaffirmed |websitepages=Official American Academy of Family Physicians Website34-6 |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.<ref>{{REFjournal |last=Howard |init=CR |last2=Howard |init2=FM |last3=Garfunkel |init3=LC |last4=de BlieckPenile injections of anesthetic are now recommended by all of the major medical institutions. In their [http://www.ama-assn.org/ama/no-index/about-ama/13585.shtml Report 10 of the Council on Scientific Affairs], the AMA states ''"When the decision is made to proceed with circumcision, local anesthesia should be provided for the procedure. Ring block or dorsal penile blocks [injections] are most effective. EMLA cream has limited utility"''. Alarmingly, ''"Despite the clear evidence that newborn males generate brisk pain responses during circumcision, a recent survey of residency training programs found that 26% of programs that taught circumcision provided no instruction on the use of local anesthesia". The AMA reports that "Of physicians performing circumcision, 45% use anesthesia, 71% of pediatricians, 56% of family practitioners, and 25% of obstetricians"''. |init4=EA |last5=Weitzman |init5=M |title=Neonatal circumcision and pain relief: current training practices |journal=Pediatrics |date=1998 |volume=101 |issue= |pages=423-8 |url= |accessdate=}}</ref><ref>{{REFwebREFjournal |titlelast=Stang |init=Report 10 of the Council on Scientific Affairs (I-99): Neonatal CircumcisionHJ |websitelast2=American Medical Association Official WebsiteSnellman |urlinit2=http://www.ama-assn.org/ama/no-index/about-ama/13585.shtmlLW |title=Circumcision practice patterns in the United States |accessdatejournal=2011-05-04Pediatrics}}</ref> |date=1998 |volume=101The AAP's [http: |issue=e5 |pages= |url= |accessdate= |note=Link to [[AAP]] website}}<//wwwref>.healthychildren.org/English/ages-stages/prenatal/decisions-During procedures which take several minutes, babies tend to-make/pages/Where-We-Stand-Circumcision.aspx Heatlhy Children website] suggests ''"Your pediatrician (or your obstetrician) should discuss fall into a state of stupor, which in the past was falsely interpreted as peaceful sleep, nurturing the forms of analgesia belief that are available"''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>{{REFwebREFjournal |titlelast=Where We Stand: CircumcisionGunnar |publisherinit=[[AAP]]MR |datelast2=2011-03-23Fisch |init2=RO |last3=Korsvik |urlinit3=http://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/pages/Where-We-Stand-Circumcision.aspxS |last4=Donhowe |accessdateinit4=2019-10-12JM}}</ref> Be that as it may, few forms |title=The effects of analgesia are recommended. There are basically two types of injections to choose from, circumcision on serum cortisol and the website does not go into the difference between a 'dorsal nerve block' and a 'ring block' injection.behavior |journal=Psychoneuroendocrinology |date=1981 |volume=6Given 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 |issue=3 |pages=269-75 |url=https://www. 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 circumcisioncirp."'' The AAP may be holding back, however, perhaps because this would upset the doctororg/library/pain/gunnar/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. |accessdate=2019-11-26To control pain, some physicians that circumcise use Tylenol, sugar,}}</ref>{{REFweb | quote=To calm * Postoperative wound pain, in the baby during the procedure, a sugar filled gauze pacifier soaked with sweet juice is used, and soothing music is played in case of children's circumcisions conceivably worsened by the forceful breaking of the roompreputial adhesions. | url=http://www* Postoperative pain from the exposure of the sensitive glans penis to clothing.pollockclinicsThis pain will endure for several weeks or even longer in some cases.com/circumcision/circumcision-guide.html | title=Parents' Guide * 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 Circumcisionhypovolaemia, hypovolaemic [[shock]] and even death.<ref>{{REFbook | last= | first= | publisheryear=2000 | worktitle=Paediatric Handbook | dateurl= | accessdatework=2011-04-08}}</ref><ref>{{REFweb | quote |editors=During the circumcisionSmart J, your son will receive sugar pacifiers to suck on which reduce his pain perceptionsNolan T. | urledition=http://www.pollockclinics.com/circumcision/circumcision-before.html 6 | titlevolume=Before the Circumcision | lastchapter= | firstpage=82 | publisherlocation={{AUSC|VIC}}, Australia |publisher=Blackwell Science Asia | workisbn= | datequote=2011-04-08 | accessdate=2011-04-08 |note=}}</ref> a topical cream,<ref>{{REFwebREFdocument | quotetitle=Then in our office, he will have topical anesthetic applied to his penis.Autopsy of Demetrius Manker | url=http://www.pollockclinics.com/circumcision/circumcision-before.html | titlecontribution=Before the CircumcisionCase 93-1711 | last=Wetli | first=CV | publisher=Miami: Dade County Medical Examiner Department | workformat= | date=20111993-0406-0823 | accessdate=2011-04-08}}</ref> and/or a local anaesthetic injection called a dorsal penile ring block.<ref>{{REFwebREFjournal | quotelast=We use extensive pain control methods including Tylenol, a sugar solution (to reduce pain perceptions), a topical freezing cream, and a local anesthetic injection.Hiss |init=J |last2=Horowitz | urlinit2=http://www.pollockclinics.com/circumcision/circumcision-guide.htmlA | titlelast3=Parents' Guide to CircumcisionKahana | lastinit3=T | firsttitle=Fatal haemorrhage following male ritual circumcision | publisherjournal=J Clin Forensic Med | workdate=2000 | datevolume=7 |issue= | accessdatepages=2011-0432-084}}< |url=https://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 block is not always effective in stopping the pain of circumcisionwww.cirp.<ref name='Journal of Perinatology Aprilorg/library/death/hiss1/May 2002'>{{REFjournal |lastaccessdate=Taeusch2019-11-06}}</ref><ref>{{REFdocument |firsttitle=H. WilliamJudgement of inquiry into the death of McWillis, Ryleigh Roman Bryan |initurl=HWhttp://www.circumstitions.com/death-exsang.html |last2contribution=Martinez |first2last=Alma M.Newell |init2first=AMTEC |last3publisher=Partridge |first3=JBurnaby, B.C.: B.C. ColinCoroner's Service |init3format=JC |last4date=Sniderman2004-01-19 |first4accessdate=Susan2019-11-26 |init4=S}}</ref> |last5=Armstrong-Wells* Post operative [[lymphoedema]]. * Postoperative [[Infection|first5=Jenniferinfections]]. This includes both local infections, which can be treated with local therapy, and systemic infections, requiring systemic antibiotic treatment.<ref>{{REFconference |init5last=JDr. med. Hartmann |last6first=Fuentes-AfflickWolfgang |first6url=Elena |init6place=ERechtsausschuss des Bundestages [Legal Committee of the Bundestag] (German) |title=Pain During Mogen or Plastibell CircumcisionStellungnahme zur Anhörung am 26. November 2012 [Opinion on the hearing on 26 November 2012] (German) |journaldate=Journal of Perinatology |volume=22 |issue=3 |pages=2142012-11-218 |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. |pubmedID= |pubmedCID= |DOI= |note=April/May 2002 |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=412-416 |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. |pubmedID= |pubmedCID= |DOI= |date=1986-08 |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 |journal=The Lancet |volume=376 |issue=9748 |pages=1225-1232 |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. |pubmedID= |pubmedCID= |DOI= |date=2010-10-09 |accessdate=2011-04-08}}</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>{{REFjournal |last=Taddio |first=Anna |init=A |first2=Morton |init2=M |last2=Goldbach |first3=Moshe |init3=M |last3=Ipp |first4=Bonnie |init4=B |last4=Stevens |first5=Gideon |init5=G |last5=Koren |title=Effect of neonatal circumcision on pain responses during vaccination in boys |journal=The Lancet |volume=345 |issue=8945 |pages=291-2 |url=http://www.cirp.org/library/pain/taddio/ |quote= |pubmedID=7837863 |pubmedCID= |DOI= |date=1995 |accessdate=}}</ref><ref>{{REFjournal |last=Taddio |first=Anna |init=A |last2=Katz |init2=J |last3=Ilersich |init3=AL |last4=Koren |init4=G |title=Effects of neonatal circumcision on pain response during subsequent routine vaccination |journal=The Lancet |volume=349 |issue=9052 |pages=599-603 |url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)10316-0/fulltext |quote= |pubmedID=9057731 |pubmedCID= |DOI=10.1016/S0140-6736(96)10316-0 |date=1997-0326

* [[Wound dehiscence]], meaning the separation of the edges of the wound or the tissue after suturing.=== Sexual effects === Circumcision * Adhesion between the surface or rim of the [[Glans penis|glans]] with the neighbouring [[penile skin]], causing [[skin]] pockets and frenectomy remove tissues with heightened erogenous sensitivitybridges, as well as visually unpleasant results like uneven scars, which make a re-circumcision necessary. Boyle ''et al.'' (2002) wrote* Postoperative [[phimosis]]: a phimotic ring can develop during scarring, "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings&mdash;many of which are lost makes a re-circumcision necessary. According to circumcisiona study by Blalock et al."<ref>{{REFjournal |last=Boyle |first=Gregory J.Blalock |init=GJHJ |author-link=Gregory Boyle |first2last2=Gillian A.Vemulakonda |init2=GAV |last2last3=BensleyRitchey |titleinit3=Adverse Sexual and Psychological Effects of Male Infant CircumcisionML |journallast4=Psychological reportsRibbeck |volumeinit4=88M |issuetitle=3, Part 2Outpatient management of [[phimosis]] Following newborn circumcision |pagesjournal=1105–1106 |url=http://www.cirp.org/library/psych/boyle5/ |quote= |pubmedID=11597060 |pubmedCID= |DOI=10.1046/j.1464-410x.1999.0830s1085.xJ Urol |date=July 2001 |accessdate=}}</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 |init=RS |author-link=Robert Van Howe |last2=Cold |init2=CJ |title=Advantages and Disadvantages of Neonatal Circumcision |journal=The Journal of the American Medical Association2003 |volume=277169 |issue=136 |pages=10522332-74 |url=httphttps://www.ncbicirp.nlm.nih.govorg/library/complications/pubmedblalock1/9218663 |quoteaccessdate= |pubmedID=9218663 |pubmedCID= |DOI= |date=19972019-0411-02 |accessdate=26}}</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 painprevalence is 2.9%, according to Leitch<ref>{{REFjournal |last=ColdLeitch |init=CJIOW |init2title=JRCircumcision - a continuing enigma |last2journal=TaylorAust Paediatr J |title=The prepuce |journaldate=British Journal of Urology International1970 |volume=836

|pages=3459-4465 |url=httphttps://www.cirp.org/library/anatomygeneral/leitch1/cold |accessdate=2019-12-taylor15}}</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 |quoteurl=http://www.nytimes.com/2012/03/08/nyregion/infants-death-renews-debate-over-a-circumcision-ritual.html?_r=0 |pubmedIDtitle=10349413Baby’s Death Renews Debate Over a Circumcision Ritual |pubmedCIDlast=Robbins |DOIfirst=Liz |date=19992012-03-107 |accessdate=2019-10-11

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

| 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=

 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

|pages=72-733

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 non-therapeutic circumcision of newborn babies; and circumcision is widely accepted as a postnatal procedure in American hospitals.<ref>{{REFbook

|pages=259-27171

}}</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 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

|pages=307-31414 |url=httphttps://www.cirp.org/library/legal/Re_J/2000.html

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"/>refer<ref>{{REFweb |quote==Video== |url=http://www.icgi.org/2010/04/infant-circumcision-causes-100-deaths-each-year-in-us |title=Infant =Is circumcision causes 100 deaths each year in US |lasthealthy?=Bollinger |first=Dan |author-link=Dan Bollinger |publisher=International Coalition The video ''Is Circumcision Healthy'' is recommended for Genital Integrityparental viewing.<br><br> |date<youtube>D_3LQjZgdbQ</youtube> ===Dr. Christopher Guest discusses circumcision===2010-04-26 |accessdate<br><youtube>v=2019-10-12}}TQIp9f4krVQ</refyoutube>

===Plastibel circumcision=== {{SEEALSOUNI|Stanford University|SU}}* [[Adolescent and adult circumcision]]* [[Pain]]* [[Sexual effects of circumcision]]* [[FGM]]* [[MGM]]* [[Risks and complications]]* [[Documented severe complications of circumcision]]* [[Circumcision scar]]* [[Circumpendium]]* [[Human rights]]* [[Ethics has published a video of an actual non-therapeutic child plastibell circumcision]]* [[Rights situation . 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 circumcision]]the soundtrack.* [[Circumcision methods]]* [[Case Histories]]* [[Lymphoedema]]* [[Psychological issues of male https://med.stanford.edu/newborns/professional-education/circumcision]/plastibell-technique.html Plastibell Technique]

* {{REFweb |url=http'''Not for the squeamish://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 MThis is a video of an actual circumcision with a Gomco clamp. Fleiss |title=The foreskin is necessaryinfant boy received two dorsal penile nerve block (DPNB) analgesic injections but they did not seem to work. |journal=Mothering |date=1997-01 |volume= |issue= |pages=36-45 |url=http* [https://www.noharmmreddit.orgcom/r/mothering.htm |accessdate=2020-06-29}}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: <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, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand. However it is reasonable for parents to weigh the benefits and risks of circumcision and to make the decision whether or not to circumcise their sons.<ref name="racp2010">{{REFdocument |title=Circumcision of Infant Males |url=https://www.racp.edu.au//docs/default-source/advocacy-library/circumcision-of-infant-males.pdf |contribution= |last= |first= |publisher=The Royal Australasian College of Physicians |format=PDF |date=2010-09-01 |accessdate=2021-11-08}}</ref></blockquote> * The [[American Academy of Pediatrics]] (AAP) has not re-affirmed its disastrous, failed 2012 Circumcision Policy Statement, which expired in 2017, so currently has no position on child circumcision. * Medical historian [[Robert Darby]] (2014) wrote simply:<blockquote>"To avoid circumcision complications, avoid circumcision."<ref>{{REFjournal |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=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578472/ |quote= |pubmedID=26435672 |pubmedCID=4578472 |DOI=10.1093/pch/20.6.311 |accessdate=2019-10-27}}</ref></blockquote> * The [[Canadian Urological Association]] (CUA) considered the matter of circumcision and 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-link= |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=2018-02 |volume=12 |issue=2 |pages=18-28 |url=https://cuaj.ca/index.php/journal/article/view/5034/3470 |quote= |pubmedID= |pubmedCID= |DOI= |accessdate=2021-11-09}}</ref></blockquote>==British family court opinion==The issue of non-therapeutic circumcision of male children came before the court in the 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-consenting 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= Informed consent, parental permission, and assent in pediatric 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=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=e20161485 |pages= |url=https://watermark.silverchair.com/peds_20161485.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAApwwggKYBgkqhkiG9w0BBwagggKJMIIChQIBADCCAn4GCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQM8zYHFd0Ylu9Annq_AgEQgIICT24ikc839aJMYOiypqC2G9f7_yKGAGkAekzzbCtck5TElALWVCGNoVSOaA6rDA_dOkQ_LyJnxYlZ88J9-uk15tvlIBbE82_aNyYfq5e9xmEfqD2vh374q3Naz57dxZaUbgxUkKX4PqsiLmYHLvVrr7bQK2MZuuUOKiQU8JZy7lLjkp-PjJO1U9cyIplTAgs_EdvgK8MWWoIsj-X-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=2023-05-21}}</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=2023-05-21}}</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]]* [[Pain]]* [[Psychological issues of male circumcision]]* [[Rights situation on circumcision]]* [[Risks and complications]]* [[Sexual effects of circumcision]]* [[Sudden Infant Death Syndrome]] (SIDS)* [[Trauma]]{{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

|archivedtitle=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=English |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=SimoneGarrett |first=Judy |authorinit=CJ |publisher=Intact America |date=2023-11-10 |accessdate=2024-03-22}}* {{REFweb |url=https://intactamerica.org/groups-who-pressure-you-to-linkcircumcise/ |title=The 4 Authority Figures and Groups Who Will Pressure You to Circumcise (and What You Can Do) |last=Anonymous |first= |init= |publisher=IntactionIntact America |date=2024-01-24 |accessdate=2024-01-27}}* {{REFweb |websiteurl=https://intactionintactamerica.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=20202024-0701-2624 |accessdate=20202024-01-29}}* {{REFweb |url=https://intactamerica.org/timeline-of-10circumcision-04suffering/ |title=A Timeline of Circumcision Suffering: A Detailed Look |last=Anonymous |first= |init= |publisher=Intact America |formatdate=2024-02-02 |quoteaccessdate=2024-02-09}}{{REF}}

[[Category:TermsPenile surgery]][[Category:Medical term]][[Category:Male genital mutilation]]