Changes

* [[Phimosis]]: as mentioned earlier, true [[phimosis]] is rare and can be treated effectively without surgery. According to a study by Blalock et.al. (2003)<ref>Blalock HJ, Vemulakonda V, Ritchey ML, Ribbeck M. Outpatient management of [[phimosis]] Following newborn circumcision. ''J Urol '' 2003;169(6):2332-4.</ref>, 2.9% of those circumcised develop a post-operative [[phimosis]], in which the circumcision scar constricts. In intact patients, the rate of [[phimosis]] is only 1% (see also the study by Jakob Øster above). Therefore, circumcision is not a preventive measure for [[phimosis]].

* 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>Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. ''JAMA '' 1997;277:1052-7.</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<ref>Fleiss PM, Hodges FM, Van Howe RS. Immunological functions of the human prepuce. ''Sex Transm Inf '' 1998;74:364-7.</ref> support this. According to the [[AAP]], the general sexual behaviour of the male - such as frequent change in partners and the use of condoms - has a much higher impact on sexually transmitted diseases then the circumcision status.<ref>Task Force on Circumcision. Circumcision policy statement. ''Pediatrics '' 1999;103(3):686-93.</ref>

* Due to the inevitable loss of sensitivity as a result of circumcision, there is also the temptation to go without condoms, in order not to lose even more sensitivity.<ref>Hooykaas C, van der Velde FW, van der Linden MM. et al. The importance of ethnicity as a risk factor for STDs and sexual behaviour among heterosexuals. ''Genitourin Med '' 1991; 67(5): 378-83.</ref><ref>Michael RT, Wadsworth J, Feinleib J, ''et al''. Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison. ''Am J Public Health '' 1998;88(5):749-54.</ref><ref>Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. ''JAMA '' 1997;277:1052-7.</ref>* Two studies that have been published in early 2007<ref>Gray RH and colleagues. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007:369;657-666.</ref><ref>[[Robert C. Bailey|Bailey RC]] and colleagues. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. ''Lancet''. 2007:369;643-656.</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. The fact that the USA has both the highest rate of circumcised males in the western world, as well as the highest HIV infection rate, makes the studies look dubious. Besides that, several other studies concluded that circumcision does not have a significant impact on the risk of infection with HIV.<ref>Grosskurth H, Mosha F, Todd J, et al. A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results. ''AIDS '' 1995;9(8):927-34.</ref><ref>Barongo LR, Borgdorff MW, Mosha FF, ''et al''. The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania. ''AIDS '' 1992;6(12):1521-8.</ref><ref>Changedia SM, Gilada IS. Role of male circumcision in HIV transmission insignificant in conjugal relationship (abstract no. ThPeC7420). Presented at the Fourteenth International AIDS Conference, Barcelona, Spain, July 7-12, 2002.</ref><ref>Connolly CA, Shishana O, Simbayi L, Colvin M. HIV and circumcision in South Africa (Abstract No. MoPeC3491). Presented at the 15th International AIDS Conference, Bangkok, Thailand, July 11-16, 2004.</ref><ref>Thomas AG, Bakhireva LN, Brodine SK, Shaffer RA. Prevalence of male circumcision and its association with HIV and sexually transmitted infections in a U.S. navy population (Abstract no. TuPeC4861). Presented at the 15th International AIDS Conference, Bangkok, Thailand, July 11-16, 2004.</ref>* Urinary tract infections (UTI): a UTI can be effectively treated with antibiotics, this was also proven by studies<ref>McCracken G. Options in antimicrobial management of urinary tract infections in infants and children. ''Pediatr Infect Dis J '' 1989;8(8):552–55.</ref><ref>Larcombe J. Urinary tract infection in children. ''BMJ '' 1999;319:1173–5.</ref>. A Swedish study <ref>Mårild S, Jodal U. Incidence rate of first–time symptomatic urinary tract infection in children under 6 years of age. ''Acta Paediatr '' 1998;87(5):549–52.</ref> found that, during the first 6 years of life, the incidence of UTIs in boys was 1.8%, but in girls was 6.6%. UTIs are less common in boys after the first year of life. Mueller ''et.al''. <ref>Mueller ER, Steinhardt, G., Naseer S. The incidence of genitourinary abnormalities in circumcised and uncircumcised boys presenting with an initial urinary tract infection by 6 months of age. ''Pediatrics '' 1997;100 (Supplement): 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>Menahem S. Complications arising from ritual circumcision: pathogenesis and possible prevention. ''Isr J Med Sci '' 1981;17(1):45–8.</ref><ref>Cohen HA, Drucker MM, Vainer S, et al. Postcircumcision urinary tract infection. Clin Pediatr 1992;31(6):322–4.</ref><ref>Goldman M, Barr J, Bistritzer T, Aladjem M. Urinary tract infection following ritual Jewish circumcision ''Isr J Med Sci '' 1996;32:1098–102.</ref>

<ref>Wolbarst A. Circumcision and penile cancer. ''Lancet '' 1932;1(5655):150–53.</ref>. Today, it is known that sexually transmitted human papillomavirus (HPV) is a major risk factor<ref>McCance DJ, Kalache A, Ashdown K, ''et al''. Human papillomavirus types 16 and 18 in carcinomas of the penis from Brazil. ''Int J Cancer '' 1986;37(1):55–9.</ref>, as well as smoking<ref>Harish K, Ravi R. The role of tobacco in penile carcinoma. ''Brit J Urol '' 1995;75(3):375–7.</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>American Academy of Family Physicians. Position Paper on Neonatal Circumcision. Leawood, Kansas, (February 14, 2002).</ref>. The influence of circumcision on the infection risk of the female partner with cervical cancer has been refuted several times as well. HPV vaccination is an effective measure against carcinoma of the cervix.