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|accessdate=
|note=
}}</ref><ref>Wetli CV. {{REFdocument |title=Autopsy of Demetrius Manker |url= |contribution=Case 93-1711. ''Autopsy of Demetrius Manker''. |last=Wetli |first=CV |publisher=Miami: Dade County Medical Examiner Department, June |format= |date=1993-06-23, 1993. |accessdate=}}</ref><ref>{{REFjournal
|last=Hiss J, Horowitz A, Kahana T
|first=
|url=
|accessdate=
}}</ref><ref>Newell TEC. ''{{REFdocument |title=Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan''. |url= |contribution= |last=Newell |first=TEC |publisher=Burnaby, B.C.: B.C. Coroner's Service, Monday, |format= |date=2004-01-19 January 2004 |accessdate=}}</ref>* Postoperative infections. This includes both local infections, which can be treated with local therapy, and systemic infections, requiring systemic antibiotic treatment.<ref>{{REFconference |last=Dr.med Wolfram . Hartmann, |first=Wolfgang |url= |place=Rechtsausschuss des Bundestages [Legal Committee of the Bundestag] (German) |title=Stellungnahme zur Anhörung am 26. November 2012 im ''Rechtsausschuss des Bundestages''.[Opinion on the hearing on 26 November 2012] (German) |date=2012-11-26 |accessdate=}}</ref>
* Wound dehiscence, meaning the separation of the edges of the wound or the tissue after suturing.
* Adhesion between the surface or rim of the [[Glans penis|glans]] with the neighbouring penile skin, causing skin pockets and bridges, as well as visually unpleasant results like uneven scars, which make a re-circumcision necessary.
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* Circumcisions, especially those that happen without consent, can spark feelings of helplessness and alienation, which can persist as trauma. These feeling can also be triggered later, when someone circumcised as an infant becomes aware of his circumcision. In an online study, interviewed men stated they felt betrayed - 55% by the mother, 50% by the father, and 58% by the doctor, and 73% felt that their human rights had been violated.<refname="GSoCH">{{REFweb |url=http://www.circumcisionharm.org/ |title=Global Survey of Circumcision Harm |accessdate=2019-10-12}}</ref>* It can frequently be found that the loss is denied, much as happens with the loss of other body parts. This denial can lead to fathers having their sons circumcised in order not to be reminded of their own loss. In this process, their own body is defined as "normal" and the [[foreskin]] redefined as a foreign object. Their own parents are seen as "good", so that this image is projected onto the circumcision their parents carried out as well, in order to keep the positive emotion intact. The father wants to be a "good" father later in life as well, and so, following an idealised image of his own parents, circumcision, which has been redefined as a "good thing", is passed on to his son by having him circumcised as well.<ref>{{REFjournal |last=van der Kolk |first=BA. [ |url=http://www.cirp.org/library/psych/vanderkolk/ |title=The compulsion to repeat the trauma: re-enactment, revictimization, and masochism]. '' |journal=Psychiatr Clin North Am'' |date=1989; |volume=12( |issue=2): |pages=389-411. |accessdate=2019-10-12}}</ref><ref>{{REFjournal |last=Goldman |first=R. [[ |author-link=Ronald Goldman |url=http://www.cirp.org/library/psych/goldman1/ |title=The psychological impact of circumcision]]. '' |journal=BJU Int'' |date=1999; |volume=83 |issue=Suppl. 1: |pages=93-103. |accessdate=2019-10-12}}</ref>* If the circumcised male feels incomplete, or due to the missing [[foreskin]] disadvantaged compared to intact males, an inferiority complex and depression may occur. This can be accompanied by conscious recognition of his own incompleteness, or the deficiency may remain completely subconscious<ref>{{REFjournal |last=Rhinehart |first=J. [ |url=http://www.cirp.org/library/psych/rhinehart1/ |title=Neonatal circumcision reconsidered]. '' |journal=Transactional Analysis J'' |date=1999; |volume=29( |issue=3): |pages=215-21.221 |accessdate=2019-10-12}}</ref>. In an online study, 75% of those interviewed stated that they felt incomplete, and 66% said they felt inferior compared with intact males.<ref>http://www.circumcisionharm.org/<name="GSoCH"/ref>* Cases in which children felt ill treated or punished have been documented as well. G. Cansever found in her study on 12 boys aged between 4 and 7 years, who had previously been prepared for their impending circumcision, that the children experienced the operation as an aggressive assault on their bodies.<ref>{{REFjournal |last=Cansever, |first=G. ( |date=1965). [ |url=http://www.cirp.org/library/psych/cansever/ |title=Psychological effects of circumcision]. '' |journal=Brit. J. Med. Psychol''. |volume=38: |pages=321-331. |accessdate=2019-10-12}}</ref>* Fear of being alone or darkness.<ref name="Levy1945">{{REFjournal |last=Levy |first=David M. Levy, [ |url=http://www.cirp.org/library/psych/levy1/ |title=Psychic trauma of operations in children; and a note on combat neurosis]. '' |journal=American Journal of Diseases of Children'', Vol. |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" />
== Historical background ==
The amputation of the [[foreskin]] is a very old ritual, whose exact origin cannot be verified beyond doubt. Medical historians assume that circumcision already served in ancient history as a way 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 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>http{{REFweb |url=https://commons.wikimedia.org/wiki/File:Circumcision_Sakkara_3.jpg |title=File:Circumcision Sakkara 3.jpg |accessdate=2019-10-12}}</ref> is an Egyptian tomb relief from the 6th dynasty, approximately 2300-2000 BC. It is not known precisely who was circumcised and why in those times.
In many cultures circumcision during puberty serves as a rite of passage, bringing adolescents into the community. As with other painful or humiliating initiation rites, proof of courage and mastering of critical situations are the key motivations. From some African tribes it is also known that the amputation of the [[foreskin]] is seen as the removal of an inborn piece of femininity from the boys, thus making them men.
In the Jewish religion, the tradition of circumcision goes back to a passage in the Book of Genesis (17, 10-14). It is seen as a covenant between God and man, dating back to the patriarch Abraham.
{{Citation
| Text=10 This is my covenant with you and your descendants after you, the covenant you are to keep: Every male among you shall be circumcised. 11 You are to undergo circumcision, and it will be the sign of the covenant between me and you. 12 For the generations to come every male among you who is eight days old must be circumcised, including those born in your household or bought with money from a foreigner—those who are not your offspring. 13 Whether born in your household or bought with your money, they must be circumcised. My covenant in your flesh is to be an everlasting covenant. 14 Any uncircumcised male, who has not been circumcised in the flesh, will be cut off from his people; he has broken my covenant.” | Author=Bible | Source=Gen 17, 10-14, NIV
}}
According to the anthropologist and sociologist Nissan Rubin, the Jewish form of circumcision, called brit mila, during the first two millennia did not include the later customary periah, namely the complete scraping of the inner [[foreskin]] from the [[Glans penis|glans]]. This was only added around 135 AD, to make it impossible to restore the [[foreskin]] by stretching, which became popular in the wake of Hellenic influence. While originally only the tip of the [[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 Maimonides pointed out that circumcision was necessary, as it diminished sexual desires and reduced the pleasure to a degree just sufficient for mere reproduction.
In Christianity, circumcision is only common in a few orthodox churches. Nevertheless, Christian moral notions had decisive influence on the spread of this practice. In the puritan influenced USA, circumcision of children was popular in the 19th century as a means to prevent masturbation. In those days, this so-called ‘self-abuse‘ was not only considered immoral, but was supposedly responsible for a variety of diseases. Even the mere existence of a [[foreskin]] was linked to many illnesses. Among them one could find syphilis, epilepsy, paralysis of the spine, bed wetting, scoliosis (spinal deformity), paralysis of the bladder, club foot, nerve pain in the lower abdomen, tuberculosis and lazy eye. One of the best known advocates of child circumcision was [[John Harvey Kellogg]], co-inventor of the Corn Flakes bearing his name. In 1888, he wrote:
{{Citation
| Text=A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of [[phimosis]]. The operation should be performed by a surgeon without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement, and preventing the recurrence of the practice in those whose will-power has become so weakened that the patient is unable to exercise entire self-control. | Author=[[John Harvey Kellogg]] | Source= | ref=<ref>[{{REFbook |url=https://archive.org/details/plainfaorold00kell/page/290 |chapter=Treatment for Self-abuse and Its Effects], '' |title=Plain Facts for Old and Young'', |location=Burlington, Iowa, |publisher=F. Segner & Co. ( |year=1888) p. |pages=107}}</ref>
}}
Following the discovery of bacteria as a cause of many diseases – such as tuberculosis – the search began for other illnesses that could be prevented by circumcision.
In the 1920s it was penile cancer<ref>Abraham L. Wolbarst behauptet, die Beschneidung könne dem Peniskrebs vorbeugenclaims that circumcision can prevent penile cancer. {{REFjournal |last=Wolbarst |first=Abraham L. |author-link=Abraham L. Wolbarst |title=Is circumcision a prophylactic against penis cancer? '' |journal=Cancer'' |date=Jul 1926 Jul; |volume=3( |issue=4): |pages=301-10]}}</ref>, in the 1940 prostate- and tongue cancer as well as STDs<ref>Eugene H. Hand erklärt, dass die Beschneidung irgendwie gegen Geschlechtskrankheiten und Zungenkrebsexplains that circumcision somehow protects against venereal diseases and tongue cancer. {{REFjournalschütze. |title=Circumcision and venereal disease. '' |last=Hand |first=Eugene H. |journal=Archives of Dermatology and Syphilology'' |date=Sep 1949 Sep; |volume=60( |issue=3): |pages=341-6346}}</ref>, in . In the 1950s it was cervical cancer<ref>Abraham Ravich erfindet den Mythos, die Beschneidung verringere das Risiko von Frauen an Gebärmutterhalskrebs zu erkrankeninvents the myth that circumcision reduces the risk of women getting cervical cancer. [{{REFjournal |url=https://www.ncbi.nlm.nih.gov/pubmed/14853120 |title=Prophylaxis of cancer of the prostate, penis, and cervix by circumcision]. '' |last=Ravich |first=Abraham |last2=Ravich |first2=RA |journal=New York State Journal of Medicine'' |date=Jun 1951 Jun; |volume=51( |issue=12): |pages=1519-201520 |pubmedID=14853120 |accessdate=2019-10-12}}</ref>, in the late 1960s it was neuroses<ref>Morris Fishbein fordert die Beschneidung zur Prävention von Nervosität und natürlich auch Masturbationcalls for circumcision to prevent nervousness and, of course, masturbation. [{{REFbook |last=Fishbein |first=Morris |chapter=Sex hygiene. '' |title=Modern Home Medical Adviser''. |location=Garden City, New York: |publisher=Doubleday & Co: |year=1969 pp |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<ref>Abraham Ravich behauptet, dass die Beschneidung Blasenkrebs und Rektumskrebs vorbeugen würdeclaims that circumcision would prevent bladder cancer and rectal cancer. [{{REFjournal |last=Ravich |first=Abraham |url=https://www.deepdyve.com/lp/wiley/viral-carcinogenesis-in-venereally-susceptible-organs-HCeWmTLmKl |title=Viral carcinogenesis in venereally susceptible organs]. '' |journal=Cancer'' |date=Jun 1971 Jun; |volume=27( |issue=6) |pages=1493-6]1496 |accessdate=2019-10-12 }}</ref>, and in the 1980s UTIs<ref>Thomas E. Wiswell behauptet, eine Beschneidung verringere das Risiko für Harntraktinfektionenclaims that circumcision reduces the risk of urinary tract infections. {{REFjournal |last=Wiswell |first=Thomas E. |author-link=Thomas E. [Wiswell |url=https://pediatrics.aappublications.org/content/75/5/901 |title=Decreased incidence of urinary tract infections in circumcised male infants]. '' |journal=Pediatrics'' |date=May 1985 May; |volume=75( |issue=5): |pages=901-3903 |accessdate=2019-10-12}}</ref> and AIDS<ref>Aaron J. Fink behauptet, dass die Beschneidung gegen claims that circumcision protects against AIDS schütze. [https://www{{REFjournal |last=Fink |first=Aaron J.nejm |author-link=Aaron J.org/doi/full/10.1056/NEJM198610303151818 Fink |title=A possible explanation for heterosexual male infection with AIDS]. '' |journal=New England Journal of Medicine'' |date=1986 Oct -10-30; |volume=31( |issue=18) |pages=1167 |url=https:1167]//www.nejm.org/doi/full/10.1056/NEJM198610303151818 |DOI=10.1056/NEJM198610303151818 |accessdate=}}</ref> followed. Retrospectively, circumcision was always advertised as a cure for whatever disease was in the public spotlight at the time.
The sheer mass of studies and publications that were released during those almost 180 years on this topic are the reason that even arguments that have been disproved multiple times, especially regarding infant and child circumcision, tenaciously persist up until today.
{{FromIntactWiki
| URL=http://intactwiki.org/wiki/Circumcision | Title=Circumcision
}}
Many cultures perform circumcision as a rite of passage into manhood. This is common in the Middle East and amongst some indigenous African and Southeast Asian peoples.
The United States and Israel are the only industrialized countries in the world to have a high incidence of routine infant male circumcision. The vast majority of infant circumcisions performed in the United States are for non-religious, non-medical reasons. See [[History of Circumcisioncircumcision]].
===Religious===
The circumcision of newborn boys is seen as a divine commandment in the 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 circumcision, but it is not always required.
===Medical Indicationindication===
In some cases, 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 rare.
| DOI=
| date=1996-2
| accessdate=2019-10-12
}}</ref> 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>
|isbn=0306461315
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In the past, advocates of circumcision claimed that a newborn child's nerve system was not yet fully developed, and that as a result, the child felt no pain during the circumcision procedure. Research has shown that newborn children do in fact feel pain, and more acutely than adults. This has led American health associations to recommend doctors take measures to reduce the pain of circumcision in infants.
The [[Position Statements on Infant Circumcision|AAP Circumcision Policy Statement]] states quite clearly that ''"There is considerable evidence that newborns who are circumcised without analgesia experience pain and physiologic stress"''. Furthermore, the pain is quite severe, and requires injections for proper pain management. Sucrose and Acetaminophen ''"cannot be recommend 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 Vol |date=March 1999 |volume=103 No. |issue=3 March 1999, pp. |pages=686-693. ( |url= |accessdate= |note=Statement Reaffirmed Sept. 1, 2005)."}}</ref>
The AAFP states quite simply in their [[Position Statements on Infant Circumcision|position paper]], ''"Newborns experience pain during circumcision".''<ref>"{{REFweb |title=Circumcision: Position Paper on Neonatal Circumcision. Board Approved: August 2007 Reaffirmed". |website=Official American Academy of Family Physicians Website. |url=http://www.aafp.org/online/en/home/clinical/clinicalrecs/children/circumcision.html. Accessed 5/2/ |accessdate=2011.-05-02}}</ref> This is not a debatable fact, and yet, it is not widely accepted, even by some doctors. It might be hard for some doctors to accept, as they may have been taught that the infant does not feel pain, and may have performed countless circumcisions with this idea. Usage of anesthesia for infant circumcision is still by no means the rule.
Penile injections of 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"''.<ref>"{{REFweb |title=Report 10 of the Council on Scientific Affairs (I-99): Neonatal Circumcision". |website=American Medical Association Official Website. |url=http://www.ama-assn.org/ama/no-index/about-ama/13585.shtml. Accessed May 4, |accessdate=2011.-05-04}}</ref>
The AAP's [http://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/pages/Where-We-Stand-Circumcision.aspx Heatlhy Children website] suggests ''"Your pediatrician (or your obstetrician) should discuss the forms of analgesia that are available"''.<ref>{{REFweb |title=Where We Stand: Circumcision". |publisher=[[AAP Official Website. ]] |date=2011-03/-23/2011. |url=http://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/pages/Where-We-Stand-Circumcision.aspx |accessdate=2019-10-12}}</ref> Be that as it may, few forms of analgesia are recommended. There are basically two types of injections to choose from, and the website does not go into the difference between a 'dorsal nerve block' and a 'ring block' injection.
Given what is known from aforementioned official documents, the AAP website may be more informative and effective if it would say ''"Make sure your doctor knows of the ineffectiveness of anything short of local anesthesia, and make sure your baby is given an injection. This is your responsibility, because your doctor may or may not be up to date on the latest understandings of infant sensitivity to pain during circumcision."'' The AAP may be holding back, however, perhaps because this would upset the doctor/parent power relationship, and may cause too much questioning of doctors in general. One may not expect to find this kind of advice on such a website, and yet, anything less than this is a dangerously weak statement.
Human babies, because they are not yet in possession of language, are incapable of giving or refusing consent for being circumcised. The element of force has led some scholars to view the circumcision of baby boys as a category of forced circumcision.<ref>For example, Frederick M. Hodges, a medical historian, writes: "In the late 1970s, as the Americans were growing increasingly aware of the abuses of power rampant throughout the nation's social institutions, influential grass-roots movements protesting the forced circumcision of American children sprang up nationwide." F. Hodges, "A Short History," p. 31; see also [[Leonard B. Glick|Glick]], ''Marked in Your Flesh'', pp. 273-281.</ref> There are, however, physicians in the United States who argue strongly for routine circumcision of newborn babies; and circumcision is widely accepted as a postnatal procedure in American hospitals.<ref>{{REFbook
| last=Fletcher | first=Christopher R. | year=1999 | title=Circumcision in America in 1998: Attitudes, Beliefs, and Charges of American Physicians | url=http://www.springerlink.com/content/h2150v731233m177/ | work=Male and Female Circumcision | editor=[[George C. Denniston]], [[Frederick M. Hodges|Frederick Mansfield Hodges]], [[Marilyn Fayre Milos]] | edition= | volume= | chapter=Section 5 | pages=259-271 | location=New York | publisher=Kluwer Academic/Plenum Publishers | isbn= | quote= | accessdate=2019-10-12 | note=ID 10.1007/978-0-585-39937-9_19}}</ref> Parental consent is required.<ref>See, e.g., Shephard and Shephard, ''The Complete Guide'', p. 125.</ref> A statement published by the American Academy of Pediatrics in 1999 declares 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> In the United Kingdom, where routine circumcision has now become far less prevalent than in the United States, a written consent of both parents is required, if a physician is to perform a non-therapeutic circumcision of a child.<ref>[{{REFjournal |last= |first= |title=Re J (child's religious upbringing and circumcision) |journal=Family Court Reports |date=2000 |volume=1 |issue= |pages=307-314 |url=http://www.cirp.org/library/legal/Re_J/2000.html Re J (child's religious upbringing and circumcision)], ''Family Court Reports'', vol. 1 (2000), pp. 307 |accessdate=2019-10-314.12}}</ref>
In recent years, legal writers in several English-speaking countries have been questioning the practice of acceding to parental wishes.<ref>See, e.g., Somerville, "Therapeutic and Non-Therapeutic Medical Procedures"; Poulter, ''English Criminal Law''; 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>{{REFjournal
| last=Bollinger | first=Dan | coauthors=Boy's Health Advisory | title=Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths | journal=Thymos: Journal of Boyhood Studies | volume=4 | issue=1 | pages=78-90 | url=httphttps://www.mensstudiesacademia.comedu/content6394940/b64n267w47m333x0/?p=7ebbd6b446d940cbbd4274c095754b12π=5Lost_Boys_An_Estimate_of_U.S._Circumcision-Related_Infant_Deaths | quote= | pubmedID= | pubmedCID= | DOI=10.3149/thy.0401.78 | date=2010-04-26 | accessdate=2019-10-12
}}</ref><ref>{{REFweb
| quote= | url=http://www.icgi.org/2010/04/infant-circumcision-causes-100-deaths-each-year-in-us | title=Infant circumcision causes 100 deaths each year in US | last=ICGIBollinger | first=Dan | publisherauthor-link=[[Dan Bollinger]] | Special:CreateMassMessageListpublisher=International Coalition for Genital Integrity | date=2010-04-26 | accessdate=2019-10-12
}}</ref>