"Circumcision".
Related Topics:Circumcision set.jpg|right|thumb|Seixas Family circumcision set and trunk, ca. eighteenth century.
Wooden box covered in cow hide with silver implements: silver trays, clip, pointer, silver flask, spice vessel.]]
Circumcision is the removal of some or all of the foreskin (prepuce) from the penis. The frenulum may also be removed at the same time, in a procedure called frenectomy. The word "circumcision" comes from Latin circum (meaning "around") and caedere (meaning "to cut").
The practice of circumcision predates recorded human history, with depictions found in stone-age cave drawings and Egyptian tombs. as quoted in: The origins of the practice are lost in antiquity. Theories include that circumcision is a form of ritual sacrifice or offering, a sign of submission to a deity, a rite of passage to adulthood, a mark of defeat or slavery, or an attempt to alter esthetics or sexuality. Circumcision continues to be performed as a religious requirement on members of the Muslim and Jewish faiths, and also the majority of Americans, South Koreans and Filipinos.
Non-therapeutic infant circumcision has become controversial in recent decades. Medical associations in the US, Australia, and Canada do not recommend routine non-therapeutic circumcision. In the US and UK, when circumcision is chosen, it is largely because of social or cultural expectations, rather than medical concerns. The genital integrity movement condemns non-therapeutic infant circumcision as a form of male genital mutilation that they consider comparable to female genital cutting. Those who support circumcision often explain their view in terms of what they consider to be the medical benefits of the procedure.
Circumcision may be recommended to treat medical conditions in males, such as phimosis, chronic inflammation of the penis, and penile cancer. However, there are often less invasive treatments that can be tried first.,
Circumcision removes the foreskin from the penis. For infant circumcision, clamps, such as the Gomco, Plastibell, and Mogen are often used. These clamps are meant to protect the glans while they crush the foreskin and stop any bleeding. With the Plastibell clamp, the foreskin and the clamp come away in three to seven days. Before a Gomco clamp is used, a section of skin is crushed with a hemostat then slit with scissors. Then, the foreskin is drawn over the bell shaped portion of the clamp, which is then inserted through a hole in the base of the clamp, and the clamp is tightened, "crushing the foreskin between the bell and the base plate" (this crushing action provides the hemostasis necessary to limit bleeding). With the flared bottom of the bell fit tightly against the hole of the base plate, the foreskin is cut away with a scalpel from above the base plate, while the bell covers the glans to prevent it being reached by the scalpel.
With a Mogen clamp, used by many physicians and all mohels (Jewish ritual circumcisers), the foreskin is dissected away from the glans with a blunt probe and/or curved hemostat (as with the first part of the Gomco procedure). The foreskin is then grabbed dorsally with a straight hemostat, and tented up as the Mogen clamp is slid between the glans and hemostat. The clamp is then locked shut, and a scalpel used to remove the foreskin from the flat (upper) side of the clamp. ,
According to a 1998 study, anaesthesia is used by 45% of physicians performing infant circumcisions. Dorsal penile nerve block was the most commonly used form. Obstetricians were notable in the study for a significantly lower rate of anaesthesia use (25%) than pediatricians (71%) or family practitioners (56%). A 2004 Cochrane review concluded that dorsal penile nerve block is the most effective form of anaesthesia, while EMLA (topical anaesthesia) was less effective. The authors noted that both anaesthetics appear safe, but neither of them completely eliminated pain. Adult circumcisions are often performed without clamps, and require 4 to 6 weeks of abstinence from masturbation or intercourse after the operation to allow the wound to heal.
Some cultures circumcise their males as a matter of tradition, either shortly after birth, in childhood or around puberty, when it may be (or form part of) a rite of passage. The practice is most notable among Jews and Muslims, and is more prevalent in the United States than in other Western nations.
On 1 January, the Catholic Church celebrates the Solemnity of Mary. This has replaced the Circumcision of Christ, which used to be celebrated on that day and may still be celebrated by some Traditional Catholics.
There is no specific reference to male circumcision in the Hindu holy books, and Hindus in India generally do not practise circumcision. Some conservative Hindus oppose circumcision with a similar fervor to which Jews and Muslims support it.
"Circumcision holds no relevance to a Sikh." For Sikhs, "acceptance of Nature's beautiful body is an important component of the Sikh value system."
The timing of Muslim circumcision varies. Some Muslim communities perform circumcision on the eighth day of life, as with Jews; others, earlier or later. Turkish, Balkan, rural Egyptians and Central Asian Muslims typically circumcise boys between the ages of six and eleven and the event is viewed communally as a joyous occasion and is celebrated with sweets and feasting.This feast is called "Sunnet Dugunu" and considered a very important celebration in man's life as a passage to a man from childhood in Turkey. In contrast, Iranian Muslims are typically circumcised in the hospital at birth without much ado. Urban Egyptians, as with many industrialized countries such as the USA, perform the procedure at a hospital. Kamyar et al describe it as an 'obligatory custom', and note that it is not necessary for the circumciser to be a Muslim.
Circumcision is a religious practice traditionally required by Judaism, usually performed in a ceremony called a Brit milah (or Bris milah, colloquially simply bris) (Hebrew for "Covenant of circumcision"). A mohel performs the ceremony on the eighth day after birth unless health reasons force a delay. According to the Torah (Genesis, chapter 17 verses 9-14), God commanded Abraham to circumcise himself, his offspring and his slaves as part of an everlasting covenant. According to Jewish law, failure to follow the commandment carries the penalty of karet, or being cut off from the community by God. Brit milah is so important that should the eighth day fall on Shabbat, actions that would normally be forbidden because of the sanctity of the day are permitted in order to fulfill the requirement to circumcise.
Less commonly practised, and the subject of greater controversy, is metzitzah b'peh, or oral suction. This is a procedure where after removing the foreskin, the mohel will suck out the blood from the wound to clean it, "The practice is known as oral suction, or in Hebrew, metzitzah b'peh: after removing the foreskin of the penis, the practitioner, or mohel, sucks the blood from the wound to clean it." although today this is usually done with a glass tube. "Metzizah b’peh — loosely translated as oral suction — is the part of the circumcision ceremony where the mohel removes the blood from the baby’s member; these days the removal of the blood is usually done using a sterilized glass tube, instead of with the mouth, as the Talmud suggests." Hartog, Kelly.Death Spotlights Old Circumcision Rite, The Jewish Journal of Greater Los Angeles, February 18, 2005.
Circumcision can be part of an initiation rite in some African, Pacific Islander, and Australian aboriginal traditions. Among some West African animist groups, such as the Dogon and Dowayo, it is taken to represent a removal of "feminine" aspects of the male, turning boys into fully masculine males. Among Nilotic peoples, such as the Nandi, circumcision is a rite of passage observed collectively by a number of boys every few years, and boys circumcised at the same time are taken to be members of a single age set. In the Pacific, ritual circumcision is nearly universal in Vanuatu; participation in the traditional land diving on Pentecost Island is reserved for those who have been circumcised. Circumcision is also commonly practised in the Pacific Islands of Samoa, Tonga, Niue, and Tikopia. In Samoa, it is accompanied by a celebration. Circumcision ceremonies among certain Australian aboriginal societies constitute a rite of passage and are noted for their painful nature, including subincision for some aboriginal peoples in the Western Desert.
Circumcising infants as a public health measure is controversial. Circumcision advocates assert that circumcision is a significant public health measure, preventing infections, and possibly slowing down the spread of AIDS, while the genital integrity movement asserts that infant circumcision is a human rights violation and a sexual assault, and that the practice of circumcising infants or children should be discouraged or banned.
The mainstream medical organizations do not consider circumcision to be a legal issue as long as the decision for circumcision was made by the legal guardians, and that they have given their informed consent.
In Islam and Judaism, it is customary or obligatory for boys to be circumcised for religious reasons. Many believe that this practice is protected by the principle of freedom of religion. Others argue that the right of a child to bodily integrity takes precedence over parental preference or religious custom. Another argument is that freedom of religion only applies to personal belief, and circumcision should not be imposed on minors.
The most extreme example of the latter arguments implementation can be found in the laws of Sweden. which, in 2001, passed a law restricting male infant circumcision to be performed only by medical doctors in a hospital setting. However, the law does allow persons certified by the National Board of Health to perform the rite within the first two months of life, but a medical doctor or an anesthesia nurse must accompany them. Most Jewish mohels have been so certified.
Neonatal circumcision has been studied using cost-benefit analyses. Largely these have computed the average net lifetime health and financial results of circumcision. The complications morbidity is compared to the potential gain in expected longevity, and the medical costs of circumcision are compared to the expected reduction in lifetime health costs. In the words of the BMA, “There is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research.” Biases notwithstanding, some studies decided that circumcision has a net benefit, some decided that it has a net decrement, and others decided that the benefits and risks balance each other out and that other factors must be taken into consideration. ,
The American Medical Association, American Academy of Pediatrics, and the Royal Australasian College of Physicians all suggest that anasthesia be used if performing circumcision.,,
The American Medical Association quotes a complication rate of 0.2%–0.6%, based on the studies of Gee and Harkavey. These same studies are quoted by the American Academy of Pediatrics. The American Academy of Family Physicians quotes a range of anywhere between 0.1% and 35%. The Royal Australasian College of Physicians and the Canadian Paediatric Society bring the AMA results together with other studies with results ranging anywhere between 0.06% to 55%, and bring Williams & Kapila citing that a 2%–10% seems reasonable.,
Fatal complications have been reported. The American Academy of Family Physicians states that death is rare, and cites an estimated death rate with circumcisions of infants of 1 in 500,000. Gairdner's 1949 study reported that an average of 16 children per year, out of an estimated 90,000 circumcisions per year, died following circumcision in the UK during the 1940s. At that time, deaths attributed to phimosis and circumcision were grouped together, but Gairdner stated that the deaths were more likely due to circumcision. Gairdner also stated that most deaths had occurred suddenly under anaesthesia, and couldn't be explained further, but haemorrhage and infection had also proven fatal.
The Jewish practice of metzitzah b'peh has also been implicated in the fatal transfer of HSV carried by the mohel to the child. In either 2003 and 2004, there were a few infants upon whom this procedure was performed in New York City who contracted herpes, one of which died. However, there remains no conclusive medical evidence as to whether it was caused by the mohel performing the procedure or not.
More recently, the results of the first randomised controlled trials were published in November 2005, reporting that male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa, affording a 60% reduction in the rate of new HIV infection in the circumcised group. Results of two further randomised trials to investigate the protective effect of circumcision against HIV infections will become available in 2007.
Research by the World Health Organization published in the US Public Library of Science Medicine journal showed that men who had been circumcised had a significantly lower risk of infection with the AIDS virus, and calculated that if all men were circumcised over the next 10 years, some two million new infections could be avoided.
The Royal Australasian College of Physicians emphasizes that a non-circumcised infant's penis requires no special care and should be left alone, stating that attempts to forcibly retract the foreskin, e.g. to clean it, are painful, often injure the foreskin, and can lead to scarring, infections and pathologic phimosis. It is recommended that, while there is no special age where the foreskin should be retractable, once the foreskin becomes retractible, the child should gently wash it with soap and water. It has been suggested, however, that excessive washing of the foreskin and the glans will make infections such as balanitis more likely.
It has been suggested that circumcision arose in peoples living in arid and sandy regions as a public health measure intended to prevent recurring irritation and infection caused by sand accumulating under the foreskin. Darby, after checking the official war histories of Britain, Australia and New Zealand and other records, and finding no mention of ‘balanitis’ or ‘foreskin’ or ‘circumcision’ dismissed this idea as a “medical urban myth,” concluding that “‘sand under the foreskin,’ balanitis, and circumcision were not significant problems during either of the World Wars.”
There are less invasive treatments than circumcision for posthitis (an inflamed foreskin) and balanitis (inflammation of the glans) **." target="_blank" >However, these are not as successful in treating balanitis xerotica obliterans (BXO) *" target="_blank" >*" target="_blank" >[http://www.netdoctor.co.uk/ate/menshealth/203993.html.
Lichen sclerosus et atrophicus (LSA) produces a whitish-yellowish patch on the skin, and is not believed to be always harmful or painful, and may sometimes disappear without intervention. Some consider balanitis xerotica obliterans to be a form of LSA that happens to be on the foreskin, where it may cause pathological phimosis. Circumcision is believed to reliably reduce the threat of BXO. *
In 1998, the American Cancer Society labelled some claims about a relationship of circumcision with penile cancer misleading. It said:
However, in 2005, the society said:
In another 2005 statement, they state:
The American Academy of Pediatrics state:
The American Medical Association state:
The AAP state that the true frequency of such problems is unknown. Fergusson et al found phimosis in 16% of non-circumcised boys, while Herzog and Alvarez found it in 2.6%.Rickwood and Walker raised concern that phimosis is frequently misdiagnosed by physicians confusing it with the developmentally non-retractible foreskin.[http://www.cirp.org/library/treatment/phimosis/rickwood2/
Several studies have identified phimosis as a risk factor for penile cancer, leading Willcourt to state that it would be irresponsible to expose a patient to risk for longer than necessary.*
The Canadian Paediatric Society poses the question of whether increased UTI and balanitis rates in non-circumcised male infants may be caused by forced premature retraction.Neonatal circumcision revisited: Fetus and Newborn Committee, Canadian Paediatric Society (CPS). CMAJ. 1996; 154(6): 769-780 (full text) According to the Lerman and Liao, aside from its effects on UTI infection rates, "Most of the other medical benefits of circumcision probably can be realized without circumcision as long as access to clean water and proper penile hygiene are achieved."Lerman SE, Liao JC. Neonatal circumcision. Pediatr Clin North Am. 2001 Dec;48(6):1539-57. PMID 11732129
The American Medical Association supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics.
There are few studies on sexual partner preference for penises with or without foreskins, and the results are inconclusive. They are discussed more fully in the full article.
The American Academy of Pediatrics states "a survey of adult males using self-report suggests more varied sexual practice and less sexual dysfunction in circumcised adult men. There are anecdotal reports that penile sensation and sexual satisfaction are decreased for circumcised males." The American Academy of Family Physicians states "no valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."*
It has been variously proposed that circumcision began as a religious sacrifice, as a rite of passage marking a boy's entrance into adulthood, as a form of sympathetic magic to ensure virility, as a means of suppressing (or enhancing) sexual pleasure, as an aid to hygiene where regular bathing was impractical, as a means of marking those of lower (or higher) social status, as a means of differentiating a circumcising group from their non-circumcising neighbors, as a means of discouraging masturbation or other socially proscribed sexual behaviors, to remove "excess" pleasure, to increase a man's attractiveness to women, as a symbolic castration, as a demonstration of one's ability to endure pain, or as a male counterpart to menstruation or the breaking of the hymen. It is possible that circumcision arose independently in different cultures for different reasons.
Circumcision was common, although not universal, among ancient Semitic peoples. The Book of Jeremiah, written in the sixth century BCE, lists the Egyptians, Jews, Edomites, Ammonites, and Moabites as circumcising cultures. Herodotus, writing in the fifth century BCE, would add the Colchians, Ethiopians, Phoenicians, and Syrians to that list.
In the aftermath of the conquests of Alexander the Great, Greek dislike of circumcision led to a decline in its incidence among many peoples that had previously practised it. The writer of the 1 Maccabees wrote that under the Seleucids, many Jewish men attempted to hide or reverse their circumcision so they could exercise in Greek gymnasia, where nudity was the norm. First Maccabees also relates that the Seleucids forbade the practice of brit milah (Jewish circumcision), and punished those who performed it–as well as the infants who underwent it–with death.
With the proliferation of hospitals in urban areas, childbirth, at least among the upper and middle classes, was increasingly undertaken in the care of a physician in a hospital rather than that of a midwife in the home. It has been suggested that once a critical mass of infants were being circumcised in the hospital, circumcision became a class marker of those wealthy enough to afford a hospital birth.*
By the 1920s, advances in the understanding of disease had undermined much of the original medical basis for preventive circumcision. Doctors continued to promote it, however, as good penile hygiene and as a preventive for a handful of conditions local to the penis: balanitis, phimosis, and penile cancer.
Routine infant circumcision was taken up in the English-speaking parts of Canada, the United States and Australia, and to a lesser extent in New Zealand and the United Kingdom. Although it is difficult to determine historical circumcision rates, one estimate* of infant circumcision rates in the United States holds that 30% of newborn American boys were being circumcised in 1900, 55% in 1925, and 72% in 1950.
In Canada, individual provincial health services began delisting circumcision in the 1980s. At present, only Manitoba pays for the procedure.
In South Korea, circumcision was largely unknown before the establishment of the United States trusteeship in 1945 and the spread of American influence. More than 90% of South Korean high school boys are now circumcised, but the average age of circumcision is 12 years *.
In some South African ethnic groups, circumcision has roots in several belief systems, and is performed most of the time on teenage boys:
Prior to 1989, the American Academy of Pediatrics had a long-standing opinion that medical indications for routine circumcision were lacking. This stance, according to the AMA, was reversed in 1989, following new evidence of reduction in risk of urinary tract infection. A study in 1987 found that the prominent reasons for parents choosing circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns.A 1999 study reported that reasons for circumcision included "ease of hygiene (67 percent), ease of infant circumcision compared with adult circumcision (63 percent), medical benefit (41 percent), and father circumcised (37 percent)." The authors commented that "Medical benefits were cited more frequently in this study than in past studies, although medical issues remain secondary to hygience and convenience."*A" target="_blank" >2005 study suggested that increased recognition of the potential benefits may be responsible for an observed increase in the rate of neonatal circumcision in the USA between 1988 and 2000.[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15711354&query_hl=1&itool=pubmed_docsum In a 2001 survey, 86.6% of parents felt respected by their medical provider, and parents who did not circumcise "felt less respected by their medical provider".*
The major medical societies in Britain, Canada, Australia and New Zealand do not support routine non-therapeutic infant circumcision. Major medical organizations in the United States state that parents should decide what is in their child's best interests, explicitly not recommending the procedure for medical reasons. Neonatal circumcision remains the most common pediatric operation carried out in the U.S. today.
Estimates of the proportion of males that are circumcised worldwide vary from one sixthWilliams N, Kapila L. Complications of circumcision. Brit J Surg. 1993;80:1231-6. (full text) to one thirdCrawford DA. Circumcision: a consideration of some of the controversy. J Child Health Care. 2002 Dec;6(4):259-70. PMID 12503896.
The National Center for Health Statistics stated that the overall rate of neonatal circumcision was 64.3% in 1979 and 65.3% in 1999. However, the rate for white infants was 0.3% lower in 1999 than 1979 and the circumcision rate for black infants increased by 6.5% over this time Also, strong regional differences developed. In the West, circumcision declined from 63.9% to 36.7%, but this was counterbalanced by rises in the Midwest and South. Latin Americans, who usually do not circumcise [http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions.htm" target="_blank" >*.
A recent study, which used data from the Nationwide Inpatient Sample (a sample of 5-7 million of the nation's total inpatient stays, and representing a 20% sample taken from 8 states in 1988 and 28 in 2000), stated that circumcisions rose from 48.3% in 1988 to 61.1% in 1997.*
Figures from the Nationwide Hospital Discharge Survey (for the 2003 survey based on a sample of 320,000 inpatient stays in 426 non-Federal short-stay hospitals; cf Abstract on p. 1 of state that circumcision rates declined from 64.7% in 1980 to 59.0% in 1990, then rose to 64.1% in 1995, and fell again to 55.9% in 2003. Overall, the West saw the most significant change, declining from 61.8% in 1980 to 31.4% in 2003 (see Table 44, page 52 of the National Hospital Discharge Survey 2003) [http://www.cdc.gov/nchs/data/series/sr_13/sr13_160.pdf.
Some obstetricians have been accused of using circumcision as a quick and easy way of making money Medicaid funding for infant circumcision used to be universal in the United States however sixteen states no longer pay for the procedure under Medicaid *
Circumcision | Circumcision debate | Body modification | Penis
Обрязване | Bolo koli | Circumcisió | Omskæring | Zirkumzision | Ümberlõikamine | Circuncisión | circoncision | מילה | Circoncisione | 割礼 | Машко обрежување | khatan | Besnijdenis | Obrzezanie | Обрезание | Ympärileikkaus | Manlig omskärelse | 割包皮
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