Circumcision

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Circumcision is a procedure in which pieces of the genitalia are excised for religious, social, or alleged health benefits. For the biological male, the foreskin of the penis is removed. For the biological female, it is the removal of some or all of the external female genitalia.

Some groups claim that circumcision is a form of genital mutilation, and argue that it should be ended.[1][2][3] These groups often cite a perceived decrease in sexual pleasure and the lack of consent on the part of the often infant child as evidence of child abuse. However, most major medical organizations do not agree with this. None of the American Medical Association, American Association of Pediatrics[4], WHO[5], or the British Medical Association[6] condemn male circumcision, citing variously potential minor health benefits and the right of parents to make choices for their children. No major medical organization outright recommends circumcision;[citation needed] the AAP merely says that benefits outweigh the risks but are not great enough to warrant recommending the surgery. [7] Other organizations and individuals [8] actively defend the practice, as they claim the alleged detriments of the procedure are entirely based on dubious anecdotal evidence and woo.[9] More importantly, in sub-Saharan Africa, where HIV/AIDS is a serious public health issue, circumcision of males has been found to be an effective way of lessening the risk of the transmission of the virus from infected females to male sexual partners.[10][11]

The literature does not support the contention that the possible drawbacks are serious or likely enough to occur to justify discouraging the practice when performed by a medical professional. However, the possible benefits are equally slight and unlikely in Western countries. In particular, some medical benefits would be just as effective if the decision to circumcise is deferred until adulthood when the man can make it himself, or when a condition such as phimosisWikipedia's W.svg is diagnosed. There is also evidence that attitudes to circumcision, even within the scientific literature, are coloured by how normalised the practice is in the practitioner's country.[12]

Groups that circumcise[edit]

A global map of male circumcision prevalence at the country level.
A global map of male circumcision prevalence at the country level.
  no data
  0-20%
  20-80%
  80-100%

An estimated 30% of the global male population is circumcised,[13] with the most circumcised areas being the Middle East, Africa, Southeast Asia, Australia, Canada and the United States of America.

In the U.S., the majority of males are circumcised.[14] The percentage circumcised has changed little in the last decade,[15] though this has more to do with tradition than religious requirement. Canada and Australia do it for this reason as well. It is virtually non-existent in most other Western nations, except among Jews and Muslims.

Judaism customarily requires male circumcision, as commanded in Genesis 17:10-14. It is also an integral part of the conversion of a non-Jewish man to Judaism.[16] Islam, through ordering followers to uphold the religion of Ibraheem and respect of the hadiths, similarly strongly supports circumcision.[17][18] Christians aren't required to practice circumcision because Jesus said he didn't care in Galatians 5:6.

Medical issues[edit]

Various issues with the foreskin[edit]

Obviously, by removing the foreskin, circumcision removes any risk of cancer in the foreskin, though penile cancer in general is very rare and often stems from infection with HPV.

Furthermore, removal of the foreskin ensures that problems such as phimosisWikipedia's W.svg and paraphimosisWikipedia's W.svg cannot occur. (NSFW)

HIV prevention[edit]

Circumcision is sometimes promoted as a way of reducing HIV transmission, especially in endemic regions. This is because the cells of the underside of the foreskin, for reasons that aren't yet fully understood, are especially susceptible to the virus.[19][20] By removing this portion of the foreskin, circumcision may reduce HIV transmission rates by up to 70%.[21] In another study, HIV incidence decreased by 51% in all sociodemographic, behavioural, and sexually transmitted disease symptom subgroups.[22]

The World Health Organization is quite clear on the role of circumcision in reducing HIV transmission among heterosexual males in epidemic regions:[23]

There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. Three randomized controlled trials have shown that male circumcision provided by well-trained health professionals in properly equipped settings is safe. WHO/UNAIDS recommendations emphasize that male circumcision should be considered an efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence.

By contrast, circumcision does not seem to reduce risk of transmission for men who have sex with men.[24]

However, for those living in areas where HIV infection is not endemic, this is less of an issue. Indeed, the BMA has this to say:[25]

There is a spectrum of views within the BMA’s membership about whether non-therapeutic male circumcision is a beneficial, neutral, or harmful procedure or whether it is superfluous, and whether it should ever be done on a child who is not capable of deciding for himself. The medical harms or benefits have not been unequivocally proved except to the extent that there are clear risks of harm if the procedure is done inexpertly. The Association has no policy on these issues. Indeed, it would be difficult to formulate a policy in the absence of unambiguously clear and consistent medical data on the implications of the intervention. As a general rule, however, the BMA believes that parents should be entitled to make choices about how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices.

So, in short, outside of high-risk areas, the jury is still out on medical circumcision.

Sexual pleasure[edit]

Though foreskin is noted for its significant innervation, there does not appear to be a clear consensus in the medical community on whether or not circumcision markedly reduces overall sexual pleasure.

A study performed by the British Journal of Urology found that, of their sample of roughly 1300 men, those that were circumcised "reported decreased sexual pleasure and lower orgasm intensity. They also stated more effort was required to achieve orgasm, and a higher percentage of them experienced unusual sensations (burning, prickling, itching, or tingling and numbness of the glans penis [as well as other complications])." [26]

In a meta-study spanning 40,473 males, the studies rated most accurate found that "circumcision had no overall adverse effect on penile sensitivity, sexual arousal, sexual sensation, erectile function, premature ejaculation, ejaculatory latency, orgasm difficulties, sexual satisfaction, pleasure, or pain during penetration."[27]

Lack of safety[edit]

Unfortunately, non-medical circumcision performed by religious leaders is unambiguously risky. In New York City, at least 11 baby boys were infected with herpes over an 11-year period in the early 21st century due to an Ultra-Orthodox Jewish circumcision ritual in which a mohel orally sucks off the tip of the bloody baby penis sucks blood out of the incision.[28][29] And as with any medical procedure, on rare occasions things can go wrong with medical circumcision; the tragic story of David ReimerWikipedia's W.svg began with a botched circumcision due to phimosis, which left his penis so badly mutilated that it necessitated removal.[30]

Biblical references[edit]

In Judaism, the call for circumcision is first found in Genesis 17; specifically, Genesis 17:10-14, as a covenant (or contract) between God and Abraham, and unto his descendants (e.g., all male children of Israel).[31] Where his son Ishmael was circumcised at the age of 13, Isaac was seen as more holy for being circumcised on the 8th day of life. Isaac was not as holy as Shem though; Shem was born without a foreskin, a rare medical condition called aposthia.

In Christianity, as Paul of Tarsus specifically speaks against it (as synecdoche for the Law of Moses) in Galatians. Galatians 5:6 suggests that Jesus did not care about whether you were cut or not, but Paul's words paint him as suffering from a little butthurt dickhurt.

It is worth considering that originally, only the very tip of the foreskin was cut away. It wasn't until the Hellenization period that periah, the removal of the entire foreskin, caught on. This was because a fair number of Hebrew traditionalists were upset with how younger men were restoring their foreskin under advice and/or pressure from the Greeks, who viewed even the slight circumcision as a vile travesty against the sacrosanct physical body. Despite the end of Hellenization, reversion to pre-periah has been... slow.

Female genital mutilation[edit]

See the main article on this topic: Female genital mutilation

The procedure sometimes called "female circumcision" (FGM) involves excision of parts of the female genitalia, in extreme cases including the clitoris and the inner labia. The vast majority of such procedures are carried out without the consent of the individual involved, as with male circumcision. Most studies conclude that FGM is significantly more dangerous than male infant circumcision, but many do not account for the other forms, only examining the most extreme forms. Therefore, this should not be used as an excuse for performing male circumcision. Naturally, it must be judged on its own merits.

Interestingly, circumcision is not banned in most countries where FGM is, in large part to the fact that certain religions require or recommend it, while none require FGM. Circumcision's a touchy point with men's rights activists[32] because they believe that outrage over FGM and acceptance of circumcision is proof of anti-male bias. Needless to say, this is a false equivalence (kind of like comparing a politician you don't like to Hitler), as circumcision generally does not cause the serious damage commonly seen with the harsher forms of FGM. More congruous procedures would be castration, or a penile subincision or dorsal slitWikipedia's W.svg, and although not entirely dead, traditions involving these have fortunately disappeared in many of the cultures previously featuring it. Men's rights quacks aren't the only ones concerned with the issue, however. Gloria Steinem and Ayaan Hirsi Ali, both feminists and human rights activists, have condemned the procedure in addition to condemning female genital mutilation.[citation needed]

Restoration[edit]

Non-surgical techniques[edit]

Accomplished by stretching tissue to stimulate mitosis. Can be done manually or with a device. Just make sure you know what the heck you're doing so you don't rip your dick off get sore.

Surgical[edit]

  • Foreskin reconstruction
    • Involves skin transplant
  • Foreskin regeneration
    • Regrowing the patient's foreskin — the organization ForeGen[33] has professional assistance to prove out preliminary procedures needed, including the successful decellularization of a human foreskin scaffold.

See also[edit]

References[edit]

  1. http://nocirc.org/
  2. http://www.circumstitions.com/
  3. Federal circumcision guidelines meet with opposition, San Fran Chronicle
  4. http://jama.jamanetwork.com/article.aspx?articleid=1730514
  5. http://www.who.int/hiv/topics/malecircumcision/en/
  6. http://jme.bmj.com/content/30/3/259.full
  7. https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/newborn-male-circumcision.aspx
  8. http://www.circinfo.net
  9. PUBMed: Circumcision in adults: effect on sexual function.
  10. [1]
  11. [2]
  12. http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896.full.pdf+html
  13. http://whqlibdoc.who.int/publications/2007/9789241596169_eng.pdf
  14. O’Donnell, Hugh. "The United States' Circumcision Century". Circumcision Statistics of the 20th Century. BoysToo.com. April 2001. Web. 09 October 2014.
  15. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a4.htm?s_cid=mm6034a4_w
  16. "Circumcision in Judaism". ReligionFacts.com. 01 July 2013. Web. 09 October 2014.
  17. See the Wikipedia article on Khitan (circumcision).
  18. "Male circumcision - the Islamic View". ConvertingToIslam.com. Studio-S. n.d. Web. 09 October 2014.
  19. http://www.nytimes.com/2006/04/28/world/africa/28africa.html
  20. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)15840-6/abstract
  21. http://www.sfgate.com/health/article/Circumcision-may-offer-Africa-AIDS-hope-2657030.php
  22. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60313-4/abstract
  23. http://www.who.int/hiv/topics/malecircumcision/en/
  24. http://jama.ama-assn.org/cgi/content/short/300/14/1674
  25. http://jme.bmj.com/content/30/3/259.full#xref-ref-3-1
  26. http://www.ncbi.nlm.nih.gov/pubmed/23374102
  27. http://www.ncbi.nlm.nih.gov/pubmed/23937309
  28. http://healthland.time.com/2012/06/07/how-11-new-york-city-babies-contracted-herpes-through-circumcision/
  29. http://www.nytimes.com/2015/01/15/nyregion/mayor-de-blasio-and-rabbis-near-accord-on-new-circumcision-rule.html?_r=0
  30. http://documentarystorm.com/dr-money-and-the-boy-with-no-penis/
  31. Somehow, Abraham found this agreeable — apparently, the act was a "gateway" into being able to be convinced of the less-reasonable killing of his son, Isaac, later in the same book.
  32. http://www.womenagainstmen.com/medical/male-genital-mutilation-circumcision.html
  33. http://www.foregen.org/update_from_the_foregen_labs_november_2016