Circumcision
Circumcision is the surgical removal of some or all of the prepuce or foreskin (including the ridged band), a highly sensitive part of the penis. Female circumcision is a term applied to a variety of mutilations performed on female genitalia, of which only one, the removal of the clitoral hood, is comparable to male circumcision. Only the operation on males is discussed in the remainder of this article. The word circumcision comes from Latin circum (="around") and caedere (="to cut"). Another form of surgery practiced on the penis in some cultures is subincision.Circumcision may be considered for medical reasons in a small number of cases, such as phimosis. However, the majority of circumcisions are performed for religious or cultural reasons, and when medical benefits are claimed, these are of a preventive rather than therapeutic nature; that is, the procedure is supposed to reduce certain risks later in life and not supposed to be a cure. The practice is the source of considerable controversy.
In infants, a variety of methods are used. In the great majority of cases, there is either no anaesthetic or only a local anaesthetic. All methods have in common the tearing away of the skin covering the glans penis (these are still attached in infants), and the removal of a varying amount of skin. The extent of the removal, the precise location of the removal, and the cosmetic result all vary a great deal: some circumcised males retain a significant proportion of their nerve-rich penile skin and have an amount of mobile skin remaining on the erect penis, while others do not. In some cases the scar is small and unnoticeable; in others it is large, jagged and obvious.
In adults, circumcision is sometimes performed under general anaesthetic. The foreskin is removed with a sharp-bladed instrument of some kind. The remaining skin is then stitched back using dissolvable stitches. The penis is then wrapped in protective bandages and a jockstrap style harness to keep it in place.
The glans, which was previously protected by the foreskin, is very sensitive; some people are prone to bleeding. After the circumcision, the pain is controllable and goes away quickly during the day. Normally there is no distress when the penis is flaccid, but the penis becomes partially or fully erect one or more times each night. Thus, for the first week or two after an adult circumcision, the patient can experience a significant amount of pain during the erection. Some patients stay in a hospital for 1-2 nights after the operation. The glans slowly becomes desensitized during the following month.
Approximately one sixth of males worldwide are circumcised [1]; the vast majority for religious or cultural reasons. The United States is the only country that still practices circumcision routinely on a majority of infants for non-religious reasons.
The majority of males are circumcised in the following countries:
Historically, routine neonatal circumcision was promoted during late Victorian times in the English-speaking parts of Canada, Australia, New Zealand, the United States and the United Kingdom and was widely practiced during the first part of the 20th century in these countries. However, the practice declined sharply in the United Kingdom after the Second World War, and somewhat later in Canada, Australia and New Zealand. It has been argued (e.g., Goldman 1997) that the practice did not spread to other European countries because others considered the arguments for it fallacious. In South Korea, circumcision was largely unknown before the establishment of the United States trusteeship in 1945. More than 90% of South Korean high school boys are now circumcised, but the average age of circumcision is 12 years, which makes South Korea a unique case [1].
From the late Victorian era, circumcision became more common in the higher classes in the United Kingdom. Queen Victoria had the notion that her family was descended from King David of Israel, and mandated that her sons, including the future King Edward VII be circumcised. King Edward continued the practice, and among the English royal family, the practice is still widespread: Prince Charles, Prince Andrew, and Prince Edward, were all circumcised. Reportedly, the late Diana, Princess of Wales rebelled against the royal tradition and refused to allow her sons, Prince William and Prince Harry, to be circumcised.
Routine infant circumcision has been abandoned in New Zealand and Britain, and is now much less common in Australia and in Canada (see table 1). The decline in circumcision in the United Kingdom followed the decision by the National Health Service (NHS) in 1948 not to cover the procedure following an influential article by Douglas Gardiner which claimed that circumcision resulted in the deaths of about 16 children under 5 each year in the United Kingdom. [1]. In most of the rest of the world, circumcision is done either as a religious or cultural practice.
Routine neonatal circumcision in the United States grew out of a widespread fear that masturbation caused various diseases, a view now universally rejected by the medical community. Circumcision was thought to reduce masturbation and other sexual behavior considered undesirable. Circumcision, depending on how it is practiced, can have a significant impact on masturbation; see masturbation for a detailed discussion.
Circumcision is now also dwindling in the United States. The rate has been steadily decreasing from near universality in the 1960s to approximately 55% today. While some states no longer pay for the procedure under Medicaid, more than 75% of the states still do.
Many medical claims have been made about circumcision. These included the prevention of epilepsy, penile cancer and phimosis. Circumcision advocates today claim that it reduces urinary tract infections and HIV infection, but these claims are strongly disputed and argued against. (See medical analysis of circumcision.)
The major medical societies in Britain, Canada, Australia and New Zealand do not support routine infant circumcision. All major medical organizations in the United States now judge the benefits of the procedure to be too small to justify the risks associated with performing it routinely. Neonatal circumcision nonetheless still remains the most common pediatric operation carried out in the U.S. today.
How circumcision is performed
An uncircumcised penis, a circumcised penis
Prevalence
In most of these countries the predominant religion endorses circumcision, such as Islam or Judaism.
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Table 1 International circumcision rates |