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Disambig Bakınız: Sünnet, İlm-i hitan
Dosya:Circumcision central Asia2.jpg

Sünnet, erkeklerde penis başını örten ve koruyan üstderinin (prepus) bir kısmının veya tamamının kesilip atılması. Üç tipi vardır:

  • 1. Tip: Üstderinin kısmen veya tamamen kesilip atılması, frenilumynı işlem sırasında zarar görebilir, ya da kesilip atılabilir.
  • 2. Tip: Penis derisinin tamamen, bazen erbezi torbası ve kasıkları da kapsayacak şekilde yüzülmesi. Arabistan Yarımadası'nın güney kesimlerinde uygulanmış olduğu biliniyor. (halen uygulanmakta olabilir) Jacque Lantier benzer bir uygulamayı Afrika'da Namshi kabilesinde gözlemlemiştir
  • 3. Tip: Üriner tüpün erbezi torbasından penis başına kadar yarılarak açılması. Bu tür Avustralya yerlileri arasında halen uygulanmaktadır. [1]

Daha çok erkeklerde 1. tip sünnet uygulanır.

   
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Erkeklerde uygulanan sünnetin AIDS ve diğer cinsel yolla bulaşan hastalıklar ile penis kanseri riskini azalttığı tespit edilmiştir.[2] Sünnetin, penisin ısı hassasiyetini artırarak erken boşalma sorununu tetiklediği yönünde veriler bulunmakla beraber[3] tam aksine haz barajını yükselterek erken boşalma sorununu tedavide etkili olduğu yönünde veriler de vardır.[4][5]
   
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—Britannica, Healthcarebeauty.org


Etimoloji Edit

Sünnet kelimesi, “âdet, yol, davranış” anlamlarına gelen Arapça kökenli bir sözcüktür.

Tarihçe Edit

Dosya:Egypt circ.jpg

Sünnetle ilgili pek çok teori bulunmakta ise de, tam olarak nerede, ne zaman ve nasıl ortaya çıktığı bilinmemektedir. Sünnet, yazılı tarihten önce başlamıştır. Uygulamanın kaynağı, tarihin derinliklerinde kaybolmuştur. Erkeklerin sünneti Yahudi inancında mecburidir, pek çok Müslüman topluluğu ve bazı Hıristiyan topluluklarında ise gelenekselleştirilmiştir. Kadın sünneti ile ilgili herhangi bir dini atıf bulunmamasına rağmen özellikle Mısır'daki Müslüman topluluğu ve Afrika'daki Hıristiyan topluluklarınca dinen gerekli görülmektedir. Erkek sünneti ABD,Türkiye Güney Kore ve Filipinler'de de uygulanmaktadır. Her yıl onüç milyondan fazla erkek ve üç milyondan fazla kız çocuğu sünnet edilmektedir. [6][7]

Bu teorilerin en önemlilerinden biri James DeMeo'nun, "Erkek ve Kadın Jenital Yaralamalarının Coğrafyası" (1997) adlı makalesidir. DeMeo, toplumların ataerkil özellikleri, sünnet uygulayıp uygulamadıkları ve uyguluyorlarsa bunun şiddetini ve küresel kuraklık endeksini bir harita üzerine koyarak karşılaştırır. Bu üç faktörün kesiştiğini farkeden DeMeo, sünnetin MÖ 5000 yıllarında Sahara'nın çölleşmesi ve bunun sonucunda kurulan ataerkil düzen ile ortaya çıktığı sonucuna varır. Daha sonra bazı tarihsel olayları inceleyerek sünnetin ataerkillikle birlikte Sahara'dan dünyanın başka yerlerine yayılışını açıklar. [8]

Ashley Montagu de "Sakatlanan İnsanlık" (1991) adlı makalesinde her iki cinste sünnetin, ataerkilliğin yükselmesi ile ortaya çıktığını iddia eder. Günümüzde sünnetin devam etmesini, eski ataerkil eğilimlerin halen güçlü olmasına bağlar.[9]

Nörofizyolog James Prescott'a göre erken yaşlarda, özellikle bebeklerde yapılan sünnet, bireyin gelişen beyin yapısında cinsel zevk duygusunun acı ile birlikte kodlanmasına neden olur, ve bu şekilde cinsel olarak sağlıklı gelişmesini, ve ileri yaşlarda cinsel zevki ve cinselliğin manevi boyutunu gerektiği şekilde yaşamasını güçleştirir. Ataerkil toplum, bireylerin cinselliğini bu şekilde kontrol eder.[10]

Modern zamanlara kadar sünnet, cinsel bir kontrol aracı olarak düşünülmüştür. Bu görüşlerin en çok bilinenlerinden biri Yahudi asıllı düşünür İbn Meymun'un 1190 yılına ait şu sözleridir:

"Söz konusu sünnet olduğunda, öyle sanıyorum ki amaçlanan cinsel ilişkiyi azaltmak, cinsel organı zayıflatmak, ve bu şekilde erkeğin mutedil olmasını sağlamaktır. Bazı insanlar sanır ki, sünnet erkeğin yapısındaki bir bozukluğu gidermek içindir, ama buna herkes kolaylıkla cevap verebilir: Nasıl olur da doğadaki canlılar dışarıdan düzeltmeyi gerektirecek kadar "eksik yaratılmış" olabilirler, hele bu özellikle üstderi gibi işlevi açık seçik belli olan bir yapı ise? Gerçek şu ki, bu emir, eksik yaratılışlı bir yapıyı düzeltmek için değil, insanın ahlaki yetersizliklerini tamamlamak içindir. Bu organda açılan yara tam da istendiği gibidir; ne gerekli işlevlere zarar verir, ne de çoğalma yeteneğine. Sünnet basitçe aşırı isteği dengeler, çünkü sünnetin cinsel heyecanı azalttığına dair şüphe yoktur. Organ daha başlangıçtan kan kaybederek ve koruyucu tabakasını yitirerek güçsüz hale gelir......" (49. Bölüm, s.609) Şaşırmışlara Rehber, İbn Meymun

19. yüzyıla kadar sünnet, Sahara Çölü, ve bu bölgeyle yakın etkileşim içindeki ve etkisindeki coğrafi alanlar ve topluluklarla sınırlı kalır. Bu ana kadar Batı dünyasının tavrı, sünnete karşı genelde dışlayıcı ve sünnet yapan ulusları küçük görücüdür.[11] Ne var ki bu durum 19. yüzyılın yaygın cinsellik karşıtı ortamı ve mastürbasyon korkusu ile değişir. İngilizce konuşan ülkelerde sünnet, pek çok hastalığa neden olduğu düşünülen mastürbasyona karşı bir önlem olarak benimsenir. Sünnetle kesilip atılan prepus, gereksiz, hastalıklı bir organ olarak görülmeye başlanır. Uygulamada daha çok erkek çocuklar söz konusudur, ama kız çocukları da nasibini alır. Bu durum ABD haricinde İngilizce konuşan ülkelerde sünnetin büyük oranda terkedildiği 1940'lara kadar sürer. [12] Bu değişimde cinsellik karşıtı ortamın yumuşaması yanında Douglas Gairdner'in prepusun işlevlerini açıkladığı 1949 yılına ait makalesi de büyük rol oynamıştır. Bugün ABD'de sünnet oranının %60 ile %80 arasında, diğer İngilizce konuşan ülkelerde ise ortalama %10'un altında olduğu sanılmaktadır. Ancak kesin istatistikler yoktur. Bunun dışında sömürge döneminde (19. yüzyıl) Filipinler'de, ve ABD askeri varlığı ile Güney Kore'de de (1950'den sonra) sünnet başlamıştır.

Dinlerin bakışı Edit

Sünnet Yahudi dini inancında büyük yer tutar. Kutsal kitaplarına göre, Tanrı, elçisi İbrahim aracılığı ile Yahudilerle arasında "Akide" adı verilen anlaşmayı yapmış, ve bu anlaşmanın delili olarak da İbrahim ve halkına sünnet olmalarını emretmiştir. Bu inanışın gereği olarak Yahudiler, doğumdan kısa bir süre sonra erkek bebeklerini sünnet ederler.

Yahudiler arasında doğan Hıristiyanlık inanışında da sünnet önceleri tartışma konusu olmuş, ancak havarilerin ve özellikle de Paul'un "gereksiz" olarak görmesi nedeniyle dini bir gereklilik halini almamıştır. Ne var ki Mısır'daki Kıpti topluluğu gibi Afrika'daki bazı Hıristiyan gruplar hem kadın hem erkek sünnetini, ABD'deki bazı Protestan mezhepler ve Filipinler'deki Katolikler ise erkek sünnetini dinen gerekli olarak kabul ederler.

Müslümanların kutsal kitabında sünnetle ilgili herhangi bir ifade yer almaz, ayrıca İslamiyet'in ilk yıllarında sünnet tartışma konusu da olmamıştır. Bu sıralarda Arapların kadın ve erkek sünnetini ne oranda uyguladıkları bilinmemektedir. Bugün Müslümanların büyük çoğunluğu erkek sünnetini, Afrika'daki inananlarının büyük bir kısmı ise kadın ve erkek sünnetini dinen gerekli görürler. Sünnetin Müslümanlar tarafından gelenekselleştirilmesinin 9. yüzyılda İslam'a dönen Yahudi asıllılarının beraberlerinde kendi dinlerinin inançlarını İslam'a taşıması anlamına gelen İsrailiyyat ile olduğu sanılmaktadır.[13] İslam inanışına göre peygamber sünnetli doğmuştur (Boratav 2003:201).Şablon:Olgu

Sünnetle ilgili dini yorumların, bulunulan coğrafi bölgeye göre değişmesi (Mısır'lı Hıristiyan Kıptiler örneğinde olduğu gibi), uygulamadaki temel belirleyicinin din değil coğrafya (Asya'ya uzanan Sahara çöl kuşağı), ve bununla bağlantılı ataerkillik olduğunu göstermektedir.

Tıbbi ve cinsel boyutu Edit

Özellikle hijyenik olmayan erkeklerde sünnetin AIDS ve diğer cinsel yolla bulaşan hastalıklar ile penis kanseri riskini azalttığı tespit edilmiştir.[14] Sünnetin, penisin ısı hassasiyetini artırarak erken boşalma sorununu tetiklediği yönünde veriler bulunmakla beraber[15] tam aksine haz barajını yükselterek erken boşalma sorununu tedavide etkili olduğu yönünde veriler de vardır.[16][17]

Türk kültüründe Edit

Türkçe'de sünnet olmaya sünnet veya kestirme denilir, Araplarda ise buna hıtan denilmektedir. Türk kültüründe sünnet hem dini, hem de geleneksel bir görev olarak görülmektedir.

Dosya:Jongetjes in prinsenkledij voor besnijdenisfeest.JPG

Türkiye'de çocuk okula başlamadan sünnet ettirilir ki, sünnet düğünü yaygın bir gelenektir. (son zamanlarda batı etkisinde bebekler de sünnet edilmektedir) Çok çocuklu aileler, çocukların hepsini birden sünnet ettirmek için uygun bir zamanı beklerler. Sünnet düğünleri genellikle yaz aylarında yapılır. Köylerde sünnet düğünü okuyucu, elçi denilen çağrıcılarla, kentlerde davetiye ile olur.

Sünnet yeri ya evdir ya yahut orduevi ya da bahçedir. Çocuğun yatağı hazırlanır, süslenir. Mütevazı düğünlerde misafirlere yemek verilir, hoca çağrılır, Kur'an okunur ve dua edilir, mevlid okunur. Çalgılı düğünler de yaygındır.

Çocuğun sünnet giysisi hazır satılan veya diktirilen beyaz ceket ve pantolondur. Bu giysiye üzerinde maşallah yazan bir kuşak takılır. Çocuğun sırtına da kırmızı veya mavi pelerin atılır veya kurdele takılır, başına taç konur. Sünnet sonrası için geniş bir gecelik hazırlanır, çocuk birkaç gün rahat rahat tuvalete gitsin diye. Hatta birkaç gün rahat uyusun diye. En yakınlarından biri tutar, çocuğun dikkatini başka yöne çekerken sünnetçi kesimi tamamlar. Bu sırada tekbir getirilir, "oldu da bitti maşallah" tekerlemesi söylenir. Sünnetçi aleti mengeneli çok keskin bir bıçaktır. Penisin ucundaki deriyi kesme işlemi bittikten sonra sünnetçi pansuman yapar, pamukla sarar, çocuk yatağına götürülür. Bazı yörelerde sünnetçi, kirve ve çocuğun üzerine bir örtü serilmektedir. Kesilen deri parçası rasgele atılmaz, genellikle bir cami yakınına gömülür.

Sünnetten sonra davetliler çocuğun yatağına giderek hediyeler verir, çocuğa para takarlar. Bazı yerlerde tur denilen tepsiyle para toplama adeti görülmektedir.

Tartışmalı hususlarEdit

İngilizce konuşulan ülkelerde sünnetin uygulanmaya başladığı 19. yüzyılda, bazı hastalıklara mikropların neden olabileceği gibi modern teoriler henüz bilinmemektedir. Bunun yerine hastalıklara, kas kasılması gibi olaylarla açıklama getirilmeye çalışılmaktadır. Bu ortam içinde erkek ve kız çocuklardaki prepusun, ve bu arada mastürbasyonun pek çok hastalığa gerekçe olduğu düşünüldü. Bu hastalıklara çare ya da önlem olarak da, daha çok erkek çocuklarda sünnete başlandı. Ne var ki hastalık nedenleri ile ilgili bu iddialar mikropların öneminin anlaşılması ve tıp biliminin ilerlemesi ile 20. yüzyılın başlarında terkedildi.[18]

Bugün, büyük ölçüde Afrika kıtasına özgü olan kadın sünneti lehinde tibbi hiçbir argüman sunulmamaktadır. Ne var ki başta Mısır olmak üzere çeşitli ülkelerdeki din adamları zaman zaman kadın sünnetinin dini bir vecibe olduğunu ileri sürmekte, ve sünnet aleyhtarlığını eleştirmektedirler. Bu ve benzeri geleneksel baskıların ağırlığı sonucu kadın sünneti çeşitli uluslararası örgütlerin ve devletlerin muhalefetine rağmen, Afrika'da yaygın bir şekilde uygulanmaya devam etmektedir.

Erkek sünneti içinse farklı olarak, hem dini hem de tıbbi argümanlar ileri sürülmektedir. 20. yüzyılda, sünnetin erkeklerde penis, kadınlarda rahim kanserini, bebeklerde idrar yolları enfeksiyonunu, bazı cinsel yolla bulaşan hastalıkları, ve son olarak da AIDS'i önlediği ileri sürülmüştür. Bunlardan sonuncusu olan AIDS hariç, diğer teoriler ilk ortaya atıldıklarında ilgi çektiyseler de, hastalık riskinin sünnetin kendi riskinden düşük olması, veya diğer hastalık yapıcıların keşfedilmesi nedeni ile bugün sünnet için yeterli gerekçe olarak görülmemektedir. AIDS konusundaki tartışma sürmektedir.

Erkeklerde prepusun kendisinden kaynaklanabilecek sorunlar da sünnet için diğer nedenler olarak öne sürülmüştür. Sünnet karşıtları ise bu sorunların ortaya çıktıkları zaman sünnet dışı yöntemlerle tedavi edilebileceğini, sünnete en son çare olarak başvurulabileceğini söylemektedirler. [19]

Bu arada erkek cinsel organı hakkındaki yaygın bilinçsizlik, prepusun doğal gelişiminin hastalıklı olarak görülmesine, ve pek çok gereksiz sünnete neden olmaktadır. [20]

Erkek sünneti konusundaki dini tartışma Yahudiler, ve ABD'deki az sayıdaki Hıristiyan mezhep arasında devam etmektedir. Müslümanlar arasında ise genelde konu tartışmaya açılmamıştır.

Ayrıca bakınız Edit

Kaynakça Edit

  • Pertev Naili Boratav, Yüz Soruda Türk Folkloru, K Kitaplığı, İstanbul 2003.
  • Sedat Veyis Örnek, Türk Halkbilimi, TC Kültür Bakanlığı Y., 2. baskı, Ankara 2000.
  • Sami Aldeeb Abu Sahliyeh, "Muslims Genitalia in the Hands of the Clergy"

Dipnotlar Edit

  1. "FGM and Circumcision, Problems of Definition"
  2. Şablon:Britannica
  3. Sünnet ve erken boşalma Sünnet.wetpaint.com. Erişim: 28 Nisan 2009
  4. "Does circumcision help with premature ejaculation" Ezinearticles.com. Erişim: 28 Nisan 2009
  5. "Circumcision for the treatment of premature ejaculation" Healthcarebeauty.org. Erişim: 28 Nisan 2009
  6. NOHARMM Estimated Worldwide Incidence of Male Circumcision [1]
  7. Sami Aldeeb, Myth of the Difference [2]
  8. James Demeo, Ph.D. Kyoto Review 23: 19-38, Spring 1990 (Japan) "Saharasia"
  9. Ashley Montagu, Mutilated Humanity [3]
  10. James Prescott, Genital Pleasure vs Genital Pain, [4] The Truth Seeker, Volume 1 Number 3, Pages 14-21
  11. Paul M. Fleiss MD, The Case Against Circumcision [5]
  12. History of Circumcision [6]
  13. Sami Aldeeb, Myth of the Difference [7]
  14. Şablon:Britannica
  15. Sünnet ve erken boşalma Sünnet.wetpaint.com. Erişim: 28 Nisan 2009
  16. "Does circumcision help with premature ejaculation" Ezinearticles.com. Erişim: 28 Nisan 2009
  17. "Circumcision for the treatment of premature ejaculation" Healthcarebeauty.org. Erişim: 28 Nisan 2009
  18. Gollaher, David L. (February 2000). Circumcision: a history of the world’s most controversial surgery. New York, NY: Basic Books, 53–72. ISBN 978-0-465-04397-2.
  19. Conservative, Non Surgical Treatment of Penile Problems [8]
  20. Conservative Treatment of Phimosis, Alternatives to Radical Circumcision [9]

Dış bağlantılarEdit

Wikimedia Commons'ta:
Erkeklerde sünnet ile ilgili çoklu ortam kategorisi bulunur.

Şablon:TıpUyarı

Şablon:Din-taslak Şablon:Cinsellik-taslak Şablon:Cerrahi-taslak


ar:ختان az:Sünnət de:Zirkumzision el:Περιτομή en:Circumcision eo:Cirkumcido es:Circuncisión et:Ümberlõikamine eu:Erdainkuntza fa:ختنه fi:Ympärileikkaus fr:Circoncision gl:Circuncisión he:מילה (ניתוח) hi:ख़तना hr:Obrezivanje hu:Körülmetélés id:Sunat it:Circoncisione

Şablon:POV-section

This article is about male circumcision. For female circumcision, see Female genital cutting. For Islam's circumcision ritual, see Khitan (circumcision). For Judaism's circumcision ritual, see Brit milah. For the controversy in early Christianity, see Circumcision controversy in early Christianity.
Dosya:Circumcision central Asia2.jpg

Male circumcision is the removal of some or all of the foreskin (prepuce) from the penis.[1] The word "circumcision" comes from Latin circum (meaning "around") and cædere (meaning "to cut"). Early depictions of circumcision are found in cave paintings and Ancient Egyptian tombs, though some pictures are open to interpretation.[2][3][4] Religious male circumcision is considered a commandment from God in Judaism.[5] In Islam, though not discussed in the Qur'an, male circumcision is widely practised and most often considered to be a sunnah.[6] It is also customary in some Christian churches in Africa, including some Oriental Orthodox Churches.[7] According to the World Health Organization (WHO), global estimates suggest that 30% of males are circumcised, of whom 68% are Muslim.[8] The prevalence of circumcision varies mostly with religious affiliation, and sometimes culture. Most circumcisions are performed during adolescence for cultural or religious reasons;[9] in some countries they are more commonly performed during infancy.[8]

There is controversy regarding circumcision. An advocate of circumcision argues, for example, that it provides important health advantages which outweigh the risks, has no substantial effects on sexual function, has a low complication rate when carried out by an experienced physician, and is best performed during the neonatal period.[10] Two opponents of circumcision argue, for example, that it adversely affects penile function and sexual pleasure, is justified by medical myths, is extremely painful, and is comparable to female genital cutting.[11]

The American Medical Association stated in 1999: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."[12]

The World Health Organization (WHO; 2007), the Joint United Nations Programme on HIV/AIDS (UNAIDS; 2007), and the Centers for Disease Control and Prevention (CDC; 2008) state that evidence indicates male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides minimal protection and should not replace other interventions to prevent transmission of HIV.[13][14]

HistoryEdit

OriginsEdit

Dosya:Circumcision Precinct of Mut.png

It has been variously proposed that circumcision began as a religious sacrifice, an offering to ensure fertility, a tribal mark, a rite of passage, an attempt to emphasise masculinity, as a means of humiliating enemies and slaves,[15] or as a hygienic measure.[16][15] Darby describes these theories as "conflicting", and states that "the only point of agreement among proponents of the various theories is that promoting good health had nothing to do with it."[15] Immerman et al. suggest that circumcision causes lowered sexual arousal of pubescent males, and hypothesize that this was a competitive advantage to tribes practising circumcision, leading to its spread regardless of whether the people understood this.[17] It is possible that circumcision arose independently in different cultures for different reasons. The oldest documentary evidence for circumcision comes from ancient Egypt.[18] Circumcision was common, although not universal, among ancient Semitic peoples.[19] In the aftermath of the conquests of Alexander the Great, however, Greek dislike of circumcision (they regarded a man as truly "naked" only if his prepuce was retracted) led to a decline in its incidence among many peoples that had previously practiced it.[20]

Circumcision has ancient roots among several ethnic groups in sub-equatorial Africa, and is still performed on adolescent boys to symbolize their transition to warrior status or adulthood.[21]

Non-religious circumcision in the English-speaking worldEdit

Infant circumcision was taken up in the United States, Australia and the English-speaking parts of Canada, South Africa, New Zealand and to a lesser extent in the United Kingdom. There are several hypotheses to explain why infant circumcision was accepted in the United States about the year 1900. The germ theory of disease elicited an image of the human body as a conveyance for many dangerous germs, making the public "germ phobic" and suspicious of dirt and bodily secretions. The penis became "dirty" by association with its function, and from this premise circumcision was seen as preventative medicine to be practised universally.[22] In the view of many practitioners at the time, circumcision was a method of treating and preventing masturbation.[22] Aggleton wrote that John Harvey Kellogg viewed male circumcision in this way, and further "advocated an unashamedly punitive approach."[23] Circumcision was also said to protect against syphilis,[24] phimosis, paraphimosis, balanitis, and "excessive venery" (which was believed to produce paralysis).[22] Gollaher states that physicians advocating circumcision in the late nineteenth century expected public scepticism, and refined their arguments to overcome it.[22]

Although it is difficult to determine historical circumcision rates, one estimate of infant circumcision rates in the United States holds that 32% of newborn American boys were being circumcised in 1933.[25] Laumann et al. reported that the prevalence of circumcision among US-born males was approximately 70%, 80%, 85%, and 77% for those born in 1945, 1955, 1965, and 1971 respectively.[25] Xu et al. reported that the prevalence of circumcision among US-born males was 91% for males born in the 1970s and 84% for those born in the 1980s.[26] Between 1981 and 1999, National Hospital Discharge Survey data from the National Center for Health Statistics demonstrated that the infant circumcision rate remained relatively stable within the 60% range, with a minimum of 60.7% in 1988 and a maximum of 67.8% in 1995.[27] A 1987 study found that the most prominent reasons US parents choose circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns.[28] However, a later study speculated that an increased recognition of the potential benefits of neonatal circumcision may have been responsible for the observed increase in the US rate between 1988 and 2000.[29] A report by the Agency for Healthcare Research and Quality placed the 2005 national circumcision rate at 56%.[30]

In 1949, the United Kingdom's newly-formed National Health Service removed infant circumcision from its list of covered services, and circumcision has since been an out-of-pocket cost to parents. Among men (aged 15 years or older) who are neither Jews nor Muslims, the overall prevalance of circumcision in the UK is 6% according to the WHO's estimates.[8] When "data from targeted oversampling of black Caribbean, black African, Indian, and Pakistani groups (the Natsal ethnic minority boost) were combined with the main [Natsal II] survey data", it was found that the prevalence of circumcision in the UK is age-graded, with 11.7% of those aged 16–19 years circumcised and 19.6% of those aged 40–44 years.[31] There is a clear ethnic division: "With the exception of black Caribbeans, men from all ethnic minority backgrounds were significantly [(3.02 times)] more likely to report being circumcised compared to men who described their ethnicity as white". These particular findings "confirm that the prevalence of male circumcision among British men appears to be declining. This is despite an increase in the proportion of the British population describing their ethnicity as nonwhite"; indeed, the proportion of newborns circumcised in England and Wales has fallen to less than one percent.

The circumcision rate has declined sharply in Australia since the 1970s, leading to an age-graded fall in prevalence, with a 2000-01 survey finding 32% of those aged 16–19 years circumcised, 50% for 20–29 years and 64% for those aged 30–39 years.[32][33]

In Canada, Ontario health services delisted circumcision in 1994.[34]

Cultures and religions Edit

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See also Brit milah Circumcision controversies Religious male circumcision Khitan (circumcision)

In some cultures, males must be circumcised shortly after birth, during childhood, or around puberty as part of a rite of passage. Circumcision is commonly practised in the Jewish and Islamic faiths.

Jewish law states that circumcision is a 'mitzva aseh ("positive commandment" to perform an act) and is obligatory for Jewish-born males and for non-circumcised Jewish male converts. It is only postponed or abrogated in the case of threat to the life or health of the child.[35] It is usually performed by a mohel on the eighth day after birth in a ceremony called a Brit milah (or Bris milah, colloquially simply bris), which means "Covenant of circumcision" in Hebrew. It is considered of such importance that in some Orthodox communities the body of an uncircumcised Jewish male will sometimes be circumcised before burial.[36] Although 19th century Reform leaders described it as "barbaric", the practice of circumcision "remained a central rite"[37] and the Union for Reform Judaism has, since 1984, trained and certified over 300 practicing mohels under its "Berit Mila Program".[38] Humanistic Judaism argues that "circumcision is not required for Jewish identity."[39]

In Islam, circumcision is mentioned in some hadith (it is referred as Khitan), but not in the Qur'an. Some Fiqh scholars state that circumcision is recommended (Sunnah); others that it is obligatory.[40] Some have quoted the hadith to argue that the requirement of circumcision is based on the covenant with Abraham.[41] While endorsing circumcision for males, Islamic scholars note that it is not a requirement for converting to Islam.[42]

The Catholic Church condemned the observance of circumcision as a mortal sin and ordered against its practice in the Ecumenical Council of Basel-Florence in 1442.[43]

Circumcision is customary among the Coptic, Ethiopian, and Eritrean Orthodox Churches, and also some other African churches.[7] Some Christian churches in South Africa oppose circumcision, viewing it as a pagan ritual, while others, including the Nomiya church in Kenya,[7][44] require circumcision for membership. Some Christian churches celebrate the Circumcision of Christ.[45][46] The vast majority of Christians do not practise circumcision as a religious requirement.

Circumcision in South Korea is largely the result of American cultural and military influence following the Korean War. In West Africa infant circumcision may have had tribal significance as a rite of passage or otherwise in the past; today in some non-Muslim Nigerian societies it is medicalised and is simply a cultural norm.[47] Circumcision is part of initiation rites in some African, Pacific Islander, and Australian aboriginal traditions in areas such as Arnhem Land,[48] where the practice was introduced by Makassan traders from Sulawesi in the Indonesian Archipelago.[49] Circumcision ceremonies among certain Australian aboriginal societies are noted for their painful nature: subincision is practised amongst some aboriginal peoples in the Western Desert.[50]

In the Pacific, circumcision or superincision is nearly universal among the Melanesians of Fiji and Vanuatu,[51] while participation in the traditional land diving on Pentecost Island is reserved for those who have been circumcised.[52] Circumcision or superincision is also commonly practiced in the Polynesian islands of Samoa, Tonga, Niue, and Tikopia, where the custom is recorded as a pre-Christian/colonial practice. In Samoa it is accompanied by a celebration.

Among some West African groups, such as the Dogon and Dowayo, circumcision is taken to represent a removal of "feminine" aspects of the male, turning boys into fully masculine males.[53] Among the Urhobo of southern Nigeria it is symbolic of a boy entering into manhood. The ritual expression, Omo te Oshare ("the boy is now man"), constitutes a rite of passage from one age set to another.[54] For Nilotic peoples, such as the Kalenjin and Maasai, 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.[55]

PrevalenceEdit

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Estimates of the proportion of males that are circumcised worldwide vary from one-sixth[56] to a third.[57] The WHO has estimated that 664,500,000 males aged 15 and over are circumcised (30% global prevalence), with almost 70% of these being Muslim.[8] Circumcision is most prevalent in the Muslim world, parts of South East Asia, Africa, the United States, The Philippines, Israel, and South Korea. It is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia and Oceania. Prevalence is near-universal in the Middle East and Central Asia.[8] The WHO states that "there is generally little non-religious circumcision in Asia, with the exceptions of the Republic of Korea and the Philippines".[8] The WHO presents a map of estimated prevalence in which the level is generally low (< 20%) across Europe,[8] and Klavs et al report findings that "support the notion that the prevalence is low in Europe".[58] In Latin America, prevalence is universally low.[59] Estimates for individual countries include Spain[60], Colombia[60] and Denmark[61] less than 2%, Finland[62] and Brazil[60] 7%, Taiwan[63] 9%, Thailand[60] 13% and Australia[33] 58.7%.

The WHO estimates prevalence in the United States and Canada at 75% and 30%, respectively.[8] Prevalence in Africa varies from less than 20% in some southern African countries to near universal in North and West Africa.[59]

Modern circumcision proceduresEdit

For infant circumcision, devices such as the Circumstraint[64], Gomco clamp, Plastibell, and Mogen clamp are commonly used.[65]

With all these devices the same basic procedure is followed. First, the amount of foreskin to be removed is estimated. The foreskin is then opened via the preputial orifice to reveal the glans underneath and ensure it is normal. The inner lining of the foreskin (preputial epithelium) is then bluntly separated from its attachment to the glans. The device is then placed (this sometimes requires a dorsal slit) and remains there until blood flow has stopped. Finally, the foreskin is amputated.[66] Sometimes, the frenulum band may need to be broken or crushed and cut from the corona near the urethra to ensure that the glans can be freely and completely exposed.[67]

  • With the Plastibell, once the glans is freed the Plastibell is placed over the glans, and the foreskin is placed over the Plastibell. A ligature is then tied firmly around the foreskin and tightened into a groove in the Plastibell to achieve hemostasis. Foreskin distal to the ligature is excised and the handle is snapped off the Plastibell device. The Plastibell falls from the penis after the wound has healed, typically in four to six days.[68]
  • With a Gomco clamp, a section of skin is dorsally crushed with a hemostat and then slit with scissors. The foreskin is drawn over the bell shaped portion of the clamp and inserted through a hole in the base of the clamp. The clamp is tightened, "crushing the foreskin between the bell and the base plate." The crushed blood vessels provide hemostasis. The flared bottom of the bell fits tightly against the hole of the base plate, so the foreskin may be cut away with a scalpel from above the base plate.[69]
  • With a Mogen clamp, the foreskin is pulled dorsally with a straight hemostat, and lifted. The Mogen clamp is then slid between the glans and hemostat, following the angle of the corona to "avoid removing excess skin ventrally and to obtain a superior cosmetic result" to Gomco or Plastibell circumcisions. The clamp is locked, and a scalpel is used to cut the skin from the flat (upper) side of the clamp.[70][71]

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.[72] In some African countries, male circumcision is often performed by non-medical personnel under unsterile conditions.[73] After hospital circumcision, the foreskin may be used in biomedical research,[74] consumer skin-care products,[75] skin grafts,[76][77][78] or β-interferon-based drugs.[79] In parts of Africa, the foreskin may be dipped in brandy and eaten by the patient, eaten by the circumciser, or fed to animals.[80] According to Jewish law, after a Brit milah, the foreskin should be buried.[81]

Ethical, psychological, and legal considerationsEdit

Ethical issuesEdit

Ethical questions have been raised over removing healthy, functioning genital tissue from a minor. Opponents of circumcision state that infant circumcision infringes upon individual autonomy and represents a human rights violation.[82][83][84] Rennie et al. note that using circumcision as a way of preventing HIV in high prevalence, low-income countries in sub-Saharan Africa, is controversial, but argue that "it would be unethical to not seriously consider one of the most promising—although also one of the most controversial—new approaches to HIV-prevention in the 25-year history of the epidemic".[85]

ConsentEdit

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Views differ on whether limits should be placed on caregivers having a child circumcised.

Some medical associations take the position that the parents should determine what is in the best interest of the infant or child,[12][66][86] but the Royal Australasian College of Physicians (RACP) and the British Medical Association (BMA) observe that controversy exists on this issue.[16][87] The BMA state that in general, "the parents should determine how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices." They state that because the parents' interests and the child's interests sometimes differ, there are "limits on parents' rights to choose and parents are not entitled to demand medical procedures contrary to their child's best interests." They state that competent children may decide for themselves.[87] UNAIDS states that "[m]ale circumcision is a voluntary surgical procedure and health care providers must ensure that men and young boys are given all the necessary information to enable them to make free and informed choices either for or against getting circumcised."[88]

Some argue that the medical problems that have their risk reduced by circumcision are already rare, can be avoided, and, if they occur, can usually be treated in less invasive ways than circumcision. Somerville states that the removal of healthy genital tissue from a minor should not be subject to parental discretion and that physicians who perform the procedure are not acting in accordance with their ethical duties to the patient.[82] Denniston states that circumcision is harmful and asserts that in the absence of the individual's consent, non-therapeutic child circumcision violates several ethical principles that govern medicine.[89]

Others believe neonatal circumcision is permissible, if parents should so choose. Viens argues that, in a cultural or religious context, circumcision is of significant enough importance that parental consent is sufficient and that there is "an absence of sufficient evidence or persuasive argumentation" to support changing the present policy.[90] Benatar and Benatar argue that circumcision can be beneficial to a male before he would be able to otherwise provide consent, that "it is far from obvious that circumcision reduces sexual pleasure," and that "it is far from clear that non-circumcision leaves open a future person’s options in every regard."[91]

Acknowledgment of painEdit

Williams (2003) argued that human attitudes toward the pain that animals (including humans) experience may not be based on speciesism, developing an analogy between attitudes toward the pain pigs endure while having their tails docked, and "our culture's indifference to the pain that male human infants experience while being circumcised."[92]

Psychological and emotional consequencesEdit

The British Medical Association (2006) states that "it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks."[87] Milos and Macris (1992) argue that circumcision encodes the perinatal brain with violence and negatively affects infant-maternal bonding and trust.[11] Goldman (1999) discussed the possible trauma of circumcision on children and parents, anxieties over the circumcised state, a tendency to repeat the trauma, and suggested a need on the part of circumcised doctors to find medical justifications for the procedure.[93] Furthermore, there are reports of males attempting to undo the effects of circumcision through the practice of foreskin restoration.[94] Moses et al.' (1998) state, however, that "scientific evidence is lacking" for psychological and emotional harm, citing a longitudinal study which did not find a difference in developmental and behavioural indices.[95] A literature review by Gerharz and Haarmann (2000) reached a similar conclusion.[96] Boyle et al. (2002) state that circumcision may result in psychological harm, including post-traumatic stress disorder (PTSD), citing a study reporting high rates of PTSD among Filipino boys after either ritual or medical circumcision.[97] Hirji et al. (2005) state that "Reports of [...] psychological trauma are not borne out in studies but remain as an anecdotal cause for concern."[98]

Legal issuesEdit

In 2001, Sweden passed a law allowing only persons certified by the National Board of Health to circumcise infants, requiring a medical doctor or an anesthesia nurse to accompany the circumciser and for anaesthetic to be applied beforehand. Jews and Muslims in Sweden objected to the law,[99] and in 2001, the World Jewish Congress stated that it was "the first legal restriction on Jewish religious practice in Europe since the Nazi era."[100] In 2005, the Swedish National Board of Health and Welfare reviewed the law and recommended that it be maintained. In 2006, the U.S. State Department's report on Sweden stated that most Jewish mohels had been certified under the law and 3000 Muslim and 40–50 Jewish boys were circumcised each year.[101]

In 2006, a Finnish court found that a parent's actions in having her 4-year-old son circumcised was illegal.[102] However, no punishment was assigned by the court, and in 2008 the Finnish Supreme Court ruled that the mother's actions did not constitute a criminal offense and that circumcision of a child for religious reasons, when performed properly, is not a crime.[103] In 2008, the Finnish government was reported to be considering a new law to legalize ritual circumcision if the practitioner is a doctor, "according to the parents' wishes, and with the child's consent", as reported.[104]

By 2007, the Australian states of Victoria, New South Wales, Western Australia and Tasmania had stopped the practice of non-therapeutic male circumcision in all public hospitals.[105]

Medical aspectsEdit

Medical cost-benefit analyses of circumcision have varied. Some found a small net benefit of circumcision,[106][107] some found a small net decrement,[108][109] and one found that the benefits and risks balanced each other out and suggested that the decision could "most reasonably be made on nonmedical factors."[110]

Pain and pain reliefEdit

According to the American Academy of Pediatrics' 1999 Circumcision Policy Statement, “There is considerable evidence that newborns who are circumcised without analgesia experience pain and physiologic stress.”[66] It therefore recommended using pain relief for circumcision.[66] One of the supporting studies, Taddio 1997, found a correlation between circumcision and intensity of pain response during vaccination months later.[111] While acknowledging that there may be "other factors" besides circumcision to account for different levels of pain response, they stated that they did not find evidence of such. They concluded "pretreatment and postoperative management of neonatal circumcision pain is recommended based on these results."[111] Other medical associations also cite evidence that circumcision without anesthetic is painful.[112][113]

Stang, 1998, found 45% of physicians responding to a survey who circumcise used anaesthesia – most commonly a dorsal penile nerve block – for infant circumcisions. The obstetricians in the sample used anaesthesia less often (25%) than the family practitioners (56%) or pediatricians (71%).[114] Howard et al. (1998) surveyed US medical doctor residency programs and directors, and found that 26% of the programs that taught the circumcision procedure "failed to provide instruction in anesthesia/analgesia for the procedure" and recommended that "residency training in neonatal circumcision should include instruction in pain relief techniques".[115] A 2006 follow-up study revealed that the percentage of programs that taught circumcision and also taught administration of topical or local anesthetic had increased to 97%.[116] However, the authors of the follow-up study also noted that only 84% of these programs used anesthetic "frequently or always" when the procedure was conducted.[116]

Glass, 1999, stated that Jewish ritual circumcision is so quick that "most mohelim do not routinely use any anaesthesia as they feel there is probably no need in the neonate." Glass continued, "However, there is no Talmudic objection and should the parents wish for local anaesthetic cream to be applied there is no reason why this cannot be done." Glass also stated that for older children and adults, a penile block is used.[35] In 2001 the Swedish government passed a law requiring all boys undergoing a bris to be given anaesthetic administered by a medical professional.[117]

Lander et al. demonstrated that babies circumcised without anesthesia showed behavioral and physiological signs of pain and distress.[118] Comparisons of the dorsal penile nerve block and EMLA (lidocaine/prilocaine) topical cream methods of pain control have revealed that while both are safe,[119][120] the dorsal nerve block controls pain more effectively than topical treatments,[121] but neither method eliminates pain completely.[119] Razmus et al. reported that newborns circumcised with the dorsal block and the ring block in combination with the concentrated oral sucrose had the lowest pain scores.[122] Ng et al. found that EMLA cream, in addition to local anaesthetic, effectively reduces the sharp pain induced by needle puncture.[123]

Sexual effectsEdit

The sexual effects of circumcision are the subject of much debate. The American Academy of Pediatrics (1999) stated "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." They continued, "Masters and Johnson noted no difference in exteroceptive and light tactile discrimination on the ventral or dorsal surfaces of the glans penis between circumcised and uncircumcised men."[66] Conversely a 2002 review by Boyle et al. stated that "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings—many of which are lost to circumcision, with an inevitable reduction in sexual sensation experienced by circumcised males." They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."[124] In January 2007, The American Academy of Family Physicians (AAFP) stated "The effect of circumcision on penile sensation or sexual satisfaction is unknown. Because the epithelium of a circumcised glans becomes cornified, and because some feel nerve over-stimulation leads to desensitization, many believe that the glans of a circumcised penis is less sensitive. [...] No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."[112] Payne et al. reported that direct measurement of penile sensation during sexual arousal failed to support the hypothesised sensory differences associated with circumcision status.[125] In a 2007 study, Sorrells et al., using monofilament touch-test mapping, found that the foreskin contains the most sensitive parts of the penis, noting that these parts are lost to circumcision. They also found that "the glans of the circumcised penis is less sensitive to fine-touch than the glans of the uncircumcised penis."[126] In a 2008 study, Krieger et al. stated that "Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm."[127]

Reports detailing the effect of circumcision on erectile dysfunction have been mixed. Studies have shown that circumcision can result in a statistically significant increase,[128][129] or decrease,[25][130] in erectile dysfunction among circumcised men, while other studies have shown little to no effect.[131][132][133]

ComplicationsEdit

Complication rates ranging from 0.06% to 55% have been cited;[134] more specific estimates have included 2-10%[56] and 0.2-0.6%[12][66].

According to the American Medical Association (AMA), blood loss and infection are the most common complications, but most bleeding is minor and can be stopped by applying pressure.[12] A survey of circumcision complications by Kaplan in 1983 revealed that the rate of bleeding complications was between 0.1% and 35%.[135] A 1999 study of 48 boys who had complications from traditional male circumcision in Nigeria found that haemorrhage occurred in 52% of the boys, infection in 21% and one child had his penis amputated.[136]

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One study looking at 354,297 births in Washington State from 1987-1996 found that immediate post-birth complications occurred at a rate of 0.2% in the circumcised babies and at a rate of 0.01% in the uncircumcised babies. The authors judged that this was a conservative estimate because it did not capture the very rare but serious delayed complications associated with circumcisions (eg, necrotizing fasciitis, cellulitis) and the less serious but more common complications such as the circumcision scar or a less than ideal cosmetic result. They also stated that the risks of circumcision "do not seem to be mitigated by the hands of more experienced physicians".[137]

Meatal stenosis (a narrowing of the urethral opening) may be a longer-term complication of circumcision. It is thought that because the foreskin no longer protects the meatus, ammonia formed from urine in wet diapers irritates and inflames the exposed urethral opening. Meatal stenosis can lead to discomfort with urination, incontinence, bleeding after urination and urinary tract infections.[138][139][140]

Circumcisions may remove too much or too little skin.[56][141] If insufficient skin is removed, the child may still develop phimosis in later life.[56] Van Howe states that "when operating on the infantile penis, the surgeon cannot adequately judge the appropriate amount of tissue to remove because the penis will change considerably as the child ages, such that a small difference at the time of surgery may translate into a large difference in the adult circumcised penis. To date (1997), there have been no published studies showing the ability of a circumciser to predict the later appearance of the penis."[142]

Cathcart et al. report that 0.5% of boys required a procedure to revise the circumcision.[143]

Other complications include concealed penis[144][145], urinary fistulas, chordee, cysts, lymphedema, ulceration of the glans, necrosis of all or part of the penis, hypospadias, epispadias and impotence.[135] Kaplan stated “Virtually all of these complications are preventable with only a modicum of care" and "most such complications occur at the hands of inexperienced operators who are neither urologists nor surgeons.”[135]

Another complication of infant circumcision is skin bridge formation, whereby a remaining part of the foreskin fuses to other parts of the penis (often the glans) upon healing. This can result in pain during erections and minor bleeding can occur if the shaft skin is forcibly retracted.[146] Van Howe advises that to prevent adhesions forming after circumcision, parents should be instructed to retract and clean any skin covering the glans.[142]

Although deaths have been reported,[135][147] the American Academy of Family Physicians states that death is rare, and cites an estimated death rate of 1 infant in 500,000 from circumcision.[112] Gairdner's 1949 study[148] reported that an average of 16 children per year out of about 90,000 died following circumcision in the UK. He found that most deaths had occurred suddenly under anaesthesia and could not be explained further, but hemorrhage and infection had also proven fatal. Deaths attributed to phimosis and circumcision were grouped together, but Gairdner argued that such deaths were probably due to the circumcision operation. The penis is thought to be lost in 1 in 1,000,000 circumcisions.[149]

Sexually transmitted diseasesEdit

Human immunodeficiency virusEdit

Over forty observational studies have been conducted to investigate the relationship between circumcision and HIV infection.[150] Reviews of these studies have reached differing conclusions about whether circumcision could be used as a prevention method against HIV.[151][152][153][154]

Experimental evidence was needed to establish a causal relationship between lack of circumcision and HIV, so three randomized controlled trials were commissioned as a means to reduce the effect of any confounding factors.[154] Trials took place in South Africa,[155] Kenya[156] and Uganda.[157] All three trials were stopped early by their monitoring boards on ethical grounds, because those in the circumcised group had a lower rate of HIV contraction than the control group.[156] The results showed that circumcision reduced vaginal-to-penile transmission of HIV by 60%, 53%, and 51%, respectively.[158] A meta-analysis of the African randomised controlled trials found that the risk in circumcised males was 0.44 times that in uncircumcised males, and that 72 circumcisions would need to be performed to prevent one HIV infection. The authors also stated that using circumcision as a means to reduce HIV infection would, on a national level, require consistently safe sexual practices to maintain the protective benefit.[159]

As a result of these findings, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that male circumcision is an efficacious intervention for HIV prevention but should be carried out by well trained medical professionals and under conditions of informed consent.[8][13][160] Both the WHO and CDC indicate that circumcision may not reduce HIV transmission from men to women, and that data is lacking for the transmission rate of men who engage in anal sex with a female partner.[13][14] The joint WHO/UNAIDS recommendation also notes that circumcision only provides partial protection from HIV and should never replace known methods of HIV prevention. Male Circumcision Clearinghouse website was formed by WHO, UNAIDS, FHI and AVAC to provide current evidence-based guidance, information and resources to support the delivery of safe male circumcision services in countries that choose to scale up male circumcision as one component of comprehensive HIV prevention services. [161], [162]

Circumcision has been judged to be a cost-effective method to reduce the spread of HIV in a population,[8] though not necessarily more cost-effective than condoms.[8][163] Some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy.[164][165]

In addition to the studies which provided information about female-to-male transmission, some studies have addressed other transmission routes. A randomised controlled trial in Uganda found that male circumcision did not reduce male to female transmission of HIV. The authors could not rule out the possibility of higher risk of transmission from men who did not wait for the wound to fully heal before engaging in intercourse.[166] A meta-analysis of data from fifteen observational studies of men who have sex with men found "insufficient evidence that male circumcision protects against HIV infection or other STIs."[167]

Human papilloma virusEdit

Meta-analyses by Van Howe [168] and Bosch et al.[169] of observational studies reached differing conclusions as to whether circumcision reduces infection with human papillomavirus (HPV). A recent prospective trial in Uganda [170] randomized 3393 subjects to circumcision or a control group and found a significant reduction of HPV infection in the circumcision group. At 24 month follow-up, there was a 27.9% prevalence of high-risk HPV genotypes in the control group and only a 18.0% prevalence in the circumcision group (adjusted risk ratio, 0.65; 95% CI, 0.46 to 0.90; P=0.009). Another recent trial by Auvert et al. in Orange Farm, South Africa, randomized men to either a circumcision or control group. At the 21 month visit, the prevalence of high-risk HPV infection was lower in the circumcised men than the uncircumcised participants (14.8% and 22.3% respectively, a prevalence rate ratio of 0.66) in the absence of any difference in reported sexual behaviour or gonorrhea prevalence.[171]

Two studies have shown that circumcised men report, or were found to have, a higher prevalence of genital warts than uncircumcised men;[172][173] however, a 2009 meta-analysis of multiple studies found a non-significant association between genital warts and the presence of a foreskin.[169]

Other sexually transmitted infectionsEdit

Studies evaluating the effect of circumcision on the incidence of other sexually transmitted infections have reached conflicting conclusions. A meta-analysis of observational data from twenty-six studies found that circumcision was associated with lower rates of syphilis, chancroid and possibly genital herpes.[174] A large randomized prospective trial in Uganda found a reduction in HSV-2 infection, but not syphilis infection, in the circumcision arm of the study.[170] In contrast, some studies have failed to find a prophylactic benefit to circumcision. A prospective trial in India found that circumcision offered no protective benefit against herpes simplex virus type 2, syphilis, or gonorrhea.[175] A clinical study of 5,925 women from Uganda, Zimbabwe and Thailand found that the circumcision status of their partner did not significantly affect the incidence of Chlamydia, gonorrhea or trichomoniasis.[176] Laumann et al. examined observational data from the United States and found no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases.[25]

Hygiene, and infectious and chronic conditionsEdit

The American Academy of Pediatrics (1999) stated: "Circumcision has been suggested as an effective method of maintaining penile hygiene since the time of the Egyptian dynasties, but there is little evidence to affirm the association between circumcision status and optimal penile hygiene."[66]

An inflammation of the glans penis and foreskin is called balanoposthitis; that affecting the glans alone is called balanitis. Both conditions are usually treated with topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams. Although not as necessary as in the past, circumcision may be considered for recurrent or resistant cases.[177][178] Escala and Rickwood recommend against a policy of routine infant circumcision to avoid balanitis saying that the condition affects no more than 4% of boys, does not cause pathological phimosis, and in most cases is not serious.[179]

Fergusson studied 500 boys and found that by 8 years, the circumcised children had a rate of 11.1 problems per 100 children, and the uncircumcised children had a rate of 18.8 per 100. During infancy, circumcised children were found to have a significantly higher risk of problems than uncircumcised children, but after infancy the rate of penile problems was significantly higher among the uncircumcised. Fergusson et al. said that the great majority of penile problems were relatively minor (penile inflammation including balanitis, meatitis, and inflammation of the prepuce) and most (64%) were resolved after a single medical consultation.[180] Herzog and Alverez found the overall frequency of complications (including balanitis, irritation, adhesions, phimosis, and paraphimosis) to be higher among the uncircumcised children; again, most of the problems were minor.[181] In a study of 398 randomly selected dermatology students, Fakjian et al. reported: "Balanitis was diagnosed in 2.3% of circumcised men and in 12.5% of uncircumcised men."[182] In a study of 225 men, O'Farrell et al. reported: "Overall, circumcised men were less likely to be diagnosed with a STI/balanitis (51% and 35%, P = 0.021) than those non-circumcised."[183] Van Howe found that circumcised penises required more care in the first 3 months of life, and that circumcised boys are more likely to develop balanitis.[184]

The American Medical Association states that circumcision, properly performed, protects against the development of phimosis.[12] Rickwood and other authors have argued that many infant circumcisions are performed unnecessarily for developmental non-retractability of the prepuce rather than for pathological phimosis.[185][186] Metcalfe et al. stated that "Gairdner[148] and Oster[187] made a strong case for leaving boys uncircumcised, allowing the natural separation of the foreskin from the glans to take place gradually, and instructing boys in proper hygiene. This obviates the need for 'preventive' circumcision."[188] In a study to determine the most cost-effective treatment for phimosis, Van Howe concluded that using cream was 75% more cost-effective than circumcision at treating pathological phimosis.[189]

Urinary tract infectionsEdit

A meta-analysis of 12 studies (one randomised controlled trial, four cohort studies and seven case-control studies) representing 402,908 children determined that circumcision was associated with a significantly reduced risk of urinary tract infection (UTI). However, the authors noted that only 1% of boys with normal urinary tract function experience a UTI, and the number-needed-to treat (number of circumcisions necessary) to prevent one urinary tract infection was calculated to be 111. Because haemorrhage and infection are the commonest complications of circumcision, occurring at rate of about 2%, assuming equal utility of benefits and harms, the authors concluded that the net clinical benefit of circumcision is only likely in boys at high risk of urinary tract infection (such as those with high grade vesicoureteral reflux or a history of recurrent UTIs, where the number needed to treat declined to 11 and 4, respectively).[190]

Some UTI studies have been criticized for not taking into account a high rate of UTI's among premature infants, who are usually not circumcised because of their fragile health status.[66] The AMA stated that “depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI," and noted one decision analysis model that concluded that circumcision was not justified as a preventative measure against UTI.[12]

Penile cancerEdit

The American Cancer Society (2009) stated, "Most experts agree that circumcision should not be recommended solely as a way to prevent penile cancer."[191]

The American Academy of Pediatrics (1999) stated that studies suggest that neonatal circumcision confers some protection from penile cancer, but circumcision at a later age does not seem to confer the same level of protection. Further, because penile cancer is a rare disease, the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, remains low.[66]

The age-adjusted annual incidence of penile cancer is 0.82 per 100,000 in Denmark, 2.9-6.8 per 100,000 in Brazil, 0.9 to 1 per 100,000 in the USA, and 2.0-10.5 per 100,000 in India.[66] Researchers have reported that the risk of penile cancer is greater in never-circumcised men than in men who had been circumcised at birth; estimates of the relative risk include 3[192] and 22.[193]

Policies of various national medical associationsEdit

AustralasiaEdit

The Royal Australasian College of Physicians (RACP; 2009) state that "after extensive review of the literature [they do] not recommend that routine circumcision in infancy be performed, but [accept] that parents should be able to make this decision with their doctors. One reasonable option is for routine circumcision to be delayed until males are old enough to make an informed choice. In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents. In the absence of evidence of substantial harm, parental choice should be respected."[194]

The Tasmanian President of the Australian Medical Association (AMA), Haydn Walters, has stated that the AMA would support a call to ban circumcision for non-medical, non-religious reasons.[195]

CanadaEdit

The Fetus and Newborn Committee of the Canadian Paediatric Society posted "Neonatal circumcision revisited" in 1996 and "Circumcision: Information for Parents" in November 2004. The 1996 position statement says that "circumcision of newborns should not be routinely performed",[86] and the 2004 information to parents says: 'Circumcision is a "non-therapeutic" procedure, which means it is not medically necessary. Parents who decide to circumcise their newborns often do so for religious, social, or cultural reasons. [...] After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.'[113]

United KingdomEdit

“Male circumcision that is performed for any reason other than physical clinical need is termed non-therapeutic (or sometimes “ritual”) circumcision. Some people ask for non-therapeutic circumcision for religious reasons, some to incorporate a child into a community, and some want their sons to be like their fathers. Circumcision is a defining feature of some faiths.” “The Association has no policy on these issues.”

The BMA provides that “male circumcision is generally assumed to be lawful provided that it is performed competently; it is believed to be in the child’s best interests; and there is valid consent” from both parents and the child, if possible."

The BMS stipulates that “competent children may decide for themselves; the wishes that children express must be taken into account; if parents disagree, non-therapeutic circumcision must not be carried out without the leave of a court; consent should be confirmed in writing."

"In the past, circumcision of boys has been considered to be either medically or socially beneficial or, at least, neutral. The general perception has been that no significant harm was caused to the child and therefore with appropriate consent it could be carried out. The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks. It is essential that doctors perform male circumcision only where this is demonstrably in the best interests of the child. The responsibility to demonstrate that non-therapeutic circumcision is in a particular child’s best interests falls to his parents. The BMA considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it."[87]

United StatesEdit

The American Academy of Pediatrics (1999) stated: "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child."[66] The AAP recommends that if parents choose to circumcise, analgesia should be used to reduce pain associated with circumcision. It states that circumcision should only be performed on newborns who are stable and healthy.[66]

The American Medical Association supports the AAP's 1999 circumcision policy statement with regard to non-therapeutic circumcision, which they define as the non-religious, non-ritualistic, not medically necessary, elective circumcision of male newborns. They state that "policy statements issued by professional societies representing Australian, Canadian, and American pediatricians do not recommend routine circumcision of male newborns."[12]

The American Academy of Family Physicians (2007) recognizes the controversy surrounding circumcision and recommends that physicians "discuss the potential harms and benefits of circumcision with all parents or legal guardians considering this procedure for their newborn son."[196]

The American Urological Association (2007) stated that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks.[197]

See alsoEdit

Further readingEdit

  • Billy Ray Boyd. Circumcision Exposed: Rethinking a Medical and Cultural Tradition. Freedom, CA: The Crossing Press, 1998. (ISBN 978-0-89594-939-4)
  • Anne Briggs. Circumcision: What Every Parent Should Know. Charlottesville, VA: Birth & Parenting Publications, 1985. (ISBN 978-0-9615484-0-7)
  • Robert Darby. A surgical temptation: The demonization of the foreskin and the rise of circumcision in Britain. Chicago: University of Chicago Press, 2005. (ISBN 978-0-226-13645-5)
  • Aaron J. Fink, M.D. Circumcision: A Parent's Decision for Life. Kavanah Publishing Company, Inc., 1988. (ISBN 978-0-9621347-0-8)
  • Paul M. Fleiss, M.D. and Frederick Hodges, D. Phil. What Your Doctor May Not Tell You About Circumcision. New York: Warner Books, 2002. (ISBN 978-0-446-67880-3)
  • Leonard B. Glick. Marked in Your Flesh: Circumcision from Ancient Judea to Modern America. New York: Oxford University Press, 2005. (ISBN 978-0-19-517674-2)
  • David Gollaher. Circumcision: A History of the World's Most Controversial Surgery. New York: Basic Books, 2000. (ISBN 0465026532)
  • Ronald Goldman, Ph.D. Circumcision: The Hidden Trauma. Boston: Vanguard, 1996. (ISBN 978-0-9644895-3-0)
  • Paysach J. Krohn, Rabbi. Bris Milah. Circumcision—The Covenant Of Abraham/A Compendium of Laws, Rituals, And Customs From Birth To Bris, Anthologized From Talmudic, And Traditional Sources. New York: Mesorah Publications, 1985, 2005.
  • Brian J. Morris, Ph.D., D.Sc. In Favour of Circumcision. Sydney: UNSW Press, 1999. (ISBN 978-0-86840-537-7)
  • Peter Charles Remondino. History of Circumcision from the Earliest Times to the Present. Philadelphia and London; F. A. Davis; 1891.
  • Holm Putzke, Ph.D. Die strafrechtliche Relevanz der Beschneidung von Knaben. Zugleich ein Beitrag über die Grenzen der Einwilligung in Fällen der Personensorge, in: H. Putzke u.a. (Hrsg.), Strafrecht zwischen System und Telos, Festschrift für Rolf Dietrich Herzberg zum siebzigsten Geburtstag am 14. Februar 2008 , Mohr Siebeck: Tübingen 2008, p. 669–709 (ISBN 978-3161495700)
  • Holm Putzke, Ph.D., Maximilian Stehr, Ph.D., and Hans-Georg Dietz, Ph.D. Liability to penalty for circumcision in boys. Medico-legal aspects of a controversial medical intervention, in: Monatsschrift Kinderheilkunde 8/2008, p. 783–788
  • Rosemary Romberg. Circumcision: The Painful Dilemma. South Hadley, MA Bergan & Garvey, 1985. (ISBN 978-0-89789-073-1)
  • Edgar J Schoen, M.D. Ed Schoen, MD on Circumcision. Berkeley, CA: RDR Books, 2005. (ISBN 978-1-57143-123-3)
  • Edward Wallerstein. Circumcision: An American Health Fallacy. New York: Springer, 1980 (ISBN 978-0-8261-3240-6)
  • Gerald N. Weiss M.D. and Andrea W Harter. Circumcision: Frankly Speaking. Wiser Publications, 1998. (ISBN 978-0-9667219-0-4)
  • Yosef David Weisberg, Rabbi. Otzar Habris. Encyclopedia of the laws and customs of Bris Milah and Pidyon Haben. Jerusalem: Hamoer, 2002.

Notes and referencesEdit

Some referenced articles are available on-line only in the Circumcision Information and Resource Page’s (CIRP) library or in The Circumcision Reference Library (CIRCS). CIRP articles are chosen from an anti-circumcision point of view, and text in support of this position is often highlighted on-screen using HTML. CIRCS articles are chosen from a pro-circumcision point of view. If documents are not freely available on-line elsewhere, links to articles in one or other of these two websites may be provided.
  1. Dictionary definitions of circumcision:
    • "The act of cutting off the prepuce or foreskin of males, or the internal labia of females." Webster's Revised Unabridged Dictionary (1913) [10]
    • "to remove the foreskin of (males) sometimes as a religious rite." The Macquarie Dictionary (2nd Edition, 1991)
    • "Cut off foreskin of (as Jewish or Mohammedan rite, or surgically), Concise Oxford Dictionary, 5th Edition, 1964

    Circumcision defined in a medical context:

  2. Hodges, F.M. (Fall 2001). "The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme.". The Bulletin of the History of Medicine 75 (3): 375–405. doi:10.1353/bhm.2001.0119. PMID 11568485. 
  3. Wrana, P. (1939). "Historical review: Circumcision". Archives of Pediatrics 56: 385–392.  as quoted in: Zoske, Joseph (Winter 1998). "Male Circumcision: A Gender Perspective". The Journal of Men's Studies 6 (2): 189–208. http://www.noharmm.org/zoske.htm. Retrieved 2006-06-14. 
  4. {{{başlık}}}. ISBN 978-0-465-04397-2 Şablon:LCCN.
  5. "Circumcision". American-Israeli Cooperative Enterprise. http://www.jewishvirtuallibrary.org/jsource/Judaism/circumcision.html. Retrieved 2006-10-03. 
  6. Rizvi, S.A.H.; A Naqvi, S.A.; Hussain, M.; Hasan, A.S. (1999). "Religious circumcision: a Muslim view". BJU International 83: 13. doi:10.1046/j.1464-410x.1999.0830s1013.x. 
  7. 7,0 7,1 7,2 Customary in some Coptic and other churches:
    • "The Coptic Christians in Egypt and the Ethiopian Orthodox Christians —two of the oldest surviving forms of Christianity— retain many of the features of early Christianity, including male circumcision. Circumcision is not prescribed in other forms of Christianity.…Some Christian churches in South Africa oppose the practice, viewing it as a pagan ritual, while others, including the Nomiya church in Kenya, require circumcision for membership and participants in focus group discussions in Zambia and Malawi mentioned similar beliefs that Christians should practice circumcision since Jesus was circumcised and the Bible teaches the practice." Male Circumcision: context, criteria and culture (Part 1), Joint United Nations Programme on HIV/AIDS, February 26, 2007.
    • "The decision that Christians need not practice circumcision is recorded in Acts 15; there was never, however, a prohibition of circumcision, and it is practiced by Coptic Christians." "circumcision", The Columbia Encyclopedia, Sixth Edition, 2001-05.
  8. 8,00 8,01 8,02 8,03 8,04 8,05 8,06 8,07 8,08 8,09 8,10 "Male circumcision: Global trends and determinants of prevalence, safety and acceptability" (PDF). World Health Organization. 2007. http://whqlibdoc.who.int/publications/2007/9789241596169_eng.pdf. Retrieved 2009-03-04. 
  9. Schmid GP, Dick B. (2008). "Adolescent boys: who cares?" (PDF). Bulletin of the World Health Organization 86 (9): 659. doi:10.2471/BLT.08.057752. PMID 18797635. PMC 2649485. http://www.who.int/entity/bulletin/volumes/86/9/08-057752.pdf. 
  10. Schoen, Edgar J (December 1, 2007). "Should newborns be circumcised? Yes". Can Fam Physician 53 (12): 2096–8, 2100–2. PMID 18077736. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18077736. Retrieved 2008-05-02. 
  11. 11,0 11,1 Milos, Marilyn Fayre; Donna Macris (March–April 1992). "Circumcision: A medical or a human rights issue?". Journal of Nurse-Midwifery 37 (2 S1): S87–S96. doi:10.1016/0091-2182(92)90012-R. PMID 1573462. http://www.cirp.org/library/ethics/milos-macris/. Retrieved 2007-04-06. 
  12. 12,0 12,1 12,2 12,3 12,4 12,5 12,6 "Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision". 1999 AMA Interim Meeting: Summaries and Recommendations of Council on Scientific Affairs Reports. American Medical Association. December 1999. pp. 17. http://www.ama-assn.org/ama/no-index/about-ama/13585.shtml. Retrieved 2006-06-13. 
  13. 13,0 13,1 13,2 Şablon:Cite paper
  14. 14,0 14,1 "Male Circumcision and Risk for HIV Transmission and Other Health Conditions: Implications for the United States". Centers for Disease Control and Prevention. 2008. http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm. 
  15. 15,0 15,1 15,2 Robert Darby (2003). "Medical history and medical practice: persistent myths about the foreskin". Medical Journal of Australia 178(4): 178-9. http://www.mja.com.au/public/issues/178_04_170203/dar10676_fm.html. 
  16. 16,0 16,1 "Policy Statement On Circumcision" (PDF). Royal Australasian College of Physicians. September 2004. http://www.racp.edu.au/index.cfm?objectid=B5606813-F174-8FA9-0522EE1FC3053078. Retrieved 2010-01-25. ""The Paediatrics and Child Health Division, The Royal Australasian College of Physicians (RACP) has prepared this statement on routine circumcision of infants and boys to assist parents who are considering having this procedure undertaken on their male children and for doctors who are asked to advise on or undertake it. After extensive review of the literature the RACP reaffirms that there is no medical indication for routine neonatal circumcision. Circumcision of males has been undertaken for religious and cultural reasons for many thousands of years. It remains an important ritual in some religious and cultural groups.…In recent years there has been evidence of possible health benefits from routine male circumcision. The most important conditions where some benefit may result from circumcision are urinary tract infections, HIV and later cancer of the penis.…The complication rate of neonatal circumcision is reported to be around 1% to 5% and includes local infection, bleeding and damage to the penis. Serious complications such as bleeding, septicaemia and meningitis may occasionally cause death. The possibility that routine circumcision may contravene human rights has been raised because circumcision is performed on a minor and is without proven medical benefit. Whether these legal concerns are valid will be known only if the matter is determined in a court of law. If the operation is to be performed, the medical attendant should ensure this is done by a competent operator, using appropriate anaesthesia and in a safe child-friendly environment. In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents. Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate."
    "Circumcision of males has been undertaken for religious and cultural reasons for many thousands of years. It probably originated as a hygienic measure in communities living in hot, dusty and dry environments."
    "
     
  17. Immerman, R.S.; W.C. Mackey (Fall-Winter 1997). "A biocultural analysis of circumcision". Social Biology 44 (3-4): 265–275. doi:10.1111/j.1467-9744.1976.tb00285.x. PMID 9446966. http://www.cirp.org/library/psych/immerman2/. 
  18. Tomb artwork from the Sixth Dynasty (2345–2181 BCE) shows men with circumcised penises, and one relief from this period shows the rite being performed on a standing adult male. The Egyptian hieroglyph for "penis" depicts either a circumcised or an erect organ. The examination of Egyptian mummies has found some with foreskins and others who were circumcised.
  19. The book of Genesis records circumcision as God's covenant/command to Abraham. It was a sign of obedience and was to be performed by the male child's eighth day after birth. 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.
  20. 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.
  21. Marck, J (1997). "Aspects of male circumcision in sub-equatorial African culture history". Health Transit Review 7 (supplement): 337–360. PMID 10173099. 
  22. 22,0 22,1 22,2 22,3 Gollaher, David (Fall 1994). "From ritual to science: the medical transformation of circumcision in America". Journal of Social History 28 (1): 5–36. http://www.cirp.org/library/history/gollaher/. Retrieved 2007-12-06. 
  23. Aggleton, P. (2007). "Roundtable: “Just a Snip”?: A Social History of Male Circumcision." (PDF). Reproductive Health Matters 15 (29): 15–21. doi:10.1016/S0968-8080(07)29303-6. PMID 17512370. http://www.hsph.harvard.edu/pihhr/files/RHM/RHM29%20-%20Aggleton.pdf. Retrieved 2008-12-17. 
  24. "On the influence of circumcision in preventing syphilis". Medical Times and Gazette NS Vol II: 542–3. 1855. 
  25. 25,0 25,1 25,2 25,3 Laumann, E.; C. Masi and F. Zuckerman (1997). "Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice". JAMA 277 (13): 1052–1057. doi:10.1001/jama.277.13.1052. PMID 9091693. http://www.circs.org/library/laumann/index.html. 
  26. Xu F, Markowitz LE, Sternberg MR, Aral SO (July 2007). "Prevalence of circumcision and herpes simplex virus type 2 infection in men in the United States: the National Health and Nutrition Examination Survey (NHANES), 1999-2004". Sex Transm Dis 34 (7): 479–84. doi:10.1097/01.olq.0000253335.41841.04. PMID 17413536. 
  27. "Trends in circumcisions among newborns". National Hospital Discharge Survey. National Center for Health Statistics. January 11, 2007. http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions.htm. Retrieved 2008-08-19. 
  28. Brown, M.S.; C.A. Brown (August 1987). "Circumcision decision: prominence of social concerns". Pediatrics 80 (2): 215–219. PMID 3615091. 
  29. Nelson, C.P.; R. Dunn, J. Wan, J.T. Wei (March 2005). "The increasing incidence of newborn circumcision: data from the nationwide inpatient sample". Journal of Urology 173 (3): 978–981. doi:10.1097/01.ju.0000145758.80937.7d. PMID 15711354. 
  30. Şablon hatası:başlık gerekiyor.
  31. Dave SS, Fenton KA, Mercer CH, Erens B, Wellings K, Johnson AM (December 2003). "Male circumcision in Britain: findings from a national probability sample survey". Sexually Transmitted Infections 79 (6): 499–500. doi:10.1136/sti.79.6.499. PMID 14663134. 
  32. "In Australia and New Zealand, the circumcision rate has fallen considerably in recent years and it is estimated that currently only 10%-20% of male infants are routinely circumcised." (RACP: 2004)
  33. 33,0 33,1 Richters, J; et al. (2006). "Circumcision in Australia: prevalence and effects on sexual health". Int J STD AIDS 17 (8): 547–554. doi:10.1258/095646206778145730. PMID 16925903. http://www.cirp.org/library/general/richters1/. "Neonatal circumcision was routine in Australia until the 1970s … In the last generation, Australia has changed from a country where most newborn boys are circumcised to one where circumcision is the minority experience.". 
  34. Walton RE, Ostbye T, Campbell MK (1997). "Neonatal male circumcision after delisting in Ontario. Survey of new parents". Can Fam Physician 43: 1241–7. PMID 9241462. 
  35. 35,0 35,1 Glass JM (January 1999). "Religious circumcision: a Jewish view". BJU Int. 83 Suppl 1: 17–21. PMID 10349410. http://www3.interscience.wiley.com/cgi-bin/fulltext/119091414/PDFSTART. 
  36. {{{başlık}}}. ISBN 0-8246-0126-2.
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  38. Berit Mila Program of Reform Judaism, Union for Reform Judaism website. Retrieved January 23, 2010.
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  40. Al-Munajjid, Muhammed Salih. "Question #9412: Circumcision: how it is done and the rulings on it". Islam Q&A. http://www.islam-qa.com/index.php?ln=eng&ds=qa&lv=browse&QR=9412&dgn=4. Retrieved 2006-07-01. 
  41. Al-Munajjid, Muhammed Salih. "Question #7073: The health and religious benefits of circumcision". Islam Q&A. http://www.islam-qa.com/index.php?ln=eng&ds=qa&lv=browse&QR=7073&dgn=3. Retrieved 2006-07-01. 
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  43. "Session 11—4 February 1442 (Bull of union with the Copts)". Eccumenical Council of Florence (1438-1445). Eternal Word Television Network. http://www.ewtn.com/library/councils/Florence.htm#5. Retrieved 2009-05-11. "Therefore it strictly orders all who glory in the name of Christian, not to practise circumcision either before or after baptism, since whether or not they place their hope in it, it cannot possibly be observed without loss of eternal salvation." 
  44. Mattson CL, Bailey RC, Muga R, Poulussen R, Onyango T (February 2005). "Acceptability of male circumcision and predictors of circumcision preference among men and women in Nyanza Province, Kenya". AIDS Care 17 (2): 182–94. doi:10.1080/09540120512331325671. PMID 15763713. 
  45. "Greek Orthodox Archdiocese calendar of Holy Days". http://www.goarch.org/en/chapel/calendar.asp?Y=2007&M=1. 
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  50. Jones IH (June 1969). "Subincision among Australian western desert Aborigines". The British Journal of Medical Psychology 42 (2): 183–90. PMID 5783777. 
  51. "RECENT GUEST SPEAKER". Australian AIDS Fund Incorporated. 2006. http://www.aids.net.au/aids-png-project-20060403.htm. Retrieved 2006-07-01. 
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  54. Agberia, J. T. (2006). "Aesthetics and Rituals of the Opha Ceremony among the Urhobo People". Journal of Asian and African Studies 41: 249. doi:10.1177/0021909606063880. 
  55. "Masai of Kenya". http://www.masaikenya.org/. Retrieved 2007-04-06. "Authority derives from the age-group and the age-set. Prior to circumcision a natural leader or olaiguenani is selected; he leads his age-group through a series of rituals until old age, sharing responsibility with a select few, of whom the ritual expert (oloiboni) is the ultimate authority. Masai youths are not circumcised until they are mature, and a new age-set is initiated together at regular intervals of twelve to fifteen years. The young warriors (ilmurran) remain initiates for some time, using blunt arrows to hunt small birds which are stuffed and tied to a frame to form a head-dress." 
  56. 56,0 56,1 56,2 56,3 Williams, N; L. Kapila (October 1993). "Complications of circumcision". British Journal of Surgery 80 (10): 1231–1236. doi:10.1002/bjs.1800801005. http://www.cirp.org/library/complications/williams-kapila/. Retrieved 2006-07-11. 
  57. Crawford, DA (December 2002). "Circumcision: a consideration of some of the controversy". J Child Health Care. 6 (4): 259–270. doi:10.1177/136749350200600403. PMID 12503896. http://chc.sagepub.com/cgi/content/abstract/6/4/259. 
  58. Klavs I, Hamers FF (February 2008). "Male circumcision in Slovenia: results from a national probability sample survey". Sexually Transmitted Infections 84 (1): 49–50. doi:10.1136/sti.2007.027524. PMID 17881413. 
  59. 59,0 59,1 Drain PK, Halperin DT, Hughes JP, Klausner JD, Bailey RC (2006). "Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries". BMC Infectious Diseases 6: 172. doi:10.1186/1471-2334-6-172. PMID 17137513. 
  60. 60,0 60,1 60,2 60,3 Castellsagué X, Bosch FX, Muñoz N, et al. (April 2002). "Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners". The New England Journal of Medicine 346 (15): 1105–12. doi:10.1056/NEJMoa011688. PMID 11948269. 
  61. Frisch M, Friis S, Kjaer SK, Melbye M (December 1995). "Falling incidence of penis cancer in an uncircumcised population (Denmark 1943-90)". BMJ 311 (7018): 1471. PMID 8520335. PMC 2543732. http://bmj.com/cgi/pmidlookup?view=long&pmid=8520335. 
  62. Schoen EJ, Colby CJ, To TT (March 2006). "Cost analysis of neonatal circumcision in a large health maintenance organization". The Journal of Urology 175 (3 Pt 1): 1111–5. doi:10.1016/S0022-5347(05)00399-X. PMID 16469634. 
  63. Ko MC, Liu CK, Lee WK, Jeng HS, Chiang HS, Li CY (April 2007). "Age-specific prevalence rates of phimosis and circumcision in Taiwanese boys". Journal of the Formosan Medical Association = Taiwan Yi Zhi 106 (4): 302–7. doi:10.1016/S0929-6646(09)60256-4. PMID 17475607. "…the prevalence of circumcision slightly increased with age from 7.2% (95% CI, 5.3-10.8%) for boys aged 7 years to 8.7% (95% CI, 6.5-13.3%) for boys aged 13 years.". 
  64. "Circumstraint™ Infant Immobilizer". http://www.natus.com/index.cfm?page=company_1&crid=128/circumstraint.htm. 
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  66. 66,00 66,01 66,02 66,03 66,04 66,05 66,06 66,07 66,08 66,09 66,10 66,11 "Circumcision policy statement. American Academy of Pediatrics. Task Force on Circumcision". Pediatrics 103 (3): 686–93. March 1999. doi:10.1542/peds.103.3.686. PMID 10049981. 
  67. "Neonatal Circumcision: An Audiovisual Primer". Stanford School of Medicine. http://newborns.stanford.edu/Circumcision.html. 
  68. Barrie H, Huntingford PJ, Gough MH (July 1965). "The Plastibell Technique for Circumcision". British Medical Journal 2 (5456): 273–5. doi:10.1136/bmj.2.5456.273. PMID 14310205. 
  69. Peleg D, Steiner A (September 1998). "The Gomco circumcision: common problems and solutions". American Family Physician 58 (4): 891–8. PMID 9767725. 
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  72. Holman JR, Stuessi KA (March 1999). "Adult circumcision". American Family Physician 59 (6): 1514–8. PMID 10193593. http://www.aafp.org/afp/990315ap/1514.html. 
  73. "In Africa, a problem with circumcision and AIDS". http://www.iht.com/articles/2007/02/27/news/health.php. 
  74. Hovatta O, Mikkola M, Gertow K, et al. (July 2003). "A culture system using human foreskin fibroblasts as feeder cells allows production of human embryonic stem cells". Human Reproduction 18 (7): 1404–9. doi:10.1093/humrep/deg290. PMID 12832363. 
  75. "The Skinny On 'Miracle' Wrinkle Cream". NBC10.com. NBC Universal, Inc. November 2002. http://www.nbc10.com/health/1808693/detail.html. Retrieved 2008-08-20. 
  76. "High-Tech Skinny on Skin Grafts". www.wired.com:science:discoveries. CondéNet, Inc. 02.16.99. http://www.wired.com/science/discoveries/news/1999/02/17912. Retrieved 2008-08-20. 
  77. "Skin Grafting". www.emedicine.com. WebMD. http://www.emedicine.com/derm/TOPIC867.HTM. Retrieved 2008-08-20. 
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  79. Cowan, Alison Leigh (April 19, 1992). "Wall Street; A Swiss Firm Makes Babies Its Bet". New York Times:Business. New York Times. http://query.nytimes.com/gst/fullpage.html?res=9E0CE6D81E38F93AA25757C0A964958260&partner. Retrieved 2008-08-20. 
  80. Anonymous (editorial) (1949-12-24). "A ritual operation". British Medical Journal 2: 1458–1459. ""...in parts of West Africa, where the operation is performed at about 8 years of age, the prepuce is dipped in brandy and eaten by the patient; in other districts the operator is enjoined to consume the fruits of his handiwork, and yet a further practice, in Madagascar, is to wrap the operation specifically in a banana leaf and feed it to a calf."". 
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  83. Van Howe, R.S.; J.S. Svoboda, J.G. Dwyer, and C.P. Price (January 1999). "Involuntary circumcision: the legal issues" (PDF). BJU International 83 (Supp1): 63–73. doi:10.1046/j.1464-410x.1999.0830s1063.x. PMID 10349416. http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1063.x. Retrieved 2007-02-12. 
  84. Tanne, Janice Hopkins (August 2005). "US group lobbies UN to outlaw male circumcision". British Medical Journal 331 (7514): 422. doi:10.1136/bmj.331.7514.422-b. 
  85. Rennie S, Muula AS, Westreich D (June 2007). "Male circumcision and HIV prevention: ethical, medical and public health tradeoffs in low-income countries". Journal of Medical Ethics 33 (6): 357–61. doi:10.1136/jme.2006.019901. PMID 17526688. 
  86. 86,0 86,1 Fetus and Newborn Committee (March 1996). "Neonatal circumcision revisited". Canadian Medical Association Journal 154 (6): 769–780. http://www.cps.ca/english/statements/FN/fn96-01.htm. Retrieved 2006-07-02.  "We undertook this literature review to consider whether the CPS should change its position on routine neonatal circumcision from that stated in 1982. The review led us to conclude the following. There is evidence that circumcision results in an approximately 12-fold reduction in the incidence of UTI during infancy. The overall incidence of UTI in male infants appears to be 1% to 2%. The incidence rate of the complications of circumcision reported in published articles varies, but it is generally in the order of 0.2% to 2%. Most complications are minor, but occasionally serious complications occur. There is a need for good epidemiological data on the incidence of the surgical complications of circumcision, of the later complications of circumcision and of problems associated with lack of circumcision. Evaluation of alternative methods of preventing UTI in infancy is required. More information on the effect of simple hygienic interventions is needed. Information is required on the incidence of circumcision that is truly needed in later childhood. There is evidence that circumcision results in a reduction in the incidence of penile cancer and of HIV transmission. However, there is inadequate information to recommend circumcision as a public health measure to prevent these diseases. When circumcision is performed, appropriate attention needs to be paid to pain relief. The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns. There is therefore no indication that the position taken by the CPS in 1982 should be changed. When parents are making a decision about circumcision, they should be advised of the present state of medical knowledge about its benefits and harms. Their decision may ultimately be based on personal, religious or cultural factors."
  87. 87,0 87,1 87,2 87,3 Medical Ethics Committee (June 2006). "The law and ethics of male circumcision – guidance for doctors". British Medical Association. http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp. Retrieved 2006-07-01. 
  88. "Information Package on Male Circumcision and HIV Prevention" (PDF). http://data.unaids.org/pub/InformationNote/2007/mc_briefing_pack1_en.pdf. 
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  91. Benatar, David; Benatar, Michael (2003). "How not to argue about circumcision" (PDF). American Journal of Bioethics 3 (2): W1–W9. doi:10.1162/152651603102387820. http://bioethics.net/journal/pdf/3_2_LT_w01_Benetar.pdf. 
  92. Williams, R. M. (2003-01). "On the Tail-Docking of Pigs, Human Circumcision, and their Implications for Prevailing Opinion Regarding Pain". Journal of Applied Philosophy 20 (1): 89–93. doi:10.1111/1468-5930.00237. http://www.blackwell-synergy.com/doi/abs/10.1111/1468-5930.00237. Retrieved 2008-06-24. 
  93. Goldman, R. (January 1999). "The psychological impact of circumcision" (PDF). BJU International 83 (S1): 93–102. doi:10.1046/j.1464-410x.1999.0830s1093.x. http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1093.x. Retrieved 2006-07-02. 
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  95. Moses, S; Bailey, RC; Ronald AR (1998). "Male circumcision: assessment of health benefits and risks". Sex Transm Infect 74: 368–73. doi:10.1136/sti.74.5.368. 
  96. Gerharz EW, Haarmann C (August 2000). "The first cut is the deepest? Medicolegal aspects of male circumcision". BJU Int. 86 (3): 332–8. doi:10.1046/j.1464-410x.2000.00103.x. PMID 10930942. 
  97. Boyle, G; Goldman, R; Svoboda, JS; Fernandez E (2002). "Male Circumcision: Pain, Trauma and Psychosexual Sequelae". Journal of Health Psychology 7 (3): 329–343. 
  98. Hirji, H; Charlton, R; Sarmah S (2005). "Male circumcision: a review of the evidence". Journal of men's health 2 (1): 21–30. http://www.journals.elsevierhealth.com/periodicals/jmhg/article/PIIS1571891305000105/abstract. 
  99. "Sweden restricts circumcisions". BBC Europe. October 1, 2001. http://news.bbc.co.uk/2/hi/europe/1572483.stm. Retrieved 2006-10-18. "Swedish Jews and Muslims object to the new law, saying it violates their religious rights." 
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  102. "Court rules circumcision of four-year-old boy illegal". HELSINGIN SANOMAT, INTERNATIONAL EDITION. 2006-08-07. http://www.hs.fi/english/article/Court+rules+circumcision+of+four-year-old+boy+illegal/1135220958830. Retrieved 2007-09-17. 
  103. Şablon hatası:başlık gerekiyor.
  104. "Finland Considers Legalising Male Circumcision". Ylesiradio. 2008-07-31. http://www.yle.fi/news/left/id97605.html. Retrieved 2008-08-05. 
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  106. Schoen, Edgar J.; Christopher J. Colby, Trinh T. To (March 2006). "Cost Analysis of Neonatal Circumcision in a Large Health Maintenance Organization" (Abstract). The Journal of Urology 175 (3): 1111–1115. doi:10.1016/S0022-5347(05)00399-X. PMID 16469634. http://www.jurology.com/article/PIIS002253470500399X/abstract. Retrieved 2006-07-01. 
  107. Alanis, Mark C.; Richard S. Lucidi (May 2004). "Neonatal Circumcision: A Review of the World’s Oldest and Most Controversial Operation" (Abstract). Obstetrical & Gynecological Survey 59 (5): 379–395. doi:10.1097/00006254-200405000-00026. PMID 15097799. http://www.obgynsurvey.com/pt/re/obgynsurv/abstract.00006254-200405000-00026.htm;jsessionid=FbJT6LYnQxr66KhvWNsBW0msy7shpJgL39wbFTGLnQpzJ82BGLVQ!1096339265!-949856144!8091!-1. Retrieved 2006-09-27. 
  108. Van Howe, Robert S. (November 2004). "A Cost-Utility Analysis of Neonatal Circumcision" (Abstract). Medical Decision Making 24 (6): 584–601. doi:10.1177/0272989X04271039. PMID 15534340. http://mdm.sagepub.com/cgi/content/abstract/24/6/584. Retrieved 2006-07-01. 
  109. Ganiats, TG; Humphrey JB, Taras HL, Kaplan RM. (Oct–December 1991). "Routine neonatal circumcision: a cost-utility analysis". Medical Decision Making 11 (4): 282–293. doi:10.1177/0272989X9101100406. PMID 1766331. 
  110. Lawler, FH; Bisonni RS, Holtgrave DR. (Nov–December 1991). "Circumcision: a decision analysis of its medical value.". Family Medicine 23 (8): 587–593. PMID 1794670. 
  111. 111,0 111,1 Taddio, Anna; Joel Katz, A Lane Ilersich, Gideon Koren (March 1997). "Effect of neonatal circumcision on pain response during subsequent routine vaccination" (PDF — free registration required). The Lancet 349 (9052): 599–603. doi:10.1016/S0140-6736(96)10316-0. http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673696103160.pdf. Retrieved 2007-08-08. 
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  113. 113,0 113,1 "Circumcision: Information for parents". Caring for kids. Canadian Paediatric Society. November 2004. http://www.cps.ca/caringforkids/pregnancy&babies/Circumcision.htm. Retrieved 2006-10-24. "Circumcision is a "non-therapeutic" procedure, which means it is not medically necessary. Parents who decide to circumcise their newborns often do so for religious, social, or cultural reasons. To help make the decision about circumcision, parents should have information about risks and benefits. It is helpful to speak with your baby’s doctor. After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions." 
  114. Stang, Howard J.; Leonard W. Snellman (June 1998). "Circumcision Practice Patterns in the United States" (PDF). Pediatrics 101 (6): e5–. doi:10.1542/peds.101.6.e5. Şablon:ISSN. http://pediatrics.aappublications.org/cgi/reprint/101/6/e5.pdf. Retrieved 2006-06-29. 
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  117. "Jews protest Swedish circumcision restriction". Reuters, June 7, 2001.
  118. Lander, J.; Brady-Fryer, B., Metcalfe, J.B., Nazarali, S. and S. Muttitt (1997). "Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision: a randomized controlled trial". JAMA 278 (24): 2157–2162. doi:10.1001/jama.278.24.2157. PMID 9417009. 
  119. 119,0 119,1 Brady-Fryer, B; Wiebe N, Lander JA (July 2004). "Pain relief for neonatal circumcision". The Cochrane Database of Systematic Reviews (3): Art. No.: CD004217. doi:10.1002/14651858.CD004217.pub2. PMID 15495086. 
  120. Lehr, V.T.; E. Cepeda, D.A. Frattarelli, R. Thomas, J. LaMothe and J.V. Aranda (2005). "Lidocaine 4% cream compared with lidocaine 2.5% and prilocaine 2.5% or dorsal penile block for circumcision". Am J Perinatol 22 (5): 231–237. doi:10.1055/s-2005-871655. PMID 16041631. 
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  123. Ng, WT; et al. (2001). "The use of topical lidocaine/prilocaine cream prior to childhood circumcision under local anesthesia". Ambul Surg 9 (1): 9–12. doi:10.1016/S0966-6532(00)00061-5. PMID 11179706. 
  124. Boyle, Gregory J; Svoboda, J Steven; Goldman, Ronald; Fernandez, Ephrem (2002). "Male circumcision: pain, trauma, and psychosexual sequelae". Bond University Faculty of Humanities and Social Sciences. http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1036&context=hss_pubs. 
  125. Payne, Kimberley; Lea Thaler, Tuuli Kukkonen, Serge Carrier, Yitzchak Binik (April 2007). "Sensation and Sexual Arousal in Circumcised and Uncircumcised Men". Journal of Sexual Medicine 4 (3): 667–674. doi:10.1111/j.1743-6109.2007.00471.x. PMID 17419812. http://www3.interscience.wiley.com/journal/118496134/abstract. Retrieved 2008-09-07. 
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  127. Krieger, JN; Mehta SD, Bailey RC, Agot K, Ndinya-Achola JO, Parker C, Moses S (August 2008). "Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya". The Journal of Sexual Medicine Epub ahead of print (11): 2610–22. doi:10.1111/j.1743-6109.2008.00979.x. PMID 18761593. 
  128. Fink, K.S.; C.C. Carson, R.S. DeVellis (May 2002). "Adult Circumcision Outcomes Study: Effect on Erectile Dysfunction, Penile Sensitivity, Sexual Activity and Satisfation". Journal of Urology 167 (5): 2113–2116. doi:10.1016/S0022-5347(05)65098-7. PMID 11956453. http://www.cirp.org/library/sex_function/fink1/. Retrieved 2008-06-28. 
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  132. Collins S, Upshaw J, Rutchik S, Ohannessian C, Ortenberg J, Albertsen P (2002). "Effects of circumcision on male sexual function: debunking a myth?". J Urol 167 (5): 2111–2. doi:10.1016/S0022-5347(05)65097-5. PMID 11956452. 
  133. Masood S, Patel H, Himpson R, Palmer J, Mufti G, Sheriff M (2005). "Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly?". Urol Int 75 (1): 62–6. doi:10.1159/000085930. PMID 16037710. 
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  135. 135,0 135,1 135,2 135,3 Kaplan, G.W. (August 1983). "Complications of Circumcision". Urologic Clinics of North America 10 (3): 543–549. PMID 6623741. http://www.cirp.org/library/complications/kaplan/. Retrieved 2006-09-29. 
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  146. Naimer, Sody A.; Roni Peleg, Yevgeni Meidvidovski, Alex Zvulunov, Arnon Dov Cohen, and Daniel Vardy (November 1, 2002). "Office Management of Penile Skin Bridges with Electrocautery" (PDF). Journal of the American Board of Family Practice 15 (6): 485–488. PMID 10605531. http://www.jabfm.org/cgi/reprint/15/6/485. Retrieved 2006-07-01. 
  147. Paediatric Death Review Committee: Office of the Chief Coroner of Ontario (April 2007). "Coroner's Corner Circumcision: A minor procedure?" (PDF). Paediatric Child Health Vol 12 No 4, April 2007 pages 311–312. Pulsus Group Inc.. http://www.pulsus.com/Paeds/12_04/Pdf/zwol_ed.pdf. Retrieved 2007-06-17. 
  148. 148,0 148,1 Gairdner D (December 1949). "The fate of the foreskin, a study of circumcision". British Medical Journal 2 (4642): 1433–7, illust. doi:10.1136/bmj.2.4642.1433. PMID 15408299. 
  149. "Complications Of Circumcision". Paediatric Policy – Circumcision. The Royal Australasian College of Physicians. October 2004. Archived from the original on 2007-01-11. http://web.archive.org/web/20070111015035/http://www.racp.edu.au/hpu/paed/circumcision/complications.htm. Retrieved 2006-07-11. 
  150. Szabo, R.; R.V. Short (June 2000). "How does male circumcision protect against HIV infection?". BMJ 320 (7249): 1592–1594. doi:10.1136/bmj.320.7249.1592. PMID 10845974. PMC 1127372. http://www.bmj.com/cgi/content/full/320/7249/1592?. 
  151. Van Howe, R.S. (January 1999). "Circumcision and HIV infection: review of the literature and meta-analysis". International Journal of STD's and AIDS 10: 8–16. doi:10.1258/0956462991913015. http://www.cirp.org/library/disease/HIV/vanhowe4/. Retrieved 2008-09-23. "Thirty-five articles and a number of abstracts have been published in the medical literature looking at the relationship between male circumcision and HIV infection. Study designs have included geographical analysis, studies of high-risk patients, partner studies and random population surveys. Most of the studies have been conducted in Africa. A meta-analysis was performed on the 29 published articles where data were available. When the raw data are combined, a man with a circumcised penis is at greater risk of acquiring and transmitting HIV than a man with a non-circumcised penis (odds ratio (OR)=1.06, 95% confidence interval (CI)=1.01-1.12). Based on the studies published to date, recommending routine circumcision as a prophylactic measure to prevent HIV infection in Africa, or elsewhere, is scientifically unfounded.". 
  152. O'Farrell N, Egger M (March 2000). "Circumcision in men and the prevention of HIV infection: a 'meta-analysis' revisited". International Journal of STD & AIDS 11 (3): 137–42. doi:10.1258/0956462001915480. PMID 10726934. http://ijsa.rsmjournals.com/cgi/pmidlookup?view=long&pmid=10726934. "The results from this re-analysis thus support the contention that male circumcision may offer protection against HIV infection, particularly in high-risk groups where genital ulcers and other STDs 'drive' the HIV epidemic. A systematic review is required to clarify this issue. Such a review should be based on an extensive search for relevant studies, published and unpublished, and should include a careful assessment of the design and methodological quality of studies. Much emphasis should be given to the exploration of possible sources of heterogeneity. In view of the continued high prevalence and incidence of HIV in many countries in sub-Saharan Africa, the question of whether circumcision could contribute to prevent infections is of great importance, and a sound systematic review of the available evidence should be performed without delay.". 
  153. Weiss HA, Quigley MA, Hayes RJ (October 2000). "Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis". AIDS 14 (15): 2361–70. doi:10.1097/00002030-200010200-00018. PMID 11089625. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0269-9370&volume=14&issue=15&spage=2361. "Male circumcision is associated with a significantly reduced risk of HIV infection among men in sub-Saharan Africa, particularly those at high risk of HIV. These results suggest that consideration should be given to the acceptability and feasibility of providing safe services for male circumcision as an additional HIV prevention strategy in areas of Africa where men are not traditionally circumcised.". 
  154. 154,0 154,1 Siegfried, N; M Muller, J Volmink, J Deeks, M Egger, N Low, H Weiss, S Walker, P Williamson (July 2003). "Male circumcision for prevention of heterosexual acquisition of HIV in men". Cochrane Database of Systematic Reviews (3). http://www.cirp.org/library/disease/HIV/cochrane2003/. Retrieved 2009-07-25. "We found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men. The results from existing observational studies show a strong epidemiological association between male circumcision and prevention of HIV, especially among high-risk groups. However, observational studies are inherently limited by confounding which is unlikely to be fully adjusted for. In the light of forthcoming results from RCTs, the value of IPD analysis of the included studies is doubtful. The results of these trials will need to be carefully considered before circumcision is implemented as a public health intervention for prevention of sexually transmitted ". 
  155. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A (November 2005). "Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial". PLoS Medicine 2 (11): e298. doi:10.1371/journal.pmed.0020298. PMID 16231970. "There were 20 HIV infections (incidence rate = 0.85 per 100 person-years) in the intervention group and 49 (2.1 per 100 person-years) in the control group, corresponding to an RR of 0.40 (95% CI: 0.24%-0.68%; p < 0.001). This RR corresponds to a protection of 60% (95% CI: 32%-76%).". 
  156. 156,0 156,1 Bailey RC, Moses S, Parker CB, et al. (February 2007). "Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial". Lancet 369 (9562): 643–56. doi:10.1016/S0140-6736(07)60312-2. PMID 17321310. "The two year HIV incidence was 2.1% (95% CI 1.2-3.0) in the circumcision group and 4.2% (3.0-5.4) in the control group (p=0.0065); the relative risk of HIV infection in circumcised men was 0.47 (0.28-0.78), which corresponds to a reduction in the risk of acquiring an HIV infection of 53% (22-72).". 
  157. Gray RH, Kigozi G, Serwadda D, et al. (February 2007). "Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial". Lancet 369 (9562): 657–66. doi:10.1016/S0140-6736(07)60313-4. PMID 17321311. "In the modified intention-to-treat analysis, HIV incidence over 24 months was 0.66 cases per 100 person-years in the intervention group and 1.33 cases per 100 person-years in the control group (estimated efficacy of intervention 51%, 95% CI 16-72; p=0.006). The as-treated efficacy was 55% (95% CI 22-75; p=0.002); efficacy from the Kaplan-Meier time-to-HIV-detection as-treated analysis was 60% (30-77; p=0.003).". 
  158. Siegfried N, Muller M, Deeks JJ, Volmink J (2009). "Male circumcision for prevention of heterosexual acquisition of HIV in men". Cochrane Database of Systematic Reviews (Online) (2): CD003362. doi:10.1002/14651858.CD003362.pub2. PMID 19370585. 
  159. Mills E, Cooper C, Anema A, Guyatt G (July 2008). "Male circumcision for the prevention of heterosexually acquired HIV infection: a meta-analysis of randomized trials involving 11,050 men". HIV Medicine 9 (6): 332–5. doi:10.1111/j.1468-1293.2008.00596.x. PMID 18705758. 
  160. "WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention". World Health Organisation. March 2007. http://www.who.int/hiv/mediacentre/news68/en/index.html. 
  161. Male Circumcision Clearinghouse Male Circumcision Clearinghouse
  162. AVAC About male circumcision
  163. Mcallister RG, Travis JW, Bollinger D, Rutiser C, Sundar V (Fall 2008). "The cost to circumcise Africa". International Journal of Men's Health (Men's Studies Press) 7 (3): 307–316. doi:10.3149/jmh.0703.307. http://www.thefreelibrary.com/The+cost+to+circumcise+Africa.-a0189486243. 
  164. Mills, J.; N. Siegfried (October 2006). "Cautious optimism for new HIV/AIDS prevention strategies.". Lancet 368 (9543): 1236. doi:10.1016/S0140-6736(06)69513-5. PMID 17027724. ""The inferences drawn from the only completed randomised controlled trial (RCT) of circumcision could be weak because the trial stopped early. In a systematic review of RCTs stopped early for benefit, such RCTs were found to overestimate treatment effects. When trials with events fewer than the median number (n=66) were compared with those with event numbers above the median, the odds ratio for a magnitude of effect greater than the median was 28 (95% CI 11--73). The circumcision trial recorded 69 events, and is therefore at risk of serious effect overestimation. We therefore advocate an impartial meta-analysis of individual patients' data from this and other trials underway before further feasibility studies are done.". 
  165. Dowsett, G.W.; M. Couch (May 2007). "Male circumcision and HIV prevention: is there really enough of the right kind of evidence?" (PDF). Reproductive Health Matters 15 (29): 33–44. doi:10.1016/S0968-8080(07)29302-4. PMID 17512372. http://download.journals.elsevierhealth.com/pdfs/journals/0968-8080/PIIS0968808007293024.pdf. 
  166. Wawer, Maria; et al. (18 July 2009). "Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial". Lancet 374 (9685): 229–237. doi:10.1016/S0140-6736(09)60998-3. PMID 19616720. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/fulltext. 
  167. Millett GA, Flores SA, Marks G, et al. (2008). "Circumcision Status and Risk of HIV and Sexually Transmitted Infections Among Men Who Have Sex With Men". JAMA 300 (14): 1674–1684. doi:10.1001/jama.300.14.1674. http://jama.ama-assn.org/cgi/content/short/300/14/1674. 
  168. Van Howe, Robert S. (May 2007). "Human papillomavirus and circumcision: A meta-analysis". Journal of Infection 54 (5): 490–496. doi:10.1016/j.jinf.2006.08.005. PMID 16997378. http://www.cirp.org/library/disease/cancer/vanhowe2006b/. Retrieved 2008-09-18. 
  169. 169,0 169,1 Bosch FX, Albero G, Castellsagué X (January 2009). "Male circumcision, human papillomavirus and cervical cancer: from evidence to intervention". J Fam Plann Reprod Health Care 35 (1): 5–7. doi:10.1783/147118909787072270. PMID 19126309. 
  170. 170,0 170,1 Tobian, Aaron; et al. (March 2009). "Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis". New England Journal of Medicine 360 (13): 1298–1309. doi:10.1056/NEJMoa0802556. PMID 19321868. PMC 2676895. http://content.nejm.org/cgi/content/short/360/13/1298. 
  171. Auvert, B.; J. Sobngwi-Tambekou, E. Cutler, M. Nieuwoudt, P. Lissouba, A. Puren, D. Taljaard (2009). "Effect of Male Circumcision on the Prevalence of High-Risk Human Papillomavirus in Young Men: Results of a Randomized Controlled Trial Conducted in Orange Farm, South Africa". Journal of Infectious Diseases 199 (1): 14–19. doi:10.1086/595566. PMID 19086814. http://www.journals.uchicago.edu/doi/pdf/10.1086/595566. Retrieved 2009-01-05. 
  172. Dinh, T.H.; M. Sternberg, E.F. Dunne and L.E. Markowitz (April 2008). "Genital Warts Among 18- to 59-Year-Olds in the United States, National Health and Nutrition Examination Survey, 1999-2004". Sexually Transmitted Diseases 35 (4): 357–360. doi:10.1097/OLQ.0b013e3181632d61. PMID 18360316. "The percentage of circumcised men reporting a diagnosis of genital warts was significantly higher than uncircumcised men, 4.5% (95% CI, 3.6%–5.6%) versus 2.4% (95% CI, 1.5%–4.0%)". 
  173. Cook LS, Koutsky LA, Holmes KK (August 1993). "Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic". Genitourinary Medicine 69 (4): 262–4. PMID 7721284. 
  174. Weiss HA, Thomas SL, Munabi SK, Hayes RJ (April 2006). "Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis". Sexually Transmitted Infections 82 (2): 101–9; discussion 110. doi:10.1136/sti.2005.017442. PMID 16581731. 
  175. Reynolds SJ, Shepherd ME, Risbud AR, et al. (March 2004). "Male circumcision and risk of HIV-1 and other sexually transmitted infections in India". Lancet 363 (9414): 1039–40. doi:10.1016/S0140-6736(04)15840-6. PMID 15051285. 
  176. Turner AN, Morrison CS, Padian NS, et al. (July 2008). "Male circumcision and women's risk of incident chlamydial, gonococcal, and trichomonal infections". Sexually Transmitted Diseases 35 (7): 689–95. doi:10.1097/OLQ.0b013e31816b1fcc. PMID 18418300. 
  177. Leber, Mark J.; Anuritha Tirumani (June 8, 2006). "Balanitis". EMedicine. http://www.emedicine.com/derm/topic615.htm. Retrieved 2008-10-14. 
  178. Osipov, Vladimir O.; Scott M. Acker (November 14, 2006). "Balanoposthitis". Reactive and Inflammatory Dermatoses. EMedicine. http://www.emedicine.com/derm/topic615.htm. Retrieved 2006-11-20. 
  179. Escala, JM; AMK Rickwood (March 1988). "Balanitis". British journal of urology 63 (2): 196–197. doi:10.1111/j.1464-410X.1989.tb05164.x. PMID 2702407. http://www.cirp.org/library/disease/balanitis/escala1/. Retrieved 2008-10-14. 
  180. Fergusson, DM; JM Lawton and FT Shannon (April 1988). "Neonatal circumcision and penile problems: an 8-year longitudinal study". Pediatrics 81 (4): 537–541. PMID 3353186. http://www.circs.org/library/fergusson/index.html. Retrieved 2007-07-18. 
  181. Herzog, LW; SR Alvarez (March 1986). "The frequency of foreskin problems in uncircumcised children". Am J Dis Child 140 (3): 254–6. PMID 3946358. http://www.circs.org/library/herzog/index.html. 
  182. Fakjian, N; S Hunter, GW Cole and J Miller (August 1990). "An argument for circumcision. Prevention of balanitis in the adult". Arch Dermatol 126 (8): 1046–7. doi:10.1001/archderm.126.8.1046. PMID 2383029. 
  183. O’Farrel, Nigel; Maria Quigley and Paul Fox (August 2005). "Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study" (Abstract). International Journal of STD & AIDS 16 (8): 556–588(4). doi:10.1258/0956462054679151. PMID 16105191. http://ijsa.rsmjournals.com/cgi/content/abstract/16/8/556. Retrieved 2008-09-06. "Overall, circumcised men were less likely to be diagnosed with a STI/balanitis (51% and 35%, P = 0.021) than those non-circumcised.". {verify source}
  184. Van Howe, RS (May 2007). "Neonatal Circumcision and Penile Inflammation in Young Boys". Clinical Pediatrics 46 (4): 329–333. doi:10.1177/0009922806295708. PMID 17475991. http://cpj.sagepub.com/cgi/content/abstract/46/4/329. "Penile inflammation was more common in circumcised than noncircumcised boys, especially in the first 3 years of life (exact odds ratio, 8.01, 95% confidence interval, 31-329.15). When adjusted for the number of genital examinations and age younger than 3 years, exact logistic regression found an adjusted exact odds ratio of 7.91 (95% confidence interval, 1.76-77.66).". 
  185. Rickwood AM, Walker J (September 1989). "Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence?". Annals of the Royal College of Surgeons of England 71 (5): 275–7. PMID 2802472. 
  186. Shankar KR, Rickwood AM (July 1999). "The incidence of phimosis in boys". BJU International 84 (1): 101–2. doi:10.1046/j.1464-410x.1999.00147.x. PMID 10444134. 
  187. Oster J (April 1968). "Further fate of the foreskin. Incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys". Archives of Disease in Childhood 43 (228): 200–3. doi:10.1136/adc.43.228.200. PMID 5689532. 
  188. Metcalfe, Thomas J.; Lucy M. Osborn, E. Mark Mariani (August 1983). "Circumcision: A Study of Current Practices". Clinical Pediatrics 22 (8): 575–579. doi:10.1177/000992288302200811. PMID 6861426. http://www.cirp.org/library/procedure/metcalf/. 
  189. Van Howe RS (October 1998). "Cost-effective treatment of phimosis". Pediatrics 102 (4): E43. doi:10.1542/peds.102.4.e43. PMID 9755280. "The argument that circumcision is a minor surgical procedure without complications is not only erroneous, but also irrelevant. It is ethically as well as economically questionable to operate on a child to treat a physiological process". 
  190. Singh-Grewal D, Macdessi J, Craig J (August 2005). "Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies". Archives of Disease in Childhood 90 (8): 853–8. doi:10.1136/adc.2004.049353. PMID 15890696. "Circumcision was associated with a significantly reduced risk of UTI (OR = 0.13; 95% CI, 0.08 to 0.20; p<0.001) with the same odds ratio (0.13) for all three types of study design.". 
  191. "Can Penile Cancer be Prevented?". http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_penile_cancer_be_prevented_35.asp. 
  192. Maden, C; et al. (January 1993). "History of circumcision, medical conditions, and sexual activity and risk of penile cancer". J Natl Cancer Inst 85 (1): 19–24. doi:10.1093/jnci/85.1.19. PMID 8380060. 
  193. Schoen, EJ; Oehrli, M; Colby, C; Machin, G (March 2000). "The highly protective effect of newborn circumcision against invasive penile cancer". Pediatrics 105 (3): e36. doi:10.1542/peds.105.3.e36. PMID 10699138. http://pediatrics.aappublications.org/cgi/content/full/105/3/e36. 
  194. "Current College Position on Circumcision". Royal Australasian College of Physicians. 27 August 2009. http://racp.edu.au/download.cfm?DownloadFile=59AE2C7C-9F08-B344-21061157DF3636B9. 
  195. Şablon hatası:başlık gerekiyor.
  196. "Circumcision: Position Paper on Neonatal Circumcision". American Academy of Family Physicians. 2007. http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html. Retrieved 2007-01-30. "Considerable controversy surrounds neonatal circumcision. Putative indications for neonatal circumcision have included preventing UTIs and their sequelae, preventing the contraction of STDs including HIV, and preventing penile cancer as well as other reasons for adult circumcision. Circumcision is not without risks. Bleeding, infection, and failure to remove enough foreskin occur in less than 1% of circumcisions. Evidence-based complications from circumcision include pain, bruising, and meatitis. More serious complications have also occurred. Although numerous studies have been conducted to evaluate these postulates, only a few used the quality of methodology necessary to consider the results as high level evidence.

    The evidence indicates that neonatal circumcision prevents UTIs in the first year of life with an absolute risk reduction of about 1% and prevents the development of penile cancer with an absolute risk reduction of less than 0.2%. The evidence suggests that circumcision reduces the rate of acquiring an STD, but careful sexual practices and hygiene may be as effective. Circumcision appears to decrease the transmission of HIV in underdeveloped areas where the virus is highly prevalent. No study has systematically evaluated the utility of routine neonatal circumcision for preventing all medically-indicated circumcisions in later life. Evidence regarding the association between cervical cancer and a woman’s partner being circumcised or uncircumcised, and evidence regarding the effect of circumcision on sexual functioning is inconclusive. If the decision is made to circumcise, anesthesia should be used.

    The American Academy of Family Physicians recommends physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering this procedure for their newborn son.
    "
     
  197. American Urological Association. "Circumcision". http://www.auanet.org/content/guidelines-and-quality-care/policy-statements/c/circumcision.cfm. Retrieved 2008-11-02. 

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Sünnet

Bu bölümün tarafsızlığı tartışmalı olduğunu. Lütfen tartışma sayfasında üzerinde tartışma bkz. Lütfen bu iletiyi kadar anlaşmazlığı giderildi. (Aralık 2009) çıkarmayın Bu yazı hakkında erkek sünnet. Kadın sünneti için, Erkek genital kesme bkz. İslam'ın sünnet ritüel için) Khitan (sünnet bkz. Yahudilik's sünnet ritüel için, Brit milah bkz. Erken Hıristiyanlık içinde tartışma için erken Hıristiyanlığa Sünnet tartışmalara bakın.


Sünnet Orta Asya, (çoğu Türkmenistan,) c. olasılıkla gerçekleştirildiğini 1865-1872. Restore albumen baskı. Erkek sünnetinin bazı veya tüm sünnet derisi penis dan (sünnet derisi) of kaldırılmasıdır. [1] kelimesi "sünnet" (yani "ne var") Latince durumlar gelir ve cædere (anlamı "kesmek"). Ancak bazı resimler yoruma açık sünnet erken tasvirleri mağara resimleri ve Antik Mısır mezar içinde, bulunmaktadır. [2] [3] [4] Din erkek sünnetinin Tanrı Yahudilik içinde gelen bir emir olarak kabul edilir. [5] İslam içinde, ama Kur'an ele değil, erkek sünnetinin yaygın ve uygulanmaktadır çoğunlukla bir sünneti olarak kabul. [6] Ayrıca Afrika bazı Hıristiyan kiliselerinde, bazı Doğu Ortodoks Kiliseleri gibi alışılmış bir. [7] Dünya Sağlık göre Örgütü (DSÖ), küresel tahminlerine göre erkeklerin% 30, kimi% 68 Müslüman vardır. sünnet edilmektedirler [8] sünnetinin yaygınlık çoğunlukla dini eğilimleri, ve bazen kültür değişir öneririz. En sünnet kültürel veya dini nedenlerle ergenlik döneminde gerçekleştirilir; [9] daha yaygın bebeklik döneminde gerçekleştirilen bazı ülkelerde. [8] Orada tartışmalara sünnet ile ilgili olduğunu. Sünnetin bir savunucusu, örneğin, bunun, bu risklerden daha fazla önemli sağlık avantajlar sağlamaktadır cinsel fonksiyon üzerinde önemli etkileri vardır, savunuyor düşük komplikasyon oranı zaman deneyimli bir doktor tarafından gerçekleştirildiği, ve en iyi yenidoğan dönemi sırasında yapılır. [sünnetinin 10] İki muhalifleri, örneğin, bu olumsuz, penis işlev ve cinsel zevk etkiler tıbbi mitler tarafından haklı olduğunu, çok acı verici olduğunu ve kadın genital kesim ile karşılaştırılabilecek savunuyorlar. [11] Amerikan Tıp Birliği 1999 yılında belirtilen "özel toplumlar ve tıp kuruluşları tarafından rutin yenidoğan sünneti önermiyoruz hemen hemen tüm güncel politika tablolar ve velilere seçtikleri bilgilendirmek doğru ve tarafsız bilgi destek sağlanması." [12] Dünya Sağlık Örgütü (WHO, 2007), Birleşmiş Milletler Ortak Programı, HIV / AIDS (UNAIDS; 2007) ve Hastalık Kontrol ve Önleme (CDC; 2008) devlet için bu kanıt önemli HIV riskini azaltır erkek sünnetinin gösterir penil-vajinal cinsel ilişki sırasında erkek tarafından satın alınması, aynı zamanda devlet sünnetin sadece minimum koruma sağlar HIV iletimi önlemek için başka müdahaleler yerini gerekir. [13] [14] Içeriği [hide] 1 Tarihçe 1,1 Origins 1,2 Sigara İngilizce konuşulan dünya dini sünnet 2 Kültürler ve dinler 3 Prevalans 4: Modern sünnet işlemleri 5 Etik, psikolojik ve yasal etkenler 5,1 etik sorunlar 5.1.1 Onay Acı 5.1.2 Alındı 5,2 Psikolojik ve duygusal sonuçları 5,3 Yasal konular 6 Tıbbi yönleri 6,1 Ağrı ve ağrı kesici 6,2 Cinsel etkileri 6,3 Komplikasyonlar 6,4 Cinsel yolla bulaşan hastalıklar 6.4.1 İnsan Bağışıklık 6.4.2 İnsan Papilloma virüsü 6.4.3 diğer cinsel yolla bulaşan enfeksiyonlar 6,5 Hijyen ve bulaşıcı ve kronik 6.5.1 İdrar yolu enfeksiyonları 6,6 Penis kanseri Çeşitli ulusal tıbbi derneklerin 7 Politikaları 7,1 Avustralasya 7,2 Kanada 7,3 İngiltere 7,4 Amerika Birleşik Devletleri 8 Ayrıca bakınız 9 Ayrıca okuma 10 Notlar ve referanslar 11 Dış bağlantılar 11,1 Sünnet muhalefet 11,2 Sünnet promosyon 11,3 Sünnet teknikleri ve videolar [Değiştir] Tarihçe

Ana madde: erkek sünnetinin Tarihi [Değiştir] Kaynak


Eski Mısır, Tapınağı Khonspekhrod of iç kuzey duvarından Semt Mut, Luxor, Mısır ile de. Onsekizinci hanedanı, Amenhotep III, c. sünnetinin sahne oyulmuş 1.360 M.Ö.. Bu çeşitli sünnetin dini bir kurban, bereket sağlamak için bir teklif olarak başladı ileri sürülmektedir, aşağılayıcı düşman ve köleler, aracı [15 olarak aşiret işareti geçiş bir ayin, bir girişim erkeklik vurgulamak için,] veya hijyenik olarak ölçmek. [16] [15] Darby bu teorileri "çelişkili ve devletler açıklanır çeşitli teorilerin savunucuları arasında anlaşmanın" tek nokta, teşvik sağlık onunla ilgisi olduğu. "[15] Immerman et ark. sünnetin, tüylü erkeklerin cinsel uyarılma indirdi nedenleri ve hipotez bu kabileler sünnet pratik bir rekabet avantajı olduğunu, onun yayılmaya bakılmaksızın kişi bunu anladı lider öneririz. [17] Bu sünnet bağımsız farklı doğdu mümkündür Farklı nedenlerden dolayı kültürler. Sünnet için en eski belge eski Mısır geliyor. [18] Sünnet yaygın olarak, her ne kadar, antik Semitik halklar arasında. [19] Alexander ve fetihler Büyük sonrasında Ancak yılında, sünnet Yunan antipati (bunlar kabul evrensel değil gerçekten "çıplak" yalnızca onun sünnet derisi geri çektiği olduğu gibi bir adam) daha önce o vardı uygulanan birçok halklar arasındaki insidansı bir düşüşe yol açtı. [20] Sünnet alt çeşitli etnik gruplar-ekvator Afrika arasında ve antik kökleri vardır hala ergen çocuklar üzerinde savaşçı durum veya erişkin kendi geçiş sembolize yapılır. [21] [Değiştir] Sigara dini sünnet İngilizce konuşan dünyada Bebek sünnet Amerika Birleşik Devletleri, Avustralya ve Türkiye daha az bir ölçüde Türkiye, Güney Afrika, Yeni Zelanda ve bir İngilizce konuşulan kesimlerinde kadar alınmıştır. Orada neden bebek sünnet Birleşik Devletleri'nde yılda yaklaşık 1.900 kabul edildi açıklamak için çeşitli hipotezler vardır. Hastalığın mikrop teorisi, kamu "fobisi" mikrop ve kir ve vücut salgıları şüpheli hale çok tehlikeli mikroplar için bir iletim olarak insan vücudunun bir görüntü elicited. Penis "kendi fonksiyonu ile dernek tarafından, kirli oldu ve bu öncül sünnet gelen önleyici ilaç olarak görülmüştür evrensel olarak uygulanmaktadır gerekir. [22] anda birçok uygulayıcılar görünümünde, sünnet tedavi ve mastürbasyon önleyen bir yöntem oldu. [22] Aggleton ki John Harvey Kellogg bu şekilde, ve erkek sünnetinin incelendi daha fazla "bir unashamedly cezalandırıcı yaklaşımı savunuyordu yazdı." [23] Sünnet de frengi karşı, korumak için söylenir [24] Fimozis, Parafimoz, balanit ve "aşırı venery "(bu) felç üretmek inanılırdı. [22] Gollaher devletler olarak hekimlerin on dokuzuncu yüzyılın kamu şüphe beklenen, sünnet savunan ve rafine kendi argümanlarını bunu aşmak için. [22] Rağmen tarihsel sünnet oranlarını belirlemek zordur, Amerika Birleşik Devletleri bebek sünnet oranları bir tahmin, yeni doğmuş Amerikan erkek çocukların% 32 1933 yılında sünnet ediliyordu tutar. [25] Laumann ve ark. Bildirdiğine göre arasında sünnetinin yaygınlık ABD - doğan erkeklerin yaklaşık% 70,% 80,% 85, ve bu 1945, 1955, 1965 doğumlu için% 77, ve 1.971 olarak bulundu. [25] Xu ve ark. o arasında sünnetinin yaygınlık ABD doğumlu erkeklerde 91 olduğunu bildirdiler Bu 1980'li yıllarda doğan erkek 1970'lerde doğan ve 84% için%. [26] 1981 ve 1999 tarihleri arasında, Ulusal Sağlık İstatistikleri Merkezi için ulusal Hastanesi Tahliye Araştırması verileri bu bebek sünnet oranı nispeten% 60 içinde sabit kalmıştır gösterdi 1988 yılında 60,7% minimum 1995 yılında% 67.8 ile en fazla aralığı. [27] bir çalışmada 1.987 ABD veliler sünnet seçmek en önemli nedeni "eş tutumları konusunda endişeleriniz ve oğulları 'benlik kavramı vardı bulundu Gelecekte, tıbbi kaygıları "değil. [28] Ancak, daha sonraki bir çalışmada yenidoğan sünnetinin potansiyel yararları artmış bir tanıma olarak 1988 ile 2000 yılları arasında ABD oranında gözlemlenen artış sorumlu olabileceği ileri sürüldü. [29] A Ajans Sağlık Araştırma ve Kalite tarafından rapor% 56 de 2005 ulusal sünnet oranı yerleştirilir. [30] 1949 yılında, Birleşik Krallık yeni's-örtülü hizmetleri kendi listesinden bebek sünnet kaldırılmış Ulusal Sağlık Servisi oluşan ve sünnet beri bir dışı olmuştur-velilere cep maliyet. Erkekler arasında () kim ne Yahudiler ne de Müslümanlar, İngiltere'de sünnetinin genel prevalansı olan% 6'dır WHO's tahminlere göre 15 yıl veya üzeri. [8] zaman gelen "veri siyah Karayipler, bir oversampling hedefli, Afrika Hindistan siyah , ve Pakistanlı gruplar (Natsal etnik azınlık artırma) ana [Natsal II] anket verileri ", o İngiltere'de sünnetinin yaygınlık yaş nedir, bu 16-19 yaş arası% 11.7 ile kademeli bulundu ile kombine edilmiştir ve bu yıl 40-44 yaşları arasındaki% 19.6 sünnet. [31] Bu açık bir etnik bölünme var: "siyah Caribbeans hariç, tüm azınlık etnik kökenden gelen insanları)] daha fazla rapor olasılığı belirgin [(3,02 zamanlardı sünnet olmak kim beyaz olarak kendi etnik açıklanan erkeklere "karşılaştırıldı. Bu tip özel bulgular "İngiliz erkekler arasında erkek sünnetinin yaygınlık azalan gibi görünen onaylayın. Bu İngiliz nüfus nonwhite"; gerçekten, yeni doğan bebeklerde sünnet İngiltere ve Galler oranına sahiptir olarak kendi etnik tarif oranında bir artış rağmen daha az bir yüzde düşmüş. Sünnet oranı keskin Avustralya 1970'lerden beri bir yaşa kademeli düşüş yaygınlığındaki giden bir 2.000-01 anket bu 16-19 yaş arası sünnet, 20-29 yıl ve% 64 oranı% 50% 32 bulmakta reddetti o 30-39 yaş arası için. [32] [33] Kanada, İstanbul sağlık hizmetleri 1994 yılında sünnet delisted. [34] [Değiştir] Kültürler ve dinler


Aile sünnet set ve gövde, ca. On sekizinci yüzyıl Ahşap kutusunda inek gümüş ile kaplı gizlemek uygular: gümüş tepsiler, klip, pointer, gümüş şişesi, baharat gemi.


Yahudi sünnet


Sultan III üç oğullarının sünnet töreni Illustrated hesap. Dini erkek sünnetinin Khitan (sünnet) de Brit milah Sünnet tartışmalara bak Bazı kültürde, erkek doğumdan kısa süre sonra, çocukluk döneminde, sünnet olmalı ya da ergenlik civarında geçiş bir ayin bir parçası olarak. Sünnet yaygın Yahudi ve İslami inanç içinde uygulanmaktadır. Yahudi hukuku devletler sünnetin bir 'mitzva aseh ( "olumlu emir" eylemi gerçekleştirmek için) olduğu ve Yahudi için zorunludur-erkek doğan ve olmayan sünnet-Yahudi erkek dönüştürür. Sadece ertelendiği ya da ölüm veya çocuğun sağlığına tehdit durumunda kaldırıldı. [35] Genellikle sekizinci gününde bir karmaşa tarafından bir törenle doğumdan sonra yapılır (veya Bris milah, colloquially sadece bir Brit milah denir hangi "anlamına bris), Sözleşmenin sünnetinin İbranice" de. Böyle önemli bir Yahudi erkek sünnetsiz bazı Ortodoks toplulukların bu vücut bazen mezar önce sünnet olacak sayılır. [36] 19. yüzyıl Reformu liderleri "barbarca" olarak, sünnetinin uygulama "olarak nitelendirdi rağmen merkezi bir ayin" olarak kaldı [37] ve Birliği Reform Yahudilik için, 1984 yılından beri sahip eğitimli ve 300 üzerinden didinmek uygulayarak fatura onun "Berit Mila Programı". [38 altında] Hümanist Yahudilik bu "sünnet savunuyor Yahudi kimliği için gerekli değildir." [39] Islam yılında, sünnet, bazı hadislerde de (o Khitan olarak) denir, ama Kuran'da da belirtilir. Bazı Fıkıh akademisyenler Devlet, sünnet (Sünnet) tavsiye edilir, diğerleri bu zorunludur. [40] Bazıları sünnet ihtiyacı İbrahim ile söz dayanan iddia hadis alıntı var. [41] iken erkeklerde sünnet onaylayarak, İslam alimlerinin bu İslam'a dönüştürmek için bir gereklilik değildir. [42] Katolik Kilisesi bir ölümcül günah olarak sünnet gözetilmesi kınadı ve uygulamaya karşı Ekümenik Konseyi Basel sipariş-Floransa 1442. [43] Sünnet Koptik, Etiyopya arasında, alışılmış olan ve Eritre Ortodoks Kiliseleri ve diğer bazı Afrika kiliseleri. [7] Güney Afrika bazı Hıristiyan kilise, pagan bir ritüel olarak inceleyen, sünnet karşı çıkarken Kenya Nomiya kilise dahil diğerleri, [7] [44] üyelik için sünnet gerektirir. Bazı Hıristiyan kiliseleri İsa Sünnet kutlamak. [45] [46] Hıristiyanların büyük çoğunluğu dini bir gereklilik olarak sünnet pratik değildir. Sünnet Güney Kore'de büyük ölçüde Kore Savaşı aşağıdaki Amerikan kültürel ve askeri etkisinin sonucudur. Batı Afrika çocuk sünnet olarak geçmişte geçit bir ayin ya da başka türlü aşiret öneme sahip olabilir; bugün bazı olmayan-o medicalised ve sadece kültürel bir norm haline Müslüman Nijeryalı toplumların. [47] Sünnet bazı yılında başlatılması mezhepler bir parçasıdır Afrika, Pasifik Adalı, ve Avustralya Aborijin gelenekleri alanlarda Arnhem Land, gibi [48] burada pratik Makassan tüccarlar tarafından Sulawesi dan Endonezya Takımadaları yılında tanıştı. [49] belirli Avustralya Aborijin toplumlar arasında Sünnet törenleri onların ağrılı doğaya belirtilmiştir : subincision Batı Çölü'nde bazı yerli halklar arasında uygulanmaktadır. [50] Pasifik, sünnet veya superincision yılında yaklaşık Melanesians Fiji ve Vanuatu, arasında evrenseldir [51] ise Pentecost Adası üzerinde geleneksel arazi dalış katılım olanların sünnet edilmiş için ayrılmıştır. [52] Sünnet veya superincision de yaygın uygulanıyor Samoa, Tonga, Niue ve Tikopia, burada özel bir pre-Christian/colonial pratik olarak kaydedilir ve Polinezya adalarına da. Samoa yılında bir kutlama eşlik eder. Bazı Batı Afrika grupları arasında, Dogon ve Dowayo, sünnet gibi erkek kadınsı "yönlerini" bir kaldırma temsil etmek, tamamen eril erkek çocuklar dönüm içine alınır. [53] Urhobo güney Nijerya arasında bir sembolik bir mertlik içine giren çocuk. Ritüel ifade, Omo te Oshare ( "çocuk şimdi adam"), bir yaş başka ayarlamak dan geçiş bir tören olduğunu oluşturmaktadır. [54] Sudan dillerine ait halklar için, Kalenjin ve Maasai, sünnet gibi geçiş bir ayin görülmektedir Her birkaç yıl erkek bir dizi topluca ve erkekler aynı zamanda sünnet tek bir yaş kümesinin üye alınır. [55] [Değiştir] Prevalans

Ana madde: sünnet yaygınlık


Harita Birleşmiş Milletler tarafından yayınlanan (DSÖ / UNAIDS), bir ülke düzeyinde sünnet olan erkek yüzdesi gösteriliyor. Veri ÖLÇÜ DHS tarafından sağlanan oldu [2] ve diğer kaynaklar. [3] Erkeklerin oran Tahminlere göre dünya çapında bir altıncı [56], üçüncü değişir sünnet edilmektedirler. [57] DSÖ tahmin ediyor ki 664.500.000 erkek, neredeyse 70% ile 15 ve üzeri (30% küresel yaygınlık) sünnet olan yaşlı Bu Müslüman olmak. [8] Sünnet en Müslüman dünya içinde, Güney Doğu Asya, Afrika, Amerika Birleşik Devletleri, Türkiye, İsrail ve Güney Kore parçaları yaygındır. Nispeten Avrupa, Latin Amerika, Güney Afrika ve parçaları içinde ve nadir Asya ve Okyanusya çoğu. Yaygınlık yakınında evrensel Orta Doğu ve Orta Asya'da. [8] WHO devletlerin "orada genellikle küçük olmayan Asya'da dini sünnet, Güney Kore ve Filipinler of istisnalar dışında" dır. [8] DSÖ hangi düzeyde genellikle Avrupa (<% 20), karşısında [8] ve Klavs ark rapor bulgular "kavramını da yaygınlık Avrupa düşük olan destek düşük tahmin yaygınlık haritası sunuyor. [58] Latin Amerika'da , yaygınlık evrensel düşük. [tek tek ülkeler için 59] Tahminler, Kolombiya [60] ve Danimarka [61] az% 2, Finlandiya [62] ve Brezilya [60]% 7, Tayvan [63] 9 İspanya [60] içerir %, Tayland [60]% 13 ve Avustralya [33] 58,7%. DSÖ Amerika Birleşik Devletleri ve Kanada'da% 30 ve% 75 olarak, sırasıyla yaygınlık tahminleri. [8] Prevalans Afrika'da% 20'den az bazı güney Afrika ülkelerinde Kuzey ve Batı evrensel yakın Afrika değişmektedir. [59] [Değiştir] Modern sünnet işlemleri

Bebek sünnet için, Circumstraint [64] gibi cihazlar, Gomco kelepçe, Plastibell ve Mogen kelepçe yaygındır. [65] Tüm bu cihazlar ile aynı temel prosedürü takip eder. Birincisi, sünnet derisi kaldırılacak miktarı tahmin edilmektedir. Sünnet derisi sonra Prepusyal ağız yoluyla altında glans ortaya çıkarmak için açılan ve normal olduğundan emin olun. Sünnet derisi (Prepusyal epitel) ve iç astar sonra açıkça onun eki glans için ayrılmıştır. Cihaz sonra yerleştirilir (bu bazen) sırt yarık gerektirir kadar kan akışını durdurdu orada kalır. Son olarak, sünnet derisi kesilmiş olduğunu. [66] Bazen, Frenulum grup kırık olması ya da ezilmiş ve üretra yakın korona gelen bu glans olmak özgürce ve tamamen maruz sağlamak için kesmek gerekebilir. [67] Plastibell ile bir kez glans glans üzerine yerleştirilir ve Plastibell serbest bırakılan sünnet derisi Plastibell üzerine yerleştirilir. Bir bağ sonra sünnet derisi etrafında sıkıca bağlanır ve Plastibell bir oluk içine hemostaz elde etmek için sıkılır. Sünnet derisi bağ distal eksize ve kolu Plastibell Cihazı kapatmak olduğunu ısırır. Sonra yara iyileşmiş olan Plastibell Penis itibaren, dört altı gün tipik olarak düşer. [68] Bir Gomco kelepçe ile, cildin bir bölümünde dorsally bir hemostat ile ve daha sonra makas ile yarık ezilmiş olduğunu. Sünnet derisi çan kelepçe bölümünü şeklinde ve üzerinde takılı kelepçe tabanında bir delikten çizilir. Konsol, "çan ve taban plaka arasında sünnet derisi ezme sıkılır." Ezilmiş kan damarları hemostaz sağlar. Çan alevlendi alt sıkı taban tabağın delik karşı, bu nedenle sünnet derisi uzakta taban plakası üzerinde bir cerrah bıçağı ile kesilebilir uyuyor. [69] Bir Mogen kelepçe ile sünnet derisi dorsally düz bir hemostat ile çekilir ve kaldırdı. Mogen kelepçe sonra glans ve hemostat arasında korona açısını aşağıdaki "ventral deri fazlalığı çıkarmadan önlemek ve kaydı olduğu Gomco veya Plastibell sünnet için üstün bir kozmetik sonuç" elde edilir. Konsol, ve kilitli bir skalpel düz (üst itibaren deri kesmek için kullanılır) kelepçe yan. [70] [71] Yetişkin sünnet çoğu kelepçeler olmadan gerçekleştirilir ve mastürbasyon veya cinsel gelen oruç 4-6 hafta gerektiren ameliyat sonrası yara iyileşmesi sağlamak için. [72] bazı Afrika ülkelerinde, erkek sünneti genellikle sigara tarafından yapılır-unsterile koşullarda sağlık personeli . [73] sonra hastanede sünnet, sünnet derisi biyomedikal araştırma, kullanılabilir [74] tüketici cilt bakım ürünleri, [75] deri grefti, [76] [77] [78] veya β-interferon bazlı ilaçlar. [ 79] Afrika bölümlerinde, sünnet derisi brendi bandırılmış olabilir ve hasta tarafından yemiş, sünnetçi veya hayvanlara beslenen tarafından yenir. [80] Yahudi kanunu göre, bir Brit milah sonra, sünnet derisi gömülü olmalıdır. [ 81] [Değiştir] Etik, psikolojik ve yasal etkenler

[Değiştir] etik sorunlar Etik sorular küçük Sağlıklı, işleyiş genital doku çıkarmadan üzerinde yükseltilmiş edilmiştir. Sünnet devlet karşıtları bu bebek sünnet bireysel özerklik ihlal eden ve bir insan hakları ihlali temsil eder. [82] [83] [84] Rennie ve ark. Unutmayın kullanarak sünnet yüksek yaygınlık yılında, düşük gelirli ülkelerde HIV önlemenin bir yolu olarak Sahra altı Afrika, tartışmalı ama iddia bu "ciddi bir en umut verici ve-ancak aynı zamanda HIV en tartışmalı yeni yaklaşımların önleme 25-salgın yıllık tarihinin dikkate değil" etik olur . [85] [Değiştir] Rıza


Rutin bebek sünnet karşı bir protesto. Ana madde: Etik sünnetinin Views olup sınırları bakıcılar çocuk sünnet olan yer almalıdır konusunda farklı. Bazı sağlık dernekler bu veliler ne bebek veya çocuk, [12] [66] [86] ama Mahmuzlu Royal College of Physicians (RACP) ve İngiliz Tıp Derneği (BMA) yararına olup olmadığını belirlemek gerekir pozisyon almak Bu tartışmalara dikkat bu konuda var. [16] [87] BMA Devlet, genel olarak, "anne-babalar çocuklarının çıkarlarını desteklemek için nasıl en iyi belirlemek gerektiğini ve toplumun sınırları ebeveyn seçimler ne empoze gerektiğine karar vermek bu. " Bunlar devlet, çünkü anne ve babanın ilgi ve çocuğun çıkarlarının bazen farklı ki, orada "veli hak ve seçmek anne tıbbi prosedürler aykırı çocuklarının çıkarlarını talep etme hakkına sahip değildir üzerinde sınırlamalar vardır." Onlar Devlet, yetkili çocukların kendileri için karar verebilir. [87] UNAIDS bu "[m] ale sünnet devletler erkekler ve genç erkekler onları serbest olanağı sağlamak amacıyla gerekli tüm bilgileri verilmektedir sağlamalıdır gönüllü bir cerrahi işlem ve sağlık personeli olduğunu ve ya veya karşı bilinçli seçimler sünnet alıyorum. "[88] Bazıları kendi riski sünnet tarafından azalttı sağlık sorunları zaten nadirdir, ve önlenebilir eğer ortaya, genellikle sünnet daha az invazif yöntemlerle tedavi edilebilir. Somerville devletler iddia bir küçük Sağlıklı genital doku kaldırma ebeveyn takdirine ve hekimlere olan prosedürü tabi olmamalıdır göre hastanın kendi etik görevleri ile hareket değildir. [82] Denniston devletlerin sünnet zararlı ve iddia kişinin rızası olmayan tedavi yokluğunda çocuk sünnet olan tıp yöneten birkaç etik ilkeleri ihlal eder. [89] Başkaları yenidoğan sünneti câiz olduğuna inanıyorum, eğer anne çok seçmelisiniz. Viens yani, kültürel veya dini bağlamda, sünnet önemli yeterli önemi olduğunu ebeveyn izni yeterli olduğunu savunuyor ve orada "yeterli delil veya ikna edici mevcut politikasını değiştiriyor desteklemek için bir yargılama olmadığı" dır. [90] Benatar ve Benatar iddia önce o başka türlü izin vermemiz mümkün olacağını sünnetin bir erkek, yani "o kadar da sünnet" ve cinsel zevki azaltır "bu kadar olmayan sünnetin bir gelecek kişinin seçenekleri açık bırakır net is from bariz is from yararlı olabilir Her konuda. "[91] [Değiştir] Alındı ağrısı Süre onların kuyrukları demirledi olan Williams (2003) Türcülük dayalı olmayabilir bu hayvanlar (insanlar da dahil ağrı doğru insan tutumlar) deneyimi, ağrı domuz karşı tutumları arasında bir benzeşim gelişmekte olan iddia ve ağrı "bizim kültürün ilgisizlik için dayanmak da erkek bebekler insan deneyimi sırasında sünnet olmak. "[92] [Değiştir] Psikolojik ve duygusal sonuçları British Medical Association (2006) devletler şu anda yaygın olarak dahil BMA tarafından kabul "olduğunu, bu cerrahi işlem tıbbi ve psikolojik riskler." [87] Milos ve Macris (1992), sünnet şiddet ile perinatal beyin kodlar iddia ve olumsuz anne-bebek bağı ve güven etkiler. [11] Goldman (1999) sünnet devlet üzerinde, bir eğilim travma tekrarlamak için çocuk ve anne babaya sünnet olası travma, kaygıları tartışıldı ve parçası bir ihtiyaç önerdi sünnet doktorlar prosedürü için tıbbi gerekçeler bulmak için. [93] Ayrıca, erkeklerin sünnet derisi restorasyon ve uygulama yoluyla sünnet etkilerini geri almak için çalışırken rapor edilmektedir. [94] Musa ve ark. '(1998) devlet Ancak, " bilimsel kanıt "psikolojik ve duygusal zarar için, bu gelişimsel ve davranışsal endeksi bir fark bulamadık uzunlamasına bir çalışmada gerekçe yoksundur. [95] Gerharz ve Haarmann (2000) tarafından bir literatür taraması benzer bir sonuca ulaştı. [96] Boyle et ark. (2002) Devlet, sünnet psikolojik zarar olarak, posta dahil olmak üzere neden olabilir-travmatik stres bozukluğu (TSSB), bir çalışma sonrasında filipino erkek arasında TSSB yüksek oranlar rapor gerekçe ya ritüel veya tıbbi sünnet. [97] Hirji ve ark. ( 2005) Devlet, [...] psikolojik travma "Raporlar çalışmalarda ama dışarı kaynaklı değildir endişe bir anekdot nedeni olarak kalır." [98] [Değiştir] Yasal sorunlar Ana madde: Sünnet ve hukuk 2001 yılında, İsveç veya anestezi hemşire ve anestezi sünnetçi eşlik etmek için önceden uygulanacak bir yasa sadece insanlar Ulusal Sağlık Kurulu tarafından bebekler sünnet için fatura izin veren bir tıp doktoru gerektiren geçti. Yahudiler ve Müslümanlar İsveç'te hukuk, itiraz [99] ve 2001 yılında, Dünya Yahudi Kongresi bu "Nazi döneminden bu yana Avrupa Yahudi dini uygulamalara ilk yasal kısıtlama olduğunu belirtti." [100] 2005 yılında, İsveççe National Board Sağlık ve Sosyal Yardım ve hukuk inceledim ve bunun sürdürülmesini tavsiye etti. 2006 yılında, İsveç tarihinde ABD Dışişleri Bakanlığı raporunda, çoğu Yahudi mohels yasa ve 3000 Müslüman ve Yahudi çocuklar 40-50 altında fatura edilmiş her yıl sünnet olduğunu belirtti. [101] 2006 yılında Finlandiyalı bir mahkeme yaşındaki oğlu onu 4 olan bir ebeveynin eylemleri sünnet yasadışı olarak bulundu. [102] Ancak, ceza mahkemesi tarafından atanan ve 2008 yılında Finnish Yüksek Mahkeme karar verdi ki anne eylemleri yaptı Eğer bir uygulayıcı olan 2008 yılında, Fin hükümetinin sünnet yasallaştırmak için yeni bir yasa düşünüldüğünde bildirildi değildir ve dini nedenler, ne zaman düzgün yapılan bir çocuk bu sünnet, suç teşkil suç değildir. [103] doktor, "veli isteklerine göre ve çocuğun rızası" ile olarak bildirdi. [104] 2007 itibariyle, Victoria, New South Wales, Batı Avustralya ve Tasmania Avustralya devletlerinin tüm kamu hastanelerinde olmayan pratik-terapötik erkek sünnetinin durmuştu. [105] [Değiştir] Tıp yönleri

Ana madde: sünnet Tıp analizi Tıbbi maliyet-değişken var sünnet analizleri yarar. Bazı sünneti küçük bir net parası bulundu, [106] [107] bazı küçük bir net azalma bulundu, [108] [109] ve bir o yararları ve riskleri birbirlerini dengeli ve bu kararın "en makul olabilir önerdi bulundu nonmedical faktörlere yaptı. "[110] [Değiştir] Ağrı ve ağrı kesici Amerikan Pediatri Akademisi '1.999 Sünnet Policy Statement of için, "Bu önemli kanıtlar yenidoğanlarda kim analjezi deneyim ağrı ve fizyolojik stres olmadan sünnet olmasıdır göre." [66] Bu nedenle sünnet için ağrı kesici kullanarak önerilir. [66] One of çalışmaları desteklemek, Taddio 1997, aşılama ay boyunca sonra sünnet ve ağrı yanıt yoğunluğu arasında bir korelasyon bulundu. [111] süre orada "diğer etkenleri" sünnet yanında ağrı yanıtı farklı düzeylerde hesaba olabilir kabul, onlar yaptılar belirtilen kanıtlarını bulamıyor gibi. Onlar "Tedavi öncesi ve neonatal sünnet postoperatif ağrı yönetimi sonucuna Bu sonuçlara göre önerilir." [111] de kanıt anestezi olmadan sünnet agrili cite Diğer tıbbi dernekler. [112] [113] Stang, 1998, doktor kim - en yaygın sırt penil sinir bloğu - bebek sünnet için kullanılan anestezi sünnet bir ankete yanıt% 45 bulundu. Örnek olarak kadın doğum uzmanları daha az aile hekimliği (56%) veya çocuk hekimleri (% 71) daha (25%) anestezi kullanılır. [114] Howard ve ark. (1998) ABD tıp doktoru ikamet programları ve yönetmenleri araştırılmış ve bulunan bu Bu "Sünnet işlemi" anestezi / analjezi işlemleri için talimat veremediklerini öğretti ve neonatal sünnet bu "ikamet eğitim önerilen ağrının teknikleri eğitimi içermelidir programların% 26". [115] A 2.006 follow-up study Bu programların yüzdesi öğretti sünnet ve ayrıca topikal veya lokal anestezik yönetimi öğretti% 97 yükseldi ortaya çıkardı. [116] Ancak, takip ve yazarlar çalışmada da bu programların sadece 84% anestezik "sıkça kullanılan kaydetti kadar veya her zaman "ne zaman işlem yapılmıştır. [116] Olarak orada muhtemelen Yenidoğanda hiçbir ihtiyacı hissediyorum Cam, 1999, Yahudi sünnet böylece "en rutin bir anestezi kullanmayın mohelim hızlı olduğunu belirtti." Cam, "Ancak, hiçbir Talmudic itiraz ve devam veliler lokal anestezi krem temenni gereken hiçbir neden bu yapılamaz olduğunu uygulanacak." Cam da büyük çocuklar ve yetişkinler, bir penil blok için kullanılan ifade. [35] 2001 yılında İsveç hükümeti bir yasa tüm çocuklar anestezi tıbbi bir profesyonel tarafından yönetilen verilecek bir bris geçiren gerektiren geçti. [117] Lander ve ark. O bebeklerin anestezi olmadan sünnet gösterdi ağrı ve sıkıntının davranışsal ve fizyolojik belirtileri gösterdi. [Dorsal penil sinir blok 118] karşılaştırma ve EMLA (lidokain / prilokain) ağrı kontrol topikal krem yöntemleri ise her ikisi de güvenli indirdik , [119] [120] dorsal sinir bloğu daha etkili topikal tedavi daha acı kontrolleri, [121] fakat ne yöntem tamamen ağrısız ortadan kaldırır. [119] Razmus ve ark. ki yeni doğanlarda sırt blok ile birlikte halka blok sünnet rapor konsantre sözlü sakaroz ile en düşük ağrı skorları vardı. [122] Ng ve ark. bulundu ki EMLA krem, lokal anestezi ek olarak, etkili keskin ağrı iğne ponksiyon indüklenen azaltır. [123] [Değiştir] Cinsel etkileri Ana madde: sünnet cinsel etkileri Sünnet cinsel etkileri çok tartışma tabidir. Amerikan Pediatri Akademisi (1999) ve "yetişkin erkek kendini kullanarak bir anket raporunda belirtilen daha çeşitli cinsel pratik ve daha az cinsel sünnet erişkin erkeklerde işlev bozukluğu göstermektedir. Bu anekdot raporları, penis hissi ve cinsel tatmin sünnetli erkeklerde azalma vardır." They continued, " Masters and Johnson noted no difference in exteroceptive and light tactile discrimination on the ventral or dorsal surfaces of the glans penis between circumcised and uncircumcised men." [ 66 ] Conversely a 2002 review by Boyle et al. stated that "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings—many of which are lost to circumcision, with an inevitable reduction in sexual sensation experienced by circumcised males." They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well." [ 124 ] In January 2007, The American Academy of Family Physicians (AAFP) stated "The effect of circumcision on penile sensation or sexual satisfaction is unknown. Because the epithelium of a circumcised glans becomes cornified, and because some feel nerve over-stimulation leads to desensitization, many believe that the glans of a circumcised penis is less sensitive. [...] No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction." [ 112 ] Payne et al. reported that direct measurement of penile sensation during sexual arousal failed to support the hypothesised sensory differences associated with circumcision status. [ 125 ] In a 2007 study, Sorrells et al. , using monofilament touch-test mapping, found that the foreskin contains the most sensitive parts of the penis, noting that these parts are lost to circumcision. They also found that "the glans of the circumcised penis is less sensitive to fine-touch than the glans of the uncircumcised penis." [ 126 ] In a 2008 study, Krieger et al. stated that "Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm." [ 127 ] Reports detailing the effect of circumcision on erectile dysfunction have been mixed. Studies have shown that circumcision can result in a statistically significant increase, [ 128 ] [ 129 ] or decrease, [ 25 ] [ 130 ] in erectile dysfunction among circumcised men, while other studies have shown little to no effect. [ 131 ] [ 132 ] [ 133 ] [ edit ]Complications Complication rates ranging from 0.06% to 55% have been cited; [ 134 ] more specific estimates have included 2-10% [ 56 ] and 0.2-0.6% [ 12 ] [ 66 ] . According to the American Medical Association (AMA), blood loss and infection are the most common complications, but most bleeding is minor and can be stopped by applying pressure. [ 12 ] A survey of circumcision complications by Kaplan in 1983 revealed that the rate of bleeding complications was between 0.1% and 35%. [ 135 ] A 1999 study of 48 boys who had complications from traditional male circumcision in Nigeria found that haemorrhage occurred in 52% of the boys, infection in 21% and one child had his penis amputated. [ 136 ]


A penis that has been circumcised.


A penis that has not been circumcised. One study looking at 354,297 births in Washington State from 1987-1996 found that immediate post-birth complications occurred at a rate of 0.2% in the circumcised babies and at a rate of 0.01% in the uncircumcised babies. The authors judged that this was a conservative estimate because it did not capture the very rare but serious delayed complications associated with circumcisions (eg, necrotizing fasciitis , cellulitis ) and the less serious but more common complications such as the circumcision scar or a less than ideal cosmetic result. They also stated that the risks of circumcision "do not seem to be mitigated by the hands of more experienced physicians". [ 137 ] Meatal stenosis (a narrowing of the urethral opening) may be a longer-term complication of circumcision. It is thought that because the foreskin no longer protects the meatus , ammonia formed from urine in wet diapers irritates and inflames the exposed urethral opening. Meatal stenosis can lead to discomfort with urination, incontinence , bleeding after urination and urinary tract infections . [ 138 ] [ 139 ] [ 140 ] Circumcisions may remove too much or too little skin. [ 56 ] [ 141 ] If insufficient skin is removed, the child may still develop phimosis in later life. [ 56 ] Van Howe states that "when operating on the infantile penis, the surgeon cannot adequately judge the appropriate amount of tissue to remove because the penis will change considerably as the child ages, such that a small difference at the time of surgery may translate into a large difference in the adult circumcised penis. To date (1997), there have been no published studies showing the ability of a circumciser to predict the later appearance of the penis." [ 142 ] Cathcart et al. report that 0.5% of boys required a procedure to revise the circumcision. [ 143 ] Other complications include concealed penis [ 144 ] [ 145 ] , urinary fistulas , chordee , cysts , lymphedema , ulceration of the glans, necrosis of all or part of the penis, hypospadias , epispadias and impotence . [ 135 ] Kaplan stated “Virtually all of these complications are preventable with only a modicum of care" and "most such complications occur at the hands of inexperienced operators who are neither urologists nor surgeons.” [ 135 ] Another complication of infant circumcision is skin bridge formation, whereby a remaining part of the foreskin fuses to other parts of the penis (often the glans ) upon healing. This can result in pain during erections and minor bleeding can occur if the shaft skin is forcibly retracted. [ 146 ] Van Howe advises that to prevent adhesions forming after circumcision, parents should be instructed to retract and clean any skin covering the glans. [ 142 ] Although deaths have been reported, [ 135 ] [ 147 ] the American Academy of Family Physicians states that death is rare, and cites an estimated death rate of 1 infant in 500,000 from circumcision. [ 112 ] Gairdner's 1949 study [ 148 ] reported that an average of 16 children per year out of about 90,000 died following circumcision in the UK. He found that most deaths had occurred suddenly under anaesthesia and could not be explained further, but hemorrhage and infection had also proven fatal. Deaths attributed to phimosis and circumcision were grouped together, but Gairdner argued that such deaths were probably due to the circumcision operation. The penis is thought to be lost in 1 in 1,000,000 circumcisions. [ 149 ] [Değiştir] Cinsel yolla bulaşan hastalıklar [ edit ]Human immunodeficiency virus Main article: Circumcision and HIV Over forty observational studies have been conducted to investigate the relationship between circumcision and HIV infection. [ 150 ] Reviews of these studies have reached differing conclusions about whether circumcision could be used as a prevention method against HIV . [ 151 ] [ 152 ] [ 153 ] [ 154 ] Experimental evidence was needed to establish a causal relationship between lack of circumcision and HIV, so three randomized controlled trials were commissioned as a means to reduce the effect of any confounding factors . [ 154 ] Trials took place in South Africa, [ 155 ] Kenya [ 156 ] and Uganda . [ 157 ] All three trials were stopped early by their monitoring boards on ethical grounds, because those in the circumcised group had a lower rate of HIV contraction than the control group. [ 156 ] The results showed that circumcision reduced vaginal-to-penile transmission of HIV by 60%, 53%, and 51%, respectively. [ 158 ] A meta-analysis of the African randomised controlled trials found that the risk in circumcised males was 0.44 times that in uncircumcised males, and that 72 circumcisions would need to be performed to prevent one HIV infection. The authors also stated that using circumcision as a means to reduce HIV infection would, on a national level, require consistently safe sexual practices to maintain the protective benefit. [ 159 ] As a result of these findings, the WHO and the Joint United Nations Programme on HIV/AIDS ( UNAIDS ) stated that male circumcision is an efficacious intervention for HIV prevention but should be carried out by well trained medical professionals and under conditions of informed consent. [ 8 ] [ 13 ] [ 160 ] Both the WHO and CDC indicate that circumcision may not reduce HIV transmission from men to women, and that data is lacking for the transmission rate of men who engage in anal sex with a female partner. [ 13 ] [ 14 ] The joint WHO/UNAIDS recommendation also notes that circumcision only provides partial protection from HIV and should never replace known methods of HIV prevention. Male Circumcision Clearinghouse website was formed by WHO, UNAIDS, FHI and AVAC to provide current evidence-based guidance, information and resources to support the delivery of safe male circumcision services in countries that choose to scale up male circumcision as one component of comprehensive HIV prevention services. [ 161 ] , [ 162 ] Circumcision has been judged to be a cost-effective method to reduce the spread of HIV in a population, [ 8 ] though not necessarily more cost-effective than condoms. [ 8 ] [ 163 ] Some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy. [ 164 ] [ 165 ] In addition to the studies which provided information about female-to-male transmission, some studies have addressed other transmission routes. A randomised controlled trial in Uganda found that male circumcision did not reduce male to female transmission of HIV. The authors could not rule out the possibility of higher risk of transmission from men who did not wait for the wound to fully heal before engaging in intercourse. [ 166 ] A meta-analysis of data from fifteen observational studies of men who have sex with men found "insufficient evidence that male circumcision protects against HIV infection or other STIs." [ 167 ] [ edit ]Human papilloma virus Meta-analyses by Van Howe [ 168 ] and Bosch et al. [ 169 ] of observational studies reached differing conclusions as to whether circumcision reduces infection with human papillomavirus (HPV). A recent prospective trial in Uganda [ 170 ] randomized 3393 subjects to circumcision or a control group and found a significant reduction of HPV infection in the circumcision group. At 24 month follow-up, there was a 27.9% prevalence of high-risk HPV genotypes in the control group and only a 18.0% prevalence in the circumcision group (adjusted risk ratio, 0.65; 95% CI, 0.46 to 0.90; P=0.009). Another recent trial by Auvert et al. in Orange Farm, South Africa, randomized men to either a circumcision or control group. At the 21 month visit, the prevalence of high-risk HPV infection was lower in the circumcised men than the uncircumcised participants (14.8% and 22.3% respectively, a prevalence rate ratio of 0.66) in the absence of any difference in reported sexual behaviour or gonorrhea prevalence. [ 171 ] Two studies have shown that circumcised men report, or were found to have, a higher prevalence of genital warts than uncircumcised men; [ 172 ] [ 173 ] however, a 2009 meta-analysis of multiple studies found a non-significant association between genital warts and the presence of a foreskin. [ 169 ] [ edit ]Other sexually transmitted infections Studies evaluating the effect of circumcision on the incidence of other sexually transmitted infections have reached conflicting conclusions. A meta-analysis of observational data from twenty-six studies found that circumcision was associated with lower rates of syphilis, chancroid and possibly genital herpes. [ 174 ] A large randomized prospective trial in Uganda found a reduction in HSV-2 infection, but not syphilis infection, in the circumcision arm of the study. [ 170 ] In contrast, some studies have failed to find a prophylactic benefit to circumcision. A prospective trial in India found that circumcision offered no protective benefit against herpes simplex virus type 2, syphilis, or gonorrhea . [ 175 ] A clinical study of 5,925 women from Uganda, Zimbabwe and Thailand found that the circumcision status of their partner did not significantly affect the incidence of Chlamydia , gonorrhea or trichomoniasis . [ 176 ] Laumann et al. examined observational data from the United States and found no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases. [ 25 ] [ edit ]Hygiene, and infectious and chronic conditions The American Academy of Pediatrics (1999) stated: "Circumcision has been suggested as an effective method of maintaining penile hygiene since the time of the Egyptian dynasties, but there is little evidence to affirm the association between circumcision status and optimal penile hygiene." [ 66 ] An inflammation of the glans penis and foreskin is called balanoposthitis ; that affecting the glans alone is called balanitis . Both conditions are usually treated with topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams. Although not as necessary as in the past, circumcision may be considered for recurrent or resistant cases. [ 177 ] [ 178 ] Escala and Rickwood recommend against a policy of routine infant circumcision to avoid balanitis saying that the condition affects no more than 4% of boys, does not cause pathological phimosis, and in most cases is not serious. [ 179 ] Fergusson studied 500 boys and found that by 8 years, the circumcised children had a rate of 11.1 problems per 100 children, and the uncircumcised children had a rate of 18.8 per 100. During infancy, circumcised children were found to have a significantly higher risk of problems than uncircumcised children, but after infancy the rate of penile problems was significantly higher among the uncircumcised. Fergusson et al. said that the great majority of penile problems were relatively minor (penile inflammation including balanitis, meatitis, and inflammation of the prepuce) and most (64%) were resolved after a single medical consultation. [ 180 ] Herzog and Alverez found the overall frequency of complications (including balanitis, irritation, adhesions, phimosis, and paraphimosis) to be higher among the uncircumcised children; again, most of the problems were minor. [ 181 ] In a study of 398 randomly selected dermatology students, Fakjian et al. reported: "Balanitis was diagnosed in 2.3% of circumcised men and in 12.5% of uncircumcised men." [ 182 ] In a study of 225 men, O'Farrell et al. reported: "Overall, circumcised men were less likely to be diagnosed with a STI /balanitis (51% and 35%, P = 0.021) than those non-circumcised." [ 183 ] Van Howe found that circumcised penises required more care in the first 3 months of life, and that circumcised boys are more likely to develop balanitis. [ 184 ] The American Medical Association states that circumcision, properly performed, protects against the development of phimosis. [ 12 ] Rickwood and other authors have argued that many infant circumcisions are performed unnecessarily for developmental non-retractability of the prepuce rather than for pathological phimosis. [ 185 ] [ 186 ] Metcalfe et al. stated that "Gairdner [ 148 ] and Oster [ 187 ] made a strong case for leaving boys uncircumcised, allowing the natural separation of the foreskin from the glans to take place gradually, and instructing boys in proper hygiene. This obviates the need for 'preventive' circumcision." [ 188 ] In a study to determine the most cost-effective treatment for phimosis, Van Howe concluded that using cream was 75% more cost-effective than circumcision at treating pathological phimosis. [ 189 ] [ edit ]Urinary tract infections A meta-analysis of 12 studies (one randomised controlled trial , four cohort studies and seven case-control studies ) representing 402,908 children determined that circumcision was associated with a significantly reduced risk of urinary tract infection (UTI). However, the authors noted that only 1% of boys with normal urinary tract function experience a UTI, and the number-needed-to treat (number of circumcisions necessary) to prevent one urinary tract infection was calculated to be 111. Because haemorrhage and infection are the commonest complications of circumcision, occurring at rate of about 2%, assuming equal utility of benefits and harms, the authors concluded that the net clinical benefit of circumcision is only likely in boys at high risk of urinary tract infection (such as those with high grade vesicoureteral reflux or a history of recurrent UTIs, where the number needed to treat declined to 11 and 4, respectively). [ 190 ] Some UTI studies have been criticized for not taking into account a high rate of UTI's among premature infants, who are usually not circumcised because of their fragile health status. [ 66 ] The AMA stated that “depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI," and noted one decision analysis model that concluded that circumcision was not justified as a preventative measure against UTI. [ 12 ] [ edit ]Penile cancer The American Cancer Society (2009) stated, "Most experts agree that circumcision should not be recommended solely as a way to prevent penile cancer ." [ 191 ] The American Academy of Pediatrics (1999) stated that studies suggest that neonatal circumcision confers some protection from penile cancer, but circumcision at a later age does not seem to confer the same level of protection. Further, because penile cancer is a rare disease, the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, remains low. [ 66 ] The age-adjusted annual incidence of penile cancer is 0.82 per 100,000 in Denmark, 2.9-6.8 per 100,000 in Brazil, 0.9 to 1 per 100,000 in the USA, and 2.0-10.5 per 100,000 in India. [ 66 ] Researchers have reported that the risk of penile cancer is greater in never-circumcised men than in men who had been circumcised at birth; estimates of the relative risk include 3 [ 192 ] and 22. [ 193 ] [ edit ]Policies of various national medical associations

[Değiştir] Avustralasya The Royal Australasian College of Physicians (RACP; 2009) state that "after extensive review of the literature [they do] not recommend that routine circumcision in infancy be performed, but [accept] that parents should be able to make this decision with their doctors. One reasonable option is for routine circumcision to be delayed until males are old enough to make an informed choice. In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents. In the absence of evidence of substantial harm, parental choice should be respected." [ 194 ] The Tasmanian President of the Australian Medical Association (AMA), Haydn Walters, has stated that the AMA would support a call to ban circumcision for non-medical, non-religious reasons. [ 195 ] [ edit ]Canada The Fetus and Newborn Committee of the Canadian Paediatric Society posted "Neonatal circumcision revisited" in 1996 and "Circumcision: Information for Parents" in November 2004. The 1996 position statement says that "circumcision of newborns should not be routinely performed", [ 86 ] and the 2004 information to parents says: 'Circumcision is a "non-therapeutic" procedure, which means it is not medically necessary. Parents who decide to circumcise their newborns often do so for religious, social, or cultural reasons. [...] After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.' [ 113 ] [Değiştir] Türkiye “Male circumcision that is performed for any reason other than physical clinical need is termed non-therapeutic (or sometimes “ritual”) circumcision. Some people ask for non-therapeutic circumcision for religious reasons, some to incorporate a child into a community, and some want their sons to be like their fathers. Circumcision is a defining feature of some faiths.” “The Association has no policy on these issues.” The BMA provides that “male circumcision is generally assumed to be lawful provided that it is performed competently; it is believed to be in the child's best interests; and there is valid consent” from both parents and the child, if possible." The BMS stipulates that “competent children may decide for themselves; the wishes that children express must be taken into account; if parents disagree, non-therapeutic circumcision must not be carried out without the leave of a court; consent should be confirmed in writing." "In the past, circumcision of boys has been considered to be either medically or socially beneficial or, at least, neutral. The general perception has been that no significant harm was caused to the child and therefore with appropriate consent it could be carried out. The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks. It is essential that doctors perform male circumcision only where this is demonstrably in the best interests of the child. The responsibility to demonstrate that non-therapeutic circumcision is in a particular child's best interests falls to his parents. The BMA considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it." [ 87 ] [Değiştir] Amerika Birleşik Devletleri The American Academy of Pediatrics (1999) stated: "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child." [ 66 ] The AAP recommends that if parents choose to circumcise, analgesia should be used to reduce pain associated with circumcision. It states that circumcision should only be performed on newborns who are stable and healthy. [ 66 ] The American Medical Association supports the AAP's 1999 circumcision policy statement with regard to non-therapeutic circumcision, which they define as the non-religious, non-ritualistic, not medically necessary, elective circumcision of male newborns. They state that "policy statements issued by professional societies representing Australian, Canadian, and American pediatricians do not recommend routine circumcision of male newborns." [ 12 ] The American Academy of Family Physicians (2007) recognizes the controversy surrounding circumcision and recommends that physicians "discuss the potential harms and benefits of circumcision with all parents or legal guardians considering this procedure for their newborn son." [ 196 ] The American Urological Association (2007) stated that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks. [ 197 ] [Değiştir] Ayrıca bakınız

Frenectomy Genital modification and mutilation Holy Prepuce Preputioplasty Penis Dorsal slit Khitan Circumcision scar [Değiştir] Ekokuma

Billy Ray Boyd. Circumcision Exposed: Rethinking a Medical and Cultural Tradition. Freedom, CA: The Crossing Press, 1998. ( ISBN 978-0-89594-939-4 ) Anne Briggs. Circumcision: What Every Parent Should Know. Charlottesville, VA: Birth & Parenting Publications, 1985. ( ISBN 978-0-9615484-0-7 ) Robert Darby. A surgical temptation: The demonization of the foreskin and the rise of circumcision in Britain. Chicago: University of Chicago Press, 2005. ( ISBN 978-0-226-13645-5 ) Aaron J. Fink, MD Circumcision: A Parent's Decision for Life . Kavanah Publishing Company, Inc., 1988. ( ISBN 978-0-9621347-0-8 ) Paul M. Fleiss, MD and Frederick Hodges, D. Phil. What Your Doctor May Not Tell You About Circumcision. New York: Warner Books, 2002. ( ISBN 978-0-446-67880-3 ) Leonard B. Glick. Marked in Your Flesh: Circumcision from Ancient Judea to Modern America. New York: Oxford University Press, 2005. ( ISBN 978-0-19-517674-2 ) David Gollaher . Circumcision: A History of the World's Most Controversial Surgery. New York: Basic Books, 2000. ( ISBN 0465026532 ) Ronald Goldman, Ph.D. Circumcision: The Hidden Trauma. Boston: Vanguard, 1996. ( ISBN 978-0-9644895-3-0 ) Paysach J. Krohn , Rabbi. Bris Milah. Circumcision—The Covenant Of Abraham/A Compendium of Laws, Rituals, And Customs From Birth To Bris, Anthologized From Talmudic, And Traditional Sources. New York: Mesorah Publications, 1985, 2005. Brian J. Morris, Ph.D., D.Sc. In Favour of Circumcision. Sydney: UNSW Press, 1999. ( ISBN 978-0-86840-537-7 ) Peter Charles Remondino . History of Circumcision from the Earliest Times to the Present . Philadelphia and London; FA Davis; 1891. Holm Putzke, Ph.D. Die strafrechtliche Relevanz der Beschneidung von Knaben. Zugleich ein Beitrag über die Grenzen der Einwilligung in Fällen der Personensorge , in: H. Putzke ua (Hrsg.), Strafrecht zwischen System und Telos , Festschrift für Rolf Dietrich Herzberg zum siebzigsten Geburtstag am 14. Februar 2008 , Mohr Siebeck: Tübingen 2008, p. 669–709 ( ISBN 978-3161495700 ) Holm Putzke, Ph.D., Maximilian Stehr, Ph.D., and Hans-Georg Dietz, Ph.D. Liability to penalty for circumcision in boys. Medico-legal aspects of a controversial medical intervention , in: Monatsschrift Kinderheilkunde 8/2008, p. 783–788 Rosemary Romberg. Circumcision: The Painful Dilemma. South Hadley, MA Bergan & Garvey, 1985. ( ISBN 978-0-89789-073-1 ) Edgar J Schoen, MD Ed Schoen, MD on Circumcision. Berkeley, CA: RDR Books, 2005. ( ISBN 978-1-57143-123-3 ) Edward Wallerstein. Circumcision: An American Health Fallacy. New York: Springer, 1980 ( ISBN 978-0-8261-3240-6 ) Gerald N. Weiss MD and Andrea W Harter. Circumcision: Frankly Speaking. Wiser Publications, 1998. ( ISBN 978-0-9667219-0-4 ) Yosef David Weisberg, Rabbi. Otzar Habris. Encyclopedia of the laws and customs of Bris Milah and Pidyon Haben. Jerusalem: Hamoer, 2002. [Değiştir] Notlar ve referanslar

Some referenced articles are available on-line only in the Circumcision Information and Resource Page's (CIRP) library or in The Circumcision Reference Library (CIRCS). CIRP articles are chosen from an anti-circumcision point of view, and text in support of this position is often highlighted on-screen using HTML . CIRCS articles are chosen from a pro-circumcision point of view. If documents are not freely available on-line elsewhere, links to articles in one or other of these two websites may be provided. ^ Dictionary definitions of circumcision: "The act of cutting off the prepuce or foreskin of males, or the internal labia of females." Webster's Revised Unabridged Dictionary (1913) [1] "to remove the foreskin of (males) sometimes as a religious rite." The Macquarie Dictionary (2nd Edition, 1991) "Cut off foreskin of (as Jewish or Mohammedan rite, or surgically), Concise Oxford Dictionary, 5th Edition, 1964 Circumcision defined in a medical context: "Male circumcision is the surgical removal of all or part of the foreskin of the penis." Information Package on Male Circumcision and HIV Prevention:Insert 1 , World Health Organization "Circumcision, surgical removal of all or part of the foreskin of the human male...", "Circumcision", Microsoft Encarta , 2007. "Male circumcision is an elective surgery to remove the foreskin..." Circumcision , British Columbia Health Guide, June 2, 2006. Retrieved July 18, 2007. "Circumcision is surgery..." Pain and Your Infant: Medical Procedures, Circumcision and Teething , University of Michigan Health System, February 2007. Retrieved July 18, 2007. " Circumcision is cutting away part of the foreskin... When this surgery is performed..." Newborn Care , Danbury Hospital website. Retrieved July 18, 2007. ^ Hodges, FM (Fall 2001). "The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme.". The Bulletin of the History of Medicine 75 (3): 375–405. doi : 10.1353/bhm.2001.0119 . PMID 11568485 . ^ Wrana, P. (1939). "Historical review: Circumcision". Archives of Pediatrics 56 : 385–392. as quoted in: Zoske, Joseph (Winter 1998). "Male Circumcision: A Gender Perspective" . The Journal of Men's Studies 6 (2): 189–208 . http://www.noharmm.org/zoske.htm . Retrieved 2006-06-14 . ^ Gollaher, David L. (February 2000). Circumcision: a history of the world's most controversial surgery . New York, NY : Basic Books . pp. 53–72. ISBN 978-0-465-04397-2 LCCN 99-40015 . ^ "Circumcision" . American-Israeli Cooperative Enterprise . http://www.jewishvirtuallibrary.org/jsource/Judaism/circumcision.html . Retrieved 2006-10-03 . ^ Rizvi, SAH; A Naqvi, SA; Hussain, M.; Hasan, AS (1999). "Religious circumcision: a Muslim view". BJU International 83 : 13. doi : 10.1046/j.1464-410x.1999.0830s1013.x . ^ a b c Customary in some Coptic and other churches: "The Coptic Christians in Egypt and the Ethiopian Orthodox Christians —two of the oldest surviving forms of Christianity— retain many of the features of early Christianity, including male circumcision. Circumcision is not prescribed in other forms of Christianity.…Some Christian churches in South Africa oppose the practice, viewing it as a pagan ritual, while others, including the Nomiya church in Kenya, require circumcision for membership and participants in focus group discussions in Zambia and Malawi mentioned similar beliefs that Christians should practice circumcision since Jesus was circumcised and the Bible teaches the practice." Male Circumcision: context, criteria and culture (Part 1) , Joint United Nations Programme on HIV/AIDS , February 26, 2007. "The decision that Christians need not practice circumcision is recorded in Acts 15; there was never, however, a prohibition of circumcision, and it is practiced by Coptic Christians." "circumcision" , The Columbia Encyclopedia, Sixth Edition, 2001-05. ^ a b c d e f g h i j k "Male circumcision: Global trends and determinants of prevalence, safety and acceptability" (PDF). World Health Organization . 2007 . http://whqlibdoc.who.int/publications/2007/9789241596169_eng.pdf . 2009/03/04 alındı. ^ Schmid GP, Dick B. (2008). "Adolescent boys: who cares?" (PDF). Bulletin of the World Health Organization 86 (9): 659. doi : 10.2471/BLT.08.057752 . PMID 18797635 . PMC 2649485 . http://www.who.int/entity/bulletin/volumes/86/9/08-057752.pdf . ^ Schoen, Edgar J (December 1, 2007). "Should newborns be circumcised? Yes" . Can Fam Physician 53 (12): 2096–8, 2100–2. PMID 18077736 . http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18077736 . 2008/05/02 alındı. ^ a b Milos, Marilyn Fayre; Donna Macris (March–April 1992). "Circumcision: A medical or a human rights issue?" . Journal of Nurse-Midwifery 37 (2 S1): S87–S96. doi : 10.1016/0091-2182(92)90012-R . PMID 1573462 . http://www.cirp.org/library/ethics/milos-macris/ . Retrieved 2007-04-06 . ^ a b c d e f g "Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision" . 1999 AMA Interim Meeting: Summaries and Recommendations of Council on Scientific Affairs Reports . American Medical Association . December 1999. pp. 17 . http://www.ama-assn.org/ama/no-index/about-ama/13585.shtml . Retrieved 2006-06-13 . ^ a b c (PDF) New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications . World Health Organization . March 28, 2007 . http://www.who.int/hiv/mediacentre/MCrecommendations_en.pdf . 2007/08/13 alındı. ^ a b "Male Circumcision and Risk for HIV Transmission and Other Health Conditions: Implications for the United States" . Hastalık Kontrol ve Önleme. 2008 . http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm . ^ a b c Robert Darby (2003). "Medical history and medical practice: persistent myths about the foreskin" . Medical Journal of Australia 178(4) : 178-9 . http://www.mja.com.au/public/issues/178_04_170203/dar10676_fm.html . ^ a b "Policy Statement On Circumcision" (PDF). Royal Australasian College of Physicians . September 2004 . http://www.racp.edu.au/index.cfm?objectid=B5606813-F174-8FA9-0522EE1FC3053078 . 2010/01/25 alındı. " "The Paediatrics and Child Health Division, The Royal Australasian College of Physicians (RACP) has prepared this statement on routine circumcision of infants and boys to assist parents who are considering having this procedure undertaken on their male children and for doctors who are asked to advise on or undertake it. After extensive review of the literature the RACP reaffirms that there is no medical indication for routine neonatal circumcision. Circumcision of males has been undertaken for religious and cultural reasons for many thousands of years. It remains an important ritual in some religious and cultural groups.…In recent years there has been evidence of possible health benefits from routine male circumcision. The most important conditions where some benefit may result from circumcision are urinary tract infections, HIV and later cancer of the penis.…The complication rate of neonatal circumcision is reported to be around 1% to 5% and includes local infection, bleeding and damage to the penis. Serious complications such as bleeding, septicaemia and meningitis may occasionally cause death. The possibility that routine circumcision may contravene human rights has been raised because circumcision is performed on a minor and is without proven medical benefit. Whether these legal concerns are valid will be known only if the matter is determined in a court of law. If the operation is to be performed, the medical attendant should ensure this is done by a competent operator, using appropriate anaesthesia and in a safe child-friendly environment. In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents. Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate." "Circumcision of males has been undertaken for religious and cultural reasons for many thousands of years. It probably originated as a hygienic measure in communities living in hot, dusty and dry environments." " ^ Immerman, RS; WC Mackey (Fall-Winter 1997). "A biocultural analysis of circumcision" . Social Biology 44 (3-4): 265–275. doi : 10.1111/j.1467-9744.1976.tb00285.x . PMID 9446966 . http://www.cirp.org/library/psych/immerman2/ . ^ Tomb artwork from the Sixth Dynasty (2345–2181 BCE) shows men with circumcised penises, and one relief from this period shows the rite being performed on a standing adult male. The Egyptian hieroglyph for "penis" depicts either a circumcised or an erect organ. The examination of Egyptian mummies has found some with foreskins and others who were circumcised. ^ The book of Genesis records circumcision as God's covenant/command to Abraham. It was a sign of obedience and was to be performed by the male child's eighth day after birth. 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. ^ 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. ^ Marck, J (1997). "Aspects of male circumcision in sub-equatorial African culture history". Health Transit Review 7 (supplement): 337–360. PMID 10173099 . ^ a b c d Gollaher, David (Fall 1994). "From ritual to science: the medical transformation of circumcision in America" . Journal of Social History 28 (1): 5–36 . http://www.cirp.org/library/history/gollaher/ . Retrieved 2007-12-06 . ^ Aggleton, P. (2007). "Roundtable: “Just a Snip”?: A Social History of Male Circumcision." (PDF). Reproductive Health Matters 15 (29): 15–21. doi : 10.1016/S0968-8080(07)29303-6 . PMID 17512370 . http://www.hsph.harvard.edu/pihhr/files/RHM/RHM29%20-%20Aggleton.pdf . 2008/12/17 alındı. ^ "On the influence of circumcision in preventing syphilis". Medical Times and Gazette NS Vol II : 542–3. 1855. ^ a b c d Laumann, E.; C. Masi and F. Zuckerman (1997). "Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice" . JAMA 277 (13): 1052–1057. doi : 10.1001/jama.277.13.1052 . PMID 9091693 . http://www.circs.org/library/laumann/index.html . ^ Xu F, Markowitz LE, Sternberg MR, Aral SO (July 2007). "Prevalence of circumcision and herpes simplex virus type 2 infection in men in the United States: the National Health and Nutrition Examination Survey (NHANES), 1999-2004". Sex Transm Dis 34 (7): 479–84. doi : 10.1097/01.olq.0000253335.41841.04 . PMID 17413536 . ^ "Trends in circumcisions among newborns" . National Hospital Discharge Survey . National Center for Health Statistics. January 11, 2007 . http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions.htm . Retrieved 2008-08-19 . ^ Brown, MS; CA Brown (August 1987). "Circumcision decision: prominence of social concerns". Pediatrics 80 (2): 215–219. PMID 3615091 . ^ Nelson, CP; R. Dunn, J. Wan, JT Wei (March 2005). "The increasing incidence of newborn circumcision: data from the nationwide inpatient sample". Journal of Urology 173 (3): 978–981. doi : 10.1097/01.ju.0000145758.80937.7d . PMID 15711354 . ^ "US circumcision rates vary by region" (PDF). Agency for Healthcare Research and Quality. January, 2008 . http://www.hcup-us.ahrq.gov/reports/statbriefs/sb45.pdf . Retrieved 2008-08-19 . ^ Dave SS, Fenton KA, Mercer CH, Erens B, Wellings K, Johnson AM (December 2003). "Male circumcision in Britain: findings from a national probability sample survey" . Sexually Transmitted Infections 79 (6): 499–500. doi : 10.1136/sti.79.6.499 . PMID 14663134 . ^ "In Australia and New Zealand, the circumcision rate has fallen considerably in recent years and it is estimated that currently only 10%-20% of male infants are routinely circumcised." (RACP: 2004) ^ a b Richters, J; et al. (2006). "Circumcision in Australia: prevalence and effects on sexual health" . Int J STD AIDS 17 (8): 547–554. doi : 10.1258/095646206778145730 . PMID 16925903 . http://www.cirp.org/library/general/richters1/ . "Neonatal circumcision was routine in Australia until the 1970s … In the last generation, Australia has changed from a country where most newborn boys are circumcised to one where circumcision is the minority experience.". ^ Walton RE, Ostbye T, Campbell MK (1997). "Neonatal male circumcision after delisting in Ontario. Survey of new parents" . Can Fam Physician 43 : 1241–7. PMID 9241462 . ^ a b Glass JM (January 1999). "Religious circumcision: a Jewish view" . BJU Int. 83 Suppl 1 : 17–21. PMID 10349410 . http://www3.interscience.wiley.com/cgi-bin/fulltext/119091414/PDFSTART . ^ Lamm, Maurice (1969). The Jewish way in death and mourning . Middle Village, NY: J. David. pp. 239–40. ISBN 0-8246-0126-2 . http://www.chabad.org/library/article_cdo/aid/281541/jewish/The-Jewish-Way-in-Death-and-Mourning.htm . ^ adapted from Shamash (2007). "The Origins of Reform Judaism" . Jewish Virtual Library . http://www.jewishvirtuallibrary.org/jsource/Judaism/The_Origins_of_Reform_Judaism.html . 2007/11/03 alındı. ^ Berit Mila Program of Reform Judaism , Union for Reform Judaism website. Retrieved January 23, 2010. ^ Hilary Leila Kreiger (21 November 2002). "A cut above the rest" . Jerusalem Post . http://jewishcircumcision.org/israel_news.htm . ^ Al-Munajjid, Muhammed Salih. "Question #9412: Circumcision: how it is done and the rulings on it" . Islam Q&A . http://www.islam-qa.com/index.php?ln=eng&ds=qa&lv=browse&QR=9412&dgn=4 . Retrieved 2006-07-01 . ^ Al-Munajjid, Muhammed Salih. "Question #7073: The health and religious benefits of circumcision" . Islam Q&A . http://www.islam-qa.com/index.php?ln=eng&ds=qa&lv=browse&QR=7073&dgn=3 . Retrieved 2006-07-01 . ^ al-Sabbagh, Muhammad Lutfi (1996). Islamic ruling on male and female circumcision . Alexandria : World Health Organization . p. 16. ^ "Session 11—4 February 1442 (Bull of union with the Copts)" . Eccumenical Council of Florence (1438-1445) . Eternal Word Television Network . http://www.ewtn.com/library/councils/Florence.htm#5 . 2009/05/11 alındı. " Therefore it strictly orders all who glory in the name of Christian, not to practise circumcision either before or after baptism, since whether or not they place their hope in it, it cannot possibly be observed without loss of eternal salvation. " ^ Mattson CL, Bailey RC, Muga R, Poulussen R, Onyango T (February 2005). "Acceptability of male circumcision and predictors of circumcision preference among men and women in Nyanza Province, Kenya". AIDS Care 17 (2): 182–94. doi : 10.1080/09540120512331325671 . PMID 15763713 . ^ "Greek Orthodox Archdiocese calendar of Holy Days" . http://www.goarch.org/en/chapel/calendar.asp?Y=2007&M=1 . ^ "Russian Orthodox Church, Patriarchate of Moscow" . http://www.holytrinityorthodox.com/calendar/los/January/01-01.htm . ^ Ajuwon et al. , "Indigenous surgical practices in rural southwestern Nigeria: Implications for disease," Health Educ. Res..1995; 10: 379–384 Health Educ. Res..1995; 10: 379–384 Retrieved 3 October 2006 ^ Aaron David Samuel Corn (2001) (PDF). Ngukurr Crying: Male Youth in a Remote Indigenous Community . Working Paper Series No. 2. University of Wollongong . http://www.uow.edu.au/arts/sealcp/wkgpapers/wp2.pdf . Retrieved 2006-10-18 . ^ "Migration and Trade" . Green Turtle Dreaming . http://www.mfgsc.vic.edu.au/greenturtledreaming/EKmigrate.htm . Retrieved 2006-10-18 . "In exchange for turtles and trepang the Makassans introduced tobacco, the practice of circumcision and knowledge to build sea-going canoes." ^ Jones IH (June 1969). "Subincision among Australian western desert Aborigines". The British Journal of Medical Psychology 42 (2): 183–90. PMID 5783777 . ^ "RECENT GUEST SPEAKER" . Australian AIDS Fund Incorporated. 2006 . http://www.aids.net.au/aids-png-project-20060403.htm . Retrieved 2006-07-01 . ^ "Weird & Wonderful" . United Travel . http://www.getaway.co.nz/destination.asp?id=34 . Retrieved 2006-07-01 . ^ "Circumcision amongst the Dogon" . The Non-European Components of European Patrimony (NECEP) Database. 2006 . http://www.necep.net/articles.php?id_soc=12&id_article=84 . Retrieved 2006-09-03 . ^ Agberia, JT (2006). "Aesthetics and Rituals of the Opha Ceremony among the Urhobo People". Journal of Asian and African Studies 41 : 249. doi : 10.1177/0021909606063880 . ^ "Masai of Kenya" . http://www.masaikenya.org/ . Retrieved 2007-04-06 . " Authority derives from the age-group and the age-set. Prior to circumcision a natural leader or olaiguenani is selected; he leads his age-group through a series of rituals until old age, sharing responsibility with a select few, of whom the ritual expert (oloiboni) is the ultimate authority. Masai youths are not circumcised until they are mature, and a new age-set is initiated together at regular intervals of twelve to fifteen years. The young warriors (ilmurran) remain initiates for some time, using blunt arrows to hunt small birds which are stuffed and tied to a frame to form a head-dress. " ^ a b c d Williams, N; L. Kapila (October 1993). "Complications of circumcision" . British Journal of Surgery 80 (10): 1231–1236. doi : 10.1002/bjs.1800801005 . http://www.cirp.org/library/complications/williams-kapila/ . 2006/07/11 alındı. ^ Crawford, DA (December 2002). "Circumcision: a consideration of some of the controversy" . J Child Health Care. 6 (4): 259–270. doi : 10.1177/136749350200600403 . PMID 12503896 . http://chc.sagepub.com/cgi/content/abstract/6/4/259 . ^ Klavs I, Hamers FF (February 2008). "Male circumcision in Slovenia: results from a national probability sample survey". Sexually Transmitted Infections 84 (1): 49–50. doi : 10.1136/sti.2007.027524 . PMID 17881413 . ^ a b Drain PK, Halperin DT, Hughes JP, Klausner JD, Bailey RC (2006). "Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries" . BMC Infectious Diseases 6 : 172. doi : 10.1186/1471-2334-6-172 . PMID 17137513 . ^ a b c d Castellsagué X, Bosch FX, Muñoz N, et al. (April 2002). "Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners". The New England Journal of Medicine 346 (15): 1105–12. doi : 10.1056/NEJMoa011688 . PMID 11948269 . ^ Frisch M, Friis S, Kjaer SK, Melbye M (December 1995). "Falling incidence of penis cancer in an uncircumcised population (Denmark 1943-90)" . BMJ 311 (7018): 1471. PMID 8520335 . PMC 2543732 . http://bmj.com/cgi/pmidlookup?view=long&pmid=8520335 . ^ Schoen EJ, Colby CJ, To TT (March 2006). "Cost analysis of neonatal circumcision in a large health maintenance organization". The Journal of Urology 175 (3 Pt 1): 1111–5. doi : 10.1016/S0022-5347(05)00399-X . PMID 16469634 . ^ Ko MC, Liu CK, Lee WK, Jeng HS, Chiang HS, Li CY (April 2007). "Age-specific prevalence rates of phimosis and circumcision in Taiwanese boys". Journal of the Formosan Medical Association = Taiwan Yi Zhi 106 (4): 302–7. doi : 10.1016/S0929-6646(09)60256-4 . PMID 17475607 . "…the prevalence of circumcision slightly increased with age from 7.2% (95% CI, 5.3-10.8%) for boys aged 7 years to 8.7% (95% CI, 6.5-13.3%) for boys aged 13 years.". ^ "Circumstraint™ Infant Immobilizer" . http://www.natus.com/index.cfm?page=company_1&crid=128/circumstraint.htm . ^ Holman JR, Lewis EL, Ringler RL (August 1995). "Neonatal circumcision techniques". American Family Physician 52 (2): 511–8, 519–20. PMID 7625325 . ^ a b c d e f g h i j k l "Circumcision policy statement. American Academy of Pediatrics. Task Force on Circumcision". Pediatrics 103 (3): 686–93. March 1999. doi : 10.1542/peds.103.3.686 . PMID 10049981 . ^ "Neonatal Circumcision: An Audiovisual Primer" . Stanford School of Medicine . http://newborns.stanford.edu/Circumcision.html . ^ Barrie H, Huntingford PJ, Gough MH (July 1965). "The Plastibell Technique for Circumcision" . British Medical Journal 2 (5456): 273–5. doi : 10.1136/bmj.2.5456.273 . PMID 14310205 . ^ Peleg D, Steiner A (September 1998). "The Gomco circumcision: common problems and solutions". American Family Physician 58 (4): 891–8. PMID 9767725 . ^ Fowler, Grant C.; Pfenninger, John L. (2003). Pfenninger and Fowler's procedures for primary care . St. Louis: Mosby. ISBN 978-0-323-00506-7 . [ page needed ] ^ Reynolds RD (July 1996). "Use of the Mogen clamp for neonatal circumcision". American Family Physician 54 (1): 177–82. PMID 8677833 . ^ Holman JR, Stuessi KA (March 1999). "Adult circumcision" . American Family Physician 59 (6): 1514–8. PMID 10193593 . http://www.aafp.org/afp/990315ap/1514.html . ^ "In Africa, a problem with circumcision and AIDS" . http://www.iht.com/articles/2007/02/27/news/health.php . ^ Hovatta O, Mikkola M, Gertow K, et al. (July 2003). "A culture system using human foreskin fibroblasts as feeder cells allows production of human embryonic stem cells". Human Reproduction 18 (7): 1404–9. doi : 10.1093/humrep/deg290 . PMID 12832363 . ^ "The Skinny On 'Miracle' Wrinkle Cream" . NBC10.com . NBC Universal, Inc. November 2002 . http://www.nbc10.com/health/1808693/detail.html . Retrieved 2008-08-20 . ^ "High-Tech Skinny on Skin Grafts" . www.wired.com:science:discoveries . CondéNet, Inc. 02.16.99 . http://www.wired.com/science/discoveries/news/1999/02/17912 . Retrieved 2008-08-20 . ^ "Skin Grafting" . www.emedicine.com . WebMD . http://www.emedicine.com/derm/TOPIC867.HTM . Retrieved 2008-08-20 . ^ Amst, Catherine; Carey, John (July 27, 1998). "Biotech Bodies" . www.businessweek.com . The McGraw-Hill Companies Inc . http://www.businessweek.com/1998/30/b3588001.htm . Retrieved 2008-08-20 . ^ Cowan, Alison Leigh (April 19, 1992). "Wall Street; A Swiss Firm Makes Babies Its Bet" . New York Times:Business . New York Times . http://query.nytimes.com/gst/fullpage.html?res=9E0CE6D81E38F93AA25757C0A964958260&partner . Retrieved 2008-08-20 . ^ Anonymous (editorial) (1949-12-24). "A ritual operation" . British Medical Journal 2 : 1458–1459. " "...in parts of West Africa, where the operation is performed at about 8 years of age, the prepuce is dipped in brandy and eaten by the patient; in other districts the operator is enjoined to consume the fruits of his handiwork, and yet a further practice, in Madagascar, is to wrap the operation specifically in a banana leaf and feed it to a calf." ". ^ Shulchan Aruch , Yoreh Deah , 265:10 ^ a b Somerville, Margaret (November 2000). "Altering Baby Boys' Bodies: The Ethics of Infant Male Circumcision" . The ethical canary: science, society, and the human spirit . New York, NY : Viking Penguin Canada . pp. 202–219. LCCN 2001-369341 . ISBN 0670893021 . http://www.intact.ca/canary.htm . Retrieved 2007-02-12 . ^ Van Howe, RS; JS Svoboda, JG Dwyer, and CP Price (January 1999). "Involuntary circumcision: the legal issues" (PDF). BJU International 83 (Supp1): 63–73. doi : 10.1046/j.1464-410x.1999.0830s1063.x . PMID 10349416 . http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1063.x . 2007/02/12 alındı. ^ Tanne, Janice Hopkins (August 2005). "US group lobbies UN to outlaw male circumcision" . British Medical Journal 331 (7514): 422. doi : 10.1136/bmj.331.7514.422-b . ^ Rennie S, Muula AS, Westreich D (June 2007). "Male circumcision and HIV prevention: ethical, medical and public health tradeoffs in low-income countries". Journal of Medical Ethics 33 (6): 357–61. doi : 10.1136/jme.2006.019901 . PMID 17526688 . ^ a b Fetus and Newborn Committee (March 1996). "Neonatal circumcision revisited" . Canadian Medical Association Journal 154 (6): 769–780 . http://www.cps.ca/english/statements/FN/fn96-01.htm . Retrieved 2006-07-02 . "We undertook this literature review to consider whether the CPS should change its position on routine neonatal circumcision from that stated in 1982. The review led us to conclude the following. There is evidence that circumcision results in an approximately 12-fold reduction in the incidence of UTI during infancy. The overall incidence of UTI in male infants appears to be 1% to 2%. The incidence rate of the complications of circumcision reported in published articles varies, but it is generally in the order of 0.2% to 2%. Most complications are minor, but occasionally serious complications occur. There is a need for good epidemiological data on the incidence of the surgical complications of circumcision, of the later complications of circumcision and of problems associated with lack of circumcision. Evaluation of alternative methods of preventing UTI in infancy is required. More information on the effect of simple hygienic interventions is needed. Information is required on the incidence of circumcision that is truly needed in later childhood. There is evidence that circumcision results in a reduction in the incidence of penile cancer and of HIV transmission. However, there is inadequate information to recommend circumcision as a public health measure to prevent these diseases. When circumcision is performed, appropriate attention needs to be paid to pain relief. The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns. There is therefore no indication that the position taken by the CPS in 1982 should be changed. When parents are making a decision about circumcision, they should be advised of the present state of medical knowledge about its benefits and harms. Their decision may ultimately be based on personal, religious or cultural factors." ^ a b c d Medical Ethics Committee (June 2006). "The law and ethics of male circumcision – guidance for doctors" . British Medical Association . http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp . Retrieved 2006-07-01 . ^ "Information Package on Male Circumcision and HIV Prevention" (PDF) . http://data.unaids.org/pub/InformationNote/2007/mc_briefing_pack1_en.pdf . ^ "Circumcision and the Code of Ethics, George C. Denniston, Humane Health Care Volume 12, Number 2" . http://www.humanehealthcare.com/Article.asp?art_id=620 . ^ Viens AM (2004). "Value judgment, harm, and religious liberty" . J Med Ethics 30 (3): 241–7. doi : 10.1136/jme.2003.003921 . PMID 15173355 . ^ Benatar, David; Benatar, Michael (2003). "How not to argue about circumcision" (PDF). American Journal of Bioethics 3 (2): W1–W9. doi : 10.1162/152651603102387820 . http://bioethics.net/journal/pdf/3_2_LT_w01_Benetar.pdf . ^ Williams, RM (2003-01). "On the Tail-Docking of Pigs, Human Circumcision, and their Implications for Prevailing Opinion Regarding Pain" . Journal of Applied Philosophy 20 (1): 89–93. doi : 10.1111/1468-5930.00237 . http://www.blackwell-synergy.com/doi/abs/10.1111/1468-5930.00237 . 2008/06/24 alındı. ^ Goldman, R. (January 1999). "The psychological impact of circumcision" (PDF). BJU International 83 (S1): 93–102. doi : 10.1046/j.1464-410x.1999.0830s1093.x . http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1093.x . Retrieved 2006-07-02 . ^ Schultheiss D, Truss MC, Stief CG, Jonas U (1998). "Uncircumcision: A Historical Review of Preputial Restoration". Plast Reconstr Surg. 101(7) (7): 1990–8. PMID 9623850 . ^ Moses, S; Bailey, RC; Ronald AR (1998). "Male circumcision: assessment of health benefits and risks". Sex Transm Infect 74 : 368–73. doi : 10.1136/sti.74.5.368 . ^ Gerharz EW, Haarmann C (August 2000). "The first cut is the deepest? Medicolegal aspects of male circumcision". BJU Int. 86 (3): 332–8. doi : 10.1046/j.1464-410x.2000.00103.x . PMID 10930942 . ^ Boyle, G; Goldman, R; Svoboda, JS; Fernandez E (2002). "Male Circumcision: Pain, Trauma and Psychosexual Sequelae". Journal of Health Psychology 7 (3): 329–343. ^ Hirji, H; Charlton, R; Sarmah S (2005). "Male circumcision: a review of the evidence" . Journal of men's health 2 (1): 21–30 . http://www.journals.elsevierhealth.com/periodicals/jmhg/article/PIIS1571891305000105/abstract . ^ "Sweden restricts circumcisions" . BBC Europe . October 1, 2001 . http://news.bbc.co.uk/2/hi/europe/1572483.stm . Retrieved 2006-10-18 . "Swedish Jews and Muslims object to the new law, saying it violates their religious rights." ^ "Jews protest Swedish circumcision restriction" . Reuters . 2001-06-07 . http://www.hrwf.net/religiousfreedom/news/sweden2001.html#JewsprotestSwedish . "A WJC spokesman said, "This is the first legal restriction placed on a Jewish rite in Europe since the Nazi era. This new legislation is totally unacceptable to the Swedish Jewish community."" ^ Bureau of Democracy, Human Rights, and Labor (September 15, 2006). "Sweden" . International Religious Freedom Report 2006 . US Department of State . http://www.state.gov/g/drl/rls/irf/2006/71410.htm . Retrieved 2007-07-04 . ^ "Court rules circumcision of four-year-old boy illegal" . HELSINGIN SANOMAT, INTERNATIONAL EDITION. 2006-08-07 . http://www.hs.fi/english/article/Court+rules+circumcision+of+four-year-old+boy+illegal/1135220958830 . Retrieved 2007-09-17 . ^ "Supreme Court: Properly performed religious based male circumcision no crime" . Helsingin Sanomat. October 17, 2008 . http://www.hs.fi/english/article/Supreme+Court+Properly+performed+religious+based+male+circumcision+no+crime/1135240316614 . Retrieved 2008-10-17 . ^ "Finland Considers Legalising Male Circumcision" . Ylesiradio. 2008-07-31 . http://www.yle.fi/news/left/id97605.html . Retrieved 2008-08-05 . ^ "Circumcision debate on Mornings" . ABC Tasmania. 2007-07-15 . http://www.abc.net.au/tasmania/stories/s2004776.htm . . ^ Schoen, Edgar J.; Christopher J. Colby, Trinh T. To (March 2006). "Cost Analysis of Neonatal Circumcision in a Large Health Maintenance Organization" (Abstract). The Journal of Urology 175 (3): 1111–1115. doi : 10.1016/S0022-5347(05)00399-X . PMID 16469634 . http://www.jurology.com/article/PIIS002253470500399X/abstract . 2006/07/01 alındı. ^ Alanis, Mark C.; Richard S. Lucidi (May 2004). "Neonatal Circumcision: A Review of the World's Oldest and Most Controversial Operation" (Abstract). Obstetrical & Gynecological Survey 59 (5): 379–395. doi : 10.1097/00006254-200405000-00026 . PMID 15097799 . http://www.obgynsurvey.com/pt/re/obgynsurv/abstract.00006254-200405000-00026.htm;jsessionid=FbJT6LYnQxr66KhvWNsBW0msy7shpJgL39wbFTGLnQpzJ82BGLVQ!1096339265!-949856144!8091!-1 . Retrieved 2006-09-27 . ^ Van Howe, Robert S. (November 2004). "A Cost-Utility Analysis of Neonatal Circumcision" (Abstract). Medical Decision Making 24 (6): 584–601. doi : 10.1177/0272989X04271039 . PMID 15534340 . http://mdm.sagepub.com/cgi/content/abstract/24/6/584 . 2006/07/01 alındı. ^ Ganiats, TG; Humphrey JB, Taras HL, Kaplan RM. (Oct–December 1991). "Routine neonatal circumcision: a cost-utility analysis". Medical Decision Making 11 (4): 282–293. doi : 10.1177/0272989X9101100406 . PMID 1766331 . ^ Lawler, FH; Bisonni RS, Holtgrave DR. (Nov–December 1991). "Circumcision: a decision analysis of its medical value.". Family Medicine 23 (8): 587–593. PMID 1794670 . ^ a b Taddio, Anna; Joel Katz, A Lane Ilersich, Gideon Koren (March 1997). "Effect of neonatal circumcision on pain response during subsequent routine vaccination" (PDF — free registration required). The Lancet 349 (9052): 599–603. doi : 10.1016/S0140-6736(96)10316-0 . http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673696103160.pdf . 2007/08/08 alındı. ^ a b c "Circumcision: Position Paper on Neonatal Circumcision" . American Academy of Family Physicians . 2007 . http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html . Retrieved 2007-01-30 . ^ a b "Circumcision: Information for parents" . Caring for kids . Canadian Paediatric Society . November 2004 . http://www.cps.ca/caringforkids/pregnancy&babies/Circumcision.htm . Retrieved 2006-10-24 . " Circumcision is a "non-therapeutic" procedure, which means it is not medically necessary. Parents who decide to circumcise their newborns often do so for religious, social, or cultural reasons. To help make the decision about circumcision, parents should have information about risks and benefits. It is helpful to speak with your baby's doctor. After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions. " ^ Stang, Howard J.; Leonard W. Snellman (June 1998). "Circumcision Practice Patterns in the United States" (PDF). Pediatrics 101 (6): e5–. doi : 10.1542/peds.101.6.e5 . ISSN 1098-4275 . http://pediatrics.aappublications.org/cgi/reprint/101/6/e5.pdf . 2006/06/29 alındı. ^ Howard, CR; FM Howard, LC Garfunkel, EA de Blieck, M. Weitzman (1998). "Neonatal Circumcision and Pain Relief: Current Training Practices" . Pediatrics 101 (3): 423–428. doi : 10.1542/peds.101.3.423 . PMID 9481008 . http://pediatrics.aappublications.org/cgi/content/abstract/101/3/423 . 2008/06/19 alındı. ^ a b Yawman, D.; CR Howard, P. Auinger, LC Garfunkel, M. Allan and M. Weitzman (2006). "Pain relief for neonatal circumcision: a follow-up of residency training practices". Ambulatory Pediatrics 6 (4): 210–214. doi : 10.1016/j.ambp.2006.04.008 . PMID 16843252 . ^ "Jews protest Swedish circumcision restriction". Reuters, June 7, 2001. ^ Lander, J.; Brady-Fryer, B., Metcalfe, JB, Nazarali, S. and S. Muttitt (1997). "Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision: a randomized controlled trial". JAMA 278 (24): 2157–2162. doi : 10.1001/jama.278.24.2157 . PMID 9417009 . ^ a b Brady-Fryer, B; Wiebe N, Lander JA (July 2004). "Pain relief for neonatal circumcision". The Cochrane Database of Systematic Reviews (3): Art. No.: CD004217. doi : 10.1002/14651858.CD004217.pub2 . PMID 15495086 . ^ Lehr, VT; E. Cepeda, DA Frattarelli, R. Thomas, J. LaMothe and JV Aranda (2005). "Lidocaine 4% cream compared with lidocaine 2.5% and prilocaine 2.5% or dorsal penile block for circumcision". Am J Perinatol 22 (5): 231–237. doi : 10.1055/s-2005-871655 . PMID 16041631 . ^ Garry, DJ; E. Swoboda, A. Elimian and R. Figueroa (2006). "A video study of pain relief during newborn male circumcision". J Perinatology 26 (2): 106–110. doi : 10.1038/sj.jp.7211413 . PMID 16292334 . ^ Razmus I, Dalton M, Wilson D (2004). "Pain management for newborn circumcision". Pediatr Nurs 30 (5): 414–7, 427. PMID 15587537 . ^ Ng, WT; et al. (2001). "The use of topical lidocaine/prilocaine cream prior to childhood circumcision under local anesthesia". Ambul Surg 9 (1): 9–12. doi : 10.1016/S0966-6532(00)00061-5 . PMID 11179706 . ^ Boyle, Gregory J; Svoboda, J Steven; Goldman, Ronald; Fernandez, Ephrem (2002). "Male circumcision: pain, trauma, and psychosexual sequelae" . Bond University Faculty of Humanities and Social Sciences . http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1036&context=hss_pubs . ^ Payne, Kimberley; Lea Thaler, Tuuli Kukkonen, Serge Carrier, Yitzchak Binik (April 2007). "Sensation and Sexual Arousal in Circumcised and Uncircumcised Men" . Journal of Sexual Medicine 4 (3): 667–674. doi : 10.1111/j.1743-6109.2007.00471.x . PMID 17419812 . http://www3.interscience.wiley.com/journal/118496134/abstract . 2008/09/07 alındı. ^ Sorrells, ML; JL Snyder, MD Reiss, C. Eden, MF Milos, N. Wilcox and RS Van Howe (May 2007). "Fine-touch pressure thresholds in the adult penis". BJU International 99 (4): 864–869. doi : 10.1111/j.1464-410X.2006.06685.x . PMID 17378847 . ^ Krieger, JN; Mehta SD, Bailey RC, Agot K, Ndinya-Achola JO, Parker C, Moses S (August 2008). "Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya". The Journal of Sexual Medicine Epub ahead of print (11): 2610–22. doi : 10.1111/j.1743-6109.2008.00979.x . PMID 18761593 . ^ Fink, KS; CC Carson, RS DeVellis (May 2002). "Adult Circumcision Outcomes Study: Effect on Erectile Dysfunction, Penile Sensitivity, Sexual Activity and Satisfation" . Journal of Urology 167 (5): 2113–2116. doi : 10.1016/S0022-5347(05)65098-7 . PMID 11956453 . http://www.cirp.org/library/sex_function/fink1/ . 2008/06/28 alındı. ^ Shen, Z.; S. Chen, C. Zhu, Q. Wan and Z. Chen (2004). "Erectile function evaluation after adult circumcision (in Chinese)". Zhonghua Nan Ke Xue 10 (1): 18–19. PMID 14979200 . ^ Richters J, Smith AM, de Visser RO, Grulich AE, Rissel CE (August 2006). "Circumcision in Australia: prevalence and effects on sexual health". Int J STD AIDS 17 (8): 547–54. doi : 10.1258/095646206778145730 . PMID 16925903 . ^ Senkul, T.; C. IşerI, B. şen, K. KarademIr, F. Saraçoğlu and D. Erden (2004). "Circumcision in adults: effect on sexual function". Urology 63 (1): 155–8. doi : 10.1016/j.urology.2003.08.035 . PMID 14751371 . ^ Collins S, Upshaw J, Rutchik S, Ohannessian C, Ortenberg J, Albertsen P (2002). "Effects of circumcision on male sexual function: debunking a myth?". J Urol 167 (5): 2111–2. doi : 10.1016/S0022-5347(05)65097-5 . PMID 11956452 . ^ Masood S, Patel H, Himpson R, Palmer J, Mufti G, Sheriff M (2005). "Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly?". Urol Int 75 (1): 62–6. doi : 10.1159/000085930 . PMID 16037710 . ^ Fetus and Newborn Committee (March 1996). "Neonatal circumcision revisited" . Canadian Medical Association Journal 154 (6): 769–780 . http://www.cps.ca/english/statements/FN/fn96-01.htm . Retrieved 2006-07-02 . ^ a b c d Kaplan, GW (August 1983). "Complications of Circumcision" . Urologic Clinics of North America 10 (3): 543–549. PMID 6623741 . http://www.cirp.org/library/complications/kaplan/ . Retrieved 2006-09-29 . ^ Ahmed A,, A; Mbibi NH, Dawam D, Kalayi GD (March 1999). "Complications of traditional male circumcision". Annals of Tropical Paediatrics 19 (1): 113–117. doi : 10.1080/02724939992743 . PMID ISSN 0272-4936 10605531 ISSN 0272-4936 . ^ Christakis, Dmitry A.; Eric Harvey, Danielle M. Zerr, Chris Feudtner, Jeffrey A. Wright, and Frederick A. Connell (January 2000). "A Trade-off Analysis of Routine Newborn Circumcision" . Pediatrics 105 (1): 246–249. doi :10.1542/peds.105.1.S2.246 (inactive 2008-06-26). PMID 10617731 . http://pediatrics.aappublications.org/cgi/content/full/105/1/S2/246 . 2006/07/01 alındı. ^ Yegane, Rooh-Allah; Abdol-Reza Kheirollahi, Nour-Allah Salehi, Mohammad Bashashati, Jamal-Aldin Khoshdel, and Mina Ahmadi (May 2006). "Late complications of circumcision in Iran" (Abstract). Pediatric Surgery International 22 (5): 442–445. doi : 10.1007/s00383-006-1672-1 . PMID 16649052 . http://www.springerlink.com/content/l62453357073k7mn/ . 2008/09/25 alındı. ^ Angel, Carlos A. (June 12, 2006). "Meatal Stenosis" . eMedicine . WebMD . http://www.emedicine.com/PED/topic2356.htm . Retrieved 2006-07-02 . ^ Van Howe, RS (2006). "Incidence of meatal stenosis following neonatal circumcision in a primary care setting". Clinical Pediatrics (Phila) 45 (1): 49–54. doi : 10.1177/000992280604500108 . PMID 16429216 . ^ Yegane, RA; AR Kheirollahi, NA Salehi, M. Bashashati, JA Khoshdel and M. Ahmadi (May 2006). "Late complications of circumcision in Iran". Pediatr Surg Int 22 (5): 442–445. doi : 10.1007/s00383-006-1672-1 . PMID 16649052 . ^ a b Van Howe, RS (November 1997). "Variability in penile appearance and penile findings: a prospective study." . British Journal of Urology 80 (5): 776–782. PMID 9393302 . http://www.cirp.org/library/complications/vanhowe/ . ^ Cathcart P, Nuttall M, van der Meulen J, Emberton M, Kenny SE (July 2006). "Trends in paediatric circumcision and its complications in England between 1997 and 2003". Br J Surg 93 (7): 885–90. doi : 10.1002/bjs.5369 . PMID 16673355 . ^ Trier, William C.; George W. Drach (February 1973). "Concealed Penis: Another Complication of Circumcision" . American Journal of diseases of children 125 (2): 276–277. PMID 4685840 . http://www.cirp.org/library/complications/trier1/ . 2008/09/25 alındı. ^ Bergeson, Paul S.; Robert J. Hopkin, Robert B. Bailey, Leigh C. MCGill, Janice P. Piatt (December 1993). "The inconspicuous penis" . Pediatrics 92 (6): 794–799. PMID 8233739 . http://www.cirp.org/library/complications/bergeson/ . 2008/09/25 alındı. ^ Naimer, Sody A.; Roni Peleg, Yevgeni Meidvidovski, Alex Zvulunov, Arnon Dov Cohen, and Daniel Vardy (November 1, 2002). "Office Management of Penile Skin Bridges with Electrocautery" (PDF). Journal of the American Board of Family Practice 15 (6): 485–488. PMID 10605531 . http://www.jabfm.org/cgi/reprint/15/6/485 . 2006/07/01 alındı. ^ Paediatric Death Review Committee: Office of the Chief Coroner of Ontario (April 2007). "Coroner's Corner Circumcision: A minor procedure?" (PDF). Paediatric Child Health Vol 12 No 4, April 2007 pages 311–312 . Pulsus Group Inc. . http://www.pulsus.com/Paeds/12_04/Pdf/zwol_ed.pdf . Retrieved 2007-06-17 . ^ a b Gairdner D (December 1949). "The fate of the foreskin, a study of circumcision" . British Medical Journal 2 (4642): 1433–7, illust. doi : 10.1136/bmj.2.4642.1433 . PMID 15408299 . ^ "Complications Of Circumcision" . Paediatric Policy – Circumcision . The Royal Australasian College of Physicians. October 2004. Archived from the original on 2007-01-11 . http://web.archive.org/web/20070111015035/http://www.racp.edu.au/hpu/paed/circumcision/complications.htm . Retrieved 2006-07-11 . ^ Szabo, R.; RV Short (June 2000). "How does male circumcision protect against HIV infection?" . BMJ 320 (7249): 1592–1594. doi : 10.1136/bmj.320.7249.1592 . PMID 10845974 . PMC 1127372 . http://www.bmj.com/cgi/content/full/320/7249/1592 ? . ^ Van Howe, RS (January 1999). "Circumcision and HIV infection: review of the literature and meta-analysis" . International Journal of STD's and AIDS 10 : 8–16. doi : 10.1258/0956462991913015 . http://www.cirp.org/library/disease/HIV/vanhowe4/ . Retrieved 2008-09-23 . " Thirty-five articles and a number of abstracts have been published in the medical literature looking at the relationship between male circumcision and HIV infection. Study designs have included geographical analysis, studies of high-risk patients, partner studies and random population surveys. Most of the studies have been conducted in Africa. A meta-analysis was performed on the 29 published articles where data were available. When the raw data are combined, a man with a circumcised penis is at greater risk of acquiring and transmitting HIV than a man with a non-circumcised penis (odds ratio (OR)=1.06, 95% confidence interval (CI)=1.01-1.12). Based on the studies published to date, recommending routine circumcision as a prophylactic measure to prevent HIV infection in Africa, or elsewhere, is scientifically unfounded. ". ^ O'Farrell N, Egger M (March 2000). "Circumcision in men and the prevention of HIV infection: a 'meta-analysis' revisited" . International Journal of STD & AIDS 11 (3): 137–42. doi : 10.1258/0956462001915480 . PMID 10726934 . http://ijsa.rsmjournals.com/cgi/pmidlookup?view=long&pmid=10726934 . " The results from this re-analysis thus support the contention that male circumcision may offer protection against HIV infection, particularly in high-risk groups where genital ulcers and other STDs 'drive' the HIV epidemic. A systematic review is required to clarify this issue. Such a review should be based on an extensive search for relevant studies, published and unpublished, and should include a careful assessment of the design and methodological quality of studies. Much emphasis should be given to the exploration of possible sources of heterogeneity. In view of the continued high prevalence and incidence of HIV in many countries in sub-Saharan Africa, the question of whether circumcision could contribute to prevent infections is of great importance, and a sound systematic review of the available evidence should be performed without delay. ". ^ Weiss HA, Quigley MA, Hayes RJ (October 2000). "Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis" . AIDS 14 (15): 2361–70. doi : 10.1097/00002030-200010200-00018 . PMID 11089625 . http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0269-9370&volume=14&issue=15&spage=2361 . " Male circumcision is associated with a significantly reduced risk of HIV infection among men in sub-Saharan Africa, particularly those at high risk of HIV. These results suggest that consideration should be given to the acceptability and feasibility of providing safe services for male circumcision as an additional HIV prevention strategy in areas of Africa where men are not traditionally circumcised. ". ^ a b Siegfried, N; M Muller, J Volmink, J Deeks, M Egger, N Low, H Weiss, S Walker, P Williamson (July 2003). "Male circumcision for prevention of heterosexual acquisition of HIV in men" . Cochrane Database of Systematic Reviews (3) . http://www.cirp.org/library/disease/HIV/cochrane2003/ . 2009/07/25 alındı. " We found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men. The results from existing observational studies show a strong epidemiological association between male circumcision and prevention of HIV, especially among high-risk groups. However, observational studies are inherently limited by confounding which is unlikely to be fully adjusted for. In the light of forthcoming results from RCTs, the value of IPD analysis of the included studies is doubtful. The results of these trials will need to be carefully considered before circumcision is implemented as a public health intervention for prevention of sexually transmitted ". ^ Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A (November 2005). "Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial" . PLoS Medicine 2 (11): e298. doi : 10.1371/journal.pmed.0020298 . PMID 16231970 . " There were 20 HIV infections (incidence rate = 0.85 per 100 person-years) in the intervention group and 49 (2.1 per 100 person-years) in the control group, corresponding to an RR of 0.40 (95% CI: 0.24%-0.68%; p < 0.001). This RR corresponds to a protection of 60% (95% CI: 32%-76%). ". ^ A b Bailey RC, Musa S, Parker CB, et al. (Şubat 2007). "Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial". Lancet 369 (9562): 643–56. doi : 10.1016/S0140-6736(07)60312-2 . PMID 17321310 . " The two year HIV incidence was 2.1% (95% CI 1.2-3.0) in the circumcision group and 4.2% (3.0-5.4) in the control group (p=0.0065); the relative risk of HIV infection in circumcised men was 0.47 (0.28-0.78), which corresponds to a reduction in the risk of acquiring an HIV infection of 53% (22-72). ". ^ Gray RH, Kigozi G, Serwadda D, et al. (February 2007). "Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial". Lancet 369 (9562): 657–66. doi : 10.1016/S0140-6736(07)60313-4 . PMID 17321311 . " In the modified intention-to-treat analysis, HIV incidence over 24 months was 0.66 cases per 100 person-years in the intervention group and 1.33 cases per 100 person-years in the control group (estimated efficacy of intervention 51%, 95% CI 16-72; p=0.006). The as-treated efficacy was 55% (95% CI 22-75; p=0.002); efficacy from the Kaplan-Meier time-to-HIV-detection as-treated analysis was 60% (30-77; p=0.003). ". ^ Siegfried N, Muller M, Deeks JJ, Volmink J (2009). "Male circumcision for prevention of heterosexual acquisition of HIV in men". Cochrane Database of Systematic Reviews (Online) (2): CD003362. doi : 10.1002/14651858.CD003362.pub2 . PMID 19370585 . ^ Mills E, Cooper C, Anema A, Guyatt G (July 2008). "Male circumcision for the prevention of heterosexually acquired HIV infection: a meta-analysis of randomized trials involving 11,050 men". HIV Medicine 9 (6): 332–5. doi : 10.1111/j.1468-1293.2008.00596.x . PMID 18705758 . ^ "WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention" . World Health Organisation. March 2007 . http://www.who.int/hiv/mediacentre/news68/en/index.html . ^ Male Circumcision Clearinghouse Male Circumcision Clearinghouse ^ AVAC About male circumcision ^ Mcallister RG, Travis JW, Bollinger D, Rutiser C, Sundar V (Fall 2008). "The cost to circumcise Africa" . International Journal of Men's Health (Men's Studies Press) 7 (3): 307–316. doi : 10.3149/jmh.0703.307 . http://www.thefreelibrary.com/The+cost+to+circumcise+Africa.-a0189486243 . ^ Mills, J.; N. Siegfried (October 2006). "Cautious optimism for new HIV/AIDS prevention strategies.". Lancet 368 (9543): 1236. doi : 10.1016/S0140-6736(06)69513-5 . PMID 17027724 . " "The inferences drawn from the only completed randomised controlled trial (RCT) of circumcision could be weak because the trial stopped early. In a systematic review of RCTs stopped early for benefit, such RCTs were found to overestimate treatment effects. When trials with events fewer than the median number (n=66) were compared with those with event numbers above the median, the odds ratio for a magnitude of effect greater than the median was 28 (95% CI 11--73). The circumcision trial recorded 69 events, and is therefore at risk of serious effect overestimation. We therefore advocate an impartial meta-analysis of individual patients' data from this and other trials underway before further feasibility studies are done. ". ^ Dowsett, GW; M. Couch (May 2007). "Male circumcision and HIV prevention: is there really enough of the right kind of evidence?" (PDF). Reproductive Health Matters 15 (29): 33–44. doi : 10.1016/S0968-8080(07)29302-4 . PMID 17512372 . http://download.journals.elsevierhealth.com/pdfs/journals/0968-8080/PIIS0968808007293024.pdf . ^ Wawer, Maria; et al. (18 July 2009). "Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial" . Lancet 374 (9685): 229–237. doi : 10.1016/S0140-6736(09)60998-3 . PMID 19616720 . http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/fulltext . ^ Millett GA, Flores SA, Marks G, et al. (2008). "Circumcision Status and Risk of HIV and Sexually Transmitted Infections Among Men Who Have Sex With Men" . JAMA 300 (14): 1674–1684. doi : 10.1001/jama.300.14.1674 . http://jama.ama-assn.org/cgi/content/short/300/14/1674 . ^ Van Howe, Robert S. (May 2007). "Human papillomavirus and circumcision: A meta-analysis" . Journal of Infection 54 (5): 490–496. doi : 10.1016/j.jinf.2006.08.005 . PMID 16997378 . http://www.cirp.org/library/disease/cancer/vanhowe2006b/ . 2008/09/18 alındı. ^ a b Bosch FX, Albero G, Castellsagué X (January 2009). "Male circumcision, human papillomavirus and cervical cancer: from evidence to intervention". J Fam Plann Reprod Health Care 35 (1): 5–7. doi : 10.1783/147118909787072270 . PMID 19126309 . ^ a b Tobian, Aaron; et al. (March 2009). "Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis" . New England Journal of Medicine 360 (13): 1298–1309. doi : 10.1056/NEJMoa0802556 . PMID 19321868 . PMC 2676895 . http://content.nejm.org/cgi/content/short/360/13/1298 . ^ Auvert, B.; J. Sobngwi-Tambekou, E. Cutler, M. Nieuwoudt, P. Lissouba, A. Puren, D. Taljaard (2009). "Effect of Male Circumcision on the Prevalence of High-Risk Human Papillomavirus in Young Men: Results of a Randomized Controlled Trial Conducted in Orange Farm, South Africa" . Journal of Infectious Diseases 199 (1): 14–19. doi : 10.1086/595566 . PMID 19086814 . http://www.journals.uchicago.edu/doi/pdf/10.1086/595566 . 2009/01/05 alındı. ^ Dinh, TH; M. Sternberg, EF Dunne and LE Markowitz (April 2008). "Genital Warts Among 18- to 59-Year-Olds in the United States, National Health and Nutrition Examination Survey, 1999-2004". Sexually Transmitted Diseases 35 (4): 357–360. doi : 10.1097/OLQ.0b013e3181632d61 . PMID 18360316 . "The percentage of circumcised men reporting a diagnosis of genital warts was significantly higher than uncircumcised men, 4.5% (95% CI, 3.6%–5.6%) versus 2.4% (95% CI, 1.5%–4.0%)". ^ Cook LS, Koutsky LA, Holmes KK (August 1993). "Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic" . Genitourinary Medicine 69 (4): 262–4. PMID 7721284 . ^ Weiss HA, Thomas SL, Munabi SK, Hayes RJ (April 2006). "Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis" . Sexually Transmitted Infections 82 (2): 101–9; discussion 110. doi : 10.1136/sti.2005.017442 . PMID 16581731 . ^ Reynolds SJ, Shepherd ME, Risbud AR, et al. (March 2004). "Male circumcision and risk of HIV-1 and other sexually transmitted infections in India". Lancet 363 (9414): 1039–40. doi : 10.1016/S0140-6736(04)15840-6 . PMID 15051285 . ^ Turner AN, Morrison CS, Padian NS, et al. (July 2008). "Male circumcision and women's risk of incident chlamydial, gonococcal, and trichomonal infections". Sexually Transmitted Diseases 35 (7): 689–95. doi : 10.1097/OLQ.0b013e31816b1fcc . PMID 18418300 . ^ Leber, Mark J.; Anuritha Tirumani (June 8, 2006). "Balanitis" . EMedicine . http://www.emedicine.com/derm/topic615.htm . Retrieved 2008-10-14 . ^ Osipov, Vladimir O.; Scott M. Acker (November 14, 2006). "Balanoposthitis" . Reactive and Inflammatory Dermatoses . EMedicine . http://www.emedicine.com/derm/topic615.htm . Retrieved 2006-11-20 . ^ Escala, JM; AMK Rickwood (March 1988). "Balanitis" . British journal of urology 63 (2): 196–197. doi : 10.1111/j.1464-410X.1989.tb05164.x . PMID 2702407 . http://www.cirp.org/library/disease/balanitis/escala1/ . 2008/10/14 alındı. ^ Fergusson, DM; JM Lawton and FT Shannon (April 1988). "Neonatal circumcision and penile problems: an 8-year longitudinal study" . Pediatrics 81 (4): 537–541. PMID 3353186 . http://www.circs.org/library/fergusson/index.html . 2007/07/18 alındı. ^ Herzog, LW; SR Alvarez (March 1986). "The frequency of foreskin problems in uncircumcised children" . Am J Dis Child 140 (3): 254–6. PMID 3946358 . http://www.circs.org/library/herzog/index.html . ^ Fakjian, N; S Hunter, GW Cole and J Miller (August 1990). "An argument for circumcision. Prevention of balanitis in the adult". Arch Dermatol 126 (8): 1046–7. doi : 10.1001/archderm.126.8.1046 . PMID 2383029 . ^ O'Farrel, Nigel; Maria Quigley and Paul Fox (August 2005). "Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study" (Abstract). International Journal of STD & AIDS 16 (8): 556–588(4). doi : 10.1258/0956462054679151 . PMID 16105191 . http://ijsa.rsmjournals.com/cgi/content/abstract/16/8/556 . Retrieved 2008-09-06 . " Overall, circumcised men were less likely to be diagnosed with a STI/balanitis (51% and 35%, P = 0.021) than those non-circumcised. ". {verify source} ^ Van Howe, RS (May 2007). "Neonatal Circumcision and Penile Inflammation in Young Boys" . Clinical Pediatrics 46 (4): 329–333. doi : 10.1177/0009922806295708 . PMID 17475991 . http://cpj.sagepub.com/cgi/content/abstract/46/4/329 . " Penile inflammation was more common in circumcised than noncircumcised boys, especially in the first 3 years of life (exact odds ratio, 8.01, 95% confidence interval, 31-329.15). When adjusted for the number of genital examinations and age younger than 3 years, exact logistic regression found an adjusted exact odds ratio of 7.91 (95% confidence interval, 1.76-77.66). ". ^ Rickwood AM, Walker J (September 1989). "Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence?" . Annals of the Royal College of Surgeons of England 71 (5): 275–7. PMID 2802472 . ^ Shankar KR, Rickwood AM (July 1999). "The incidence of phimosis in boys". BJU International 84 (1): 101–2. doi : 10.1046/j.1464-410x.1999.00147.x . PMID 10444134 . ^ Oster J (April 1968). "Further fate of the foreskin. Incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys" . Archives of Disease in Childhood 43 (228): 200–3. doi : 10.1136/adc.43.228.200 . PMID 5689532 . ^ Metcalfe, Thomas J.; Lucy M. Osborn, E. Mark Mariani (August 1983). "Circumcision: A Study of Current Practices" . Clinical Pediatrics 22 (8): 575–579. doi : 10.1177/000992288302200811 . PMID 6861426 . http://www.cirp.org/library/procedure/metcalf/ . ^ Van Howe RS (October 1998). "Cost-effective treatment of phimosis". Pediatrics 102 (4): E43. doi : 10.1542/peds.102.4.e43 . PMID 9755280 . " The argument that circumcision is a minor surgical procedure without complications is not only erroneous, but also irrelevant. It is ethically as well as economically questionable to operate on a child to treat a physiological process ". ^ Singh-Grewal D, Macdessi J, Craig J (August 2005). "Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies" . Archives of Disease in Childhood 90 (8): 853–8. doi : 10.1136/adc.2004.049353 . PMID 15890696 . "Circumcision was associated with a significantly reduced risk of UTI (OR = 0.13; 95% CI, 0.08 to 0.20; p<0.001) with the same odds ratio (0.13) for all three types of study design.". ^ "Can Penile Cancer be Prevented?" . http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_penile_cancer_be_prevented_35.asp . ^ Maden, C; et al. (January 1993). "History of circumcision, medical conditions, and sexual activity and risk of penile cancer". J Natl Cancer Inst 85 (1): 19–24. doi : 10.1093/jnci/85.1.19 . PMID 8380060 . ^ Schoen, EJ; Oehrli, M; Colby, C; Machin, G (March 2000). "The highly protective effect of newborn circumcision against invasive penile cancer" . Pediatrics 105 (3): e36. doi : 10.1542/peds.105.3.e36 . PMID 10699138 . http://pediatrics.aappublications.org/cgi/content/full/105/3/e36 . ^ "Current College Position on Circumcision" . Royal Australasian College of Physicians. 27 August 2009 . http://racp.edu.au/download.cfm?DownloadFile=59AE2C7C-9F08-B344-21061157DF3636B9 . ^ "Doctors back call for circumcision ban" . ABC News. 2007-12-09 . http://www.abc.net.au/news/stories/2007/12/09/2113665.htm . ^ "Circumcision: Position Paper on Neonatal Circumcision" . American Academy of Family Physicians . 2007 . http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html . Retrieved 2007-01-30 . " Considerable controversy surrounds neonatal circumcision. Putative indications for neonatal circumcision have included preventing UTIs and their sequelae, preventing the contraction of STDs including HIV, and preventing penile cancer as well as other reasons for adult circumcision. Circumcision is not without risks. Bleeding, infection, and failure to remove enough foreskin occur in less than 1% of circumcisions. Evidence-based complications from circumcision include pain, bruising, and meatitis. More serious complications have also occurred. Although numerous studies have been conducted to evaluate these postulates, only a few used the quality of methodology necessary to consider the results as high level evidence.

The evidence indicates that neonatal circumcision prevents UTIs in the first year of life with an absolute risk reduction of about 1% and prevents the development of penile cancer with an absolute risk reduction of less than 0.2%. The evidence suggests that circumcision reduces the rate of acquiring an STD, but careful sexual practices and hygiene may be as effective. Circumcision appears to decrease the transmission of HIV in underdeveloped areas where the virus is highly prevalent. No study has systematically evaluated the utility of routine neonatal circumcision for preventing all medically-indicated circumcisions in later life. Evidence regarding the association between cervical cancer and a woman's partner being circumcised or uncircumcised, and evidence regarding the effect of circumcision on sexual functioning is inconclusive. If the decision is made to circumcise, anesthesia should be used.

The American Academy of Family Physicians recommends physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering this procedure for their newborn son. " ^ American Urological Association. "Circumcision" . http://www.auanet.org/content/guidelines-and-quality-care/policy-statements/c/circumcision.cfm . 2008/11/02 alındı. [Değiştir] Dış bağlantılar

Wikimedia Commons has media related to: Circumcision [ edit ]Circumcision opposition Intact America: Say No to Circumcision by Georganne Chapin. National Organization of Circumcision Information Resource Centers by Marilyn Milos , RN. The Circumcision Information and Resource Pages by Geoffrey T. Falk. Doctors Opposing Circumcision Presided by George C. Denniston, MD, MPH. Circumcision Decision-Maker: permanent decisions demand careful consideration by Dan Bollinger. [ edit ]Circumcision promotion Malecircumcision.org - Clearinghouse on Male Circumcision for HIV Prevention by WHO , the Joint United Nations Programme on HIV/AIDS (UNAIDS) , the AIDS Vaccine Advocacy Coalition (AVAC) , and Family Health International (FHI) Circinfo.net - Male Circumcision Guide for Doctors, Parents, Adults, & Teens by Professor Brian Morris Medicirc.org - Circumcision: a lifetime of medical benefits by Edgar Schoen , BSc., MD Circs.org maintained by Jake Waskett. Article on Bris Milah: Beautiful or Barbaric by Rabbi Shraga Simmons . [ edit ]Circumcision techniques and videos Description of an adult circumcision from the American Academy of Family Physicians . Videos of infant circumcision: using a Plastibell , a Gomco clamp and a Mogen clamp (all from Stanford Medical School.) Video of the circumcision procedure from the US Medical Videos Journal v • d • e Male circumcision series Sünnet Medical aspects · (HIV) · Sexual aspects Prevalence · Cultural and religious aspects · (in Judaism) · (in Islam) Ethics · Law · History Opposition · Advocacy v • d • e Genital surgical and other procedures ( ICD-9-CM V3 60-71) Erkek reproductive system Prostat Prostatectomy ( Transurethral resection of the prostate ) Vas deferens Vasectomy · Vasovasostomy Penis Circumcision · Penectomy · Penile prosthesis · Preputioplasty Testes Castration ( Inguinal orchiectomy ) Kadın reproductive system ( gynecological surgery ) Ovary Oophorectomy Fallopian tubes Tubal ligation · Salpingectomy Uterus Hysterotomy · Hysteroscopy · Pelvic exenteration · Hysterectomy · Vacuum aspiration · Cervical conization ( LEEP ) · Cervical cerclage · Myomectomy · Uterine artery embolization Vagina Colposcopy · Culdocentesis · Hymenotomy · Vaginectomy Vulva Female genital cutting · Vulvectomy reproductive system navs: anat female , male / physio / dev , noncongen / congen / neoplasia , symptoms+signs / eponymous , proc Categories : Circumcision | Body modification | Penis | Male reproductive system | Surgical removal procedures | Religion and children | Men's rights

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