Circumcision: Difference between revisions - Wikipedia

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<!-- Definition, technique, and reasons -->

'''Circumcision''' is the removal of the [[foreskin]] from the [[human penis]].<ref name=rudolph_2011>{{cite book |vauthors=Rudolph C, Rudolph A, Lister G, First L, Gershon A |title=Rudolph's Pediatrics, 22nd Edition |page=188 |date=18 March 2011 |publisher=McGraw-Hill Companies, Incorporated |isbn=978-0-07-149723-7 |url=https://books.google.com/books?id=or15PgAACAAJ |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=or15PgAACAAJ |archive-date=18 January 2016 }}</ref><ref name=sawyer_2011>{{cite book |author=Sawyer S |title=Pediatric Physical Examination & Health Assessment |pages=555–556 |date=November 2011 |publisher=Jones & Bartlett Publishers |isbn=978-1-4496-7600-1 |url=https://books.google.com/books?id=W6eRUtlujbkC&pg=PA555 |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=W6eRUtlujbkC&pg=PA555 |archive-date=2016-01-18 }}</ref> In the most common procedure the foreskin is extended with forceps (in pre-pubescent children its adhesion to the [[glans penis|glans]] must also be broken with a probe), then a [[circumcision clamp|circumcision device]] may be placed, after which the foreskin is [[wikt:excise|excised]]. Topical or locally injected [[anesthesia]] is often used to reduce pain and [[stress (physiology)|physiologic stress]].<ref name=AAP_2012>{{cite journal | author = American Academy of Pediatrics Task Force on Circumcision | title = Male circumcision | journal = Pediatrics | volume = 130 | issue = 3 | pages = e756–e785 | date = September 2012 | pmid = 22926175 | doi = 10.1542/peds.2012-1990 | url = http://pediatrics.aappublications.org/content/130/3/e756.full | url-status = live | doi-access = free | archive-url = https://web.archive.org/web/20120920054623/http://pediatrics.aappublications.org/content/130/3/e756.full | archive-date = 2012-09-20 }}</ref> The procedure is usually an [[elective surgery]] performed on babies and childrenminors as a religious[[Preventive dutyhealthcare|prophylactic orhealth cultural tradition, as in [[Israelintervention]], [[MuslimReligious worldlaw|Islamicreligious worldrite]], and severalor [[ChristiansCulture|Christiancultural/ethnic communitiespractice]];.<ref name="R. Peteet 2017 97–101">{{cite book|title=Spiritualityjournal and Religion Within the Culture of Medicine: From Evidence to Practice|first=John|last=R. Peteet|year=vauthors 2017| isbn=9780190272432| pagesCalcagno =97–101C |publisher=Oxford Universitytitle Press|quote=male circumcision[Circumcision: iswhat stilldo observedwe amongcut Ethiopianwhen and Coptic Christians, and circumcision rateswe are alsocutting?] high| todayjournal in= theUrologia Philippines| andvolume the US.}}</ref><ref name="R. Wylie74 2015| 101">{{citeissue book|title=ABC of2 Sexual Health|first=Kevan|last= R.pages Wylie|year= 2015|73–79 isbn=9781118665695| pagedate =101 |publisher=JohnApril Wiley2007 & Sons|quote= Althoughpmid it= is21086403 mostly| commondoi and= required10.5301/ru.2010.5865 in male newborns with Moslem or Jewish backgrounds, certain Christian-dominant countries such as the United States also practice it commonly.}}</ref><ref name="N. Stearns 2008 179">{{Cite book|last= N. Stearns|first=Peter|title=The Oxford Encyclopedia of the Modern World|publisher=[[Oxford University Press]]|year=2008|isbn=9780195176322|pages=179|quote=Uniformly practiced by Jews, Muslims, and the members of Coptic, Ethiopian, and Eritrean Orthodox Churches, male circumcision remains prevalent in many regions of the world, particularly Africa, South and East Asia, Oceania, and Anglosphere countries.}}</ref><ref name="R. orWylie as2015 a101">{{cite [[Preventivebook|title=ABC healthcareof Sexual Health|prophylacticfirst=Kevan|last= healthR. intervention]],Wylie|year= as2015| generallyisbn=9781118665695| donepage =101 |publisher=John Wiley & Sons|quote= Although it is mostly common and required in severalmale [[Anglosphere]]newborns with Moslem or Jewish backgrounds, certain Christian-dominant countries andsuch [[Africa]]as the United States also practice it commonly.}}</ref><ref name="R. Peteet 2017 97–101">{{cite journal book|title=Spirituality vauthorsand =Religion CalcagnoWithin Cthe |Culture titleof = [CircumcisionMedicine: whatFrom doEvidence weto cutPractice|first=John|last=R. whenPeteet|year= we are cutting?]2017| isbn=9780190272432| journalpages = Urologia97–101 |publisher=Oxford volumeUniversity Press|quote=male 74circumcision |is issuestill =observed 2among |Ethiopian pagesand =Coptic 73–79Christians, |and datecircumcision =rates Aprilare 2007also |high pmidtoday =in 21086403the |Philippines doiand =the 10US.5301/ru.2010.5865 }}</ref><ref>{{cite journal | vauthors = Wise J | title = Demand for male circumcision rises in a bid to prevent HIV | journal = Bulletin of the World Health Organization | volume = 84 | issue = 7 | pages = 509–511 | date = July 2006 | pmid = 16878217 | pmc = 2627386 | quote = As a result, there are already indications of increasing demand for male circumcision in traditionally non-circumcising societies in Southern Africa. }}</ref><ref name=WHO_2007_GTDPSA>{{cite web |title=Male circumcision: Global trends and determinants of prevalence, safety and acceptability |year=2007 |publisher=World Health Organization |url=http://www.unaids.org/sites/default/files/media_asset/jc1360_male_circumcision_en_0.pdf |url-status=live |archive-url=https://web.archive.org/web/20151222194858/http://www.unaids.org/sites/default/files/media_asset/jc1360_male_circumcision_en_0.pdf |archive-date=2015-12-22 }}</ref> MedicallyAdditionally, circumcision is a treatment option for problematic cases of [[phimosis]], and[[balanitis]], [[balanoposthitis]], [[balanitis xerotica obliterans]], and other [[Pathology|pathologies]] that do not resolve with other treatments, and for chronic [[urinary tract infection]]s (UTIs).<ref name="lissauer_2012">{{cite book|title=Illustrated Textbook of Paediatrics, Fourth edition|vauthors=Lissauer T, Clayden G|date=October 2011|publisher=Elsevier|isbn=978-0-7234-3565-5|pages=352–353|quote=}}</ref><ref name=hay_2012/> It is [[contraindicated]] in cases of certain genital structure abnormalities or poor general health.<ref name=rudolph_2011/><ref name=hay_2012>{{cite book |vauthors=Hay W, Levin M |title=Current Diagnosis and Treatment Pediatrics 21/E |pages=18–19 |date=25 June 2012 |publisher=McGraw Hill Professional |isbn=978-0-07-177971-5 |url=https://books.google.com/books?id=V8lMJniWK_QC |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=V8lMJniWK_QC |archive-date=18 January 2016 }}</ref>

<!-- Evidence and side effects -->

Male circumcision reduces the risk of [[HIV infection]] among [[heterosexual men]] in [[sub-Saharan Africa]].<ref>{{cite journal | vauthors = Chikutsa A, Maharaj P | title = Social representations of male circumcision as prophylaxis against HIV/AIDS in Zimbabwe | journal = BMC Public Health | volume = 15 | issue = 1 | pages = 603 | date = July 2015 | pmid = 26133368 | pmc = 4489047 | doi = 10.1186/s12889-015-1967-z | quote = It is now generally accepted in public health spheres that medical male circumcision is efficacious in the prevention of HIV infection. }}</ref><ref name="WHO-PrevHIV">{{cite web|title=Preventing HIV Through Safe Voluntary Medical Male Circumcision For Adolescent Boys And Men In Generalized HIV Epidemics

|year=2020|publisher=[[World Health Organization]]|url=https://www.who.int/publications/i/item/978-92-4-000854-0 |access-date=2021-05-24}}</ref><ref name=siegfried_Cochrane_2009>{{cite journal | vauthors = Siegfried N, Muller M, Deeks JJ, Volmink J | title = Male circumcision for prevention of heterosexual acquisition of HIV in men | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD003362 | date = April 2009 | pmid = 19370585 | doi = 10.1002/14651858.CD003362.pub2 | veditors = Siegfried N }}</ref> Consequently, the World Health Organization (WHO) recommends consideration of circumcision as part of a comprehensive [[HIV prevention]] program in areas with high rates of HIV; the effectiveness of using circumcision to prevent HIV in the [[Developed country|developed world]] is unclear.<ref name=WHO-PrevHIV/><ref name="kim_2010">{{cite journal | vauthors = Kim HH, Li PS, Goldstein M | title = Male circumcision: Africa and beyond? | journal = Current Opinion in Urology | volume = 20 | issue = 6 | pages = 515–519 | date = November 2010 | pmid = 20844437 | doi = 10.1097/MOU.0b013e32833f1b21 | s2cid = 2158164 }}</ref> The WHO does not recommend circumcision for HIV prevention in [[men who have sex with men]].<ref name=WHO-PrevHIV/> Circumcision is associated with reduced rates of [[Carcinogenesis|cancer-causing]] forms of [[human papillomavirus]] (HPV) and [[Urinary tract infection|UTIs]].<ref name="AAP_2012" /><ref name=larke_HPV_2011>{{cite journal | vauthors = Larke N, Thomas SL, Dos Santos Silva I, Weiss HA | title = Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis | journal = The Journal of Infectious Diseases | volume = 204 | issue = 9 | pages = 1375–1390 | date = November 2011 | pmid = 21965090 | doi = 10.1093/infdis/jir523 | doi-access = free }}</ref><ref name=rehmeyer_2011>{{cite journal | vauthors = Rehmeyer CJ | title = Male circumcision and human papillomavirus studies reviewed by infection stage and virus type | journal = The Journal of the American Osteopathic Association | volume = 111 | issue = 3 Suppl 2 | pages = S11–S18 | date = March 2011 | pmid = 21415373 }}</ref> It also decreases the risk of [[carcinoma of the penis|cancer of the penis]] via effectively curing [[phimosis]].<ref name=AAP_2012/> Studies of other [[Sexually transmitted disease|sexually transmitted infections]] suggest that circumcision is protective, including for men who have sex with men.<ref>{{cite journal | vauthors = Yuan T, Fitzpatrick T, Ko NY, Cai Y, Chen Y, Zhao J, Li L, Xu J, Gu J, Li J, Hao C, Yang Z, Cai W, Cheng CY, Luo Z, Zhang K, Wu G, Meng X, Grulich AE, Hao Y, Zou H | display-authors = 6 | title = Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data | journal = The Lancet. Global Health | volume = 7 | issue = 4 | pages = e436–e447 | date = April 2019 | pmid = 30879508 | pmc = 7779827 | doi = 10.1016/S2214-109X(18)30567-9 | doi-access = free }}</ref> A 2010 review found circumcisions performed by medical providers to have a typical [[Complication (medicine)|complication]] rate of 1.5% for babies and 6% for older children, with few cases of severe complications.<ref name=weiss_2010_complications/> Bleeding, infection, and the removal of either too much or too little foreskin are the most common acute complications. [[Meatal stenosis]] is the most common long term complication.<ref name=":1">{{Cite book| vauthors = Selekman R, Copp H |title=Campbell Walsh Wein Urology|publisher=Elsevier|year=2020|isbn=9780323672276| veditors = Partin A |edition=12th |pages=388–402 |chapter=Urologic Evaluation of the Child}}</ref> Complication rates are higher when the procedure is performed by an inexperienced operator, in unsterile conditions, or in individuals that are older.<ref name=weiss_2010_complications>{{cite journal | vauthors = Weiss HA, Larke N, Halperin D, Schenker I | title = Complications of circumcision in male neonates, infants and children: a systematic review | journal = BMC Urology | volume = 10 | pages = 2 | date = February 2010 | pmid = 20158883 | pmc = 2835667 | doi = 10.1186/1471-2490-10-2 }}</ref> Circumcision does not appear to impact sexual function.<ref name=":3">{{Cite web|last=Staff|date=January 23, 2021|title=Circumcision: Cleveland Clinic|url=https://my.clevelandclinic.org/health/treatments/16194-circumcision|url-status=live|access-date=November 28, 2021|website=[[Cleveland Clinic]]|quote=Researchers believe it doesn’t hurt or enhance sexual pleasure.}}</ref><ref name=":2">{{Cite web|last=Staff|date=September 21, 2021|title=Circumcision Information: Mayo Clinic|url=https://www.mayoclinic.org/tests-procedures/circumcision/about/pac-20393550|url-status=live|access-date=November 28, 2021|website=[[Mayo Clinic]]|quote=Nor is circumcision generally thought to enhance or detract from sexual pleasure for men or their partners.}}</ref><ref name="Morris et al. 2013">{{cite journal | vauthors = Morris BJ, Krieger JN |date=November 2013|title = Does male circumcision affect sexual function, sensitivity, or satisfaction?--a systematic review | journal = The Journal of Sexual Medicine | volume = 10 | issue = 11 | pages = 2644–2657 |citeseerx=10.1.1.693.6628|doi=10.1111/jsm.12293|pmid=23937309|quote=[The datehighest =quality] Novemberstudies 2013[have] |uniformly pmidfound =that 23937309circumcision |had doino =overall 10.1111/jsm.12293adverse |effect citeseerxon =penile 10.1.1.693.6628sensitivity, sexual arousal, sexual sensation, erectile function, premature ejaculation, ejaculatory latency, orgasm difficulties, sexual satisfaction, pleasure, or pain during penetration.}}</ref><ref name=sexual_function>The American Academy of Pediatrics Task Force on Circumcision "Technical Report" (2012) addresses sexual function, sensitivity and satisfaction without qualification by age of circumcision. Sadeghi-Nejad ''et al.'' "Sexually transmitted diseases and sexual function" (2010) addresses adult circumcision and sexual function. Doyle ''et al.'' "The Impact of Male Circumcision on HIV Transmission" (2010) addresses adult circumcision and sexual function. Perera ''et al.'' "Safety and efficacy of nontherapeutic male circumcision: a systematic review" (2010) addresses adult circumcision and sexual function and satisfaction.</ref><ref name=":14" />

<!-- Positions -->

Whether these health benefits justify routine circumcision in the developed world divides medical organizations.<ref name=":15">{{Cite journal|last=Morris|first=Brian J|last2=Krieger|first2=John N|last3=Klausner|first3=Jeffrey D|date=March 24, 2017|title=CDC's Male Circumcision Recommendations Represent a Key Public Health Measure|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478224/|journal=Global Health: Science and Practice|volume=5|issue=1|pages=15–27|doi=10.9745/GHSP-D-16-00390|issn=2169-575X|pmc=5478224|pmid=28351877}}</ref><ref name=":16">{{Cite journal|last=TASK FORCE ON CIRCUMCISION|last2=Blank|first2=Susan|last3=Brady|first3=Michael|last4=Buerk|first4=Ellen|last5=Carlo|first5=Waldemar|last6=Diekema|first6=Douglas|last7=Freedman|first7=Andrew|last8=Maxwell|first8=Lynne|last9=Wegner|first9=Steven|date=September 1, 2012|title=Circumcision Policy Statement|url=https://doi.org/10.1542/peds.2012-1989|journal=Pediatrics|volume=130|issue=3|pages=585–586|doi=10.1542/peds.2012-1989|issn=0031-4005}}</ref><ref name=":17">{{Cite journal|last=Frisch|first=Morten|last2=Aigrain|first2=Yves|last3=Barauskas|first3=Vidmantas|last4=Bjarnason|first4=Ragnar|last5=Boddy|first5=Su-Anna|last6=Czauderna|first6=Piotr|last7=de Gier|first7=Robert P.E.|last8=de Jong|first8=Tom P.V.M.|last9=Fasching|first9=Günter|last10=Fetter|first10=Willem|last11=Gahr|first11=Manfred|date=April 1, 2013|title=Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision|url=https://doi.org/10.1542/peds.2012-2896|journal=Pediatrics|volume=131|issue=4|pages=796–800|doi=10.1542/peds.2012-2896|issn=0031-4005}}</ref> Outside of areas with [[HIV/AIDS in Africa|high HIV/AIDS prevalence]], their positions are split; the [[World Health Organization]], [[Joint United Nations Programme on HIV/AIDS|UNAIDS]], and American medical organizations generally hold the belief that the elective circumcision of minors in developed countries carries prophylactic health benefits that outweigh small risks, while European medical organizations generally hold the belief that itits carriesmedical risksbenefits are not counterbalanced by its medical benefitsrisk.<ref name=":8">{{Cite book|title=Manual for early infant male circumcision under local anaesthesia|publisher=[[World Health Organization]]|year=2010|location=Geneva|language=English}}</ref><ref name=":9">{{Cite book|last1=Gable|first1=Lance|title=Legal Aspects of HIV/AIDS: A Guide for Policy and Law Reform|last2=Gamharter|first2=Katharina|last3=Gostin|first3=Lawrence|last4=Hodge Jr.|first4=James|last5=Puymbroeck|first5=Rudolf|publisher=World Bank Publications|year=2007|isbn=978-0821371053|pages=38–39|chapter=1.12 Male Circumcision}}</ref><ref name="Bolnick_2012_ch1">{{cite book|title=Surgical Guide to Circumcision|vauthors=Jacobs M, Grady R, Bolnick DA|publisher=Springer|year=2012|isbn=978-1-4471-2857-1|veditors=Bolnick DA, Koyle M, Yosha A|location=London|pages=3–8|chapter=Current Circumcision Trends and Guidelines|doi=10.1007/978-1-4471-2858-8_1|quote=Outside of strategic regions in sub-Saharan Africa, no call for routine circumcision has been made by any established medical organizations or governmental bodies. Positions on circumcision include "some medical benefit/parental choice" in the United States, "no medical benefit/parental choice" in Great Britain, and "no medical benefit/physical and psychological trauma/parental choice" in the Netherlands.|author2-link=<!--Not the Olympic athlete. Do not link-->}}</ref><ref name=":10">{{cite news | vauthors = McNeil Jr DG |date=2007-03-29|title=W.H.O. Urges Circumcision to Reduce Spread of AIDS|language=en-US|work=The New York Times|url=https://www.nytimes.com/2007/03/29/health/29hiv.html|access-date=2021-12-08|issn=0362-4331}}</ref><ref name=":4">{{cite journal | vauthors = Earp BD, Shahvisi A, Reis-Dennis S, Reis E | title = The need for a unified ethical stance on child genital cutting | journal = Nursing Ethics | volume = 28 | issue = 7–8 | pages = 1294–1305 | date = November 1, 2021 | pmid = 33719736 | doi = 10.1177/0969733020983397 | s2cid = 232231641 | author-link = Brian Earp }}</ref><ref name=":11">{{Cite web|last=Wapner|first=Jessica|date=February 24, 2015|title=The Troubled History of Foreskin|url=https://mosaicscience.com/story/troubled-history-foreskin/|url-status=live|website=Mosaic Science|quote=In the decades since, medical practice has come to rely increasingly on evidence from large research studies, which, as many American doctors see it, have supported the existing rationale... How can experts who have undergone similar training evaluate the same studies and come to opposing conclusions? I’ve spent months scrutinising the medical literature in an attempt to decide which side is right. The task turned out to be nearly impossible. That’s partly because there is so much confused thinking around the risks and benefits of circumcision, even among trained practitioners.}}</ref> No major medical organization recommends banning the procedure, with a consensus across all major medical organizations that the elective circumcision of minors should be legal, within the purview of medical professionals, and to some extent should yield to parental choice.<ref name="Bolnick_2012_ch1" /> Debates over [[Preventive healthcare|prophylactic efficacy]], [[Ethics of circumcision|bioethics]], [[culture]], [[Informed consent|consent]], [[Individual and group rights|group rights]], and [[Freedom of religion|religious freedom]] have [[Circumcision controversies|been discussed]] over these cases.<ref name=":4" /><ref name=pinto_2012>{{cite journal | vauthors = Pinto K | title = Circumcision controversies | journal = Pediatric Clinics of North America | volume = 59 | issue = 4 | pages = 977–986 | date = August 2012 | pmid = 22857844 | doi = 10.1016/j.pcl.2012.05.015 }}</ref><ref name="caga-anan_2011">{{cite book |vauthors=Caga-anan EC, Thomas AJ, Diekema DS, Mercurio MR, Adam MR |title=Clinical Ethics in Pediatrics: A Case-Based Textbook |page=43 |date=8 September 2011 |publisher=Cambridge University Press |isbn=978-0-521-17361-2 |url=https://books.google.com/books?id=C1T6NrSPD_AC&pg=PA43 |url-status=live |archive-url=https://web.archive.org/web/20160118224324/https://books.google.com/books?id=C1T6NrSPD_AC&pg=PA43 |archive-date=18 January 2016 }}</ref>

<!-- Epidemiology, history, and culture -->

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=== Elective ===

The World Health Organization promotes circumcision to prevent female-to-male HIV transmission in countries with high rates of HIV.<ref name="WHO-PrevHIV" /> The [[International AIDS Society]]-USA also suggests circumcision be discussed with [[Men who have sex with men|men who have insertive anal sex with men]], especially in regions where HIV is common.<ref name="Marrazzo et al. 2014" /> The finding that circumcision significantly reduces female-to-male HIV transmission has prompted medical organizations serving communities affected by endemic HIV/AIDS to promote circumcision as an additional method of controlling the spread of HIV.<ref name="Bolnick_2012_ch1" /> ▼

Outside of areas with high HIV/AIDS prevalence, the positions of the world's major medical organizations are sharply polarized on the routine circumcision of minors; the World Health Organization, UNAIDS, and American medical organizations generally hold the belief that it carries moderate prophylactic health benefits that outweigh small risks, while European medical organizations generally hold the belief that it carries risks which are not counterbalanced by its medical benefits.<ref name=":8" /><ref name=":9" /><ref name="Bolnick_2012_ch1" /><ref name=":10" /><ref name=":4" /><ref name=":11"/><ref name=":12">{{Cite web|last=Scott|first=Cameron|date=November 4, 2021|title=CDC Encourages Circumcision, Even for Adult Men|url=https://www.healthline.com/health-news/cdc-encourages-circumcision-120314|url-status=live|access-date=November 26, 2021|website=[[Healthline]]|language=en}}</ref> No major medical organization recommends banning the procedure, with a consensus across all major medical organizations that the elective circumcision of minors should be legal, within the purview of medical professionals, and to some extent should yield to parental choice.<ref name="Bolnick_2012_ch1" />▼

In 2007, the WHO and the [[Joint United Nations Programme on HIV/AIDS]] (UNAIDS) stated that they recommended circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV, as long as the program includes "[[informed consent]], [[confidentiality]], and absence of [[coercion]]".<ref name="WHO-PrevHIV" /> In 2020, the World Health Organization again concluded that male circumcision is an efficacious intervention for HIV prevention and that the promotion of male circumcision is an essential strategy, in addition to other preventive measures, for the prevention of heterosexually acquired HIV infection in men. Eastern and southern Africa had a particularly low prevalence of circumcised males. This region has a disproportionately high HIV infection rate, with a significant number of those infections stemming from heterosexual transmission. As a result, the promotion of prophylactic circumcision has been a priority intervention in that region since the WHO's 2007 recommendations.<ref name="WHO-PrevHIV" /><ref name=":8" />

Public health advocates of circumcision consider it to have a net benefit, and therefore feel that increasing the circumcision rate is an "bioethical imperative".<ref>{{Cite journal|last=Morris|first=Brian J.|date=November 2007|title=Why circumcision is a biomedical imperative for the 21(st) century|url=https://pubmed.ncbi.nlm.nih.gov/17935209/|journal=BioEssays: News and Reviews in Molecular, Cellular and Developmental Biology|volume=29|issue=11|pages=1147–1158|doi=10.1002/bies.20654|issn=0265-9247|pmid=17935209}}</ref> They recommend performing the procedure during the neonatal period when it is less expensive and has a lower risk of complications.<ref name="pinto_2012" /> While studies show there is [[Epidemiology|epidemiological]] benefits to circumcision, critics argue that the number of circumcisions that would have to be performed would yield a net neutral or negative public health outcome due to the resulting number of complications or other effects. Literature on the matter is highly polarized, with the type of cost-benefit analysis being highly dependent on the kinds and frequencies of health problems in the population under discussion and how circumcision affects those health problems.<ref name=":11"/><ref name="pinto_2012" /><ref name="caga-anan_2011" /><ref name=":12" />

▲Outside of these areas with high HIV/AIDS prevalence, the positions of the world's major medical organizations are sharply polarized on the routine circumcision of minors; the World Health Organization, UNAIDS, and American medical organizations generally hold the belief that it carries moderate prophylactic health benefits that outweigh small risks, while European medical organizations generally hold the belief that itthese carriesmedical risks whichbenefits are not counterbalanced by itssurgical medical benefitsrisk.<ref name=":8" /><ref name=":9" /><ref name="Bolnick_2012_ch1" /><ref name=":10" /><ref name=":4" /><ref name=":11" /><ref name=":12">{{Cite web|last=Scott|first=Cameron|date=November 4, 2021|title=CDC Encourages Circumcision, Even for Adult Men|url=https://www.healthline.com/health-news/cdc-encourages-circumcision-120314|url-status=live|access-date=November 26, 2021|website=[[Healthline]]|language=en}}</ref> No major medical organization recommends banning the procedure, withand there is a consensus across all major medical organizations that the elective circumcision of minors should be legal, within the purview of medical professionals, and to some extent should yield to parental choice.<ref name="Bolnick_2012_ch1" />

Neonatal circumcision is usually [[Elective surgery|elected]] by the parents for non-medical reasons, such as religious beliefs or personal preferences, possibly driven by societal norms.<ref name="hay_2012" /> The [[Royal Dutch Medical Association]], which expresses some of the strongest opposition to routine neonatal circumcision, argues that while there are valid reasons for banning it, doing so could lead parents who insist on the procedure to turn to poorly trained practitioners instead of medical professionals.<ref name="Bolnick_2012_ch1" /><ref name="knmg.nl">{{cite web|title=Non-therapeutic circumcision of male minors - KNMG Viewpoint|url=https://www.knmg.nl/advies-richtlijnen/knmg-publicaties/publications-in-english.htm|access-date=7 March 2018}}</ref> The argument to keep the procedure within the purview of medical professionals is found across all major medical organizations.<ref name="Bolnick_2012_ch1" /> In addition, the organizations advise medical professionals to yield to some degree to parental preferences, which are commonly based upon cultural or religious views, in their decision to agree to circumcise.<ref name="Bolnick_2012_ch1" /> The Danish College of General Practitioners has stated that circumcision should "only [be done] when medically needed, otherwise it is a case of mutilation."<ref>{{cite web|title=Referat bestyrelsesmøde den 16. december 2013|url=http://www.dsam.dk/flx/organisation/bestyrelse/referater/dagsorden_05122013//?Highlight=omsk%E6ring#flxElm_3725|access-date=4 September 2016}} {{dead link|date=December 2021}}</ref><ref>{{cite web |url=https://ugeskriftet.dk/dmj/male-circumcision-does-not-result-inferior-perceived-male-sexual-function-systematic-review |title=Male Circumcision Does Not Result in Inferior Perceived Male Sexual Function - a systematic review |date=January 7, 2016 |website=Danish Medical Journal |access-date=April 25, 2021}}</ref>▼

Public health advocates of circumcision consider it to have a net benefit, and therefore feel that increasing the circumcision rate is an "bioethical imperative".<ref>{{Cite journal|last=Morris|first=Brian J.|date=November 2007|title=Why circumcision is a biomedical imperative for the 21(st) century|url=https://pubmed.ncbi.nlm.nih.gov/17935209/|journal=BioEssays: News and Reviews in Molecular, Cellular and Developmental Biology|volume=29|issue=11|pages=1147–1158|doi=10.1002/bies.20654|issn=0265-9247|pmid=17935209}}</ref> They recommend performing it during the neonatal period when it is less expensive and has a lower risk of complications.<ref name="pinto_2012" /> According to the [[American Academy of Pediatrics]] and [[Centers for Disease Control and Prevention]], the benefits of circumcision outweigh the risks, and the procedure should be covered by insurance.<ref name=":16" /><ref name=":15" /> [[Anthony Fauci|Dr. Anthony Fauci]], the director of the [[National Institute of Allergy and Infectious Diseases]], has similarly stated that there are "significant health benefits" to routine circumcision and that it should be recommended to parents.<ref>{{Cite web|last=MacMillan|first=Amanda|date=March 25, 2009|title=Circumcision Reduces Risk of Herpes, HPV Infection|url=https://www.health.com/condition/hiv/circumcision-herpes-hpv-infection|url-status=live|access-date=January 5, 2022|website=[[Health (magazine) | Health]]|language=en|quote=Even in the United States, this study has relevance, says Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (which funded one of the trials). “In this country, circumcision for infant boys remains a personal decision for the parents,” he says. “This makes us rethink whether doctors should be more aggressive in recommending that it at least be considered. If parents say no just because generations before them have said no, they should learn more about the significant health benefits before making that choice.”}}</ref> While studies show there is [[Epidemiology|epidemiological]] benefits to circumcision, critics argue that the number of circumcisions that would have to be performed in developed nations would yield a net neutral/negative public health outcome due to the resulting number of complications or other effects.<ref name=":17" />

▲The World Health Organization promotes circumcision to prevent female-to-male HIV transmission in countries with high rates of HIV.<ref name=WHO-PrevHIV/> The [[International AIDS Society]]-USA also suggests circumcision be discussed with [[Men who have sex with men|men who have insertive anal sex with men]], especially in regions where HIV is common.<ref name="Marrazzo et al. 2014" /> The finding that circumcision significantly reduces female-to-male HIV transmission has prompted medical organizations serving communities affected by endemic HIV/AIDS to promote circumcision as an additional method of controlling the spread of HIV.<ref name="Bolnick_2012_ch1" />

▲Neonatal circumcision is usually [[Elective surgery|elected]] by the parents for non-medical reasons, such as religious beliefs or personal preferences, possibly driven by societal norms.<ref name="hay_2012" /> The [[Royal Dutch Medical Association]], which expresses some of the strongest opposition to routine neonatal circumcision, argues that while there are valid reasons for banning it, but doing so could lead parents who insist on the procedure to turn to poorly trained practitioners instead of medical professionals.<ref name="Bolnick_2012_ch1" /><ref name="knmg.nl">{{cite web|title=Non-therapeutic circumcision of male minors - KNMG Viewpoint|url=https://www.knmg.nl/advies-richtlijnen/knmg-publicaties/publications-in-english.htm|access-date=7 March 2018}}</ref> The argument to keep the procedure within the purview of medical professionals is found across all major medical organizations.<ref name="Bolnick_2012_ch1" /> In addition, the organizations advise medical professionals to yield to some degree to parental preferences, which are commonly based upon cultural or religious views, in their decision to agree to circumcise.<ref name="Bolnick_2012_ch1" /> The Danish College of General Practitioners has stated that circumcision should "only [be done] when medically needed, otherwise it is a case of mutilation."<ref>{{cite web|title=Referat bestyrelsesmøde den 16. december 2013|url=http://www.dsam.dk/flx/organisation/bestyrelse/referater/dagsorden_05122013//?Highlight=omsk%E6ring#flxElm_3725|access-date=4 September 2016}} {{dead link|date=December 2021}}</ref><ref>{{cite web |url=https://ugeskriftet.dk/dmj/male-circumcision-does-not-result-inferior-perceived-male-sexual-function-systematic-review |title=Male Circumcision Does Not Result in Inferior Perceived Male Sexual Function - a systematic review |date=January 7, 2016 |website=Danish Medical Journal |access-date=April 25, 2021}}</ref> Literature on the matter is polarized, with the type of cost-benefit analysis being highly dependent on the kinds and frequencies of health problems in the population under discussion and how circumcision affects those health problems.<ref name=":11" /><ref name="pinto_2012" /><ref name="caga-anan_2011" /><ref name=":12" /> Neonatal circumcision is usually [[Elective surgery|elected]] by the parents for non-medical reasons, such as religious beliefs or personal preferences, possibly driven by societal norms.<ref name="hay_2012" />

In 2007, the WHO and the [[Joint United Nations Programme on HIV/AIDS]] (UNAIDS) stated that they recommended circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV, as long as the program includes "[[informed consent]], [[confidentiality]], and absence of [[coercion]]".<ref name=WHO-PrevHIV/>

=== Pathologies ===

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===Sexual effects===

The extenthighest toquality which circumcision affects penile sensitivityevidence and sexual satisfaction is controversial; some research has found enhanced sensation, some research has found no difference, and some has found a loss of sensation.<ref name=dave>{{cite journal | vauthors = Dave S, Afshar K, Braga LH, Anderson P | title = Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version) | journal = Canadian Urological Association Journal | volume = 12 | issue = 2 | pages = E76–E99 | date = February 2018 | pmid = 29381458 | pmc = 5937400 | doi = 10.5489/cuaj.5033 }}</ref> The scientific consensus is that the highest quality evidence indicates that circumcision has no impact on sexual function, sensation, or pleasure.<ref name=":3" /><ref name=":2" /><ref name="Morris et al. 2013" /><ref name=sexual_function/><ref name=":14">{{cite journal | vauthors = Friedman B, Khoury J, Petersiel N, Yahalomi T, Paul M, Neuberger A | title = Pros and cons of circumcision: an evidence-based overview | journal = Clinical Microbiology and Infection | volume = 22 | issue = 9 | pages = 768–774 | date = September 2016 | pmid = 27497811 | doi = 10.1016/j.cmi.2016.07.030 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Shabanzadeh DM, Düring S, Frimodt-Møller C | title = Male circumcision does not result in inferior perceived male sexual function - a systematic review | journal = Danish Medical Journal | volume = 63 | issue = 7 | date = July 2016 | pmid = 27399981 | type = Systematic review }}</ref> Lower quality evidence has found conflicting results, including enhanced sensation, no difference, or loss of sensation.<ref name="Morris et al. 2013" /><ref name="sexual_function" /><ref name="dave">{{cite journal|vauthors=Dave S, Afshar K, Braga LH, Anderson P|date=February 2018|title=Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version)|journal=Canadian Urological Association Journal|volume=12|issue=2|pages=E76–E99|doi=10.5489/cuaj.5033|pmc=5937400|pmid=29381458}}</ref> A 2013 [[systematic review]] found that circumcision did not appear to adversely affect sexual desire, [[Dyspareunia|pain with intercourse]], [[premature ejaculation]], time until ejaculation, [[erectile dysfunction]] or difficulties with [[orgasm]].<ref name="Tian2013" /> However, the study found that the existing evidence is insufficient to make conclusive determinations.<ref name=Tian2013>{{cite journal | vauthors = Tian Y, Liu W, Wang JZ, Wazir R, Yue X, Wang KJ | title = Effects of circumcision on male sexual functions: a systematic review and meta-analysis | journal = Asian Journal of Andrology | volume = 15 | issue = 5 | pages = 662–666 | date = September 2013 | pmid = 23749001 | pmc = 3881635 | doi = 10.1038/aja.2013.47 | type = Systematic review }}</ref> The effect of circumcision on sexual partners' experiences is unclear as this has not been well studied.<ref name="bossio_2014" />

The effect of circumcision on sexual partners' experiences is unclear as this has not been well studied.<ref name="bossio_2014" />

===Psychological effects===